Doctors advise strict hygiene standards in early learning centres 

Health: The number of children suffering from the recent outbreak of hand, foot and mouth disease (HFMD) has reached 78 as of yesterday.

All of them are children of three private schools in the capital.

The public health department received information of the outbreak on March 18 after some of the doctors suspected it as HFMD.

The department then sent a team from public health and dzongkhag health authority to visit two schools in Motithang from where the outbreak was reported. Six cases were reported in the two private schools on March 18. The team also visited other schools.

Another 12 cases were reported on March 21 in the same area.

By yesterday 60 more cases were reported from another private school including the old cases.

The children, according to health officials, were aged between five and eight years.

Health ministry’s chief programme officer of communicable diseases division Dr Karma Lhazeen said that there is not much that can be done besides sensitization.

“There is no complication from the disease unless the child suffers from extremely high fever for which parents must take their child to the hospital immediately,” she said. “There is no vaccination either.”

Health officials said that the disease could have existed in the past but must have been reported as a skin infection.

As part of the ministry’s surveillance, all the satellite clinics were informed of the outbreak since March 21. Health workers at the satellite clinics will advice all the parents or school authorities that report such cases. Health officials at Thimphu referral hospital were also informed.

“These are the ongoing prevention measures,” Karma Lhazeen said.

She said that there’s no specific treatment for the disease besides symptomatic treatment.

HFMD is a common viral illness that usually affects infants and children. It can sometimes occur in adults. Symptoms include fever and blisters on various parts of the body including the mouth, fingers, palms, buttocks, nappy area, soles, upper arms or legs.

“Some children may also have fever, sore throat, runny nose or cough and blisters in the mouth making it difficult for them to eat or drink,” Dr Karma Lhazeen said. “The disease affects children aged 10 and below which is why it was first reported in the private schools.”

The schools should also take preventive measures. Children with the disease should be identified and sent to the nearest health care centre. “They should stay home for a few days until the blisters break and dries off as there is virus in the blisters,” the doctor said.

Although contagious, health officials said the disease is not a severe outbreak. There is no need to quarantine or conduct contact tracing unlike other highly contagious viral diseases. The sore heals within 10 days.

The virus in the fluid of the blisters can spread by air during coughing, singing and talking, among others. The virus is also found in child faeces, and can be present for several weeks even after the child has recovered. It is contagious as long as the blisters contain fluid.

Surveillance will be continued until the cases show a declining trend.  “We expect more cases until next week as the incubation period is three to five days,” she said.

The disease is likely to spread faster in close settings like places that are poorly ventilated. Health officials emphasized that strict hygiene standards are necessary in Early Childhood Care and Developments, which the education ministry should monitor.

Dr Karma Lhazeen clarified that the disease is not spread from cattle unless a person comes in close contact with an open wound on cattle. “There is no evidence that it is spread from cattle to humans. Humans are reservoir for such diseases,” she said. “The disease is attributed to low immunity and poor hygiene.”

“Hand hygiene is highly important,” Dr Karma Lhazeen said. “The disease is prevalent even in the developed countries.”

As of now no other dzongkhags reported the disease.

Last month, Thangza village in Lunana gewog, Gasa reported 23 children with the disease.

Kinga Dema