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What is tuberculosis (TB)?
TB is an infectious disease caused by a bacterium called Mycobacterium tuberculosis. It primarily affects the lungs but can also affect other parts of your body, such as the brain, lymph nodes, kidneys, bones, and joints.
While curable, TB remains a significant public health concern globally. In Singapore, TB is endemic and latent TB infection (LTBI) is not uncommon in our population. Refer to the Ministry of Health for the latest updates about the local TB situation.
What are the types of TB conditions?
Active TB disease occurs when the body is unable to kill or contain the bacteria, and the bacteria continues to grow. These individuals are infectious and may have symptoms. They should visit a doctor immediately to seek treatment.
However, not all individuals who are exposed to an infectious person will get active TB disease.
Some develop LTBI, where the body is able to stop the bacteria from growing, rendering them inactive. These people do not have any symptoms (e.g. cough) and cannot spread TB to others.
In 90% of healthy persons with LTBI, the TB bacteria remain inactive throughout their life. However, the disease can be activated months or years later due to a weakened immune system, certain medical conditions, or other factors.
How is TB disease transmitted?
TB is an airborne disease. TB disease spreads through the air when an infected person coughs or sneezes. Transmission usually requires close and prolonged contact with an infectious individual.
TB disease cannot be spread by shaking someone’s hand, kissing, touching bed linens, or sitting on toilet seats.
What are the symptoms of TB disease?
Symptoms of TB disease include:
Persistent cough (two weeks or more)
Persistent fever
Coughing blood or sputum
Night sweats
Weight loss
Fatigue
Loss of appetite
Chest pain
TB disease is curable and its spread is preventable. Early detection and prompt treatment is key. If you have symptoms, go see a doctor immediately. Untreated TB can lead to severe lung damage, disability, or death.
What are the risk factors?
The risk of developing TB disease is higher in those who:
Have weakened immune systems, due to drugs, sickness, or malnutrition
Are in prolonged (days to weeks) and close contact or living with someone with TB disease, especially in crowded or poorly ventilated conditions
Abuse substances (including smoking)
Suffer from certain medical conditions such as HIV and diabetes
Are children under the age of 5 and elderly
Advice for high-risk groups:
If you have LTBI, you may be offered preventive treatment to reduce the risk of developing active TB disease
If you are at high risk for TB exposure, you should be vigilant about symptoms and seek prompt medical evaluation if any concerns arise
What to do if I have TB disease?
You can help keep your family, friends, and community from getting sick by:
Completing the full course of your medication, even if you do not have any more symptoms or are feeling better
Staying home for the first two weeks except when attending Directly Observed Therapy (DOT) treatment at the polyclinic or National Tuberculosis Care Centre (NTBCC)
Wearing a face mask when you are near others
Covering your mouth when you cough or sneeze
What to do if someone close to me has TB disease?
Those who have had prolonged and close contact with someone with active TB disease may be contacted by the National Tuberculosis Programme (NTBP) for TB screening.
Screening at the National Tuberculosis Care Centre (NTBCC) are scheduled by appointment. They will receive a SMS with the date and time of the appointment. They may call the centre to change the appointment date.
Screening for TB may involve a QuantiFERON (TB) blood test and a chest X-ray, if required. A repeat test may be scheduled by the centre. The results will be out in two to three weeks.
If they have a positive blood test result, further tests (i.e., chest X-ray) are required to determine if it is latent TB infection or active TB disease.
If their blood test result is negative, it means they are not infected with TB bacteria.
TB screening is fully subsidised for registered contacts. Only those who have been identified as close contacts of active TB cases are offered screening under the NTBP.
It is advisable for these individuals to go for screening to protect themselves and their loved ones from getting active TB disease.
What to do if my employee has TB disease?
The public health officer-in-charge (PHO) will contact the workplace supervisor or HR for a risk assessment. The following information may be required:
Details of people who have been exposed to the TB patient for more than 8 hours cumulatively.
Floorplan and photographs.
The PHO may also request a site visit.
Subsequently, the PHO will prepare a list of employees who are required to go for TB screening. Their details will be submitted to the NTBCC, where they will be scheduled for screening.
These employees will receive a SMS with the date and time of appointment. The workplace supervisor or HR will also receive an email on the appointment dates for monitoring or manpower allocation.
How to prevent TB disease?
There are multiple ways you can prevent yourself from getting active TB disease:
Maintain good ventilation in living spaces if living with someone who has active TB disease
Practice good cough etiquette (cover your cough or sneeze with a tissue)
Wash your hands frequently with soap and water
How are active TB disease and latent TB infection treated?
Active TB
Active TB disease is treated with a combination of TB medications, administered for at least six to nine months. It is important for people with active TB disease to complete the course of the treatment, even if they feel better after the infectious period (first two weeks), as TB disease may recur or become resistant to medication, which becomes extremely difficult to treat.
For maximum efficacy, these individuals take their medication under the direct observation of a healthcare worker. This is called the Directly Observed Therapy (DOT). This ensures that they take the correct dosage and combination of medication, and are monitored to avoid treatment failure, drug resistance, and further spread of TB. Should their condition worsen, they may require hospitalisation or isolation.
Latent TB infection (LTBI)
Persons with LTBI may be offered preventive treatment, if suitable. It is important for these individuals to complete the course of their treatment (about four to six months) to reduce the risk of developing active TB disease in the future.
While the Bacillus Calmette-Guerin (BCG) Vaccine is available, it is only effective in protecting babies from TB meningitis and widespread TB. It offers limited protection against pulmonary (lung) TB, which is the most common form among adults.
How to get to the National Tuberculosis Care Centre?
Photo credit: National Centre for Infectious Diseases
The National Tuberculosis Care Centre (NTBCC) is the referral centre for TB evaluation and treatment.
Address:
144 Moulmein Road, Singapore 308089
General enquiries:
6356 5294
Opening hours:
Monday to Friday: 8.00am to 5.00pm
Saturday: 8.00am to 12.30pm
How to get to the National Tuberculosis Screening Centre?
Photo credit: National Centre for Infectious Diseases
The National Tuberculosis Screening Centre (NTBSC) is the screening centre for contacts of TB patients.
Address:
142 Moulmein Road, Singapore 308087
General enquiries:
6258 3142
Appointments:
6258 4430
Opening hours:
Monday to Friday: 8.00am to 11.30am, 2.30pm to 4.00pm
Saturday (walk-in only): 8.00am to 11.00am
Educational materials
Past screenings
Read more about past TB screenings below.
Screening initiation for TB clusters detected at congregate settings
In 2021, two separate clusters of TB involving 18 people who visited the Bedok Singapore Pools betting outlet were identified. No common links were found between them other than that they all frequented the Bedok centre over periods ranging from months to years and spent prolonged stretches there. As a precaution, patrons who visited the betting centre between 12 February 2020 and 25 March 2020 were contacted for screening. Voluntary screening was also offered to patrons who spent prolonged period of cumulative days at the betting centre between 2018 and 25 March 2020.
Mass on-site screening for residents living in HDB blocks
In 2024, TB screening was expanded at Jalan Bukit Merah after 10 more active TB disease cases linked to the cluster were detected following the initial screening. The screening was mandatory for those who live and work in Blocks 1 and 3 Jalan Bukit Merah, employees at ABC Brickworks Market and Food Centre, as well as clients and staff of the senior activity centre in Block 3 Jalan Bukit Merah.
In 2022, a TB cluster involving seven people staying at Block 2, Jalan Bukit Merah was identified. Genetic analysis revealed that all seven cases had similar genetic make-up, suggesting that they were linked by spread from one or more common sources. Investigations into the cases did not reveal any common links, other than they lived in the same block. Mandatory screening for residents of the block was carried out, following an earlier voluntary screening where about 170 people were tested positive for TB.
In 2020, a TB cluster involving four people was detected at a HDB block in Hougang. The four cases had similar genetic make-up and investigations into the cases did not reveal any common links, other than they lived in the same blocks. Current and former residents of the block were offered voluntary screening.
In 2016, a cluster of six multi-drug resistant TB (MDRTB) cases were detected in a block in Ang Mo Kio. Other than the three patients living in the same unit, the rest did not know or did not interact with one another. Residents of the block were offered voluntary screening.
About the National Tuberculosis Programme
The National Tuberculosis Programme (NTBP) is a national TB prevention and care programme aimed at protecting the people of Singapore from the disease. It was launched by the Ministry of Health (MOH) in 1997 to further its vision of a TB-free Singapore with people-centred care.
NTBP, which is under the Communicable Diseases Agency (CDA), uses a multi-pronged approach to control TB. This approach includes prompt diagnosis and management of the disease; effective contact tracing and screening; community engagement to raise public awareness; strengthening partnerships; and implementing sustainable strategies.
Other frequently asked questions about TB
Q: What if an identified contact shows TB disease symptoms at work?
Please advise them to seek medical attention and inform the doctor of their status as an identified contact. The doctor will assess whether they have TB disease and will inform the NTBP if the person is suspected to have TB disease.
Q: Do identified contacts need to be isolated at work?
Identified contacts do not need to be isolated. They can proceed with their daily work unless they are tested positive.
Q: When can TB disease individuals return to work?
They will be considered non-infectious after two weeks of treatment. After that, they will be required to visit the polyclinic or the NTBSC daily or a few times a week, as advised by the doctor, to take their medication until they complete treatment. Employees may request for a memo from the doctor for their follow-up appointments if the organisation requires it.
Q: Can workplaces arrange our own screening and claim from MOH?
TB screening at NTBSC is fully subsidised only for identified contacts. MOH will not bear the costs for privately arranged screening or screening for non-identified contacts.