Hand, foot and mouth disease (HFMD) mainly affects children below 􀏐ive years of age. The disease can be prevented by focusing on hand hygiene, disinfection of premises, and cough etiquette. Teachers at pre-school play a vital role in inculcating good hygiene habits among children. This project aimed to determine pre and post-intervention level of knowledge, attitude and practices on HFMD among pre-schools teachers. This study involved pre-school teachers from Ampang, Selangor, Malaysia who were invited to a 5-hour event ”HFMD: Infection Control Workshop”. Questionnaires on knowledge, attitude and practice on HFMD were distributed before and immediately after the event. A total of 112 teachers were recruited. All were female, mostly (90%) from government pre-schools with the mean age of 35.8. Post-intervention total means a score of knowledge increased significantly, notably on the causative agent (23%) and complications of HFMD (26-45%). Mean attitude scores were also significantly increased, especially regarding the cleaning of toys and sharing of utensils. Meanwhile, practice scores were very high during pre-intervention but were insignificantly reduced post-intervention. The intervention improved respondents’ knowledge and attitude significantly. Findings from this study highlighted the need to provide more HFMD program focusing on the basic information of the disease, including mode of transmission and clinical manifestation. We hope that the knowledge gained will be imparted to fellow teachers and children under their care towards minimising the spread of HFMD.

Dengue fever is a significant public health problem in Asia, resulting in serious morbidity and even mortality. It is mainly known for causing severe constitutional symptoms and bleeding, often resulting in haemorrhagic shock. Dengue fever may manifest cutaneously in several forms. These include petechial rash, maculopapular rash and what has been termed as islands of white in a sea of red. Most can be attributed to capillary fragility, which led to tests such as the tourniquet test. This case highlights the dengue fever cutaneous presentation of islands of white in a sea of red in a multigravida woman during her first trimester. Her husband and son who was infected at the same time did not develop similar skin condition but developed the more common maculopapular and petechial rashes. The pathophysiology of such lesions is not well understood, and its relation to pregnancy is not known. Blood investigations were typical of dengue fever. The outcome of the patient’s pregnancy was also normal. This case highlights the need for doctors to look out for such lesions in dengue patients.

Pteropine orthoreovirus (PRV) is an emerging zoonotic respiratory virus that can be transmitted from bats to humans. In Malaysia, aside from PRV2P (Pulau virus) being isolated from Pteropus hypomelanus sampled in Tioman Island, PRV3M (Melaka virus), PRV4K (Kampar virus), and PRV7S (Sikamat virus) were all isolated from samples of patients who reported having a disease spectrum from acute respiratory distress to influenza-like illness and sometimes even with enteric symptoms such as diarrhea and abdominal pain. Screening of sera collected from human volunteers on Tioman Island in 2001–2002 demonstrated that 12.8% (14/109) were positive for PRV2P and PRV3M. Taking all these together, we aim to investigate the serological prevalence of PRV (including PRV4K and PRV7S) among Tioman Island inhabitants again with the assumption that the seroprevalence rate will remain nearly similar to the above reported if human exposure to bats is still happening in the island. Using sera collected from human volunteers on the same island in 2017, we demonstrated seroprevalence of 17.8% (28/157) against PRV2P and PRV3M, respectively. Seropositivity of 11.4% among Tioman Island inhabitants against PRV4K and PRV7S, respectively, was described in this study. In addition, the seroprevalence of 89.5% (17/19), 73.6% (14/19), 63.0% (12/19), and 73.6% (14/19) against PRV2P, PRV3M, PRV4K, and PRV7S, respectively, were observed among pteropid bats in the island. We revealed that the seroprevalence of PRV among island inhabitants remains nearly similar after nearly two decades, suggesting that potential spill-over events in bat–human interface areas in the Tioman Island. We are unclear whether such spillover was directly from bats to humans, as suspected for the PRV3M human cases, or from an intermediate host(s) yet to be identified. There is a high possibility of the viruses circulating among the bats as demonstrated by high seroprevalence against PRV in the bats.