(3) Providing assistance to kindergartens, daycare facilities and
schools during outbreaks
Despite the lack of concrete evidence on the effectiveness of child-care centre and
school closures in controlling HFMD transmission, such measures are widely used on
the assumption that they will reduce transmission or delay the spread of HFMD to the
community. There are no standard thresholds in terms of the number of cases or events
that should act as a trigger to closure, and options range from voluntary to mandatory
and tiered school closures. While information regarding virus shedding is lacking,
the average duration of closures ranges from one week to 10 days. In Singapore, for
example, depending on the severity of the situation, actions taken have included issuing
alert letters to affected institutions, conducting field investigations, and mobilizing
multi-agency efforts to prevent further spread of the disease. Licensing authorities
are also kept up to date on the local HFMD situation (number, size and attack rate, and
transmission period of clusters) on a twice-weekly basis.
(4) Strengthening infection control measures both in health care
facilities and in the community
Infection control measures need to be implemented consistently and strengthened
rapidly during outbreaks in both the community and health care facilities. In Singapore,
for example, educational institutions are referred to infection-control guidelines for
child-care centres, pre-schools and schools on practices recommended to reduce disease
transmission in a school setting by the Infection Control Association (Singapore).
(5) Improving clinical case management services, particularly for
severe manifestations requiring intensive medical care
Ensuring that health care staff are aware of HFMD and its potentially severe
manifestations requires disseminating information and providing training for those
medical staff who are most likely to be the primary consult for the disease. In Taiwan
(China), medical education, such as on the symptoms of EV71 and the timing of referral
for severe cases to hospital, has been facilitated by the Digital Infectious Disease
Learning Net, and linked to activities giving physicians continuing education credits.
The medical service response has also been upgraded and guidelines developed for the
treatment of HFMD and severe cases. In mainland China, medical services have been
upgraded through:
• The establishment of a patient triage system.
• The designation of specific hospitals for treatment.
• Clinical monitoring for the early detection and intervention of severe cases.
• The establishment of a paediatric intensive care unit (PICU).
• Reimbursement of medical fees based on the new rural cooperative medical care
regulation.