The weekly number of cases of hand, foot and mouth disease (HFMD) here has climbed to a record high this year, along with slightly more cases from the strain that caused the death of two children in Malaysia recently.
The 1,249 cases of HFMD reported in Singapore between July 29 and Aug 4 - the latest publicly available statistics as of yesterday - are the highest number reported in a week this year.
It is also almost 1 1/2 times the 868 cases reported at the same time last year.
While there has been a "slight increase" in the proportion of cases from the Enterovirus 71 (EV71) strain, the Coxsackievirus type A remains the predominant strain, just like in past years, said a Ministry of Health (MOH) spokesman.
A 17-month-old boy in Penang was reported to have died from HFMD in June. Investigations showed that he died from pulmonary infection due to complications from an EV71 infection. A two-year-old boy from Sarawak also died last month from the disease caused by the same strain.
In response, the Early Childhood Development Agency (ECDA) sent an advisory to operators and principals of pre-schools at the start of this month, reminding them to be vigilant and to practise good hygiene.
The MOH spokesman added that the ministry is monitoring the HFMD situation across the Causeway and is working with ECDA and the Ministry of Education to spread information on precautionary measures.
Dr Leong Hoe Nam, an infectious diseases specialist at Mount Elizabeth Novena Hospital, said: "The EV71 strain is particularly nasty as it causes brain infection and affects the heart and lungs too. But it is also rarer, and in Singapore, it is still not so prevalent. The Coxsackievirus type A strain is not as bad as the EV71, as it does not cause so much brain inflammation."
That said, Dr Leong was concerned about the EV71 strain's growth in Singapore and emphasised the need to be careful and make sure the virus strain does not become endemic here.
"They are very hardy and can stay and live on surfaces. But if we follow the precautions to isolate infected children and adopt wipe-down measures, we can reduce the chance of a spread."
In its advisory, ECDA reminded pre-schools of measures such as screening children for signs of HFMD, not allowing unwell children to attend classes until they are fully recovered and disinfecting objects contaminated by saliva or nasal fluids from infected children.
The MOH spokesman also urged parents to consult a doctor early if their children have symptoms of HFMD, such as fever, mouth ulcers and rashes on the palms, and not take them to school or other crowded public places.
Dr Leong observed that the number of cases typically spikes after the school holidays. He suspects that this may be due to large numbers of children returning to school and gathering at contained school premises, which would facilitate the spread of viruses.
According to the latest MOH updates last Friday, six childcare centres and two kindergartens have active HFMD clusters.
They are Agape Little Uni at Compassvale, Skool4kidz Campus at Sengkang Riverside Park, My First Skool at 2 Punggol Drive, My First Skool at Block 55 Toa Payoh Lorong 5, My First Skool at Edgedale Plains, PCF Sparkletots Preschool at Queenstown Block 365, St James Church Kindergarten in Harding Road and Little Tree House at Westwood.
A childcare centre or kindergarten is defined as having a cluster when it reports more than 10 HFMD cases or an "attack rate" higher than 13 per cent, and a transmission period of more than 16 days. The attack rate refers to the proportion of children enrolled who have come down with the disease.
A spokesman for My First Skool, which has three schools on the list, said it complies with MOH's precautions and works with parents to manage any disease outbreaks.
Ms Suraya Tay, 32, who works in marketing and communications, is among parents who are worried about the threat of HFMD.
"Every parent worries about such things affecting her children. And it's a chain reaction as parents then need to make plans to take care of them, such as by working from home," said Ms Tay, whose five-year-old son Bruce attends Amazing Star Montessori House in Ubi.
"However, as long as the school adopts the recommended precautionary measures, I am fine with it."