SEVERE DAMAGE: Mohammad Raiyan has been breathing through a ventilator since EV71 damaged his brainstem, which controls key functions such as breathing, swallowing, digestion, eye movement and the beating of the heart. -- ST PHOTO: SAMUEL HE

He breathes through a ventilator and his meals, just milk, go through a hole in his throat.

Cuddles are given - carefully - so as not to dislodge the tubes going into his nose and throat, or the wires that hook him up to a monitor that checks his oxygen levels.

Two years ago, he was infected with EV71, the virus which causes the most virulent form of hand, foot and mouth disease (HFMD).

EV71 struck again this year, infecting a third of the 13,500 children who came down with HFMD.

This same virus killed most, if not all, the seven children in the 2000-2001 outbreak here.

In 2006, the year Mohammad Raiyan became infected, over 5,000 cases of HFMD had been reported as of April that year, with 69 warded for the EV71 strain. None died.

The average weekly number of cases of HFMD in the early part of 2006 dropped from 789 in March to 399 in April, when the outbreak started to ease. Checks were increased in childcare centres then and parents were also urged to be more vigilant.

The EV71 in Mohammad Raiyan attacked and damaged his brainstem, which controls key functions such as breathing, swallowing, digestion, eye movement and the beating of the heart.

His 26-year-old mother, who wanted to be known only as Madam Idah, recalled that he appeared to have caught HFMD from his sister, who was then in kindergarten.

The toddler, who had the tell-tale rash across his buttocks, became lethargic and refused food. But a doctor who examined him dismissed the idea that he had HFMD.

A week after the rash appeared, the boy started vomiting. His family took him to National University Hospital (NUH), where he was in intensive care for 11 weeks.

Explaining the long stay, NUH paediatrician Koh Pei Lin said that Mohammad Raiyan's heart, brain and lung functions had all been affected.

Dr Koh said 'permanent brainstem damage' had taken away his ability to breathe adequately on his own or eat normally.

'If he had got to the hospital earlier, his outcome may have been better,' the doctor added.

Mohammad Raiyan, who is unlikely to get better, is possibly the most severe case among HFMD survivors here.

The long hospital stay, already subsidised, cost his family $20,000, which wiped out the Medisave accounts of his mother, a part-time cashier, and his grandfather, a cleaner.

Then the family was told that the boy would need a ventilator installed at home.

'I didn't have $20,000 for the machine,' recalled Madam Idah, a single mum, who was then at her wit's end.

Luckily, the Ronald McDonald Children's Charity Fund stepped in to buy him one - but because it has to be on all the time, the family's electricity bill has pushed past $400 a month, putting a heavy strain on their finances.

On top of that, his catheters, saline solutions and feed bags cost another $200 a month.

Madam Idah approached a Community Development Council for financial aid but was told it was only for those with full-time jobs.

She asked: 'How can I have a full-time job and look after my son?'

With her having to work four hours a day, her sister Suhaidah, who lives with them, helps look after the boy.

Madam Suhaidah wrote in her blog last June: 'I treasure him a lot. God, please don't take him away.'

EV71 has caused encephalitis or inflammation of the brain lining in three children this year. Two of the three, a girl, seven, and a boy, 10, have recovered and another boy aged 13 months was warded in intensive care at the KK Women's and Children's Hospital last week.

At the epidemic's peak this year, 1,471 cases of this usually mild illness surfaced in a week. This has since fallen to 540 last week.

salma@sph.com.sg