Singapore’s first H1N1 flu victim

Singapore’s first imported case of H1N1-2009 (Influenza A) was confirmed on 26 May 2009. Patient zero was a 22-year-old female third-year business undergraduate at the Singapore Management University (SMU). She had travelled to New York, United States, with 18 other SMU students and a university lecturer for a 10-day study trip  from 14 to 24 May.^[1]

For her return trip back to Singapore, patient zero had taken Singapore Airlines flight SQ 25 with a fellow student and the university lecturer, and was seated in row 55. She developed a cough while on board. When the plane touched down at Changi Airport at 6.30 am on 26 May, she cleared the thermal scanners as she was not running a temperature then. While at home later that morning, she developed a sore throat and a 39-degree-Celsius fever, and immediately sought medical attention from her family doctor. In view of her travel history and the symptoms displayed, the general practitioner called for the dedicated 993 emergency ambulance service for suspected H1N1 cases to take her to Tan Tock Seng Hospital.^[2]

Upon arrival at the hospital, the patient was tested for the Influenza A H1 virus. After the initial results were released at 5 pm, she was transferred to the Communicable Disease Centre. Before midnight, results from further laboratory tests confirmed that the patient was Singapore’s first H1N1 flu victim. She was put on a course of Tamiflu to treat her infection and placed in an isolation ward. Nose and throat swabs were also taken daily to monitor her progress.^[3]

On 27 May, the MOH issued home quarantine orders (HQOs) as a precautionary measure to four people who had been in close contact with the patient – the lecturer, the patient’s coursemate who was on the same flight home, her boyfriend as well as her maid who was the only person at home when she returned from her trip. The quarantine duration lasted seven days, from 27 May to 2 June.^[4]

Both the lecturer and the coursemate, who were on the same flight back to Singapore as the patient, underwent tests at Tan Tock Seng Hospital on 27 May. They were sent home when the tests came back negative.^[5]

The patient’s boyfriend, who had picked her up at the airport, sent her home and also accompanied her to see the general practitioner, was warded at the CDC for observation although he had not manifested any flu-like symptoms. He was subsequently discharged and stayed home for the duration of the home quarantine period.^[6] The maid was placed under quarantine at the Pasir Ris Aloha Loyang Resort.^[7]

One of the patient’s fellow coursemates, who had returned to Singapore earlier from the New York study trip, was asked by the Ministry of Health (MOH) to undergo tests at the Tan Tock Seng Hospital. He did not contract the H1 virus, but stayed home just to be sure.^[8]

Another 20 people – six Singaporeans and 14 foreigners – who were also issued with HQOs included the airline crew and passengers seated at rows 52 to 58 on SQ 25. In total, the MOH successfully traced 73 people (71 flight contacts and two local contacts) who had been in close contact with the patient.^[9] The other 18 students on the overseas study trip, who had remained behind in New York, were advised to visit the doctor and to halt all travelling activities if they felt ill.^[10]

As an added precaution, any Singapore Airlines crew who had approached the patient on the return flight were temporarily relieved from duty, while the ambulance driver and paramedic who had attended to the patient during the journey to Tan Tock Seng Hospital were asked to look out for flu symptoms. Cleaning and disinfection of both the plane and the ambulance were also carried out.^[11]

References
1. Ministry of Health, Singapore. (2009, May 27). First confirmed case of Influenza A (H1N1-2009) in Singapore [Press release]. Retrieved March 28, 2015, from  Ministry of Health website: https://www.moh.gov.sg/content/moh_web/home/pressRoom/pressRoomItemRelease/2009/first_confirmed_case_of_influenza_A_(H1N1-2009)_in_Singapore.html; Teh, J. L. (2009, May 28). From touchdown to isolation within hours. The Straits Times, p. 4; Zeinab, Yusuf. (2009, May 28). SMU student is first case of H1N1 here. The Business Times, p. 2. Retrieved from NewspaperSG.
2. Ministry of Health, 27 May 2009; The Straits Times, 28 May 2009, p. 4; The Business Times, 28 May 2009, p. 2.
3. Ministry of Health, 27 May 2009; The Straits Times, 28 May 2009, p. 4; The Business Times, 28 May 2009, p. 2.
4. Feng, Y. (2009, May 28). Those in close contact quarantined. The Straits Times, p. 6. Retrieved from NewspaperSG.
5. The Straits Times, 28 May 2009, p. 6.
6. The Straits Times, 28 May 2009, p. 4; Jaganathan, J., & Quek, C. (2009, May 30). Flu patients could go home next week. The Straits Times, p. 6. Retrieved from NewspaperSG.
7. The Straits Times, 28 May 2009, p. 6.
8. The Straits Times, 30 May 2009, p. 6.
9. The Straits Times, 28 May 2009, p. 6.
10. The Business Times, 28 May 2009, p. 2.
11. The Straits Times, 28 May 2009, p. 6.