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K T Goh

Publications and source records attributed to K T Goh.

At least 19 recordsLinked to original sources
PubMed2004

Oyster-associated outbreaks of Norovirus gastroenteritis in Singapore.

Outbreaks of gastroenteritis associated with the consumption of raw imported half-shelled frozen oysters occurred in Singapore between 16 Dec 2003 and 04 Jan 2004. A total of 305 cases were reported with clinical symptoms of diarrhoea (94%), abdominal cramps (72%), vomiting (69%) and fever (54%). The median incubation period was 30.8h and the duration of illness was 2-3 days. The overall relative risk of oyster consumption was 14.1 (95% CI: 8.3-24.0, P<0.001). Stool and oyster samples tested negative for common bacterial pathogens, including Vibrio parahaemolyticus. However, stool samples were positive for the presence of Norovirus group II RNA via RT PCR while oyster samples indicated the presence of Norovirus particles by electron microscopy. The clinical and epidemiological features were suggestive of Norovirus gastroenteritis and were subsequently confirmed by laboratory tests of stools and implicated oysters. Steps have been taken to ensure that food outlets do not thaw frozen oysters and serve them raw.

Adolescent↗
PubMed2003

Hemagglutinin-neuraminidase sequence and phylogenetic analyses of mumps virus isolates from a vaccinated population in Singapore.

During 1999-2000, a sustained mumps outbreak in the highly vaccinated population in Singapore was attributed to vaccine failure associated with the Rubini vaccine strain. To explain this phenomenon, the complete nucleotide and amino acid sequences of the hemagglutinin-neuraminidase (HN) gene of eight mumps virus isolates from patients with parotitis in Singapore were determined and compared with those of known vaccine strains. Phylogenetic trees constructed on the basis of HN nucleotide and amino acid sequences showed that the Singapore mumps virus isolates were more closely related to the Urabe strain and belonged to a different cluster from the Rubini and Jeryl-Lynn strains. The Rubini vaccine showed only approximately 93% nucleotide and approximately 96% amino acid sequence similarity to Urabe and Singapore isolates. Compared with the vaccine strains, six of the eight isolates lacked the extracellular glycosylation site at residues 400-402. Other significant amino acid disparities (e.g., at residue 354) may also affect the antigenic properties of the HN protein. These findings suggest that the evolution and adaptation of the currently circulating mumps virus strains in the community has led to the emergence of genetically distinct viral strains. The low vaccine efficacy of the Rubini strain represents a major reason for the recent mumps resurgence and failure of mumps immunization in Singapore.

Amino Acid Sequence↗
PubMed2002

An outbreak of multidrug-resistant Salmonella enterica subsp. enterica serotype Typhimurium, DT104L linked to dried anchovy in Singapore.

Multidrug-resistant Salmonella enterica subsp. enterica serotype Typhimurium DT104L was first reported in Singapore from mid-July to mid-October 2000. Salmonella strains isolated from clinical laboratories were submitted to a reference laboratory for serotyping, phage-typing and pulsed-field gel electrophoresis (PFGE) using XbaI restriction endonuclease. An epidemiological investigation was conducted to determine the source of infection and mode of transmission using a structured questionnaire. A total of 33 cases involving mainly infants and toddlers were detected in the 3-month long outbreak. The outbreak strain was of the R-type ACGSTSu, i.e. resistant to ampicillin, chloramphenicol, gentamicin, streptomycin, tetracycline and sulphonamide. PFGE showed all isolates had an indistinguishable pattern, indicating a common source of infection. Consumption of imported dried anchovy was found to be the vehicle of transmission after adjusting for all confounding variables in the case-control study using stepwise logistic regression (OR 25.6; 95% CI 3.9-167.9; P = 0.001). Imported dried seafood should be properly processed, packed, labelled, and thoroughly cooked to prevent transmission of multidrug-resistant S. Typhimurium.

Adolescent↗
PubMed2002

A survey of Nipah virus infection among various risk groups in Singapore.

Following the Nipah virus (NV) outbreak in March 1999 in Singapore, a serological survey was undertaken to screen individuals potentially exposed to NV. Blood samples were tested for NV IgM, IgG and neutralizing antibodies. Twenty-two (1.5%) of 1469 people tested had antibodies suggesting NV infection. Although 12 of the 22 infected people (54.6%) were symptomatic, the remaining 10 (45.4%) were clinically well and had no past history of compatible pulmonary or neurological disease. Clinical and serological findings suggested three people had been infected with NV before the outbreak was recognized. All those who were infected were male abattoir workers. None of the people who had contact with horses, and no healthcare workers exposed to infected patients and their specimens had detectable antibodies. This study provides evidence that NV causes asymptomatic infection. All of the antibody positive individuals had direct contact with pigs and there was no evidence of human to human transmission.

Abattoirs↗
PubMed2002

Stroke disease management--a framework for comprehensive stroke care.

Disease management is an approach to patient care that coordinates medical resources for the patient across the entire healthcare delivery system throughout the lifetime of the patient with the disease. Stroke is suitable for disease management as it is a well-known disease with a high prevalence, high cost, variable practice pattern, poor clinical outcome, and managed by a non-integrated healthcare system. It has measurable and actionable outcomes, with available local expertise and support of the Ministry of Health. Developing the programme requires a multidisciplinary team, baseline data on target populations and healthcare services, identification of core components, collaboration with key stakeholders, development of evidence-based clinical practice guidelines and carepaths, institution of care coordinators, use of information technology and continuous quality improvement to produce an effective plan. Core components include public education, risk factor screening and management, primary care and specialist clinics, acute stroke units, inpatient and outpatient rehabilitation facilities, and supportive community services including medical, nursing, therapy, home help and support groups for patients and carers. The family physician plays a key role. Coordination of services is best done by a network of hospital and community-based care managers, and is enhanced by a coordinating call centre. Continuous quality improvement is required, with audit of processes and outcomes, facilitated by a disease registry. Pitfalls include inappropriate exclusion of deserving patients, misuse, loss of physician and patient independence, over-estimation of benefits, and care fragmentation. Collaboration and cooperative among all parties will help ensure a successful and sustainable programme.

Comprehensive Health Care↗
PubMed2001

Helicobacter pylori in familial clusters based on antibody profile.

Studies have shown a high prevalence of Helicobacter pylori infection in close communities and that intrafamilial spread during early childhood may be a route of transmission. A total of 72 household members from 21 families were enrolled in this study. Sera from individuals showed 50/72 (69.4%) seropositive for IgG against H. pylori by ELISA. Western blots showed diversity in the protein profiles with molecular masses ranging from approximately 8 to 130 kDa. Cohen's kappa statistical analysis of the blot patterns showed that nine families demonstrated similar profiles (100%), while 4 other families showed varying similarities (17-50%). The results support the hypothesis of intrafamilial transmission of H. pylori. Furthermore, serological studies can be used as an effective approach to determine the familial status in relation to H. pylori infection.

Adolescent↗
PubMed2000

Risk factors for Nipah virus infection among abattoir workers in Singapore.

During 10-19 March 1999, 11 workers in 1 of 2 Singaporean abattoirs developed Nipah-virus associated encephalitis or pneumonia, resulting in 1 fatality. A case-control study was conducted to determine occupational risk factors for infection. Case patients were abattoir A workers who had anti-Nipah IgM antibodies; control subjects were randomly selected abattoir A workers who tested negative for anti-Nipah IgM. All 13 case patients versus 26 (63%) of 41 control subjects reported contact with live pigs (P=.01). Swine importation from Malaysian states concurrently experiencing a Nipah virus outbreak was banned on 3 March 1999; on 19 March 1999, importation of Malaysian pigs was banned, and abattoirs were closed. No unusual illnesses among pigs processed during February-March were reported. Contact with live pigs appeared to be the most important risk factor for human Nipah virus infection. Direct contact with live, potentially infected pigs should be minimized to prevent transmission of this potentially fatal zoonosis to humans.

Abattoirs↗
PubMed2000

Intra-familial evidence of horizontal transmission of hepatitis B virus surface antigen mutant G145R.

OBJECTIVES: To provide intra-familial evidence on the horizontal transmission of hepatitis B virus surface antigen (HBsAg) mutant G145R. METHODS: Serum samples from family members of 10 vaccinated infants who carried this G145R mutant were collected. The presence of the mutant was analysed by polymerase chain reaction (PCR) and sequencing. RESULTS: The G145R mutant was identified in family members of three of the 10 infants. In family 1, the mutant found initially in child 1 was identified in another child and the father. In families 2 and 3, the G145R mutant detected previously in child 1 was detected in the father. Additional mutations in HBsAg were identified in at least two members in family 1 and 2, suggesting horizontal transmission of the mutant among them. The G145R mutant was found in samples with high levels of neutralizing antibody against HBV (anti-HBs). In addition, liver damage was seen in one G145R carrier infant. CONCLUSIONS: The G145R mutant could be transmitted horizontally among family members, and this could occur in the presence of high levels of anti-HBs. Improvement of detection system for the G145R and other HBsAg mutant will be needed for their effective control.

Disease Transmission, Infectious↗
PubMed2000

Blood lead levels of a population group not occupationally exposed to lead in Singapore.

A survey was conducted between 1995 and 1997 to assess the impact of introduction of unleaded petrol and other public health measures on the blood lead level of the population. The geometric mean blood lead level of 269 government employees as determined by graphite furnace atomic absorption spectroscopy, was 66.0 microg/l, much lower than that recorded before introduction of lead-free petrol. Using multiple regression analysis, factors significantly associated with blood lead levels were: exposure to traffic, age (>50 years) and active smoking. Passive smoking, exposure to recent paint work, consumption of alcohol and traditional medicine were found not to be significantly associated with the blood lead level.

Adult↗
PubMed1999

Resurgence of mumps in Singapore caused by the Rubini mumps virus vaccine strain.

The measles, mumps, and rubella vaccine containing the highly attenuated Rubini mumps virus strain conferred no protection against acute parotitis in vaccinated children in Singapore. Its introduction into the national childhood immunisation programme has resulted in a reduction in the seroprevalence of mumps to prevaccination levels.

Adolescent↗
PubMed1998

Epidemiology of sick building syndrome and its associated risk factors in Singapore.

OBJECTIVES: To investigate the occurrence of sick building syndrome in a tropical city, and its relation to indoor air quality and other factors. METHODS: 2856 office workers in 56 randomly selected public and private sector buildings were surveyed. The study consisted of a self administered questionnaire assessing symptoms and perception of the physical and psychosocial environment, inspection of the building plans and premises, and measurement of temperature, relative humidity, respirable particles, chemicals, bioaerosols, and other variables. RESULTS: Symptoms typical of the sick building syndrome were reported in 19.6% of the respondents. Multivariate modelling substantiated contributions associated with low thermal comfort, high work related stress, too much noise, a history of allergy or other medical conditions, poor lighting, young employees, and female sex. Measurements of indoor air quality or ventilation were not found to be reliable predictors of the symptoms. CONCLUSION: The survey confirmed the presence of sick building syndrome and its risk factors in the tropics. A biopsychosocial approach to the problem involving symptomatic treatment, environmental control, good ergonomic design, and stress management is recommended.

Adolescent↗
PubMed1998

Epidemiological surveillance of melioidosis in Singapore.

During the period 1989 to 1996, a total of 372 cases of melioidosis, with 147 deaths, were reported, giving a mean annual incidence rate of 1.7 per 100,000 population and a case-fatality rate of 39.5%. Majority (89%) of the clinical cases were confirmed by culture of Burkholderia pseudomallei, while the others were presumptive cases based on a single blood specimen with an indirect haemaglutination (IHA) antibody titre of > or = 1:16. The highest incidence rate was reported in those aged 45 years and above (5.7 per 100,000 population), males (2.8 per 100,000 population), and Indian ethnic group (3.0 per 100,000 population). Cases were distributed throughout the island all year round. There was no correlation with rainfall. Most of the cases (77.4%) had other concurrent medical conditions, the most common being diabetes mellitus (57.5%). Factors significantly associated with a higher case-fatality rate were age (55 years and above), septicaemia, smoking history and heart or renal failure. The overall case-fatality rate has been declining from 60% in 1989 to 27% in 1996 due to a greater awareness among medical practitioners to diagnose and treat the disease early. The overall seroprevalence of IHA antibody (titre of > or = 1:16) among asymptomatic population groups was 0.2%. B. pseudomallei isolated from clinical specimens were sensitive to imipenem (100%), ceftazidime (99.1%), piperacillin (99.7%), ampicillin-clavulanate (98.5%), minocycline (97.4%), chloramphenicol (94.3%), doxycycline (94.3%) and tetracycline (93.9%). Of 395 samples of soil collected during epidemiological investigation of reported cases, 1.8% were positive for B. pseudomallei.

Adolescent↗
PubMed1997

Sick building syndrome: an emerging stress-related disorder?

BACKGROUND: This study examined the role of work-related psychosocial stress in the aetiology of sick building syndrome and tested the hypothesis that in buildings with no recognized environmental problems, health complaints typical of the syndrome were primarily stress-related. METHOD: A case-control study used data from confidential questionnaires to assess symptoms and perception of the physical and psychosocial environment among 2160 subjects in 67 offices. Working conditions were also inspected and indoor air quality monitored. RESULTS: We found an incremental trend in prevalence of sick building syndrome among office workers who reported high levels of physical and mental stress, and decreasing climate of co-operation. This association was confirmed after multivariate adjustment for significant personal and environmental exposure factors. Using a subsample, we further modelled interaction between stress and the other covariates but none achieved statistical significance. CONCLUSION: Our study confirmed stress to be a significant and independent determinant of the health complaints, and that symptoms compatible with the sick building syndrome in many cases were stress-related. Our findings underscore the importance of personal and organizational stress management to prevent ill health at the office.

Adolescent↗
PubMed1997

An institutional outbreak of Salmonella enteritidis in Singapore.

A large outbreak of food poisoning occurred in Singapore in March 1995 when a total of 188 inmates in an institution was taken ill. Salmonella enteritidis was isolated from the stool cultures of 35 inmates (16 symptomatic and 19 asymptomatic). All the isolates were of the serotype profile 0:1, 9, 12 and H:g, m (antigen phase I); all were sensitive to ampicillin, ceftriaxone, chloramphenicol, co-trimoxazole and ciprofloxacin. Plasmid profile analysis and restriction enzyme fragmentation patterns (REFPs), as generated with EcoRI and HindIII, of a 60 kb plasmid obtained from these isolates were all identical, confirming that the outbreak resulted from a single source of infection. Stratified statistical analysis of food-specific attack rates strongly implicated imported canned luncheon pork consumed by the inmates on 26 March 95 as the single most probable cause of the food poisoning [p < 10(6), Mantel-Haenszel weighted odds ratio (OR) = 14.33; 95% confidence interval (CI) = 6.20-33.15]. The median incubation period of this outbreak was 19.3 hours and the median duration of illness was three days. The outbreak was rapidly brought under control through prompt implementation of epidemic control measures which comprised active search for diarrheal cases, rectal swabbing of asymptomatic inmates, isolation of those found to be infected, and maintenance of a high standard of personal, food and environmental hygiene.

Disease Outbreaks↗
PubMed1997

A shipyard outbreak of salmonellosis traced to contaminated fruits and vegetables.

A large outbreak of food poisoning occurred in September 1996 and involved at least 116 workers at a shipyard in Jurong. Salmonella weltevreden was isolated from the stool specimens of 24 hospitalised cases and three food handlers, giving a total of 27 bacteriologically confirmed cases (25 symptomatic and two asymptomatic) in this outbreak. Based on a case-control analysis, a number of food items consumed on 23 and 24 September 1996 were implicated in the outbreak, viz. a vegetable dish (P < 0.01), watermelon juice (P < 0.01) and cut watermelon (P < 0.001), papaya (P < 0.001) and pineapple (P < 0.05). The median incubation period was 38 hours and the median duration of illness was two days. Four samples of cut fruits obtained from a food stall at the canteen were found to be positive for Salmonella weltevreden. (The antibiogram of all the strains isolated from food samples and stool cultures was similar, consistent with a common source of infection.) Extensive investigation suggested that contamination may have occurred through unauthorised use of industrial water for washing the fresh produce. Early recognition of the outbreak and prompt implementation of control measures prevented further spread of infection.

Adolescent↗
PubMed1997

A nationwide outbreak of coconut-associated paratyphoid A fever in Singapore.

A large outbreak of 167 cases of paratyphoid A was reported in Singapore during the period 15 February to 4 May 1996. Cases were distributed all over the country and no specific food establishment was implicated. The attack rate was highest among the Indian ethnic group between the ages of 25 and 34 years. A case-control study showed that consumption of a variety of food items in which imported deshelled coconut was used as an ingredient was statistically significantly associated with the illness (P < 0.001). As soon as the vehicle of transmission was suspected, the import of deshelled coconut was banned. No further cases were reported four weeks after the ban. The outbreak highlighted the need to maintain a high degree of vigilance against the introduction of infectious diseases through imported food.

Adolescent↗