Words Dr Rakhee Yadav

Since April this year, there has been an increase in the number of hand, foot and mouth disease (HFMD) cases among Malaysian children. HFMD is a notifiable disease and the number of cases is closely monitored by the Ministry of Health (MOH) Malaysia. In fact, official reports from MOH claim there is an almost 30 percent increase in cases compared to last year. According to a statement by the Director General of Health, Datuk Dr Noor Hisham Abdullah, more than 40,000 cases have been reported nationwide so far. Every week, 73 new cases are reported nationwide, according to Health Minister Dr Dzulkefly Ahmad.

HFMD is a highly contagious disease that is caused by viruses from the enterovirus group, namely the Coxsackie A16 and Enterovirus 71 (EV71). However, this year there has been an increase in the number of cases from the EV71 virus. Those who have been infected by a particular strain may develop immunity towards it but they may still contract HFMD caused by other strains of viruses. It remains a myth that you can only develop HFMD once in a lifetime.

HFMD easily spreads through droplets which can be from an infected individual’s saliva, mucous, stool and even blister fluid. It commonly spreads via close personal contact with an infected individual, coughing, sneezing, touching contaminated objects or even indirect/direct contact with infected stool.

While HFMD is commonly seen in children below 10 years of age, those below five years have a higher risk as their immune system may not have matured to fight the disease. HFMD may also affect older children and even adults. Children who are frequently exposed to other children, for example in places such as daycare or school, have a higher risk as there is an increased degree of exposure.

Symptoms and complications

Symptoms usually appear three to seven days after exposure to the virus. The disease is contagious in the first seven days and to make things more complicated, there sometimes may not be any symptoms during this period. HFMD is characterized by fever followed by blisters which usually occur over the hands, feet and in some cases extend to the body and genitals. These blisters may be painful and/or itchy. They may also have painful ulcers in the mouth or sore throat, leading some individuals to have poor appetite and dehydration.

There is a spectrum of symptoms in HFMD, with some children developing a mild form of the disease while others may develop its severe form with complications. Although uncommon, there have been reported fatalities amongst children with severe disease and complications. However, it is imperative to note that not all complications are fatal. Secondary infection due to scratching the blisters or dehydration caused by poor appetite are the most common complications encountered. These are treatable and result in better outcomes.

More uncommon serious complications are usually related to EV71 infection. EV71 may cause complications involving the:

1. Nervous system, such as meningitis (inflammation of the protective lining of the brain), encephalitis (inflammation of the brain) or even paralysis.
2. Heart, causing myocarditis (inflammation of the heart muscles).
3. Lungs.

Pregnant ladies affected by the Coxsackie virus may develop complications during pregnancy. Their unborn babies may develop congenital abnormalities as there is a small chance the virus could cross the placental barrier.

Treatment and prevention

Treatment of HFMD is supportive. In healthy individuals, the disease resolves within two weeks without any complications. Most cases are treated symptomatically with fever medications and creams to relieve the itchiness. Some children are given mouth sprays or lozenges to relieve the pain from their mouth ulcers. A soft, cool diet consisting of soft foods and cool items (e.g. porridge, yogurt, ice cream) may be given if a child refuses to drink or eat due to painful ulcers. In some instances, a child might need to be admitted for intravenous fluids due to dehydration, closer monitoring or specific treatment of complications.

To date, there is no vaccine against HFMD. As such, it is very important to prevent the disease from occurring and reducing its spread. The MOH has urged all childcare centres and schools to always disinfect their equipment and appliances using the correct disinfectants, screening all children upon attending class, ensuring proper disposal of diapers and practicing proper hand washing techniques for staff and children under their care. Disinfecting using a solution of bleach has been recommended by the MOH in their guidelines.

Schools with more than two reported cases are usually ordered to be closed by the MOH for disinfecting purposes. Parents and guardians are advised to isolate or home quarantine their children with signs or symptoms of HFMD. This includes avoiding public areas (e.g. shopping malls, indoor/outdoor playgrounds, school, etc). Parents working in the government sector and certain private companies are allowed to apply for quarantine leave which lets them take care of their child at home.

Prevention is better than cure and this is truly the case when it comes to HFMD. Everyone must do their part in preventing the spread by doing all we can to ensure a clean environment and avoid bringing sick children or even adults out in public. As parents, we should be more responsible not only for our own children but for others. Only then will we see a reduction in the number of cases in our country.

We can prevent the spread of HFMD by practicing home quarantine: stay at home and do not place your child in daycare or school until you or your child is completely free from infection.

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