MOH notified of Hep C outbreak in Aug; says asymptomatic cases hard to detect

The Singapore General Hospital (SGH) reported its identification of a cluster of 21 Hepatitis C cases and the outcomes of its investigations in late August, the Ministry of Health (MOH) said in a late statement on Wednesday.

MOH said it was not made aware of the Hepatitis C cluster outbreak at SGH earlier as most acute infections of viral Hepatitis C are silent.

SGH this week made public that an outbreak of the Hepatitis C virus in one of its renal wards occurred around June, which led to 22 patients being infected with the virus. Of the 22, four - who were also ill with other serious conditions - have since died. The virus in these 21 cases were related. MOH was notified of the 22nd case on September 21.

Between the August notification, and the SGH announcement on October 6, more tests and reviews were made. SGH's report was submitted to MOH on September 24, and a briefing to Health Minister Gan Kim Yong was conducted on September 25.

"As it can be difficult to detect such asymptomatic Hepatitis C based on blood tests alone, doctors generally look for a link to an event of relevant exposure, such as current intravenous drug use or a needle-stick injury," said MOH. "MOH received notifications of the cases from SGH's laboratory. However, at the point of reporting, the cases did not have symptoms such as jaundice nor history of exposure to suggest that they were acute."

MOH also said both single-dose and multi-dose injection medication vials are used in public hospitals. It added that investigations into the cluster of Hepatitis C virus infections at SGH are still ongoing, and it is not yet conclusive that the use of multi-dose vials is the cause of the Hepatitis C infection in this incident. "Regardless of whether medication vials are single-dose or multi-dose, their safe use requires healthcare providers to adhere to existing safety protocols for the use of medication vials."