Not all children have the same symptoms and must be monitored closely in case their condition worsens
BY ASSOC PROF DR TAN TOH LEONG
AND DR DANIEL CHAU JUN WEI
Hand, Foot, and Mouth Disease (HFMD) is a contagious viral infection that commonly affects children less than five years old but can occasionally affect adults. It is caused by infection with human enteroviruses, mainly Coxsackie A16 (CA16), Coxsackie A6 (CA6) and Enterovirus 71 (EV71).
HFMD is endemic in Malaysia, with the first outbreak reported in 1997. There have been cyclical spikes of reported outbreaks every 2-3 years.
There has been a reduction of cases for the past two years due to the Movement Control Orders (MCOs) resulting from the Covid-19 pandemic. Following the relief of the MCO and the recommencement of all economic sectors, there has been a significant increase in the number of cases this year. They have yet to reach their peak as the numbers continue to rise at the time of writing.
How do children get HFMD?
HFMD is spread by direct contact with unwashed, contaminated hands, nasal mucous, phlegm, saliva, fluid from blisters, stool, or contaminated surfaces such as toys and furniture. Ingestion of contaminated food and drink can also spread the virus. Children can catch the virus, especially in crowded areas such as daycare, kindergarten, or shopping malls, from their siblings and even adults who are contaminated. An infected person is most contagious during the first week of illness.
What are the symptoms of HFMD?
The symptoms start 3-6 days after catching the virus. As the name suggests, HFMD is characterised by fever with small vesicle eruptions (<5mm) and fluid-filled blisters on the hands, wrists, feet and the mouth.
Other symptoms include sore mouth ulcers, sore throat, headache and difficulty feeding.
Not all children will have the same symptoms; some may only develop vesicles in the limbs without oral ulcer, some may have no fever while some may not even have symptoms.
Although rare (1.26 per cent), HFMD caused by enterovirus 71 (EV71) may be more severe where the child may become irritable, develop fitting, neck stiffness, limb weakness, reduced consciousness, difficulty in breathing and heart failure. Severe HFMD may even result in death in some children.
How is HFMD diagnosed?
HFMD is diagnosed mainly through signs and symptoms. Although tests such as throat and vesicle swabs are available, tests are not routinely needed. If a child is suspected of contracting HFMD, he should seek treatment from healthcare facilities.
How is HFMD treated?
HFMD is usually mild and self-limiting. An infected child with mild illness usually recovers within 7-10 days. Treatment is mainly directed towards the symptoms, and no antiviral drugs are available for the virus.
A child with mild disease can be treated at home with adequate rest, adequate fluid intake to prevent dehydration, medications to relieve symptoms, and close monitoring from caretakers.
When should the child be brought to hospital?
Parents should closely monitor the child and must seek attention from the hospital if he cannot tolerate oral feeding, has persistent high-grade fever (>38oC for >48 hours), persistent vomiting, dehydration, or signs of severe disease. Also, the child could be admitted if the caretakers cannot cope with the disease.
How to prevent HFMD from spreading?
There is no vaccine to protect against HFMD infection currently. The best prevention is to practice good hygiene. Parents and children should frequently wash their hands with soap using the proper technique, clean dirty surfaces and soiled toys and clothing and avoid close contact with infected persons.
Children diagnosed with HFMD should be isolated, stay at home, and refrain from going to public areas. The infected child should not share cutlery, clothes, furniture, and other personal belongings with other children, and these need to be washed separately and disinfected regularly. — The Health
Assoc Prof Dr Tan Toh Leong is Senior Lecturer and Emergency Medical Consultant, UKM Medical Center, Universiti Kebangsaan Malaysia (UKM) and President & Founder of Malaysian Sepsis Alliance (MSA) while Dr Daniel Chau Jun Wei is Emergency Physician, Hospital Raja Permaisuri Bainun, Ipoh and member of MSA.