The Consumers Association of Penang (CAP) has called on the health and education ministries to immediately close all kindergartens and childcare centres throughout the country to curb the spread of hand, foot and mouth (HFM) disease. CAP president SM Mohamed Idris in a statement today said that the HFM disease situation in the country is "more than alarming" with the death toll rising to three and many more new cases being reported throughout the peninsula as of yesterday. "The time for applying the usual 'wait-and-see' approach has long passed. We cannot afford to wait for more deaths to occur before deciding to act. "If they (the ministries) do not act quickly, we will be faced with a similar or worse situation such as what had happened in Sarawak in 1997 when more than 40 children died due to the disease," said Mohd Idris. Meanwhile, a Chinese online daily reported today that over 3,000 kindergartens and childcare centres under the National Unity and Community Development Ministry have been ordered to close. Sinchew-i.com revealed that, however, the Education Ministry has yet to decide on the same course of action with regard to the kindergartens under its management. The Health Ministry, too, has not issued such a directive to the departments concerned. Three deaths In Petaling Jaya, a two-year-old boy referred to University Hospital from a private hospital on Wednesday died at about noon yesterday. A 30-month-old boy from Johor who followed his parents to Alor Setar a month ago died at the government hospital here on Oct 7. On Oct 3, Teo Ching Kai from Johor Bahru succumbed to suspected HFM disease after suffering from high fever for a week. According to Universiti Malaya Medical Centre director Prof Amin Jalaludin, the two-year-old boy who died in PJ yesterday had not been in Singapore in the last two weeks and his case appeared to be unrelated to the recent outbreak reported in the republic. Prof KB Chua of the university's Microbiology Department said the centre had determined that the virus responsible for the boy's death was not enterovirus 71 or Coxackie 16A. The most common cause is coxsackievirus 16A; occasionally, other strains of coxsackievirus A or EV71 cause HFM disease. The coxsackieviruses are members of a group of viruses called the enteroviruses. Chua said they hope to identify the virus within 10 days with the help of a children's hospital in Perth. There are currently 68 types under the enterovirus genus, out of which 20 cannot be identified here for lack of facilities. Meanwhile, Dr Jane Cardosa and some of her colleagues had reported in The Lancet, a respected British journal, that in the 1997 Sarawak outbreak, all the children who died from EV71 also carried another virus called adenovirus. This virus is difficult to detect because it is very slow-growing and had to be confirmed by the Centers for Disease Control, Atlanta, Georgia, in the US. Johor health authorities said between Monday and Wednesday, there were 137 cases; on Wednesday alone, 50 new cases were reported with 17 patients warded. Form a task force Idris urged the health ministry to form a task force to centrally monitor and advise state health departments on a unified plan of action. Follow-up enforcement action by the ministry is also needed as it has been found that although the directive was already given in Johor to effect a closure, there were kindergartens still operating there as of yesterday, he added. "This clearly reflects a breakdown in the regulatory and enforcement mechanisms," he said. CAP reported that a check with the Health Ministry revealed that there is no central task force to handle the HFM disease in the country, in spite of the seriousness of the situation. "At the moment, each state is handling the disease individually," said Idris. CAP also urged the Health Ministry to take immediate measures to include HFM disease in the list of notifiable diseases under the Prevention & Control of Infectious Diseases Act 1998. "This will require medical practitioners and other involved parties to inform the authorities without delay," Idris said. He also called on the authorities to keep all sections of the public informed on the latest developments and the precautions that need to be taken. Another blot on health minister DAP national chairman Lim Kit Siang said the unexpected first fatality from the HFM disease in the Klang Valley has gravely undermined parental confidence nation-wide in the Health Ministry's capability and integrity in crisis management. Lim pointed out that the revelation by Universiti Malaya's Medical Centre Prof Amin that the hospital had isolated enterovirus from samples in four of the six severe cases reported to the hospital since the end of August is another shocker. "Malaysians parents want to know why the Health Ministry had kept them completely in the dark about the disease in the Klang Valley at a time when they had been four deaths in Singapore," Lim said. He stressed that the parents in Johor and the rest of the country are entitled to know why the Malaysian health authorities had not been able to learn from the outbreak of the disease in Singapore to keep it under control in the country. "The latest HFM disease is the latest blot in the service record of Health Minister Chua Jui Meng after the disastrous Nipah virus epidemic last year and the EV71 (plus adenovirus) epidemic in Sarawak in 1997," Lim added. Disease characteristics HFM disease was officially blamed for the deaths of 31 children in Sarawak three years ago, all of whom were under six, with 24 below two years old. It is a common illness of infants and children, characterised by fever, sores in the mouth, and a rash with blisters. HFM disease begins with a mild fever, poor appetite, malaise ("feeling sick"), and frequently a sore throat. One or two days later, sores develop in the mouth as small red spots that blister and often become ulcers. They are usually located on the tongue, gums, and inside of the cheeks. The skin rash develops over one to two days with flat or raised red spots, some with blisters. The rash does not itch, and it is usually located on the palms of the hands and soles of the feet. It may also appear on the buttocks. Click[#1] here[/#] for more information on the HFM disease.