HFMD: 527 cases in a day raise concerns over outbreak

Big worry: the re-emergence of a deadly strain
Judith Tan, Straits Times 24 Apr 08;

A SHARP rise in the number of hand, foot and mouth disease (HFMD) cases, coupled with the reappearance of a deadly strain, is heightening concerns about the latest outbreak of the disease.

On Monday alone, another 527 pre-schoolers came down with the childhood ailment characterised by ulcers, rashes and blisters.

This could push this week's total way past the record 1,245 people who fell ill last week. That figure was itself a 25 per cent jump over the preceding week's.

So far this year, 7,560 people, mainly those under 10, have been hit. Most had mild symptoms and got well in 10 days; 16 were hospitalised.

One other thing is worrying: The re-emergence of the potentially deadly EV71 strain, which killed seven children here in the 2000/2001 outbreak. Back then, schools were shut down too.

Checks show that this strain caused 19 per cent of this year's cases.

This was what pushed the Health Ministry into closing three pre-schools and five childcare centres for 10 days, starting today.

Another 12 centres were also asked to do the same voluntarily to break the transmission of the virus, which spreads through contact.

Although Monday's 527 new infections represented just 1 per cent of the more than 50,000 children enrolled in 744 childcare centres, the authorities have lowered the threshold for closing schools.

Schools will now be asked to close voluntarily if children continue to be infected after 15 days; if over the same period, more than 13 children are infected or if more than 18 per cent fall ill, a mandatory closure is ordered.

Previously, when a school hit these figures, inspectors were sent to do a check before a closure was ordered.

The pre-schools and childcare centres asked to close, either mandatorily or voluntarily, spent yesterday informing parents about the closure so they could make alternative child-minding plans.

Most parents accepted the need for the closure even if it meant some inconvenience.

Administrative manager Jeandy Tan, 40, who has a four-year-old son, said the closure would 'put our minds at ease'. But some parents, like administrative executive Valerie Kway, 30, were concerned about getting time off from work.

A Ministry of Community Development, Youth and Sports (MCYS) spokesman said that parents without any form of social support could arrange with childcare centre staff for one-to-one care.

Many of the centres The Straits Times spoke to said they would use the 10 days to disinfect their toys and thoroughly clean their premises. Some are hiring professional cleaners.

MCYS Minister of State Yu-Foo Yee Shoon said surprise inspections of the childcare centres would be stepped up. She had just visited Kidsville Child Care & Development Centre in Yishun Street 21, which has only had three HFMD cases this year.

She added that there was just so much the childcare centres could do, and that parents had to be responsible about keeping their sick children at home.

Her point was echoed by Mrs Shirley Tan, the principal of the Holy Trinity Kindergarten, who urged parents not to treat the 10-day closure of schools as a holiday and take their sick children out as this would defeat the purpose of closing centres.

Mrs Yu-Foo added: 'The devil is in the daily practice of personal hygiene. If it is observed, I believe we will be able to break the spread of the disease.'

17 centres shut for 10-day clean-up
Straits Times 24 Apr 08;

Temporary closure has parents scrambling to make alternative childcare plans
By Lee Pei Qi , Jessica Jaganathan , Sumathi V. Selvaretnam
WITH some pre-schools and childcare centres shut for disinfection for 10 days, parents are scrambling to make alternative childcare arrangements.

But few will be going as far as travel agent Wendy Tee, 28, who will be leaving for Malacca with her son Brandon tomorrow. Her mother will care for the boy during this period.

The two-year-old attends Just Kids@Jurong, one of the 17 pre-schools and childcare centres to close temporarily following outbreaks of hand, foot and mouth disease (HFMD).

Said Madam Tee: 'My husband and I can't apply for leave on such short notice and there is no one here to take care of my son.'

She was told of the school's closure - effective today - when she arrived at the school with her son yesterday morning.

Other parents The Straits Times spoke to said they will either take leave from work or arrange for grandparents or maids to take over the childcare duties.

Meanwhile, the 17 childcare centres got ready for their big clean-up today.

Ramakrishna Mission Sarada Kindergarten in Bartley Road, which shut yesterday, asked its staff to scrub the floors.

The Compassvale and Anchorvale branches of NTUC Childcare and Pat's Schoolhouse in Halifax Road have hired professional cleaners; others are pooling resources to disinfect their premises.

At the PAP Community Foundation (PCF) Sengkang West Kindergarten, staff will wipe down the furniture with disinfectant, scrub the floors and toilets as well as sanitise the toys.

Most of the centres The Straits Times spoke to said they were not facing too many objections from parents about 'lost' lessons.

The Al-Istiqamah Mosque Kindergarten, for instance, may hold make-up lessons for its pre-schoolers when they return on May 5.

NTUC Childcare manager Adeline Tan said that if working parents could not make alternative childcare arrangements, staff from the two shut branches may be sent to their homes to help out.

To keep the young ones occupied, some centres have handed out worksheets.

While most parents supported the closure, others seemed indifferent to the risk of spreading the illness. On receiving notice that school was out, some parents at the PCF Tampines East Kindergarten took their kids to a nearby playground.

Ms Shirley Tan, principal of Holy Trinity Kindergarten in Tampines, said: 'Parents must be responsible for their kids and towards other kids. Don't take the closure as a holiday and take them on outings.'

Housewife Marissa Koh, 40, said she was not worried about her three-year-old daughter catching the virus because she thinks a bout would boost her immunity.

But paediatrician Low Kah Tzay advised parents against being so cavalier as there were 'innumerable' strains of HFMD and that coming down with it did not necessarily protect a child against it.

He revealed that one in five of his HFMD patients is suffering repeat infections, adding: 'Parents should keep their children at home to break the cycle. That's the whole purpose of shutting down the centres in the first place.'

Stricter guidelines to stamp out virus
Straits Times 24 Apr 08;

THE Health Ministry (MOH) has lowered its threshold for the closure of schools in a bid to halt the spread of hand, foot and mouth disease.

A centre will be advised to shut voluntarily when the virus has spread there for more than 15 days.

If the virus is active for more than 15 days and more than 13 children at the centre are affected, it will be shut down by the authorities.

The Ministry of Education and Ministry of Community Development, Youth and Sports are working with MOH to monitor the outbreak. They are advising preschools, childcare centres and schools on how to the manage the situation, said MOH in a statement.