TRAVELER’S HEALTH IN SINGAPORE

Visitors to Singapore generally don’t have health problems. The food and health standards are as good as those of European or North American countries. Singapore has an equatorial climate and used to have problems with hepatitis, stomach parasites and malaria. These diseases have largely been eliminated. However, dengue fever occasionally raises its ugly head. To be on the safe side, it is a good idea to make sure you are up to date with shots and are prepared for both travel-related and serious sicknesses.

Singapore is probably the cleanest city in Asia. Sewage and garbage disposal is never a problem. Daily trash collection is efficient. Water is potable and normally in good supply, although rationing may be imposed during prolonged drought. The government keeps up a constant battle against mosquitoes and other insects. Flies have been all but eradicated. Ants and cockroaches are more of a problem here than in temperate climates. Many travelers have found the typical overseas precautions in food preparation unnecessary in Singapore. Locally packaged food causes no ill effects. Most local restaurants, including hawker stalls, are safe.

Healthcare in Singapore is of a high quality and expensive. You should take enough medication to cover your stay and carry it in your hand baggage. Not all prescribed drugs are available in Singapore. Some over-the-counter medications need a prescription. Make sure you have adequate travel health insurance and accessible funds to cover the cost of any medical treatment abroad and that your travel insurance also covers costs for medical repatriation.

You should be aware of the following health concerns in Singapore: 1) Occasional outbreaks of mosquito-transmitted illnesses; 2) Air pollution and haze during the summer months; 3) Vaccinations: Be up-to-date on all vaccinations recommended by the U.S. Centers for Disease Control and Prevention.Further health information: World Health Organization, U.S. Centers for Disease Control and Prevention (CDC).

Inoculations and Health Entry Issues for Singapore

No vaccinations are required unless you entering Singapore from a country infected with yellow fever (usually in tropical Africa or South America) and then you need a yellow fever vaccination and documentation of it. It is a good idea to make sure you are up to date with your typhus, diphtheria and tetanus inoculations.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to Singapore. Foreign workers applying for an employment pass are required to undergo a medical screening for HIV/AIDS and a positive test will result in the rejection of a foreign worker’s application. If you’re arriving from an airport in the Middle East, you may be subject to screening for Middle East Respiratory Syndrome (MERS). If you display symptoms, you may face quarantine or further testing. Employment pass holders are subject to medical exams and may be denied or deported on medical grounds, including for HIV infection. The Government of Singapore recently ceased requiring waivers for tourism and business travel for HIV-positive travelers.

Try to get the new inoculations for food- and water-borne hepatitis A and blood-carried hepatitis B. The hepatitis B vaccination is worthwhile in case you have an accident and need blood transfusions. It may be worthwhile to get a vaccination for Japanese encephalitis, a mosquito-borne disease that is very rare but found in Asia.

Traveler doctors can tell you what shots and medications you need for specific countries. For information about travelers inoculations inquire first at your county, community or city clinic, or local university. Shots from these sources are generally much cheaper than those given at a hospital or from a private doctor. With inoculations, plan ahead. Some immunization require a series of shots that require more than a month to complete. Further information:U.S. Centers for Disease Control and Prevention (CDC).

U.S. Centers for Disease Control and Prevention (CDC)

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control at https://wwwnc.cdc.gov/travel. For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith.

1) Looking for travel health information for a particular area of the world? Please refer to Traveler's Health Destination Information. 2) Looking for a yellow fever vaccine clinic? Visit our national registry of official yellow fever vaccine providers. 3) Because Travel Medicine is a complex field, we advise consulting a travel medicine specialist or health-care provider 4–6 weeks before international travel to allow time for maximum benefit before you depart. Even if your trip is last minute, there is still benefit in consulting a travel medicine specialist.

4) See the Travel Medicine Clinics page for links to directories of private travel clinics and state health department websites (many state and county health departments also provide travel immunizations). Health-care providers can contact their state epidemiologist or local health department on the page of the Association of State and Territorial Health Officials.

For questions about travel, or comments, questions, or suggestions regarding our website, please contact CDC-INFO at: 1-800-CDC-INFO (1-800-232-4636), 1-888-232-6348 (TTY). Website: cdcinfo@cdc.gov

Diseases

Mosquito-borne diseases: Dengue is active in Singapore and can be monitored at the Singapore National Environmental Agency. In addition, the U.S. Centers for Disease Control issued a travel notice for Zika virus in Singapore and most neighboring countries are Zika endemic. UK health authorities have classified Singapore as having a risk of Zika virus transmission. For information and advice about the risks associated with Zika virus, visit the National Travel Health Network and Centre website. Hand, Foot and Mouth Disease is common in Singapore with more serious outbreaks from time to time. Young children are particularly at risk. [Source: Travel.State.Gov, U.S. Department of State, May 2019]

Otherwise Singapore has few health hazards. Malaria has been eradicated, although it may be picked up in Indonesia. There are dangerous strains along the Thailand, Myanmar and Cambodia borders. Dengue fever is more of a problem. It, too, is transmitted by mosquitoes and is enervating, lasting two or three months. Occasionally, there is a case of cholera, but such cases are few and are immediately isolated.

Children sometimes contract tropical fevers of unknown origin which may last from one to three days but, in general, Singapore provides a good environment for young children. Serious dysentery is rare. Respiratory ailments, however, are quite common. The heat and humidity increase the incidence of skin problems; treatment should be sought at the first sign of trouble, since infections spread quickly. Mosquito-borne illnesses like dengue fever occur all year round. You should take appropriate precautions to avoid being bitten by mosquitoes. [Source: Countries of the World and Their Leaders Yearbook 2009, 2008 Gale]

Insect Protection: Wear protective clothing. Use a spray like "Coulston's Duranon Tick Repellent" on your clothes. Use a 95 percent to 100 percent DEET insect repellents on your skin. Electric fans are an effective in keeping mosquitos away.

Dengue Fever

From time to time Singapore experiences a spike in the number of dengue fever cases. Outbreaks tend to be clustered in residential areas, but there have been no reports of clusters in primary tourist areas, such as the Night Safari, the Singapore zoo, or Orchard Road.

Dengue fever is a nasty, viral disease transmitted by the Aedes mosquito, usually the Aedes aegypti , the same mosquito that often carries yellow fever. Sometimes called "breakbone fever" or "break-heart" because of the intense pain it can produce, the disease is characterized by sudden onset of fever; intense pounding, frontal headaches; aching bones and joints; nausea and vomiting; and a feeling of being too sick to eat anything. Other symptoms include severe sweats, symptoms: eye pain, rash, chills, and excruciating chest pains. Tests foe dengue rely on the presence of antibodies, which can take up to a week to develop.

Dengue fever is found in 100 countries and kills about 20,000 people annually. Nine out of 10 people who get dengue fever don't even feel it or get a mild case in which they feel something akin to a slight flu. People who get full-blown dengue fever are sick for a week or more. Many patients have a rash, which appears 3 to 5 days after the onset of the disease, and experience severe emotional and mental depression during the recovery period. Most cases of the disease are benign and self-limiting although convalescence may take a long time.

A few people with dengue fever suffer gastrointestinal bleeding. Fewer still suffer brain hemorrhages. In about 1 percent of cases dengue fever can cause a severe and often fatal hemorrhagic disease called dengue hemorrhagic fever (DHF) that occurs when capillaries leak and the circulatory system collapses.. Those that die of dengue fever often get DHF hemorrhaging in the final stage of the sickness. Failing to realize they are infected, they go don't get treatment soon enough and lose blood plasma and go into shock after the initial fever passes. Some victims die within 10 hours of developing serious symptoms if they don't get appropriate treatment.

See Dengue Fever article factsanddetails.com

Japanese Encephalitis

Culex vishui mosquito Japanese encephalitis is a mosquito-born viral disease that usually infects people in rural areas in the summer and autumn in temperate regions and northern tropical zones of Bangladesh, China, India, Cambodia, Korea, Laos, Myanmar, Nepal, Thailand, Vietnam and eastern Russia. It is sometimes present in the wet season in the tropical zones of south India, Indonesia, Malaysia, the Philippines, Singapore, Sri Lanka. Taiwan and south Thailand.

Japanese encephalitis is transmitted chiefly by the Culex vishui and Culex tritaeniorhyncus mosquitos, which bite mainly in the afternoon and evening and develop from larvae found mainly in cultivated rice fields and marshes. People traveling in rural areas have a stronger likelihood of contacting the disease than those who stay in urban areas.

Most people who are infected display no symptoms, but the fatality rate is as high as 30 percent among victims who are hospitalized. Severe swelling in the head and central nervous system are manifestations of severe cases of the disease.

There is a vaccine that is given in a series of two or three injections one or two weeks apart. There is no medical cure but most victims recover on their own with rest and hospital care.

Encephalitis is a tick-bourne disease that often produces fatal swelling of the brain. Symptoms include fever, headache vomiting, neck stiffness, pain in the eyes when looking at light, alterations in consciousness, seizures, paralysis or muscle weakness. Correct diagnosis requires hospitalization. There are vaccines for encephalitis and specific tick-borne encephalitis immune globulin. Encephalitis prevention includes avoiding places with ticks such as high grass, edges of forests, clearings.

Hepatitis

Hepatitis is a viral disease that affects the liver. There are at least six known kinds of hepatitis (hepatitises A, B, C, D, E and F). Hepatitis A, hepatitis B and Hepatitis C (which wasn't even identified until 1989) are relatively common in some places. Hepatitis D and hepatitis E are very rare. Hepatitis may be infectious or noninfectious. Six or seven virus are usually responsible for the infectious versions although other viruses, parasites, fungi may cause it.

Hepatitis is debilitating disease that can last for months. It often creeps up slowly (between 15 to 50 days, usually around 25 days), peaks, sometimes with pronounced symptoms, and fades away slowly. leaving victims feeling weak and tired for a long time.

Hepatitis generally begins with mild symptoms that may or may not become severe. Hepatitis can go on a long time and cause considerable damage before people realize they have it. Early symptoms include a slight fever, achy joints, abdominal pain, lethargy and aversion to cigarette smoke. One telltale sign of hepatitis is urine that is deep orange in color regardless of how much liquid has been consumed (if you think you may have hepatitis drink a lot of water, if you urine is still really orange or yellow see a doctor).

Hepatitis A is contacted from contaminated water and hepatitis B is contacted from infected blood or bodily fluids. Both diseases can be very serious and debilitating and often include jaundice (yellowing of the skin and the whites of the eyes). Immunizations, consisting of a series of shots given over several weeks, are available for both diseases. If you are getting these shots for traveling make sure you get them well advance of your departure date.

The Hepatitis A vaccine consists of a single dosage given two weeks prior to exposure. A booster is recommended anytime between six and 12 months later to assure the best protection. The side affects are generally mild.

Hepatitis B kills or contributes to the death of at least 600,000 and maybe as many a million adults every year. It is transmitted by body fluids, primarily blood and semen but occasionally saliva, and is contacted by direct contact with an infected person's blood or contact with the infected person's bodily fluids, such as through sharing needles or having sex. Transmission is mainly through blood contact, such as a blood transfusion, or to a lesser extent from infected unsterilized needles, acupuncture and tattooing. Transmission through sex is rare. It can not be contacted through casual contact such as shaking hands.

Hepatitis B is incurable but it can be prevented with a vaccine. The Hepatitis B vaccine is made two ways: 1) the plasma-derived vaccine is made with hepatitis B virus particles taken from the blood of carriers, with all viruses in the vaccine being killed; and 2) the recombinant vaccine made from common bakers yeast through genetic engineering.

AIDS

AIDS is not a serous problem in Singapore. Don't mess with prostitutes. If you do wear a condom. The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to Singapore. Foreign workers applying for an employment pass are required to undergo a medical screening for HIV/AIDS and a positive test will result in the rejection of a foreign worker’s application. Employment pass holders are subject to medical exams and may be denied or deported on medical grounds, including for HIV infection. The Government of Singapore recently ceased requiring waivers for tourism and business travel for HIV-positive travelers.

The International AIDS-HIV charity Avert reports: “Although the number of people living with HIV in Singapore is relatively small, the country's status as an international travel and business hub, along with the high number of infections found in surrounding countries, make it possible that the country will experience a more serious epidemic in the future. The number of annual new infections has been rising in Singapore. In 2008, a record 456 people were newly diagnosed with HIV, compared to 357 in 2006. The majority of these new infections (50 percent) are diagnosed at a late-stage of HIV infection, by which point HIV treatment should already have started. [Source: Avert, International AIDS-HIV charity website]

“To combat these rising figures, the government has chosen to focus on preventing mother-to-child transmission, but controversially, has rejected widespread condom promotion. Another controversial policy in Singapore is the strict law banning sex between men, which campaigners argue undermines efforts to promote safe sex among MSM. This is concerning considering the rising number of HIV infections among MSM (38 HIV infections in 2002, compared with 185 in 2008).”

Haze and Humidity

Air pollution and haze from forest fires in neighboring countries occurs intermittently. Singapore’s National Environmental Agency’s Haze provides public updates on conditions. Haze can affect air quality in Singapore and cause respiratory problems. You should monitor the Pollutant Standards Index (PSI) updates and health advisories from the Singapore government.

From June to October Singapore can experience high levels of pollution (haze) from land clearance fires in Indonesia. The haze can cause disruption to local and regional air travel, and the air pollution may have an impact on public health. Keep up-to-date with local information and seek medical advice on appropriate precautions.

Even in a clean city like Singapore, the tropical climate seems to foster diseases; germs and viruses thrive here. Many people who have scant history of illness complain of recurring colds and other infections. Enthusiastic air conditioning probably contributes to respiratory problems. Many restaurants and shops are uncomfortably overcooled. Humidity makes mildew a problem—books, records, leather items, or anything that is not used or aired regularly or stored in air conditioning is vulnerable. Closets and bureau drawers take on a musty odor that is difficult to eliminate. Rust is also a problem; metal items that are not painted or tropicalized begin to rust in a short time.

Singapore, like every other tropical area, has its share of cockroaches, water bugs, small pesky ants, and termites. Flies are almost nonexistent. Mosquitoes can be annoying despite strenuous efforts to control them, but malaria is not a problem. [Source: Cities of the World, Gale Group Inc., 2002, adapted from a U.S. Department of State report]

Food, Water and Diarrhea Issues in Singapore

The tap water is safe to drink. But to play it safe, it is a good idea to drink bottled water and use it to brush your teeth. Also, be cautious about bottled water. Make sure the cap is sealed shut and buy the water at places regarded as trustworthy. In other words, don't buy it on the streets or in kiosks. This is generally not a problem in Singapore.

Some visitors have stomach- and bowel-related problems. To avoid this from happening use common sense. Avoid salads, ice, street food, sea food, and uncooked food. Never eat anything raw. Peel vegetables and fruit. Make sure meals are hot and recently prepared, preferably right in front of you. Don't eat anything that looks questionable or looks as if it had been sitting around for a while.

Keep your hands clean by washing with soap or a liquid sanitizer like Purell. Many people worried about hygiene bring their own chopsticks or carry swabs and packets of alcohol to wipe off chopsticks and rims of glasses in restaurant. Make sure you are inoculated against hepatitis A. Some people bring their own syringes.

Travelers Diarrhea is something travelers sometimes get in Singapore get but less than in Thailand, Malaysia and Indonesia. If the diarrhea is accompanied by sulphur tasting burps it probably means you have giardia. The best remedy for any kind of diarrhea problem is to flush your system by going 24 hours, or as long possible, drinking clear fluids. If the diarrhea persists you may need to take strong antibiotics. Immodium is only good for temporarily stopping you up. It is good for bus rides but once the medication wears off your diarrhea returns. If you have blood in your stool it means you may have dysentery; see a doctor immediately.

Sun and Heat Issues

Sun Protection: Make sure to bring a sun screen rated "15" or above and drink plenty of water if you are traveling in hot areas. Sun glasses and protection for your lips are a "must." Hats and long sleeve shirt are also a good idea.

Heat Protection: Dehydration can be is a serious problem in hot weather. It goes without saying to bring lots of water, at least 5 liters per person a day, and have access to shade. To avoid heat exhaustion and heat stroke stay in shade as much as possible, get enough salt, replace electrolytes with fruit juices or prepared drinks that replace the salts you lose, stay out of the sun and don't do strenuous exercise after 10:00am and before 4:00pm. If you do physical activity when it is hot it is good idea to go out early, right after sunrise if you can, and take a rest or a nap in the shade in the afternoon, and continue on in the late afternoon.

Heat Exhaustion: Heat cramps are the least dangerous of the heat-related conditions. They serves as a warning that more serious things might happen. The symptoms include cramps, muscle twitching, and lightheadedness. If you have any of these symptoms immediately cool down your body with some water or shade.

Heat exhaustion is a serious condition. It is characterized by severe fatigue, headaches, confusion, nausea, weak pulse, cold clammy skin, and giddiness. Heat stroke is a very dangerous and potentially fatal condition characterized by a high body temperature and no sweating. People with heat stroke need immediate hospitalization; and should be cooled with wet towels until then.

Fungal Infections are common in hot, humid places. They include athlete’s foot, ringworm and infections in the groin, scalp and between the fingers and toes. They can be avoided by keeping as dry as possible and washing frequently and drying well afterwards. Treatment usually involves using an anti-fungal cream or powder such as tolnaftate (Tinaderm).

Prickly Heat is a temporary but irritating condition caused by blocked sweat-gland pores and is characterized by tiny blisters on the skin. It is caused by sweat that can't work its way out of the body and usually occurs under thick skin or calluses. It sometimes afflicts people from temperate climates while they are hot climate. Drinking liquids to promote sweating makes it worse. Loose fitting clothing and scrubbing to open up clogged pores helps. Some medications offer relief. The condition goes away when the individual becomes acclimated to his or her hot surroundings.

Medication in Singapore

You should take enough medication to cover your stay and carry it in your hand baggage. Not all prescribed drugs are available in Singapore. Some over-the-counter medications need a prescription. If traveling with prescription medication, check with the Singapore’s Health and Science Authority website on bringing personal medications to Singapore. Always carry your prescription medication in original packaging with your doctor’s prescription.

Some prescribed and over the counter medicines available in the U.K. and U.S. are considered controlled substances in Singapore. You must apply for prior authorisation and a permit at least ten working days before your travel date from the Singapore Health Sciences Authority in order to bring any such medication into Singapore. For medicines that do not contain a controlled substance, you may bring up to three months’ supply into Singapore without prior approval, but must bring supporting documents such as a letter from your doctor or a copy of the prescription as proof that the medicines are for your personal use. For more information, please consult the Health Sciences Authority website. If you have questions please email hsa_info@hsa.gov.sg . [Source: UK government Foreign travel advice, May 2019]]

Health Care, Payment and Hospitals in Singapore

Good medical care is widely available in Singapore. If you need emergency medical assistance during your trip, dial 995 and ask for an ambulance. You should contact your insurance/medical assistance company promptly if you are referred to a medical facility for treatment. Air ambulance services providing evacuation services from Singapore are typically not required.

Healthcare services are generally first-rate; private citizens from around the world travel to Singapore for medical treatment. Most doctors and hospital staff speak fluent English. Most hospitals have medical centers with doctors practicing a wide variety of specialties. For outpatient care, Americans usually go to doctors at commercial clinics. Good pediatric and obstetric services also are available. In the event of an injury, appropriate medical treatment is widely available throughout the country. Outside of the central island of Singapore, such as during excursions to neighboring islands or activities at sea, it may take more time for first responders and medical professionals to stabilize a patient and provide life-saving assistance. U.S. citizens are encouraged to purchase medical evacuation insurance.

Medical Facilities may be expensive. As a rule doctors have received some foreign training. Emergency care is good. Larger hotels often have a list of English-speaking doctors that are on call for visitors. They are often the best doctors in town. In certain circumstances, the Ministry of Health may access patient medical records without the consent of the patient, and in certain circumstances physicians may be required to report information relating to the diagnosis or treatment without the patient's consent. Travel.State.Gov, U.S. Department of State, May 2019]

Most Americans use 1) Mt. Elizabeth (3 Mount Elizabeth Rd., near Orchard Road, Tel: 65-737-2666), Gleneagles Hospital (6A Napier Road, (65) 6473 7222), Mt. Alvernia, American Hospital, Thomson Medical Center, Youngberg Memorial Adventist, or Jurong Hospitals. All are well managed and efficient. Excellent dental and ophthalmologic care is available. Prescriptions can be filled locally. Private hospitals include Mount Elizabeth Hospital Ltd., and Singapore General Hospital (Outram Road, in Chinatown, Tel: 65-222-3322, 6222 3322); Raffles Hospital (585 North Bridge Road, Tel: (65) 6311 1111)

Doctors and hospitals expect immediate payment for health services by credit card or cash and generally do not accept U.S. health insurance. Check with your medical insurance company to make sure you are covered overseas. Hospitals may require a substantial deposit before admitting you for any major medical treatment. The U.S. government does not pay medical bills and cannot provide a letter of guarantee for payment. Be aware that U.S. Medicare does not apply overseas. [Source: Travel.State.Gov, U.S. Department of State, May 2019]

English-Speaking Doctors: You can gain access to a worldwide list of recommended doctors 24 hours a day by contacting the International Association for Medical Assistance for Travelers (IAMAT, www.iamat.org , 1623 Military Rd. #279 Niagara Falls, NY 14304-1745; Tel: (716)-754-4883. You can also contact the U.S. Embassy or consulates in Singapore or try the International Society of Travel Medicine (www.istm.org ).

Medical Insurance

Make sure your health insurance plan provides coverage overseas. Most care providers overseas only accept cash payments. The U.S. Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. The U.S. Department of State strongly recommend supplemental insurance to cover medical evacuation. It is also not a bad idea to get Travel Health Insurance. Medicare and Medicaid do not cover medical expenses rendered outside the U.S. Often what you do is pay for the medical costs with cash or credit card at the time services are rendered and then do the paperwork and file a claim when you return home and are reimbursed for a percentage of your costs. Some policies will make a payments directly to hospitals. [Source: Travel.State.Gov, U.S. Department of State, May 2019]

Things to consider when deciding about travel insurance: Medical Evacuation Insurance: 1) Pays for medical care and emergency transportation. 2) If you are traveling to a remote destination or to a place where care is not likely to be up to U.S. standards, consider buying medical evacuation insurance. 3) It can be purchased separately or as part of your travel health insurance policy.

Travel Health Insurance: 1) Pays for emergency and/or routine medical services overseas. 2) If you have health insurance in the United States, find out if it covers emergencies that happen abroad. More information is available on our page about your health abroad. 3) If your health insurance coverage is not adequate, consider buying a short-term supplemental policy. 4) Look for a policy that will make payments to hospitals directly.

Travel insurance varies widely and one should carefully read the terms of an insurance policy to make sure it fits the needs of the traveler. For example, does it cover: 1) Emergency medical care; 2) Medical transport back to the United States; 3) Travel/accommodation costs; 4) 24 hour contact line; 5) Sufficient financial coverage; 6) The region(s) you travel in; 7) Duration of travel; 8) Pre-existing conditions; 9) Activities you plan on engaging in

For medical assistance you can try the International SOS website (a travel insurance company, www.sosinternational.com ); MedicAlert (www.medicalert.org ) Tel: 1-800- 432-5378, 8:00 AM - 4:30 PM PT, Mon-Fri, Pacific Time); National Patient Travel center (www.patienttravel.org, Tel: 757-318-9174).

Image Sources: Wikimedia Commons

Text Sources: Singapore tourism websites, Singapore government websites, UNESCO, Wikipedia, Lonely Planet guides, New York Times, Washington Post, Los Angeles Times, National Geographic, The New Yorker, Bloomberg, Reuters, Associated Press, AFP, Japan News, Yomiuri Shimbun, Compton's Encyclopedia and various books and other publications.

Updated in August 2020