In Singapore, a rare disease is defined as a condition that affects fewer than one in 2,000 people. Persons with rare diseases are typically identified during the mother’s pregnancy following screening or testing, or at birth due to the presence of congenital anomalies.
In some cases, a rare disease may be late-onset, with symptoms only presenting gradually from early childhood, school-going age or even as late as adulthood. Hence, these cases may remain undetected for a long time.
Two such conditions are 22q11.2 deletion syndrome (22q11.2DS) and Neurofibromatosis Type 1 (NF1) which, while classified as rare, have a noticeable prevalence in the Singapore population.
Early detection during a routine developmental follow-up session can help patients. With a referral for tertiary assessment, patients can receive timely diagnosis and support to optimise their quality of life.
General practitioners (GPs) can help to play an active role in looking out for tell-tale signs of 22q11.2DS and NF1.
What is 22q11.2 deletion syndrome (22q11.2DS)? | |
Individuals with 22q11.2DS (also including velocardiofacial syndrome (VCFS) and DiGeorge Syndrome) are born without a small part of chromosome 22, known as 22q11.2, resulting in the loss of an estimated 40 to 60 genes. This genetic disorder occurs in one in 6,000 persons, and can affect many parts of the body, including the heart, immune system and development. | ![]() Photo credit: SingHealth |
Clinical presentation | |
Individuals can present with a combination of the following symptoms, which may gradually appear over a number of years, with varying degrees of severity: | |
Congenital heart defects |
|
Palatal abnormalities |
|
Hearing loss |
|
Craniofacial features |
|
Immune deficiency |
|
Hypoparathyroidism and hypocalcaemia |
|
Developmental delay and/or learning difficulties |
|
Common prenatal findings |
|
Testing for 22q11.2DS | |
| |
Benefits of timely diagnosis and management | |
| |
Resources | |
What is Neurofibromatosis Type 1 (NF1)? | |
NF1 is caused by a fault in the tumour suppressor NF1 gene, which produces a protein that blocks the development of tumours and cancer. About one in 3,000 people are born with NF1. The condition can affect the brain, spinal cord, nerves and skin, resulting in skin changes and the growth of tumours along the nerves. The median life expectancy of people with NF1 is at least eight years lower than that of the general population. They are almost 10 times more likely to develop cancer during their lifetime in comparison to the general population. | ![]() Photo credit: SingHealth |
Clinical features | |
Symptoms may gradually appear over a number of years, with varying degrees of severity. An individual may be diagnosed with NF1 if they sent with two or more of the following symptoms: | |
Six or more café-au-lait spots |
|
Freckling around the armpits or groins |
|
Two or more neurofibromas, or one plexiform neurofibroma |
|
Eye manifestations |
|
Skeletal changes |
|
Family history |
|
Developmental and behavioural issues |
|
Hypertension |
|
Benefits of timely diagnosis and management | |
Long-term integrated care by a multidisciplinary team consisting of genetics, dermatology, neurology, orthopaedic surgery, oncology, ophthalmology and surgical specialties. Genetic counselling to anticipate the manifestation of skin changes from an early age, to support the child’s psychological well-being and also guide them in future family planning decisions. The NF1 Clinic at KK Women’s and Children’s Hospital (KKH) is Singapore’s first such dedicated clinic for children. Launched in April 2023, and jointly led by the Genetics Service and Department of Dermatology, the team seeks to improve the care of NF1 patients with comorbidities and provide cross-disciplinary care. | |
Resources | |
Refer a patient At KKH, the Genetics Service provides comprehensive care, holistic treatment and support for patients with rare diseases, to help individuals achieve optimal health outcomes and lead fulfilling lives. Community healthcare professionals can refer patients to the Genetics Service for assessment via:
|
![]() | Dr Nikki Fong, Consultant, Genetics Service, KKH Dr Nikki Fong cares for children with rare diseases. She closely manages patients with Neurofibromatosis Type 1 (NF1), and is involved in maintaining the NF1 registry in Singapore. An active researcher, Dr Fong is pursuing a study into ‘Expanding newborn screening for treatable inherited disorders by using targeted genetic analysis’, which has obtained a grant from the SingHealth Duke-NUS Paediatrics Academic Clinical Programme’s Tan Cheng Lim Research & Education Fund. Dr Fong is also actively involved in medical education as a Clinical Assistant Professor with the Duke-NUS Medical School. Dr Fong obtained her Bachelor of Medicine and Bachelor of Surgery (MBBS) from the National University of Singapore’s Yong Loo Lin School of Medicine in 2013 and completed her paediatric residency at KKH in 2019. |
![]() | Lim Jiin Ying, Principal Genetic Counsellor, Genetics Service, KKH Lim Jiin Ying has strong interest in genetic counselling and genomic medicine. Apart from clinical interests in paediatric and general genetics, Jiin Ying is also a biocurator in the Syndromic Disorders Gene Curation Expert Panel under Clinical Genome Resource (ClinGen), a United States of America (USA) National Institutes of Health (NIH)-funded resource since 2017. Actively involved in research and teaching, Jiin Ying is a trainer for Genetics Education for Healthcare Professionals Workshop jointly developed by KKH Genetics Service and the SingHealth Duke-NUS Institute of Precision Medicine (PRISM), and supported by SingHealth Academy. She is also the Module lead for the Executive Certificate Programme in Clinical Genomics. Jiin Ying graduated from the University of Melbourne with Bachelor of Science: Double Major in Biochemistry & Molecular Biology and Genetics in 2009 and Master of Genetic Counselling in 2011. |