Virus Findings Of Fatal Cases Associated With Hand,Foot And Mouth Disease

20 Oct 2000

JOINT PRESS RELEASE BY MINISTRY OF THE ENVIRONMENT,

MINISTRY OF HEALTH

MINISTRY OF COMMUNITY DEVELOPMENT AND SPORTS

and MINISTRY OF EDUCATION:

Post-mortem findings of the two children, who died on 30 Sep showed that they had viral infection of both the lung and brain.

Dr Ling Ai Ee and Dr Chan Kwai Peng, of the Department of Pathology at the Singapore General Hospital (SGH), who were the principal investigating virologists in the current HFMD outbreak, have identified EV71 in samples from these two children.

These findings coincided exactly with the findings by the Centers for Disease Control of the USA, which we have just received.

SGH's virologists also found EV71 present in the samples from the surviving sibling of these two children.

No virus has, so far, been identified in the 2-year old child who died on 10 Sep, although post-mortem findings showed that he had viral infection of the lungs.

So far, of the completed virological studies, 80% of the samples from fatal and hospitalised cases and contacts have grown enteroviruses. EV71 has been confirmed in almost half of the positive samples and typing is continuing in the others.

From the findings obtained, the Task Force strongly believes that EV71 is the main cause of the HFMD outbreak, although other enteroviruses besides EV 71 have also been isolated, a common finding in all other outbreaks of HFMD seen elsewhere.

In addition, the National University of Singapore in collaboration with the Virology Laboratory at the Singapore General Hospital has found that the sequences of viruses for the fatal cases were closely related to the EV71 strain associated with the outbreak in the region in 1997.

Current Status

The notifications of HFMD among children below 5 years peaked on 3 and 4 Oct with 187 and 195 cases, respectively. These are children who were most likely infected on 28 to 30 September 2000, before the closure of preschools.

Since the closure of the preschools, the number of cases have dropped steadily.

The average daily number of notified cases for the first week from 1 Oct was 200 and this dropped to 90 in the second week. Over the past 7 days, the daily average number of cases was 61. We are continuing to see an encouraging decrease in the number of cases.

Hospitalised cases have also dropped significantly. As at 12 noon on 19 October, this numbered 3, compared to 33 on 4 Oct. All cases are mild and in stable condition.

This current situation shows that the control measures taken have been effective in reducing the transmission of the disease. However, we would like to urge the public and all schools to continue to co-operate and remain vigilant so that the situation will continue to improve further.