Is your child safe?

Don't let a hand, foot and mouth disease creep up on your child. Merlene Michael of HealthAnswers reports on what you should know about the infectious disease.

The mild fever was not cause for alarm. Still, Lam Rui Qi's teachers called his parents on Friday afternoon to take him home. The Lams tried to soothe their uncomfortable child, but when he developed a high fever and rashes on his body, they took him to see the doctor the next day. His condition did not improve.

On Sunday afternoon, the two-year-old was taken to Singapore's KK Women's and Children's Hospital where he started to vomit blood. Doctors pronounced the toddler dead about 12 hours later.

Rui Qi's distraught parents are now waiting to hear if their child's death was caused by the hand, foot and mouth disease (HFMD).

The Return Of HFMD

The investigation into Rui Qi's death, by chance, coincides with the announcement made by several ministries just two days ago to make HFMD a legally notifiable disease under the Singapore Infectious Diseases Act. This means that from October 1, doctors who come across such cases along with the Nipah virus and Legionnaire's Disease must notify the relevant authorities

At the press conference on Wednesday, the Environment Ministry's (ENV) Commissioner of Public Health Mr Wang Nan Chee said making HFMD notifiable would allow Singapore to find out what the norm was for the number of people with the disease. This way, the authorities would be alerted if there was an epidemic.

The move by the ENV, Ministry of Health (MOH), and Ministry of Community Development and Sports (MCDS) does not come as a surprise because HFMD is not new to this region.

This year, there has been an average of 58 cases reported each week, compared to only 27 cases weekly last year. And although there has never been a reported death resulting from the viral infection in Singapore, in June 1998, a two-year-old Chinese boy is believed to have died from complications associated with HFMD. That same year, the ENV stepped up its the monitoring of the illness after 1,344 children were reported to have been infected by it.

Singapore is not the lone nation to be hit by the scourge of HFMD. Neighbouring countries have been similarly hit. Across the causeway, more than 30 children in Malaysia died from it in 1998 and it claimed 78 Taiwanese lives the same year.

A total of 562 cases of the disease were reported in Hong Kong in 1998, with about 347 cases last year. In the first six months of this year alone, 214 cases have been reported in the special administrative region (SAR).

Virus Turns Nasty

So what is it about this normally mild infectious disease that has turned it nasty? Dr Chew Suok Kai, director of Epidemiology and Disease Control at MOH tells HealthAnswers that there is a possibility that the virus may have grown "stronger" over the past few years

It is known that HFMD, predominantly a disease of childhood, is caused either by the Coxsackie virus or enterovirus. Enterovirus 71 has been the most frequent cause of HFMD in Southeast Asia and the Far East in recent years.

The disease is usually mild and most patients do recover within seven to 10 days. On how the disease kills some and not others, Dr Chew says it depends on the individual's susceptibility and how their bodies respond to it. In rare instances, the virus can cause rare complications such as inflammation of the brain (encephalitis) and heart (myocarditis).

While the disease is not dangerous, HFMD is known to spread like wild fire. The disease has an incubation period of three to five days and the spread of the disease can occur through direct contact with nasal discharge, saliva, faeces, and fluid from broken blisters. It can also spread through indirect contact with toys, books, eating utensils, towels, clothes, bed linen, and other articles used by an infected child.

The disease can occur in people from various age groups, especially children from two weeks to five yeas of age. It also occurs most often in warm weather in small epidemics in nursery schools or day care centres. In fact, it is not unusual for more than half of the children in a school or day care centre to have the disease at any one time.

Investigations here have revealed that nine other kids in the same school as Rui Qi - Cutie Kidz Playhouse - and five of their cousins have been diagnosed with the disease. Two other centres - Tumbelina Education Centre in Sengkang and Sweetlands Childcare and Development Centre in Woodlands - have also reported outbreaks of 19 and 5 cases respectively.

As at yesterday evening, five other childcare centres from various parts of the island have reported the incidence of HFMD at their centres over the last two weeks. This involves 20 clinically diagnosed cases, bringing the total number of cases to 53.

Reducing The Risks

Fortunately, the risk of contracting HFMD can be reduced by frequent hand washing and by avoiding exposure to others who have the disease. If your child is infected, ask family members to also practise a high standard of hygiene.

It helps if you can recognise the signs and symptoms of the disease. You should consult a doctor if your child has: 

• a fever lasting two to three days
• sore throat and runny nose
• mouth ulcers
• rash (usually blister-like) over the hands, feet and diaper areas
• vomiting and diarrhoea
• tiredness and weakness.
  

Most adults are thought to have become immune to hand, foot and mouth disease in early childhood. However, as with most infectious diseases, pregnant women should consult their physicians if exposed to HFMD.

There is no specific treatment for the infection other than symptomatic relief of symptoms. But doctors recommend additional fluid when a fever is present to prevent dehydration. 

The best advice, however, as Health Minister Mr Lim Hng Kiang puts it, is for parents to "adopt a common sense approach." He said childcare centre managers should advise parents to keep their children away if they suspect the child is showing symptoms of HFMD.

"If parents see one of their children coming down with fever and displaying the symptoms, they should keep the child away from the centre. Just as when we had an outbreak of conjunctivitis, we advised people with the condition to avoid swimming pools and prevent the spread of the disease, keep your children at home until they are well."

The ENV has prepared guidelines for the prevention and control of infectious diseases in childcare centres to help tackle the problem. Parents who want more information on HFMD can call the Singapore Quarantine and Epidemiology Department at 65- 731-9758 o r65-731-9751 or MCDS at 65- 354-8187.