Hand, Foot And, Mouth Disease (HFMD) In Pre-School Centres

23 May 2003

Cases of Hand, Foot and Mouth Disease (HFMD) have been reported in two child care centres recently. Sixteen children have been infected at the NTUC Jurong West Child Care Centre after the first case was discovered on May 9. Since then, five children have recovered and have returned to the centre, while the others are still recuperating at home. Another four children were infected with HFMD at the NTUC Wellington Child Care Centre from May 14. Of these, one has recovered and has returned to the centre, while the others are recovering at home.

Officials from the Ministry of Community Development and Sports (MCDS), the licencing authority for all child care centres, and the Ministry of Health (MOH) have inspected the two centres and are satisfied with the hygiene practices and conditions. The centres are functioning normally.

We would like to assure parents and guardians who have children in child care centres that there is no cause for alarm as HFMD is generally a mild infection that is common among children and all precautionary measures have been taken to ensure that the infection does not spread.

Since the outbreak of HFMD in 2000, child care centres have put in place measures to ensure that their premises and materials are properly cleaned and maintained. The MCDS has in place a monitoring mechanism to ensure that all centres comply with good health and hygiene measures to minimise the spread of infectious diseases in child care centres.

Centres are also equipped with MOH?s guidelines on "Prevention and Control of Infectious Diseases in Child Care Centres / Kindergartens / Pre-school Centres". Vigilance in implementing these measures has been reinforced with the onset of the SARS outbreak.

All child care centres must meet stringent standards on health and hygiene practices. Regular licensing visits and audit of child care centres are performed by MCDS officials. However, as children in the centres interact in close proximity with one another, this makes them more vulnerable to infections such as HFMD.

Child care centres have in place the following operational procedures to prevent the spread of infectious diseases:

• conduct frequent health checks to detect early symptoms of infectious diseases;

• isolate the infected child in the sick bay/isolation room immediately;

• notify the parents of the sick child and the Epidemiology and Disease Control Division at Ministry of Health when the child is found to be unwell;

• remind parents to refrain from bringing their sick children to the centre;

• continue to clean and disinfect daily, the centre premises, toys, apparatus and materials the children come in contact with; and

• instill the importance of proper hand-washing especially after going to the toilet and before meals for both children and staff in the centre.

Unlike SARS, an atypical pneumonia spread by the coronavirus, HFMD is a mild viral infection caused by a few viruses in the Enterovirus group, the most common being the coxsackie A16 and the enterovirus 71,more commonly referred to as EV71. Generally, HFMD is a mild disease, normally occurring in young children below the age of 5 years. It is as mild as chicken pox in children.

HFMD is normally a self-limiting disease and the body's defences will naturally clear the virus with most patients recovering in 7 to 10 days. A child can be infected by ingesting the virus. The virus is present in nasal discharge, saliva, faeces and fluid from blisters of an individual infected with HFMD. The common way for the virus to be transmitted in young children is hand to mouth, when children come into contact with the body secretion or excretion of an infected child or contaminated toys, books, eating utensils, towel, clothes and other articles used by the infected individual.

HFMD is not a disease peculiar to pre-schools only. It is a disease that spreads when children gather together and it is therefore important for parents not to send their children to the childcare centre, kindergarten or other places where children congregate, eg playgrounds, should they have the following symptoms :

• fever;

• sore throat or runny nose;

• mouth ulcers;

• rash (blister-like and non-itchy but not always) usually located on the palms of the hands, soles of the feet and diaper areas;

• vomiting and diarrhoea; and

• tiredness and weakness.

Information on HFMD and the relevant guidelines can be found on: http://app10.internet.gov.sg/scripts/nea/cms/htdocs/category_sub.asp?cid=96