Update on Hand, Foot and Mouth Disease (HFMD) Situation in Singapore 2008

27 Mar 2008

1. There has been an increase in the number of Hand-Foot-Mouth Disease (HFMD) cases this year, especially over the last two weeks. A total of 3,721 HFMD cases have been reported to the Ministry of Health (MOH) up to 22 March 2008.

2. MOH’s surveillance has also shown higher circulation of Enterovirus 71 (EV71) virus among HFMD cases since mid-February 2008. In comparison, Coxsackie A16 (CA16) was the predominant circulating strain causing HFMD in 2007. The re-emergence of EV71 is of concern as EV 71 has occasionally been associated with serious complications.  It was the circulating strain during the outbreak of HFMD in 2000/2001 in Singapore.

3. HFMD is a common childhood disease caused by a group of viruses known as Enteroviruses which includes CA16 and EV71. The infected person can present with fever, upper respiratory symptoms, rash with blisters on the palms and soles, and mouth ulcer. While this disease is typically mild and self-limiting, on very rare occasions, complications involving the heart and brain could occur and result in death. There has not been any HFMD case with serious complications this year.

4. The infection 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.

5. 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 when coughing or sneezing;

• 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.

6. 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 practiced at home so as to prevent transmission to other family members.

7. MOH is alerting all doctors to maintain high vigilance and to detect new cases early for treatment. MOH has also worked with MCYS and MOE to alert their pre-schools  and schools to step up hygiene measures and check for sick children. This includes early identification and isolation of infected children. Where it may be necessary to interrupt transmission of a serious infectious disease, MOH may require the closure of pre-schools under the Infectious Diseases Act. MOH also provides weekly epidemiological updates to the public on its website at:http://www.moh.gov.sg/mohcorp/statisticsweeklybulletins.aspx.

8. For more information on HFMD, please see the FAQs on MOH website at http://www.pqms.moh.gov.sg/apps/fcd_faqmain.aspx.

MINISTRY OF HEALTH

27 MARCH 2008