Singapore is in the midst of another outbreak of hand, foot and mouth disease (HFMD) and parents, childcare centres and schools are wary again.

Some have even begun checking children for symptoms every day. The week ending March 29 saw 702 cases reported, nearly twice the figure of 385 reported for the same period last year. To date this year, 4,423 people have been diagnosed with HFMD.

While the Ministry of Health (MOH) has put family physicians on alert and informed all primary schools, kindergartens and childcare centres to step up hygiene measures, some parents feel that not enough is being done.

Army regular Michael Lim, 35, whose two-year-old son Jordan was diagnosed with HFMD two weeks ago, says: 'We're sure he caught it from his childcare centre as my wife and I have been quite busy the past two weeks and haven't taken him out. He hasn't been anywhere besides home and school.

'And out of his class of 17 children, 10 caught HFMD.'

Mr Lim says that he had voiced his concern over the standard of hygiene and lack of an isolation policy at the childcare centre to its principal and teachers.

He says that Jordan was not kept away from the other children even after he developed a fever of 40 deg C and started throwing up - symptoms of HFMD. But he adds that the centre's teachers have been checking on the pupils daily for symptoms of the disease since February when there was an outbreak among its charges.

HFMD is a common childhood ailment caused by small, intestinal viruses called enteroviruses. There are 70 strains of the viruses and the more common ones are coxsackie A and B as well as Enterovirus 71.

The latter has been in 'higher circulation' this year, according to MOH. This particular strain has been known to cause infections in the brain, heart and lungs and killed more than 70 children across Asia, including seven in Singapore, during a HFMD outbreak in 2000 and 2001.

The disease usually starts with a mild fever, poor appetite, lethargy and sometimes a sore throat, says Dr Chan Poh Chong, consultant paediatrician at The Children's Medical Institute at National University Hospital.

One or two days after the fever begins, sores develop in the child's mouth. Rashes and blisters may also occur on the palms and soles, and even on the buttocks of younger children.

It usually afflicts children who are less than 10 years of age, with those under five most susceptible. Adults can also catch it although their symptoms are usually less severe.

The recovery period is usually between three days and a week but immunity is short-lived and children can suffer from HFMD more than once.

Dr Chong Chia Yin, head and senior consultant of Infectious Disease at KK Women's and Children's Hospital, adds that patients continue to spread the virus from their saliva up to four weeks after symptoms subside and from their stool up till 12 weeks later.

There is no vaccine for HFMD and the only way to prevent it is by halting transmission. Doctors can treat patients only for their symptoms, like prescribing paracetamol for fever and sore throats and analgesic gels for mouth ulcers.

The viruses are spread via contaminated food or direct contact with blisters, fluid, saliva, faeces and droplets from an infected person's breath.

Assistant Professor Raymond Lin, head and senior consultant at the Division of Microbiology in NUH's Department of Laboratory Medicine, says: 'Children sharing playthings can also spread the disease to each other.

'Hand-washing is very important, and children who are sick should not go to school or childcare centres.'

Health officials emphasise the importance of washing one's hands with soap before eating and after going to the toilet; covering one's mouth and nose when coughing or sneezing, and those infected should not share utensils, food, drink, toothbrushes or toys.

Shopping malls which operate playgrounds or play areas for children have also stepped up hygiene standards and checks.

A spokesman for Ikea Singapore says that the shop's play area is cleaned with disinfectant every day and the balls in the ballroom pit are changed immediately when they are soiled by children. Staff are also trained to look out for signs of HFMD such as rashes and sores on the hands and feet of children.

Still, parents like Mr Lim are now wary about taking their children out to crowded public spaces. Mr Lim, who has stopped Jordan's weekly visits to VivoCity's playground, says: 'Since we can't eliminate the disease, the only way for us to beat it is to take preventive measures.'

• 4,423 - The number who caught hand, food and mouth disease to date this year

This article was first published in Mind Your Body, The Straits Times on Apr 9, 2008.