Recent outbreaks highlight the fact that Hand, foot and mouth disease (HFM) is the second most commonly reported viral disease in Singapore. In fact, since 2001 rates of HFM have approached those of varicella. See graph.

The following data regarding Enteroviral infection in Singapore are extracted from GIDEON [primary reference available on request]

Enteroviruses are responsible for 0.2% of lower respiratory infection in the age group 0 to 20 years (1990 to 1994).

During 1996 to 1997, 44% of school children ages 5 to 12, and 50% of their mothers were found to be seropositive toward Enterovirus 71.
- Enterovirus 71 accounted for 71% of enteroviral isolates in 2000; 44.3% in 2001; 3.5% in 2002.

Epidemics of hemorrhagic conjunctivitis due to Enterovirus 70 were reported in 1971 and 1980.
- Epidemics of hemorrhagic conjunctivitis due to Coxsackie 24 were reported in 1975; 1985; 1992; and 2002.

HFM has been a notifiable disease in Singapore since October 2000.
- Over 81% of patients with HFM are below age 5 (1998 to 1999).
- Enterovirus 71 was identified in all fatal cases reported during 2000 to 2001.

Notable outbreaks
1970 – An outbreak of hand, foot and mouth disease (HFM) (agent not identified) was reported – the first in Singapore.
1970 – An outbreak (60,000 cases) of acute hemorrhagic conjunctivitis was caused by Coxsackievirus A24.
1972 – An outbreak (104 cases) of HFM due to Coxsackievirus A16 was reported.
1974 – An outbreak (53 cases) of ‘Bornholm disease’ due to Coxsackie B3 was reported.
1975 – An outbreak (40,000 cases) of hemorrhagic conjunctivitis due to Coxsackie 24 was reported.
1981 – An outbreak (742 cases) of HFM due to Coxsackievirus A16 was reported.
1997 – An outbreak (8 cases) of Echovirus 30 meningitis was reported in a nursery – the first reports of this strain in Singapore.
2000 – An outbreak (3,790 cases) of HFM was reported – Coxsackievirus and Enterovirus 71 was implicated.
2002 – An outbreak (16,228 cases) of HFM was reported – Coxsackievirus 16 was implicated in 76.9% of cases.

Also appeared in ProMED.

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