Hand, Foot And Mouth Disease (HFMD)

19 Mar 2006

The Ministry of Health (MOH) is monitoring with concern the recent increase in HFMD cases and the occurrence of HFMD-associated deaths in the region. In Sarawak, 8 deaths have been reported among over 4,000 HFMD cases this year. Two of the deaths were known to be associated with Enterovirus 71 (EV71). One HFMD death has also been reported in Brunei.

HFMD is a common childhood disease caused by a group of viruses known as Enterovirus. The disease is generally mild and self-limiting. However, in very rare occasions, EV71 infection can cause complications involving the heart and brain, which can result in death. It has happened here before. During the outbreak of HFMD in 2000/2001 in Singapore, there were 7 deaths associated with EV71.

This year, 2,017 cases of HFMD have been reported as of 15 Mar 06. The weekly average number of cases has increased from 113 in January, to 174 in February and 331 in March.

More significantly, an increase in the circulation of EV71 has been observed among patients with HFMD here. EV71 is now found in about three-quarters of the positive tests from patients with HFMD this year. The corresponding figure In the second half of last year was about half. This is unlike in 2004 and first half of 2005 when Coxsackie A16 was the predominant circulating strain.

MOH is concerned about the transition in the circulating enterovirus strain from Coxsackie virus to EV71. Although so far there has not been any serious HFMD case, the HFMD deaths in Malaysia and Brunei should alert us to the possible occurrence here. The best way to avoid this is protection against HFMD.

HFMD is spread through direct contact with the respiratory droplets, saliva, faeces or blister fluid of an infected person and indirectly by contaminated articles. Young children, particularly those aged less than five years, are the most susceptible. Two-thirds of HFMD cases in Singapore are below five.

The Ministry would like to remind Singaporeans to maintain high standards of personal and environmental hygiene to minimize the risk of HFMD. The public should adopt the following good practice:

• Wash hands with soap before eating and after going to the toilet;

• Cover mouth and nose when coughing or sneezing;

• Maintain good air circulation;

• Clean thoroughly toys or appliances which are contaminated by nasal or oral secretions; and

• Do not share eating utensils

Parents should consult a doctor immediately if their child has fever, mouth ulcers and rashes on the palms, soles or buttocks. Children suffering from HFMD should not attend childcare centres, kindergartens or schools but should stay at home. They should avoid contact with other children until they have recovered.

MCYS and MOE have alerted schools, special schools, kindergartens and childcare centres to step up hygiene measures and check for sick children. This includes early identification and isolation of infected children. Those suffering from HFMD must be certified fit by a doctor before they are allowed to return to schools, special schools, child care centres, or kindergartens. MCYS officers will step up their health inspections at all child care centres. MCYS have also sent advisories and reminders to child care centre operators on how to manage an outbreak of infectious diseases, maintenance of good hygiene and sanitation practices, and MCYS' Standard Operational Procedure (SOP) for child care centres in the management and control of HFMD.

NEA has also intensified their hygiene inspections at these centres.

MOH has alerted all GPs to maintain vigilance and to detect new cases early for treatment. For more information, refer to the Weekly Infectious Diseases Bulletin.