Hand Foot Mouth Disease (HFMD)

Hand Foot Mouth Disease (HFMD) is a common illness in childhood. Although HFMD may affect persons of any age, it is mostly seen in children below the age of 5 years and is prevalent especially in closed settings such as nurseries and kindergartens.

There are several viruses responsible for causing HFMD with the most common being the Enterovirus 71 (EV71) and Coxsackievirus A16. Of these, EV71 infection is associated with a higher risk of complications.

HFMD is easily transmitted through direct contact of secretions, rash blister fluid, or faeces from the affected person. If a healthy child shares playthings or touch common surfaces contaminated by an infected person, the child may also contract the disease.

After the virus enters the body, there is a period of time where the person has no symptoms. This incubation period lasts between 3 to 7 days. After this period of time, the earliest symptom that arises is fever, followed by the typical rashes from the third day of illness onwards. Other frequently seen symptoms include cough, poor appetite, tiredness, eye redness, tummy pain, and diarrhoea.

The rashes of HFMD begin as raised red lesions which later become filled with clear fluid. They mostly affect the mouth (including the lips, tongue, palate, and throat), hands and feet, and occasionally at the wrists and ankles. Lesions are almost always present in the hands and may be the only manifestation of the illness. In some cases, the rash affects only the oral cavity and it may be difficult to differentiate HFMD from other common childhood illnesses such as herpangina or tonsillitis.

Dehydration is the most common complication of HFMD

The rashes in the mouth in particular may be very painful to the child and the child may completely refuse all forms of feeding. This in result causes the child to become dehydrated, at which they become tired, irritable, and have reduced passage of urine. If left untreated, the dehydration may progress to adversely affect the organs. Dehydration is by far the most common complication seen in HFMD.

One of the most serious complication of HFMD is aseptic meningitis which is the inflammation of the meninges layer of the brain. The affected child may demonstrate a high unremitting fever, develop a seizure, or have significant changes in behavior becoming confused or disorientated. This is a condition that requires immediate attention at the hospital. Thankfully, it is a rare complication of HFMD. Other rare but serious complications of HFMD include myocarditis (inflammation of heart muscles) and pulmonary oedema (abnormal fluid in the lungs).

Most cases of HFMD are mild and self-limiting. Generally most cases do not require hospital admission and can be treated as outpatient basis. There is no specific medication for HFMD, and the treatment given is for relief of the symptoms.

The following measures will be helpful:

1) Adequate fluid hydration and rest

2) The affected child should be isolated and not attend their nursery or kindergarten for 7-10 days from the start of their symptoms

3) Proper handwashing should be observed and encouraged especially after diaper change or toileting

4) Personal items such as cups and utensils should not be shared, and should be washed with detergent after use.

Please seek immediate medical attention if the following occur:

1) Child is unable to tolerate oral feeding, has reduced passage of urine and needs intravenous hydration

2) Child appears very ill and tired

3) Persistent fever (> 38 degrees Celsius) for more than 48 hours

4) Suspicion of brain involvement: seizures, abnormal change in behavior, drowsiness

5) If parents/caretakers are unable to cope with child’s illness

Nurseries and kindergartens too have an important role to play in the prevention and detection of HFMD. Regular sanitisation of common surfaces at the nursery is encouraged. Routine checks of the child’s hands and mouth for rashes prior to entry may be helpful in preventing spread in the nursery. Reporting of detected cases to the public health department is necessary and may help in curbing the spread.

With adequate awareness and knowledge of the disease, together we can help prevent the spread of hand foot mouth disease.