Recent Viral Deaths Of Two Children

02 Mar 2001

MINISTRY OF HEALTH

MINISTRY OF ENVIRONMENT

JOINT PRESS RELEASE:

An 11-month-old Chinese infant, who was admitted to KKH on 21 Feb, died on 28 Feb from encephalitis (infection of the brain) secondary to an Enterovirus 71 (EV71) infection. On the same day, another infant, an 11 month-old Malay boy died on arrival at KKH. Preliminary investigations showed that he died from myocarditis (infection of the heart) secondary to an Enterovirus infection. Further investigations are underway to identify the type of Enterovirus.

EV71 belongs to a group of viruses called Enterovirus. Many different viruses belonging to the Enterovirus family are known to cause Hand Foot and Mouth Disease (HFMD), which is generally a mild disease commonly affecting young children. However, in a small proportion of cases, EV71 has been known to cause complications such as infection of the brain, heart or lungs.

From Sep last year to now, there were a total of seven children aged under 5 years who died from infection of the brain, lungs or heart which were clinically consistent with HFMD. Of these, four were confirmed to have EV71 infection.

The reason why EV71 causes complications in certain children but not in the majority of cases is still unclear. There has been no evidence so far to suggest that a new strain of EV71 has emerged. A possible reason, however, is the relationship between the virus and the individual, of which the genetic susceptibility of the individual could be one such factor.

Singapore has one of the world's lowest death rates among children under 5 years of age, 4 per 1,000 live births. This is comparable with Switzerland, Japan, Norway and Sweden. In Singapore, there has been an average of about 16 deaths from viral infections annually in children under 5 years of age. So far, there has been no increase in the number of viral deaths among children under 5 years of age, even with this recent spate of deaths.

There is no sign of any outbreak of HFMD. Since the beginning of this year, there has been an average of about 135 reported cases of HFMD each week. In comparison, during the peak of the HFMD outbreak in Oct 2000, there was an average of 1,140 HFMD cases reported each week.

As at 12 noon today, there are 5 children admitted to hospital for HFMD. All the children are mild and in stable condition.

As there is currently no drug or vaccine to treat enterovirus infections, strict hygiene standards at home and in places where young children gather is of utmost importance to prevent transmission. In this regard, the HFMD Taskforce will continue to ensure that all preschools observe high standards of hygiene and sanitation.

Parents are advised not to send their child to school or bring them to crowded places if they are sick or unwell. Parents are also advised to consult a doctor if their child has any of the following symptoms:

Fever lasting two to three days

Sore throat and runny nose

Mouth ulcers, rashes over hands, feet and diaper areas.

They should be alert to any change in their child's normal behaviour, eg irritation and sleepiness. Should they refuse to eat or drink, have persistent vomiting or drowsiness, parents should bring their child immediately to the A&E Departments of either NUH or KKH, whichever is closer to their home.

Those who need information on HFMD can log on to the following websites.

ENV's website  http://www.mewr.gov.sg

MOH's website https://www.moh.gov.sg