Hands, Foot and Mouth Disease (HFMD)

What is HFMD?

HFMD is a viral disease commonly contracted by young children under the age of 5, especially between 1-2 years of age. However, it can also infect older children and adults alike. HFMD is mainly caused by enteroviruses, usually coxsackievirus A16 or enterovirus 71, although other viral strains may also act as causative agents of the disease.

HFMD in Malaysia

The recent outbreak in Malaysia reached a tally of 58,693 cases from January 1st up to September 6th this year. The country recorded its first ever death from complications of HFMD in June 2018, soon after which another death, also believed to be HFMD-related, was reported in the following month. There is currently no vaccine against HFMD infection approved in Malaysia (China has approved an enterovirus 71 vaccine in December 2015).

Signs and symptoms of HFMD

The time from infection to symptom presentation (incubation period) of HFMD is in the range of 3-6 days. Common symptoms of the disease include fever, feeling of being unwell, decreased appetite, sore throat and spots that may blister in/around the mouth, hands, feet and sometimes groin/buttocks area. Patients with painful mouth sores may find it difficult to swallow. These patients (or, for young patients, their parents) must ensure they take frequent sips of fluids to prevent dehydration.

Some patients experience fingernail and toenail loss between 4-8 weeks following infection. The nails will eventually resume normal growth in 1-4 months. On the other hand, some infected individuals do not present any symptoms whatsoever, while still able to spread the disease.

HFMD typically resolves on its own within 7-10 days as the body develops immunity against the virus. There is no specific treatment for HFMD; medications prescribed to HFMD patients are aimed towards symptom relief.

HFMD complications

Complications from HFMD such as meningitis (inflammation of the membranes and cerebrospinal fluid surrounding the brain and spinal cord) and encephalitis (inflammation of the brain) are rare, but they may occur and are occasionally fatal.

Modes of HFMD transmission

HFMD is transmitted via contact with an infected person’s bodily secretions (e.g. saliva, nasal mucus and blister fluids) or faecal matter, and then touching the eyes/nose/mouth before washing the hands. The virus may also be transmitted by ingestion of improperly treated recreational water, such as swimming pools. The disease frequently occurs as an outbreak in kindergartens or daycare centres, due to the close contact between children, their tendency to put their hands into the mouth, frequent diaper changes and toilet training.

Preventing HFMD transmission

The chain of transmission can be broken by good hygiene practice (such as frequent hand washing with soap, especially when handling infants/small children), maintaining a clean environment (by disinfecting toys and surfaces), screening for signs of infection on school premises and isolation from others when infected.

HFMD patients (or their parents/caretakers) should take preventive measures to prevent the spread of the disease. HFMD is most contagious within the first week of illness, and can remain contagious for a few weeks after the symptoms were resolved. Patients should stay at home, minimise contact with others and not share personal items such as eating utensils, towels or clothes. They should also not return to school, daycare centres or workplace until deemed fit to do so by their healthcare providers.

References

1. Chua KB, Kasri AR. Hand foot and mouth disease due to enterovirus 71 in Malaysia. Virol Sin. 2011;26(4):221-8.
2. Mayo Clinic. Hand-foot-and-mouth disease. Available at https://www.mayoclinic.org/diseases-conditions/hand-foot-and-mouth-disease/symptoms-causes/syc-20353035. Accessed on 5 November 2018.
3. Cabrerizo M, Tarrago D, Muñoz‐Almagro C, et al. Molecular epidemiology of enterovirus 71, coxsackievirus A16 and A6 associated with hand, foot and mouth disease in Spain. Clin Microbiol Infect. 2014;20(3):O150-6.
4. From the Desk of the Director-General of Health Malaysia. Kenyataan Akhbar KPK 7 September 2018 – Situasi Semasa Kejadian Penyakit Tangan, Kaki Dan Mulut (HFMD) di Malaysia (in Bahasa Malaysia). Available at https://kpkesihatan.com/2018/09/07/kenyataan-akhbar-kpk-7-september-2018-situasi-semasa-kejadian-penyakit-tangan-kaki-dan-mulut-hfmd-di-malaysia/. Accessed on 14 November 2018.
5. Mao QY, Wang Y, Bian L, Xu M, Liang Z. EV71 vaccine, a new tool to control outbreaks of hand, foot and mouth disease (HFMD). Expert Rev Vaccines. 2016;15(5):599-606.
6. Hoy NY, Leung AK, Metelitsa AI, Adams S. New concepts in median nail dystrophy, onychomycosis, and hand, foot, and mouth disease nail pathology. ISRN Dermatol. 2012;2012:680163.
7. Centers for Disease Control and Prevention. Hand, foot, and mouth disease (HFMD): causes & transmission. Available at https://www.cdc.gov/hand-foot-mouth/about/transmission.html. Accessed on 5 November 2018.
8. Centers for Disease Control and Prevention. Hand, foot, and mouth disease. Available at https://www.cdc.gov/features/handfootmouthdisease/index.html. Accessed on 5 November 2018.
9. Ministry of Health Malaysia. Hand foot and mouth disease (HFMD) guidelines. Available at http://www.moh.gov.my/images/gallery/Garispanduan/Guidelines%20HFMD%202007.pdf.

Accessed on 1 November 2018.