The information given in this section was chosen to assist expatriates who want to research health risks involved when living in Singapore. It is recommended to make yourself familiar with ways to protect yourself and learn how to identify symptoms by reading the below information and visit further websites recommended below.

Dengue Fever and Dengue Haemorrhagic Fever

Dengue fever is a disease caused by the dengue virus which can be transmitted to humans by the bite of an infected mosquito. The incubation period of dengue fever normally ranges from between 3 to 14 days. Dengue haemorrhagic fever is a more severe form of dengue and can be fatal if unrecognised or not treated. There is no vaccines available that can prevent dengue. Despite a general upsurge in the region, dengue is under control in Singapore as the country has put in place rigorous control measures

How do I know if I have Dengue?

Dengue is characterised by an abrupt onset of high fever lasting 2 to 7 days, severe headache, severe muscle and joint pain and also abdominal pain. Not for nothing is the local name “break-bone fever”. After about 3 to 5 days, a typical rash appears –flushed skin with little red bumps and islands of normal skin (see picture). This is usually after the fever subsides and the patient starts to feel better.

However, this is also the more dangerous phase of the illness as the blood platelet levels start to drop. Platelets are essential for blood to clot. Bleeding can then happen. This is known as dengue haemorrhagic fever and happens in only about 3% of cases. This is manifested as bleeding spots under the skin, nose or gum bleeding or worse; bleeding in the stomach or intestines, which can be life-threatening. DHF is more common if you have previously had dengue.

Most young children do not show symptoms when affected with dengue. Adults usually do. Most cases of dengue fever are self-limiting and last about 10 days to 4 weeks. However, due to the risk of DHF, you should seek medical diagnosis and management.

How Can I Prevent Dengue?

Unfortunately there is still no vaccine or medicine for protection against dengue fever.

Dengue is spread by the Aedes aegypti mosquito. It is located both in urban and rural areas. Aedes mosquitoes breed in small pools of stagnant water like blocked roof gutters, car tyres, outdoor plant pot bases, and flower vases. Do check your home regularly and empty out any collected water every 2-3 days. If you’re going on a long holiday make sure your toilets and floor traps are also covered and any containers that can collect water are not left out in the garden or balcony. Educate your domestic helper to be vigilant about these measures. Get your house fogged regularly.

The National Environment Agency (NEA) carries out investigations and fogging around the residence or work place of reported cases of dengue. You would do well to take note of these visits and co-operate with them.

On a personal level, insect avoidance measures using repellents like RID will also help (see our patient infor-mation sheets on Dengue, Insect Avoidance, and RID & DEET).
Hand, Foot and Mouth Disease  
HFMD is an illness caused by intestinal viruses, commonest being Coxsackie virus and Enterovirus 71. HFMD is endemic in Singapore.

The common symptoms are fever lasting 2-3 days, sore throat, red spots or blisters on palms and soles, mouth ulcers, poor appetite, vomiting and diarrhoea. The disease is spread by close contact and indirectly by contaminated articles. The first week is the most contagious.

Affected children should stay at home and avoid contact with other children until they have recovered. They will need a doctor’s certification that they are fit to resume schooling. Maintaining high standards of personal hygiene and disinfecting premises and toys with diluted bleach solution (one part household bleach and ten parts water) will help prevent the spread of the virus.

Who gets HFM disease?
The disease usually occurs in children under 10, being more common in the younger age groups.

How is it spread?
The disease is spread by direct contact with discharges from nose/mouth or faeces of infected people.

What are the symptoms?
Symptoms can include fever, malaise and sore throat which may appear 3-5 days after exposure, usually followed by the rash 1-2 days later. The rash usually fades after 7-10 days.

 What can be done to prevent its spread?
Children with the symptoms or rash should be excluded from school/child care until resolution. Thorough hand washing, cleaning of toys and care changing diapers are all important.

Is there a risk for pregnant women?
This is uncertain, and pregnant women are advised to consult their specialist.