Update on Hand, Foot and Mouth Disease (HFMD) Situation in Singapore

13 Aug 2010

1. The number of HFMD cases has continued to increase with 906 cases notified in the week ending 7 August 2010. This brings the total number of notified HFMD cases to 18,007 in the first 31 weeks of this year as compared with 10,770 cases in the same period last year.

2. Of the cases notified this year, about 65% occurred in children aged less than 5 years old.  HFMD is generally a mild and self-limiting childhood disease. The majority of the cases seen so far were mild infections, with only 233 (1.3%) cases requiring hospitalisation mainly because of poor feeding.  There were no cases with serious complications or deaths reported so far this year.

3. However, MOH’s sentinel surveillance has detected an increase in the circulation of Enterovirus 71 (EV71) among patients with HFMD in Singapore, with 12% of the patient samples testing positive for EV71 in July 2010. HFMD due to EV71 has been associated with a risk of increased disease severity and even death.

4. The current rise in the number of notified HFMD cases is in keeping with the regional situation. Other countries such as China, Hong Kong, Japan and Taiwan, have recently experienced HFMD outbreaks involving EV71.

5. While HFMD is endemic in Singapore and periodic outbreaks can be expected, it is important to take early control measures to prevent escalation of cases. MOH has noted childcare centres and kindergartens with prolonged ongoing transmission of HFMD and is working with MCYS and MOE to control and prevent further cases from occurring in these centres. The names of childcare centres and kindergartens with more than 10 HFMD cases or an attack rate greater than 13%, and a transmission period of more than 16 days will be published on the MOH website from today. This is so that parents can be more aware of whether the centre that their child is attending has prolonged HFMD transmission, and can be more alert to watch out for HFMD symptoms in their child.

6. To break the chain of transmission, childcare centres and kindergartens with more than 16 HFMD cases or an attack rate greater than 23%, and a transmission period of more than 24 days will be mandatorily closed for 10 days. Parents of children attending these centres will be notified by the centres, and the names of the centres that will be mandatorily closed will also be published on the MOH website from today. Please see the MOH website (www.moh.gov.sg) for the list of these childcare centres and kindergartens.

Public advice

7. The Ministry would like to stress the importance of maintaining high standards of personal and environmental hygiene to minimise the risk of HFMD. Parents should ensure that their children adopt the following good practices:

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

• Cover mouth and nose with a tissue when coughing or sneezing, and throw the tissue away into a bin immediately;

• Do not share eating utensils.

Parents should also ensure that toys or appliances that are contaminated by nasal or oral secretions should be cleaned before they are used again.

8. Parents should consult a doctor early if their child has fever, mouth ulcers and rashes on the palms, soles or buttocks. Children with HFMD should remain at home until all the blisters have dried up. During this period, contact with other children should be avoided until the child recovers. The child should not be brought to any public or crowded places. Proper hygiene should also be practised at home so as to prevent transmission to other family members.

9. MOH, together with MCYS and MOE, will continue to closely monitor the number of HFMD cases, analyse the disease trends, provide guidance to childcare centres and kindergartens, and ensure that these institutions exercise high vigilance in their management of HFMD.

10 For more information on HFMD, please see the FAQs on MOH website at http://www.pqms.moh.gov.sg/apps/fcd_faqmain.aspx, or the Infection Control Guidelines for Schools and Childcare Centres at http://www.moh.gov.sg/mohcorp/publications.aspx?id=15806.