HAND, FOOT and MOUTH DISEASE (HFMD)

What is hand, foot and mouth disease (HFMD)

• Hand, foot, and mouth disease (HFMD) is a common illness of infants and children, though adults can contract it too. It most often occurs in children under 10 years old.
• It is distinctly different from foot and mouth disease, which affects cattle, sheep and swine.
  

What causes HFMD?

• The most common causes of HFMD are coxsackie virus A16, enterovirus 71(EV71) and other enteroviruses. The enterovirus group includes polioviruses, coxsackieviruses, echoviruses and other enteroviruses.

Is HFMD serious?

• HFMD caused by coxsackie virus A16 infection is a mild and nearly all patients recover within 7 to 10 days. Complications are uncommon.
• However HFMD caused by EV71 may be associated with neurological complications such as aseptic meningitis, encephalitis and poliomyelitis-like paralysis; and might lead to death.
  

How does the disease spread?

• It is most common in clusters of children who are in daycare together. It can spread through direct contact with nose discharge, saliva, feces and fluid from the blisters.
• It can also spread through food and water which have been contaminated withfecal droplets or liquid from the mouth or nose of infected persons.
  

Is HFMD contagious?

• Yes, HFMD is moderately contagious. A person is most contagious during the first week of the illness. The virus may continue to be excreted in the stools of infected persons up till one month. HFMD is not transmitted to or from pets or other animals.
  

When and where does EV71 detected before?

• HFMD is endemic in Malaysia and occurs all year round. Major outbreaks of HFMD attributable to enterovirus EV71 have been reported in Malaysia in 1997,Taiwan in 1998 and Singapore in 2000.
  

How soon will someone become ill after getting infected?

• The usual period from infection to onset of symptoms (incubation period) is 3 to 7 days. Fever is often the first symptom of HFMD.
  

What are the clinical signs and symptoms?

• HFMD is characterised by fever, sores/ulcers in the mouth, and a rash with blisters.
• HFMD begins with a mild fever, poor appetite, malaise ("feeling sick"), and frequently a sore throat. One or 2 days after the fever begins, painful sores develop in the mouth. They begin as small red spots that blister and then often become ulcers. They are usually located on the tongue, gums, and inside of the cheeks.
  
• The skin rash develops over 1 to 2 days with flat or raised red spots, some with blisters on the palms of the hand and the soles of the feet.
  
• A person with HFMD may have only the rash on buttocks and on the legs and arms or the mouth ulcers at cheeks, gums or near the throat.
  

How is hand, foot and mouth disease diagnosed?

• Hand, foot and mouth disease is usually diagnosed based on a complete history and physical examination of your child.
  
• It is generally suspected on the age of the patient, the pattern of symptoms and appearance of blister-like rash on hands, feet and mouth in children.
  
• A throat and/or blister swab collected preferably within 2 days of onset of HFMD may be sent to a laboratory to determine which enterovirus caused the illness.
  

How is HFMD treated?

• Presently, there is no specific effective antiviral drugs and vaccine available for the treatment of HFMD.
  
• Symptomatic treatment is given to provide relief from fever, aches, or pain from the mouth ulcers.
  
• Dehydration is a concern because the mouth sores may make it difficult and painful for children to eat and drink. Taking enough liquids is very important apart from body temperature monitoring.
  

Who is at risk for HFMD?

• Everyone is at risk of HFMD infection, but not everyone who is infected becomes ill.
  
• HFMD occurs mainly in children under 10 years old, but may also occur in adults too. It is because they are less likely to have antibodies and be immune from previous exposures to them. Infection results in immunity to the specific virus, but a second episode may occur following infection with a different virus belonging to the enterovirus group.
  

What are the risks to pregnant women exposed to children with HFMD?

• As enteroviruses are very common, pregnant women are frequently exposed to the virus as well. As for any other adults, the risk of infection is higher for pregnant women who do not have antibodies from earlier exposures to these viruses, and who are exposed to young children - the primary spreaders of enteroviruses.
• Most enterovirus infections during pregnancy cause mild or no illness in the mother.
• Currently there is no clear evidence that maternal enteroviral infection causes adverse outcomes of pregnancy such as abortion, stillbirth, or congenital defects.
• However, mothers infected shortly before delivery may pass the virus to the newborn. Babies born to mothers who have symptoms of enteroviral illness around the time of delivery are more likely to be infected.
  
• Strict adherence to generally recommended good hygienic practices by the pregnant woman might help to decrease the risk of infection during pregnancy and around the time of delivery.
  

HMFD in childcare facilities

• HFMD outbreaks occurring in childcare facilities usually coincide with an increased number of cases in the community.
  
• If there is an evidence of transmission in any A childcare facility will be closed if there is 2 or more cases of HFMD detected within a period of 7 days.
  
• The closure is to stop the transmission of virus, for disinfection of the premise using diluted solution of chlorine-containing bleach and to enhance health education.
  

How to prevent HFMD?

• Maintain good ventilation.
• Wash hands before meals, and after going to toilet or handling stool soiled materials.
• Keep hands clean and wash hand properly.
• Wash hands when they are dirtied by respiratory secretion e.g. after sneezing.
• Cover nose and mouth while sneezing and coughing; and dispose of mouth and nasal discharge properly.
• Clean children’s toys and other objects thoroughly and frequently.
• Children who are ill should be kept out of school until their fever and rash have subsided and all the vesicles have dried and crusted.
• Avoid going to overcrowded places.