Six childcare centres and two kindergartens in Singapore have been identified as hand, foot and mouth disease (HFMD) clusters.
The 1,249 cases of HFMD from July 29 to Aug 4 is also the highest reported in a week this year, almost 1.5 times the 868 cases at the same time last year, according to Ministry of Health figures. There have also been slightly more cases caused by the enterovirus A71 (EV-A71), a more virulent strain behind the recent deaths of two children in Malaysia.
In an update on its website last Friday, MOH said the six childcare centres with HFMD clusters are Agape Little Uni at Compassvale, Skool4Kidz at Sengkang Riverside (pictured), My First Skool in Punggol, Lorong 5 Toa Payoh and Edgefield Plains, and PCF Sparkletots at Queenstown.
None of them has been closed due to the outbreak.
A cluster occurs when a pre-school reports more than 10 HFMD cases or an “attack rate” higher than 13 per cent and a transmission period of more than 16 days. The attack rate refers to the proportion of children enrolled who are infected.
Replying to queries by The New Paper last Friday, MOH said the HFMD Coxsackievirus type A remains the predominant strain in Singapore, as in previous years.
But its spokesman also said there has been a “slight increase” in the proportion of cases from the EV-A71 strain, and that the ministry is monitoring the HFMD situation in Malaysia.
Dr Leong Hoe Nam, an infectious diseases specialist at Mount Elizabeth Novena Hospital, said: “The EV-A71 strain is particularly nasty, as it causes brain infection and affects the heart and lungs too. But it is also rarer, and in Singapore, it is still not so prevalent. The Coxsackievirus type A strain is not as bad as the EV-A71, as it does not cause so much brain inflammation.”
That said, Dr Leong was concerned with the EV-A71 strain’s growth in Singapore, and stressed the need to be careful and make sure the virus strain does not become endemic here.
“They are very hardy and can stay and live on surfaces. But if we follow the precautions, to isolate the infected children and adopt wipe-down measures, we can reduce the chance of a spread.”
The MOH spokesman also urged parents to consult a doctor early if their children have symptoms of HFMD, such as fever, mouth ulcers and rashes on the palms, and not take them to school or other crowded public places.
Dr Leong observed that the number of cases typically spikes after the school holidays. He suspects it may be due to large numbers of children returning to school and gathering in contained school premises, which would allow for the spread of viruses.
The Early Childhood Development Agency (ECDA) also issued an advisory on Aug 1 to remind all pre-schools to exercise vigilance and maintain good hygiene practices.
There is currently no cure for HFMD, with doctors treating only its symptoms such as fever and mouth ulcers.
Fatal infections are rare, with eight reported cases since 2000, all caused by EV-A71, The Straits Times reported earlier this year.
Dr Asok Kurup from the Infectious Disease Care clinic said that while EV-A71 can cause neurological disease, it is not a new strain and is not more infectious than other strains.
Dr Jacqueline Chung, senior principal of St James’ Church Kindergarten, said: “We send out an advisory whenever a case occurs reminding parents to check their children for symptoms of HFMD.
“We also step up the cleaning of our premises. Teachers play their part by raising the children’s awareness of their personal hygiene. We are thankful that parents have been understanding and cooperative.”
Mr Kenneth Yong, 42, who has a child in kindergarten, said: “My children have been infected before and I don’t think it is from a lack of precautions taken by the school.
“It is really tough and almost impossible to avoid cross infections in such environments.
“Simple things like washing of hands, not putting their fingers into the mouth, carrying hand sanitisers around is important in maintaining good hygiene.”
A message has also been circulating online, such as on WhatsApp, advising parents not to take their children near affected areas or to crowded places such as foodcourts.
MOH and ECDA have clarified that the message is not from them.
A version of this article first appeared in The New Paper and The Straits Times.
(Photo: The New Paper; graphic: The Straits Times with source from Ministry of Health)