S'pore's National Public Health Laboratory is well prepared for monkeypox: Director

NPHL's senior medical technologist Nataline Tang at its laboratory at the National Centre for Infectious Diseases. ST PHOTO: FELINE LIM

SINGAPORE - The Republic's National Public Health Laboratory (NPHL) is "quite well prepared" for any cases of monkeypox here, its director, Adjunct Professor Raymond Lin, said on Thursday (June 2).

The facility, which is under the National Centre for Infectious Diseases (NCID), has been preparing reagents for polymerase chain reaction (PCR) tests to screen for the disease, senior medical technologist Nataline Tang said.

Prof Lin noted that NPHL had already proved two years ago – when the first case of monkeypox was detected here – that it has the ability to detect and diagnose the disease.

But he added: "From my point of view, monkeypox isn't the dangerous thing... We are actually afraid of something like smallpox, which can be very deadly, and when it presents can look like monkeypox. This is one of the things we prepare for, but hope will never happen."

NPHL has two main roles, the first of which is studying any diseases currently in the community.

This includes respiratory viruses, hand, foot and mouth disease, food-borne illnesses, vector-borne illness, antibiotic-resistant pathogens, tuberculosis and human immunodeficiency virus (HIV).

"(This is) so we have an early warning if there's an increase in disease, or a change in strain," said Prof Lin, adding that this information helps Singapore's public health system take appropriate measures.

To do this, staff spend about eight hours a day, five days a week, around a whole range of pathogens in NPHL's laboratories.

But the safety equipment and procedures in place allow staff to go about their work with peace of mind.

"We have equipment here and proper PPE, and we are trained – we have knowledge about what is safe and not safe to do, and all this adds up to how we do our work. All this helps us to feel very safe," said Ms Tang.

NPHL's second task is to prepare for pathogens which have not yet reached Singapore.

"We need to think and see what is next. We look around the world and see what the threat is," said Prof Lin.

This allowed NPHL to have a test ready when Singapore's first case of monkeypox surfaced in 2019, and also played a key role in the nation's response to Sars-CoV-2, which causes Covid-19.

Prof Lin explained that, as early as 2019, his team had anticipated that a coronavirus outbreak might be possible here, and so had prepared diagnostic tests which can detect coronaviruses.

NPHL had also improved its ability to sequence and grow viruses by the time Covid-19 hit. All this allowed its team to sequence and grow Sars-CoV-2, which, in turn, provided researchers with samples and information they needed to study the coronavirus and combat it.

NPHL also helped ensure that commercially available test kits and vaccines worked well, and worked on detecting and studying different coronavirus variants.

This meant that during peaks of infection waves, some of NPHL's staff, such as senior medical technologist Siti Zulaina Mohamed Said, had to work up to 15 hours a day.

She recalled: "I kept telling myself I had to do this for the nation, because, if we didn't do it, who else would?"


During peaks of infection waves, staff like senior medical technologist Siti Zulaina Mohamed Said had to work up to 15 hours a day. ST PHOTO: FELINE LIM

Looking to the future, Prof Lin said that there are three main scenarios that he is concerned about, but NPHL is prepared for – all of which could cause severe disruption to the economy and peoples' lives.

First, another pandemic, possibly due to a respiratory virus. Acknowledging that the next pandemic "would no doubt hold surprises", Prof Lin said that, nevertheless, Singapore's experience with Covid-19 has prepared it to adapt to the next such crisis.

Second, a vector-borne disease, especially one carried by mosquitoes. Prof Lin noted that this kind of disease can spread widely and rapidly under the right circumstances, but said NPHL's response to chikungunya and Zika has shown its ability to quickly find, identify and test emerging viruses.

Third, the release of highly dangerous pathogens, whether by accident or due to a terrorist act.

"We have adopted new methods for testing panels for multiple pathogens targeted at the likely bio-threat agents, and coordinate with other agencies to prepare for such a scenario. Laboratory preparedness is only one aspect of the whole response framework.

"We will never have things set up perfectly for the next Disease X, but we certainly will do the best we can to have a good chance to succeed," said Prof Lin.

He added that NPHL is continually trying to keep itself updated with the latest technology and training for its staff, and works with researchers from other agencies to do so.


Prof Lin said NPHL had already proven two years ago that it has the ability to detect and diagnose monkeypox. ST PHOTO: FELINE LIM

NPHL's facility at NCID – which it moved into in 2019 – is also a far cry from its previous location – a retrofitted kitchen in Tan Tock Seng Hospital (TTSH) – where it was based for 10 years.

Some of NPHL's functions were also housed at various interim locations over the years, including the National University Hospital, the former school of nursing and Biopolis.

"(The retrofitted kitchen) was very cramped, and the lab was one-third the size of our current lab. The equipment was also very limited. We had to borrow from TTSH," recalled senior medical technologist Loh Pei Ling, who has been with NPHL for 15 years.

In contrast, NCID's current facility has allowed it to handle a wider range of pathogens, and more efficiently, said Prof Lin.

For instance, Ms Tang said some new tests allow her to screen for over a dozen respiratory viruses, a vast improvement over PCR tests, which can screen for only one pathogen.

Still, it is crucial to keep learning and improving, said Prof Lin. He added: "We must be humble because we may think we know things, but they never turn out the way we'd think."


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