HAND, FOOT AND MOUTH DISEASE

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HAND, FOOT AND MOUTH DISEASE

(Preventive measures against outbreaks): 57.

Mdm Cynthia Phua asked the Minister for Health in view of the frequent outbreaks of hand, foot and mouth disease among young children (a) whether any studies have been done to understand the pattern of these outbreaks; (b) whether there are measures that can be introduced to prevent the outbreaks; (c) why are the outbreaks becoming more frequent; (d) what are the chances of an outbreak arising from public playgrounds where the environment is not regulated; and (e) can an outbreak be caused by contamination of books in public libraries.

Mr Khaw Boon Wan: We know quite a lot about the hand, foot and mouth disease (HFMD). It is a common illness that affects infants and children worldwide. Many different viruses cause HFMD. Coxsackie A16 is the most common but Enterovirus 71 (or EV71) can also cause HFMD. I mention EV71 because its infection has been associated with severe complications, including death, in young children. Infection by one virus does not confer immunity to other viruses causing HFMD. That is why a person who has recovered from HFMD may still come down with the disease again.

In temperate countries such as Japan and Australia, HFMD outbreaks occur most often in the warmer months. In Singapore, HFMD occurs throughout the year but it generally peaks during school terms and decline during the school holidays. This suggests that

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nurseries, childcare centres, kindergartens and primary schools are major sources of transmissions. Locally, EV71 has also been observed to be the predominant circulating virus every two to three years. There is no evidence to suggest that HFMD outbreaks are becoming more frequent.

The disease is spread by direct contact with nasal discharge, saliva, faeces and fluid from the rash of an infected person, or with droplets from coughing or sneezing. A person who touches a contaminated surface will be exposed if he does not wash his hands properly before eating his food or touching his mouth.

The virus can survive in the environment for a few days. Since children can be infectious even without symptoms, the virus can potentially be found in any public place, including playgrounds and public libraries. But as noted earlier, the main sources of transmissions are in childcare centres, nurseries, kindergartens and schools.

HFMD is endemic in Singapore and it cannot be eliminated as there is as yet no vaccine. However, we can minimise its spread through maintaining continuous high standards of personal and environmental hygiene. We all can play a part to maintain good personal hygiene such as washing our hands after going to the toilets and washing our hands before we eat. Parents should set good personal examples and get their children to adopt these simple hygiene habits. Together, we can reduce the spread of HFMD.