Virulent strain of HFMD affects 1 in 4 sick children in Singapore

Straits Times 7 May 08;

Rise is worrying, but Health Ministry says not necessary for all pre-schools to close
By Salma Khalik

ONE in four children who came down with hand, foot and mouth disease (HFMD) this year was infected with the virulent strain EV-71, said the Health Ministry (MOH) yesterday.

This is a jump from the 16 per cent reported in mid-April, and a potential cause for worry.

Batch tests conducted by the ministry showed that 26 per cent of the 10,490 children infected so far this year contracted the EV-71 virus, which was responsible for more than half of the seven deaths here in October 2000, when Singapore had its first major outbreak of the disease.

No fatalities have been reported in the current outbreak here, but the EV-71 virus has already killed 26 children in China this year.

Just two weeks ago, Health Minister Khaw Boon Wan said the re-emergence of EV-71 was worrying.

Noting that the strain does not surface every year, Mr Khaw said its appearance was the reason his ministry had been enforcing stricter measures, such as mandating school closures, to stem the spread.

However, the ministry told The Straits Times yesterday that it is not considering repeating the drastic step it took in 2000, when it ordered all the 1,000 or so pre-schools and childcare centres to close temporarily.

But it said the number of such centres which have been told to close or were urged to do so voluntarily is escalating.

As of Monday, 17 centres have been told to shut down.

Forced closure of 10 days is ordered when a centre has 13 sick children and transmission of the virus has not been broken after 15 days.

The ministry also wants 48 pre-schools and childcare centres where transmissions have been occurring for more than 15 days to close voluntarily.

Meanwhile, the number of infections shows little sign of abating. Last week's figure of 1,465 new cases was just one shy of the record set the week before.

The 285 new cases on Monday was higher than the one-day peak of 258 cases in 2000.

By 3pm yesterday, there were already 125 new cases.

So far this year, 130 children have been hospitalised because of the disease.

Said an MOH spokesman yesterday: 'We expect cases to remain high for a few more weeks till the mid-year school holidays.'

Regionally, infections also continue to climb.

In China, state media reported yesterday that the number of EV71 cases had risen to more than 12,000, with 26 children killed so far.

Taiwan has also seen a spike in the number of EV71 infections this year, while doctors in Vietnam say they are treating far more children this year for symptoms of HFMD.

Despite the rising numbers here, Madam Halimah Yacob, head of the Government Parliamentary Committee (GPC) for Health, cautioned against rushing to close affected childcare centres and kindergartens.

Saying such a decision has to be ' very carefully considered', she added: 'This would cause tremendous disruption to the children and working parents, and may unwittingly also cause panic and alarm among the public.'

Fellow GPC member Lam Pin Min agreed, but said that if the situation worsens, Singapore might need to take tougher action, such as closing a centre the moment it has a confirmed case, he said.

The closure of pre-schools and centres in October 2000 resulted in a dramatic drop in cases, but also caused an uproar among parents, who were forced to scramble for alternative childcare arrangements and later criticised the Government for acting too hastily.