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New cases of Tuberculosis or
TB are still being reported in Singapore.
Although the spread of TB is within
control, the community needs to be
aware of how TB is spread, what to do
and where to seek medical treatment
if they are infected.
TB is caused by bacteria that usually
attack the lungs. It can also
affect other parts of the body
such as the kidneys, spine
and brain. If not treated
properly, TB can be fatal.
Fortunately, TB can be cured as long
as it is promptly diagnosed and
treated. You are in a great position
to help your workforce should any
of them develop the disease.
This book can help you understand
how TB can be best managed in
the workplace. Read on to find
out exactly how to protect your
workforce and manage TB to
minimise disruptions to the
workflow and productivity of
your company.
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TB is a disease caused by
bacteria called Mycobacterium
tuberculosis. It usually affects the
lungs (pulmonary tuberculosis),
but can also infect other parts
of the body (extrapulmonary
tuberculosis), such as the brain,
lymph nodes, kidneys, bones
and joints.
The general symptoms of TB
include feelings of sickness or
weakness, weight loss, fever,
and night sweats. The symptoms
of TB in the lungs also include an
ongoing cough, chest pain, and
coughing up blood.
Symptoms of TB in other parts
of the body depend on the
area affected.
What is TB and how
does it spread?
5
TB is an airborne infection. When someone with TB
coughs or sneezes, TB bacteria are released into the air
and can stay there for several hours. People nearby may
breathe in these bacteria and become infected.
In this way, an untreated person will pass TB on to
10 15 people each year. On average, one in 10 of those
people will develop active, contagious TB, while the
rest will not have any symptoms or be able to pass the
disease onto others.
TB transmission
Risk of getting TB
Active TB develops in about 10% of infected
people even if they have a healthy immune
system. However, if the persons immune system
is weakened, e.g. by other health conditions, the
chance of getting sick will be higher. Hence, the risk
of developing active TB is greater among:
Children, who have naturally weaker immune
systems
People in close contact with untreated infectious
TB cases
People with underlying medical conditions such
as HIV infection and diabetes
6
Transmission depends on
How many bacteria droplets
are in the air
How strong the type of bacteria is
The size of the room
The ventilation of the room
People with active TB are most
likely to spread the bacteria to
people they spend time with every
day, such as household and family
members, friends, co-workers
or schoolmates.
Factors that affect
transmission
7
In most parts of the world, especially
in developing countries, TB is a major
cause of death and disability. Untreated
TB can cause severe complications such
as bleeding in the lungs and respiratory
failure, and can be fatal.
However, with the right
and complete treatment
TB can be cured.
It is important to recognise the symptoms
of TB, as that is the first step towards
diagnosis and cure. The next chapter
outlines the early signs of disease, and the
appropriate measures to take.
Understanding
the risks
8
Protecting your staff
from TB transmission
Symptoms of TB
The single most effective way to
prevent TB transmission is to make
sure that the person with active TB is
diagnosed early and treated properly.
By knowing the signs and symptoms,
you can ensure that your workers get
the treatment and care they need.
Cough that lasts for more than 3 weeks
Weight loss
Fever
Night sweats
Loss of appetite
Coughing up blood
9
The most common symptom
of pulmonary TB (or TB that
affects the lungs) is an ongoing
cough for 3 weeks or more.
This is the key thing to remember anyone who has a
persistent cough may have TB in his or her lungs.
If someone on your workforce has had a cough for 3 or more
weeks, they should be referred to a medical practitioner
for assessment.
Someone who is diagnosed with TB will need to take medical
leave for the first 2 weeks of treatment, so arrangements will
need to be made to cover his or her duties.
After completion of the first 2 weeks of treatment, most
people are able to re-join the workforce, posing no risk of
transmission to others. However, they must continue treatment
for at least 6 months in order to be cured of the disease.
The best way to ensure that a TB patient is properly treated
and cured is for him or her to undergo supervised treatment
(Directly Observed Therapy or DOT, see page 13).
The most common
symptom of TB
Defending your workforce
10
A doctor who diagnoses a person
with TB is required by law to notify
the Ministry of Health (MOH) National TB
registry. The TB Control Unit (TBCU) then
follows a three-step procedure:
1. TBCU identifies people who may
have been put at risk anyone
who has had close and prolonged
contact with the person with
active TB.
2. These close contacts are given
a skin test* to find out whether they
have been infected. Results are
available 48 72 hrs after testing.
3. Preventive treatment may be offered to
those with a positive skin test.
People with a positive skin test but no
signs of active TB have dormant infection.
Contact tracing is carried out by the
TBCU free of charge for identified close
contacts of infectious TB patients under
the National TB Control Programme.
* Called a Mantoux test a safe TB extract is injected under
the skin and the skin reaction is measured.
If TB is diagnosed
11
If someone suspects that he or she
has been exposed to TB, there are a
few important things to remember:
You would have to breathe in TB
bacteria from someone with active
disease in order to become
infected yourself
The inhaled bacteria would have
to multiply in your body to cause
active TB
Exposure to TB
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S M T
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6 7 8
13 14 15
20 21 22
27 28 29
Once TB has been diagnosed it needs to be
treated so the patient can recover and the spread of
TB can be prevented or minimised. Most cases can be
treated on an outpatient basis. TB drugs are provided
free to patients treated under DOT (Directly-Observed
Treatment) by the TB Control Unit.

It is important that patients take the right combination of
drugs for the right length of time (6 9 months) in order
to make a full recovery. If the TB is not drug-resistant,
and the full course of treatment is taken, more than 95%
of all patients can be cured.*
*Source: www.moh.gov.sg
Treating and curing TB
It is vital that anyone with TB completes his or her full
course of medication. People often start to feel better
after the first few weeks of treatment, and may stop or
partially skip their treatment for the next few months.
Incomplete treatment is worse than no treatment at
all as the TB bacteria will grow resistant to the drugs
that are first used. When this happens, it becomes
necessary to use different drugs for a longer duration,
and it becomes more difficult to achieve a cure.
13
A full course of
medication is key
13
W T F S
2 3 4 5
9 10 11 12
16 17 18 19
23 24 25 26
30 31
16
DOT, or Directly Observed Treatment, involves taking
TB treatment under the supervision of a nurse or
other healthcare professional. This ensures that the
patient adheres to the treatment regimen, which
increases his or her chance of being cured.
Directly Observed
Treatment
Don't miss any treat ment doses.
14
The previous pages provide the information you need
to recognise the early signs of TB and support any
employee who becomes infected with the bacteria.
In addition, the following tips provide a guide to
offering the best response to TB within the workplace.
Managing TB in
the workplace
1. Recognise that TB is a workplace issue.
TB affects businesses as it increases labour costs and
reduces productivity you could help your company and your
employee by providing TB education.
2. Create awareness.
This booklet and accompanying materials can help you
educate your workforce about TB. Employees should
understand that anyone can be infected, but that treatment
is simple and effective. They should also know where to
seek more information, medical consultation and treatment.
3. Ensure non-discrimination.
No one should be discriminated against or penalised because
of his or her real or possible TB status. Fear of stigmatisation
makes people less likely to seek diagnosis, and therefore
makes it harder to stop the spread of this disease.
Employers should support TB patients by encouraging them
to adhere to and complete the treatment course, by allowing
them time to attend DOT where necessary.
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4. Respect confidentiality.
Other members of your workforce do not need to know
about a co-workers TB status. Ensuring confidentially means
employees will place more trust in your managements
professionalism and your TB workplace health-promotion
programme, which will help it be more effective.
5. Facilitate maintenance of DOT.
Employees need to continue their DOT until they are
completely cured. Supervisors at work should exercise
empathy and concern for their employees and facilitate their
continuation of DOT at their nearest polyclinic.

For example, allow flexible working hours or time off to
receive DOT. Remember that in making these arrangements,
confidentiality on employees TB status should be maintained.
6. Develop a sustainable network of TB programme partners.
There are various healthcare organisations like SATA
CommHealth (Tel: 6244 6688; www.sata.com.sg) that can
provide long-term resources, support and information for
workplace TB programmes.
Copyright HPB B E 614-10
April 2010
For more information on TB,
please visit
www.hpb.gov.sg/infectiousdiseases
Health Promotion Board
3 Second Hospital Avenue, Singapore 168937