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      Foot, hand and mouth disease

     2001

  An 11-year-old baby boy has become the third toddler to die this year because of hand, foot and mouth disease (HFMD). Muhammed Ryan, was already dead when he was brought to KK Women's and Children's Hospital on Wednesday morning. He had an enterovirus, which causes HFMD. He is the seventh toddler to die of the disease since September 2000. (Straits Times 3 Mar 2001)

     Suspected case of Hand, Foot & Mouth Disease diagnosed on 24 Feb 2001

  A total of 126 new cases of hand, foot and mouth disease (HFMD) were seen here last week, a significant change that is being monitored closely. This works out to up to a dozen cases more each day than last month. About 70 cases a week is considered normal. (Straits Times 11 Jan 2001)

     Joint Press Release - Hand, Foot & Mouth Disease (HFMD)

  A virus associated with hand, foot and mouth disease (HFMD) has been identified in post-mortem samples taken from the four-year-old boy, CHUA Jun Hao, who died on Wednesday morning. Full post-mortem investigations are still underway. A joint statement from four ministries last night identified the virus as enterovirus 71 (EV71), one of more than 80 viruses linked to HFMD. (Straits Times  Friday 5 Jan 2001)

     2000

  About 10 cases of hand, foot and mouth disease are reported a day now, a far cry from the 258 cases reported at the peak of the outbreak on 4 Oct 2000. With the significant fall in cases reported, to about 70 cases a week, the situation is "now back to normal", said Acting Environment Minister LIM Swee Say in Parliament on 13 Nov 2000.

  Children will be able to splash in wading pools and have fun at fast-food outlets' play areas from Monday 30 Oct 2000, after a month of curbs to break the spread of hand, foot and mouth disease (HFMD). All remaining restrictions on places where children under the age of five gather will be lifted from Monday 30 Oct 2000, the Ministries of the Environment, Health, Education and Community Development and Sports said in a joint statement yesterday.

  The enterovirus 71 (EV71) has been found in samples taken from the bodies of both toddler siblings who died of hand, foot and mouth disease (HFMD) last month (September 2000). EV71 - one in a family of more than 80 viruses known to cause HFMD - is the same virus which killed more than 70 children in Taiwan in 1998 and three children in Malaysia in 1997. This was revealed by Public Health Commissioner WANG Nan Chee at a  press briefing on 19 Oct 2000.

  The Environment Ministry has given the all-clear for childcare centres and kindergartens to re-open on Monday 16 Oct 2000. But other public areas where children gather - pools and play areas in shopping and fast-food centres - must remain closed.

JOINT PRESS RELEASE BY:

MINISTRY OF THE ENVIRONMENT
MINISTRY OF HEALTH
MINISTRY OF COMMUNITY DEVELOPMENT AND SPORTS
MINISTRY OF EDUCATION     12 Oct 2000

CHILDCARE CENTRES, KINDERGARTENS AND OTHER PRE-SCHOOL INSTITUTIONS SCHEDULED FOR REOPENING ON MONDAY, 16 OCT 00

The incidence of Hand, Foot and Mouth Disease (HFMD) infection has peaked on 3rd and 4th Oct and is showing an encouraging sign of subsiding. The notifications received so far on the number of children below 5 years old with onset of illness on 3rd and 4th Oct are 170 and 155 respectively. These are children who were most likely been infected on 29 to 30 Sep, before the closure of the preschools. So far, the number with onset of illness on 5 Oct dropped to 91. While this is an encouraging sign because it showed that transmission had reduced since the closure of the pre-schools, the data also suggest that there is still transmission going on among this group of children despite the closure.

Hospitalised cases as at 5.00pm on 9 Oct 00, numbered 9, compared to 33 on 4 Oct 00. All cases are mild and in stable condition.

The Task Force, having evaluated all the data, is of the opinion that it is a bit premature to conclude that the outbreak has subsided fully.

The HFMD Taskforce will continue to monitor the situation over the next two days, and if the encouraging trend continues, all childcare centres, kindergartens, enrichment centres, play groups, special schools, foreign system schools and learning centres will re-open on Monday, 16 Oct, 00. The Taskforce will make an announcement on this on the evening of Thursday, 12 Oct.

 The HFMD Task Force will consider the following before deciding to re-open these centres:

a. the incidence of HFMD infection among children aged five years and below;
b. the absence of complicated HFMD cases hospitalised; and
c. whether there had been any deaths related to HFMD since the closure was ordered on 1 Oct 00

The Taskforce would like to emphasise that the continued success of breaking the transmission is dependent on one critical factor when schools are eventually reopened - parents should keep their children at home if they are unwell, or if they suspect that they could be unwell.  This will prevent cross infection and possible re-emergence of HFMD clusters. Also, it would be in the interest of the sick child to stay at home and rest. This is because when a
sick child has a viral infection, the child's immune system will be weakened and a secondary infection can lead to complications.

During the period of closure, childcare centres and kindergartens have taken more measures to further disinfect the centres.  Teachers have been reminded to observe strictly the guidelines on hygiene and conduct checks on children, as and when they arrive for school.  They have been instructed to isolate any child who appears unwell, and to contact their parents immediately for them to bring their child home.  Pre-school centres are also requested to provide an area for isolating the sick children while they are waiting for their parents to bring them home or to see a doctor.  This area could be an existing sick bay, the Principal's office or an available room with a comfortable rest area.
Children who are unwell should not be left at the childcare centres or at the kindergartens, as there is a risk of cross-infection leading to further complications injurious to their health.

Good personal hygiene, such as washing hands before and after using the toilet, changing diapers, and preparing food is also important. Parents should ensure that their homes are clean at all times.  They are also advised to consult a doctor if their children exhibit any of these symptoms:  fever, lasting 2-3 days, sore throat and runny nose, mouth ulcers, rash (usually blister-like) over hands, feet and diaper areas, vomiting and diarrhoea, tiredness and
weakness.

Post Mortem Findings

Post-mortem findings of the 2-year old child who died on 10 Sep showed that he had viral infection of the lungs.  However, no virus has been isolated so far.
The two children, who died on 30 Sep, had viral infection of both the lungs and brain.  The Virology Laboratory of the Department of Pathology at the Singapore General Hospital has preliminary findings of a virus, EV 71, in the samples of one of them.  In the other child, preliminary tests showed enterovirus in the samples.  Further tests are being carried out.

The Taskforce will continue to monitor the situation closely.  We would like to alert all parents and providers of services catering to children aged five and below, that should there be a recurrence of HFMD transmission, the Taskforce will reintroduce all necessary measures.

Those who need information on HFMD can log on to the following websites.

ENV's website http://www.gov.sg/env/info/press/qed
MOH's website http://www.gov.sg/moh

  The government may reopen childcare centres on Monday 16 Oct 2000 if cases of hand, foot and mouth disease (HFMD) continue to subside, as they have done over the past few days, said Acting Environment Minister LIM Swee Say at a briefing by a joint ministerial task force on 10 Oct 2000.

JOINT PRESS RELEASE BY
MINISTRY OF THE ENVIRONMENT
MINISTRY OF HEALTH
MINISTRY OF EDUCATION, AND
MINISTRY OF COMMUNITY DEVELOPMENT AND SPORTS

RE-OPENING  OF KINDERGARTENS AND CHILDCARE CENTRES: EARLIEST POSSIBILITY IS  ON THURSDAY 12 OCT 00

The earliest date that all childcare centres, kindergartens, enrichment centres, play groups, special schools, foreign system schools and learning centres which cater to children aged five years and below can expect to be re-opened is Thursday, 12 Oct 00.

The decision as to whether the centres will be re-opened on Thursday will depend on the Hand Foot and Mouth Disease (HFMD) Taskforce's assessment on whether the transmission of HFMD has been interrupted.  This will be decided based on the following criteria:
a) The incidence of HFMD infection among 5 year olds and below has dropped since the closure
b) No new complicated HFMD cases are identified
c) No more deaths related to HFMD.

The HFMD Taskforce will be monitoring the situation closely and an announcement will be made on Tuesday, 10 Oct 00 regarding the date of the re-opening of the centres. It is important that the chain of transmission is broken before the centres can be re-opened, and in this respect, the Task Force appeals to everyone to co-operate by not bringing their children to crowded places.

UPDATE ON HFMD CASES
Of the 30 cases reported to be in hospital yesterday, 16 have been discharged. Another 16 clinically suspected HFMD cases were admitted to KKH and NUH bringing the total hospitalised cases to 30.  All the cases are mild and in stable condition.

Since HFMD was made legally notifiable on 1 Oct 00,  641 cases have been reported to the Quarantine & Epidemiology Department, with the bulk of the cases, falling ill on 2 and 3 Oct 2000. To facilitate investigations and enable control measures to be taken quickly, all doctors are reminded to continue notifying immediately all cases of HFMD by fax, phone or email to:

 The Commissioner of Public Health
 Fax: 7348287
 Tel: 7319760, 7319761, 7319758
 Email: GOH_eng_seng@env.gov.sg

We would like to remind parents to keep their children away from crowded places. They should consult a doctor if their children have any of the following symptoms: fever lasting 2 ) 3 days, sore throat and runny nose, mouth ulcers, rash (usually blister-like) over hands, feet and diaper areas, vomiting and diarrhoea, tiredness and weakness. Parents are advised to observe good personal hygiene at home at all times. Parents are also advised to be alert to any worsening of their child's condition, for example refusal to eat or drink, persistent vomiting and drowsiness. If any of these are present, parents are advised to bring the child to the A&E Departments of KKH and NUH immediately.

The HFMD Taskforce would like to inform all visitors to Singapore that travel to Singapore is safe.  The HFMD is a common childhood disease that transmits among children five years and below who are in close proximity of each other.

Those who need any information can call the following Hotlines:

Ministry of the Environment:
7319184 / 7319761

ENV Hotlines:
1800-7319222
1800-4532222

Ministry of Health  :
3259220
1800-2254122

Ministry of Community Development and Sports :
1800-2580677

(For enquiries on childcare centres)

Ministry of Education  :
8722220
8796115

All these hotlines will be operational on Saturday and Sunday, from 8.30am - 6.00pm.

Information on HFMD can be also be found on the following two websites:
ENV's website
http://www.gov.sg/env/info/press/qed

MOH's website
http://www.gov.sg/moh

ISSUED ON: 6 OCT 00
News Release No. 119/2000
CLOSURE OF PRE-SCHOOL CENTRES

All kindergartens, childcare centres, nurseries and play centres have been closed till further notice, wef from 1 Oct 2000.  They will remain closed till further notice from the authorities.

The Ministry of the Environment has also advised management of fast-food restaurants and other places with children play areas to close them for the time being. Management of public swimming pools and those in condominiums are also advised to close their wading pools.  Operators of enrichment centres, special schools, foreign system schools and learning centres which cater to
children five and below are also to suspend classes or programmes for these groups of children until further notice.

We are taking these precautionary measures to break the chain of
transmission.    We understand the inconvenience parents and operators of childcare centres and kindergartens are facing but the inconvenience is unavoidable. Our primary concern currently is to protect the health and well-being of our children in Singapore.

UPDATES

The condition of the 5-year old boy at the KK Women's and Children's Hospital (KKH), is stable.

Up to 2pm today, the various hotlines of the four ministries had received a total of 1815 calls.  Most of the callers sought confirmation on the closure of the kindergartens and childcare centres, details of the HFMD, and general reassurances.  Many also complained about the inconvenience they will face because of the closure.  While we understand their concerns, we would like to
reiterate that our first priority must be to ensuring the continued good health of our children.

Parents can help by keeping their children away from crowded places.  In addition, they should consult a doctor if their children have any of the following symptoms: fever lasting two to three days, sore throat and runny nose, mouth ulcers, rash (usually blister-like) over hands, feet and diaper areas, vomiting and diarrhoea, tiredness and weakness.

ADVICE FOR FAMILIES WITH INFECTED CHILDREN

The infected child should be kept at home to limit the spread of HFMD. The toys, books, eating utensils, towels, clothes, bed linens and other articles used by the infected child should not be shared with other children.

In addition, items handled by the infected child should be washed separately. Surfaces that are easily contaminated or are frequently handled, such as toys, potty-chairs, toilets and diaper changing areas should also be clean and disinfected. Good personal hygiene such as washing hands before and after using the toilet, preparing food and changing diapers is also important.

Those who need information can call the following hotlines:

Ministry of the Environment  : 7319184 / 731976,  1800-7319222,  1800-4532222

Ministry of Community   : 1800-2580677
Development and Sports
(For parents of children in childcare centres)

Ministry of Education   : 879 6115, 872 2220

Ministry of Health   : 3259220, 1800 - 2254122

All these hotlines will be in operation till 6.00pm today and from 8.30am -
6.00pm, from tomorrow.

The public can also access ENV's website at
http://www.gov.sg/env/info/press/qed and MOH's website at
http://www.gov.sg/moh   for information on the HFMD.


JOINTLY ISSUED BY:  MINISTRY OF THE ENVIRONMENT
MINISTRY OF COMMUNITY DEVELOPMENT & SPORTS
MINISTRY OF HEALTH
MINISTRY OF EDUCATION

Issued on   : 1 October 2000

News Release No :  110/2000
JOINT PRESS RELEASE BY ENV, MOH, MCDS AND MOE
DEATH OF TWO CHILDREN - INVESTIGATIONS UNDERWAY


The Hand Foot and Mouth Disease (HFMD) Task Force received notification this morning from KK Women,s and Children,s Hospital (KKH) of two deaths clinically suspected to be related to HFMD.

The two children, a 14-month old girl and her two-and-a-half year-old brother were admitted to the KKH on 28 September with fever, rash and vomiting. Both children died this morning.  The children's older 5-year old brother is also at KKH, and in a stable condition.

At the moment, the specific virus that caused the deaths of the two children is yet to be confirmed.  Post-mortem investigations are underway.  However, the children presented with HFMD-like symptoms, such as rashes on hands and foot and mouth ulcers.  In order to minimise the risk of transmission, children in the susceptible age group below five years of age should not be gathered together. In this regard, the HFMD Taskforce has decided, as a precautionary measure, to immediately close all places where children gather, such as childcare centres, kindergartens, enrichment centres, playgroup, etc.  These will remain closed till further notice.

Parents are also advised to keep their children away from crowded places.  In addition, they should consult a doctor if their children have any of the following symptoms: fever lasting two to three days, sore throat and runny nose, mouth ulcers, rash (usually blister-like) over hands, feet and diaper areas, vomiting and diarrhoea, tiredness and weakness.

Members of the public are advised that there is no cause for concern.  The measures taken by the authorities are necessary precautionary measures to err on the side of safety.  Those who need any information can call the following hotlines:


Ministry of the Environment: 7319184 / 7319761/ 1800-7319222
ENV Hotline: 1800-4532222
Ministry of Health  : 3259220/1800 - 2254122
Ministry of Community  : 1800-2580677
Development and Sports
(For parents of children in childcare centres)
Ministry of Education  : 92173865

The public can also access ENV's website at
http://www.gov.sg/env/info/press/qed  and MOH's website at
http://www.gov.sg/moh  for information on the HFMD.


Issued on 30 September 2000
News Release No:108/2000

  All childcare centres and kindergartens will have to close for at least a week from Monday 2 Oct 2000, following the deaths of two more children yesterday, possibly from hand, foot and mouth disease. A 14-month-old girl (4th death) and her 2-year-old brother (3rd death) died. This brings to four the number of deaths reported last month of children who all showed the same symptoms: fever, vomiting and rashes. The closure will affect about 140,000 children in 557 childcare centres and 440 kindergartens. From 1 Oct 2000, all doctors are required to report any case with symptoms resembling those of hand, foot and mouth disease to the Environment Ministry

JOINT PRESS RELEASE BY ENV, MOH AND MCDS ON 15 SEP 2000
UPDATE ON HAND, FOOT AND MOUTH DISEASE 



 As of 5.00 pm today, another 54 clinically diagnosed HFMD cases from eight more childcare centres have been reported. (List of childcare centres in Annex A1). This brings the total number of cases to 107 (inclusive of the 53 cases announced yesterday). Post-mortem investigations so far do not indicate that the death of Lam Rui Qi was related to HFM disease.  Investigations are still on-going.

2 ENV and MCDS will continue to step up inspections on the health and hygiene standards of all childcare centres.

3 Parents are reminded to seek medical attention early if their children have any symptoms of HFM disease viz; fever lasting 2-3 days, sore throat and runny nose, mouth ulcers, rash (usually blister-like) over hands, feet and diaper areas, vomiting and diarrhoea, tiredness and weakness.

4 Children should be kept away from crowded public places (schools, preschools, play groups, markets, public transport etc.) if they show signs of infection. Family members are advised to follow good hygiene practices to limit the spread
of the infection. Transmission of HFMD is increased by poor hygiene and overcrowded living conditions.

5 Members of the public who need any advice or clarification can call the following numbers: 7319758 & 7319754 (ENV),  3259220 (MOH) and 3548187 (MCDS) information on childcare centres.


Annex A1
Active hand, foot and mouth clusters in Singapore, 2000
(As at 5 pm, 15 Sep 00)
1 Cutie Kidz Playgroup 113 Rivervale Walk #01-33 S(540113)
2 Thumbelina Educare 48 Jalan Merdu S(548675)
3 Sweetlands Childcare and Development 896B Woodlands Drive 50 #01-108 S(731896)
4 Small Wonder Childcare and Development Centre Pte Ltd  Plaza 888 Woodlands Drive 50 #02-741 S(730888)
5 NTUC Childcare Ang Mo Kio Branch Blk 343 Ang Mo Kio Ave 3
6 Children Learning Centre Tan Tock Seng Hospital, Jalan Tan Tock Seng

7 Juniorland Childcare Centre Blk 373 Bukit Batok St 31 #03-244 

8 Metropolitan YMCA Blk 113 Tampines Street 11
9 Sam,s Early Learning Centre Pte Ltd 29 Branksome Road
10 Kinderland Childcare Centre (TP Branch) Temasek Polytechnic 36A Tampines Avenue 1 #02-01 S(529770)
11 YMCA Child Development Centre 171 Woodlands St 11 #01-55 

12 Bethesda Pasir Ris Kindergarten 11 Pasir Ris Drive 2
13 Ci You Childcare Centre 29 Jalan Bahagia #01-348 S(320029)
14 Wonderkids Childcare & Dev Centre 317 Bedok Rd
Tel: 4450902
15 Lutheran Childcare Centre 124 Yishun St 11 #01-367 S(760124)
16 Learninghill Educare Pte Ltd 6 Lakne St S(1545)

 

JOINT MEDIA RELEASE BY ENV, MCDS AND MOH on 15 Sep 2000

HAND, FOOT AND MOUTH DISEASE: UPDATE

Following the recent media stories on the incidence of hand, foot and mouth disease (HFMD), among children attending several childcare centres, parents have become more aware of the disease.  Not surprisingly, they are also very concerned. We would like to assure parents that they should not be
unnecessarily alarmed.

We would like to reiterate that HFMD is a common, mild, but contagious childhood disease. Like many other childhood diseases, it is self-limiting, lasting from 5 ) 7 days.  Complications are rare.

Should their child develop symptoms of the disease, all they need to do is to consult the doctor and follow the doctor,s instructions.  They can also help limit the spread of HFMD by being alert and refraining from sending theirchildren to a childcare centre when diagnosed with HFMD.

Current Status

As at 5.00pm today, five other childcare centres from various parts of the island have reported the incidence of HFMD at their centres over the last two weeks. (Note: List of centres is at Annex A). This involves 20 clinically diagnosed cases.  This brings the total number of cases to 53 (inclusive of the
33 cases announced yesterday).  None are hospitalised.

Considering the current awareness among parents, the increase in numbers is not unexpected.  On the average this year, there have been about 60 cases of HFMD a week.  We can expect to see more than these numbers over the next couple of days, as more parents become aware of HFMD.

Proper maintenance of hygiene and sanitation is an ongoing daily routine at all childcare centres. MCDS will work with those centres that have reported suspected cases of HFMD and advise them on the proper measures.

Members of the public who need any advice or clarification can call the following numbers: 7319758 & 7319754 (ENV), 3259220 (MOH) and 3548187 (MCDS) information on childcare centres.

Annex A

Active hand, foot and mouth clusters in Singapore, 2000

1 Cutie Kidz Playgroup - 113 Rivervale Walk #01-33 S(540113)

2  Thumbelina Educare - 48 Jalan Merdu S(548675)

3 Sweetlands Childcare and Development - 896B Woodlands Drive 50 #01-108 S(731896)

4 Small Wonder Childcare and Development Centre Pte Ltd - Plaza 888 Woodlands Drive 50 #02-741 S(730888)

5 NTUC Childcare Ang Mo Kio Branch - Blk 343 Ang Mo Kio Ave 3

6 Children Learning Centre - Tan Tock Seng Hospital, Jalan Tan Tock Seng

7 Juniorland Childcare Centre - Blk 373 Bukit Batok St 31 #03-244

8 Metropolitan YMCA - Blk 113 Tampines Street 11

     Hand, food and mouth disease is not a dangerous illness, but it is contagious. Parents should keep infected children at home so they do not spread it. In Singapore, there was no record of death from the disease, Health Minister Lim Hng Kiang said on 14 Sep 2000. From 1 Oct 2000, hand, foot and mouth disease, together with Nipah virus and Legionaire's disease, will be made notifiable.

     On Sunday, 10 Sep 2000, 2-year-old LAM Rui Qi (2nd death) died soon after he was admitted to the KK Women's and Children's Hospital for suspected hand, foot and mouth disease. Subsequent investigations by the Ministry of the Environment (ENV) revealed that four other kids at Cutie Kidz Playhouse, a childcare centre, in Sengkang were also ill with the disease. To date, nine of the centre's kids and five of their cousins and siblings have been diagnosed with the disease. According to the ENV, the disease can be spread through nasal discharge, saliva, faeces and fluids from blisters, or through indirect contact with toys and bedlinen. As a precautionary measure, the ministry has closed the centre for at least ten days. (Straits Times 14 Sep 2000)

 

PRESS RELEASE: TEMPORARY CLOSURE OF CUTIE KIDS PLAYHOUSE

The Ministry of the Environment was notified this afternoon of a possible outbreak of hand, foot and mouth disease at the Cutie Kids Playhouse. Investigations confirmed that a 2-year old baby boy, Lam Rui Qi from the centre with suspected hand, foot and mouth disease had been admitted to Kandang Kerbau Women's and Children's hospital on Sunday afternoon.  He subsequently died that same evening.

Subsequent investigations at the child care centre showed that there were 4 other cases of suspected hand, foot and mouth disease (HFMD).

As a precautionary measure, we have closed the Cutie Kids Playhouse until further notice.  Meanwhile, we are contacting this evening, as well as tomorrow, parents with children attending the Cutie Kids Playhouse and advising them to consult the doctor if their children have symptoms suggestive of HFMD, viz; fever lasting 2-3 days, sore throat and runny nose, mouth ulcers, rash (usually blister-like) over hands, feet and diaper areas, vomiting and diarrhoea, tiredness and weakness.  ENV and MCDS officers will also be at hand tomorrow morning at the Cutie Kids Playhouse to advise parents of precautionary measures and advise them to take their children home.

HFMD is usually not a serious disease, although it can have rare complications leading to death. HFMD has an incubation period of 3 to 5 days.  The disease can be spread through direct contact with nasal discharge, saliva, faeces, and fluid from the blisters.  It can also spread through indirect contact with play equipment, bedlinen and other articles used by an infected individual.

 Members of the public who need clarification can contact the Quarantine & Epidemiology Department at 7319 758 or 7319 751.


MINISTRY OF ENVIRONMENT
12 SEPTEMBER 00

 

     On 1 Sep 2000, a 2-year-old girl (1st death) died hours after a doctor diagnosed her as having the disease.