title: Twentieth century influenza pandemics in Singapore.
abstract: BACKGROUND
  Singapore was substantially affected by three 20th Century pandemics. This study describes the course of the pandemics, and the preventive measures adopted.
  
  
  METHODS
  We reviewed and researched a wide range of material including peer-reviewed journal articles, Ministry of Health reports, Straits Settlements reports and newspaper articles. Monthly mortality data were obtained from various official sources in Singapore.
  
  
  RESULTS
  The 1918 epidemic in Singapore occurred in 2 waves--June to July, and October to November--resulting in up to 3500 deaths. The 1957 epidemic occurred in May, and resulted in widespread morbidity, with 77,000 outpatient attendances in government clinics alone. The 1968 epidemic occurred in August and lasted a few weeks, with outpatient attendances increasing by more than 65%. The preventive measures instituted by the Singapore government during the pandemics included the closure of schools, promulgation of public health messages, setting up of influenza treatment centres, and screening at ports. Students, businessmen and healthcare workers were all severely affected by the pandemics.
  
  
  CONCLUSIONS
  Tropical cities should be prepared in case of a future pandemic. Some of the preventive measures used in previous pandemics may be applicable during the next pandemic.
authors.affiliation: Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore. vernonljm@hotmail.com
authors.forename: Vernon J
authors.initials: VJ
authors.lastname: Lee
authors.forename: Chia Siong
authors.initials: CS
authors.lastname: Wong
authors.forename: Paul A
authors.initials: PA
authors.lastname: Tambyah
authors.forename: Jeffery
authors.initials: J
authors.lastname: Cutter
authors.forename: Mark I
authors.initials: MI
authors.lastname: Chen
authors.forename: Kee Tai
authors.initials: KT
authors.lastname: Goh
mesh_terms: D004196:Disease Outbreaks / Q000266:history* / Q000706:statistics & numerical data; D049673:History, 20th Century; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology / Q000266:history* / Q000401:mortality; D011634:Public Health / Q000266:history; D012846:Singapore / Q000453:epidemiology