Not feasible for docs to report every food poisoning case

Not feasible for docs to report every food poisoning case

By Dr Albert Lin

I refer to the proposal by Mr Gerald Giam to implement an Integrated Food Contamination Reporting System in his letter to the Straits Times Forum on 16 April 2009. (read letter here)

Mr Giam wrote that a web-based interface for doctors to report all cases of food poisoning they treat will enable MOH to track outbreaks earlier and faster.

While the concept behind his idea is sound, it is not feasible to implement it on the ground. As a resident physician at the emergency department, I see an average of 10 to 20 cases of gastroenteritis (food poisoning) per shift. Gastroenteritis also form 20 to 30% of the cases seen by GPs.

Given the time constraints doctors face in the course of their work, it is almost impossible for them to take a detailed clinical history to find out what the suspected food was and the stall from the food was taken, let alone to report all cases.

Besides, not all cases of gastroenteritis are caused by food poisoning. It can be due to gastric flu, side effects from common medicines like antibiotics or simply a prodrome of other diseases. All viral infections have the potential to cause diarrhoea including dengue fever and hand-foot-mouth disease.

Hence, the surveillance system mooted by Mr Giam will not work and will be a drain on precious manpower and resources.

The current MOH system of surveillance and reporting of mass food poisoning cases is adequate to deal with most outbreaks.

In the case of the Geylang Serai outbreak, there appears to be delay of 3 days for the first reports of food poisoning from the Indian Rojak stall to surface because there is usually an incubation period of between 24 and 72 hours before the symptoms first appear. It is highly unlikely that the cases are picked up within 24 hours.

While the system may not be able to detect small number of cases, a higher than average number of gastroenteritis will raise suspicions amongst doctors of a possible outbreak.

Under the Infectious Disease Act (CAP 137), all medical doctors are required by law to notify MOH of a list of infectious diseases they diagnose in their clinics through the online CDLENS portal (https://www.cdlens.moh.gov.sg).

Some of the more common notifiable diseases on the list are dengue fever, hand, food and mouth disease, tuberculosis, Salmonellosis, gonorrhoea and genital herpes. Gastroenteritis is a symptom and not a disease which explains its exclusion from the list.

Doctors are also kept updated on the latest epidemics in the world and Singapore. Urgent notifications are sent immediately via SMSes.

Nevertheless, more can be done to get GPs on board the system as most of them do not have PCs or laptops in their clinics.

I would recommend Mr Giam and all readers to visit the MOH website (www.moh.gov.sg) regularly for updates on the food poisoning incident as well as other health-related matters.

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