Over 1,000 kids fell ill last week, 13 warded; virulent EV71 virus behind 16% of cases
Salma Khalik & Sujin Thomas, Straits Times 16 Apr 08;
SINGAPORE may be facing its most serious hand, foot and mouth disease (HFMD) outbreak since an epidemic killed seven children eight years ago.
More than 1,000 children fell ill last week - the highest number of weekly infections since the 2000-2001 period.
Of the 13 who needed hospitalisation, one girl was seriously ill, with inflammation of the brain.
Diagnosed with HFMD on April 3, her condition worsened and she had to be hospitalised a week later.
Dr Chong Chia Yin, head of infectious diseases at KK Women's and Children's Hospital (KKH), said the seven-year-old's condition has since improved. She is now recovering in a general ward.
HFMD is endemic in Singapore, with children catching the virus almost daily. Symptoms include fever, headache, sore throat and a red rash, usually on the limbs and in the mouth, which gives the illness its name.
It is spread through bodily fluids, which is why it can be passed quickly among young children who share toys they may have put into their mouths.
In children, it is usually a mild disease that lasts about a week, but it can be more serious in adults.
The disease can be caused by several types of viruses, with the most dangerous being the Enterovirus 71 or EV71.
The Health Ministry said yesterday that although EV71 is picked up 'only sporadically' in normal times, it was behind 16 per cent of this year's infections.
While many of those infected with EV71 have the usual mild symptoms, it does sometimes trigger severe illness. Doctors do not know why this is so.
The ministry spokesman said it is a 'public health concern' when EV71 is circulating at a time of a large increase in HFMD cases.
The EV71 virus becomes dominant roughly every three years. It was the strain in play in the 2000 and 2003 epidemics.
Schools, kindergartens and childcare centres have all been on the alert since last month, when the number of infections began to climb. One childcare centre closed voluntarily on April 7 and 8 as a precaution against spreading the bug.
The number of infections has been above the 600-a-week mark - indicating an epidemic - for the past four weeks.
So far this year, 6,315 people have caught the disease.
One recent victim now on the mend is Demetrius Low, four, who was diagnosed at KKH on Monday night. He was not admitted, however, and has been resting at home.
He had spent the evening at his minder's house after class at The Montessori Playroom, a kindergarten in Hougang Central, earlier that day. When he saw red spots on his palms at about 9.30pm, he called his mother Euphemia Goh, who took him to hospital.
The product marketing executive said she had told her son about the symptoms to look out for, 'so he knew something was not right'.
A spokesman for The Montessori Playroom, which has about 40 children aged between two and six, said Demetrius was its first case in the current epidemic.
1,000 HFMD cases last week in Singapore
Girl recovering from encephalitis, cause still unknown
Neo Chai Chin, Today Online 16 Apr 08;
A seven-year-old girl admitted into hospital with encephalitis, or inflammation of the brain, is being tested to determine if her condition resulted from the highly-contagious Hand, Foot and Mouth Disease (HFMD).
Diagnosed with HFMD by a general practitioner on April 3, the girl was admitted to KK Women's and Children's Hospital (KKH) six days later for encephalitis, the Ministry of Health (MOH) announced yesterday.
According to a KKH spokes-person, her condition has improved and she is recovering in a general ward at the hospital.
The number of HFMD cases hit 1,000 last week, reaching epidemic levels not seen since 2001. Seven children died in the 2000-2001 HFMD outbreak, which led to the closure of childcare centres and nurseries in October 2000.
An epidemic is declared when more than 500 cases are recorded in a week — a threshold Singapore crossed about four weeks ago. A total of 6,315 HFMD cases have been reported so far this year.
The MOH has detected a rise in the incidence of the deadly enterovirus-71 (EV71) strain of HFMD that caused at least four of the seven deaths in 2000-2001. EV71 can cause complications such as encephalitis and myocarditis, or the inflammation of the heart muscle.
Mortality rates for encephalitis are high, doctors told Today.
"About one-third of patients die, one-third suffer brain damage and one-third recover," said Dr Ang Poon Liat of Thomson Medical Centre's Paediatric Clinic.
Symptoms of encephalitis include fever, severe headaches, drowsiness, fits, as well as HFMD symptoms such as mouth ulcers and rashes on the palms and buttocks, he said.
What could account for the recent spike in HFMD cases?
Doctors said it could be a number of factors, such as more children attending enrichment centres at a younger age, a possible mutation of the EV71 strain, as well as its interplay with the flu virus.
"A lot of kids are going to school much earlier. Kids over a year old are being put in infant care," said paediatrician Ang Ai Tin. "And viruses have an incubation period where the kid is ill but no one knows about it. Meanwhile, the virus would spread within a group of children."
The Influenza A virus could also be working "hand in glove" with the HFMD virus, "strengthening each other and having a greater impact on children", said Thomson Medical's Dr Ang.
The MOH is working with the Ministry of Community, Youth and Sports and the Ministry of Education to monitor the situation as it steps up hygiene measures and checks. It has asked doctors to be more vigilant in spotting children with the symptoms.
"HFMD is a well-known adversary. It is seasonal and most doctors will be watching out for it," said general practitioner Chong Yeh Woei.
Parents should also ensure that their sick children avoid crowded places, including schools and childcare centres, until they recover, advised the MOH.
HFMD cases up 12% last week
Channel NewsAsia 15 Apr 08;
SINGAPORE : The number of children who came down with Hand, Foot and Mouth Disease (HFMD) jumped 12% last week ending April 12 to hit 1,000 cases. This brings the total number of HFMD cases reported to the Ministry of Health (MOH) to 6,315.
There were 892 cases in the previous week.
13 kids or 1.3% of the infected children had to be hospitalised last week, mainly because they were not eating well.
MOH said there is a higher circulation of the Enterovirus 71 (EV71) virus. So far, 16% of the samples tested positive for EV71 this year.
MOH added that HFMD is endemic in Singapore and there will be seasonal outbreaks. The continued rise in reported cases is expected as part of the epidemic uptrend.
MOH said increased public awareness is another reason why more cases are reported now.
HFMD tends to be a self-limiting childhood disease. To minimise the risk of HFMD, MOH said it is crucial for children to adopt good hygiene practices.
Parents should consult a doctor early if their child has a fever, mouth ulcers and rashes on the palms, soles or buttocks. Children with HFMD should also stay 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.
At home, proper hygiene should also be practised so as to prevent other family members from getting infected. - CNA /ls
