Hand, Foot and Mouth Disease (HFMD)

What is Hand, Foot and Mouth Disease?
Hand, foot and mouth disease (HFMD) is a common disease of childhood, like chickenpox and measles. It is usually characterized by tiny blisters on the inside of the mouth and the palm of the hands, fingers, and sole of the feet. Blisters also commonly occur on the buttock and other parts of the body. It is commonly caused by Coxsackie virus A16 (an enterovirus), and less commonly by other types of viruses such as enterovirus 71. HFMD is not the same as foot-and-mouth disease of cattle and sheep. Foot-and-mouth disease is caused by different viruses.

What are the signs and symptoms of HFMD?
Young children are primarily affected, but it may be seen in adults. The most common age group affected is those below 10 years old. Outbreaks may occur among groups of children especially in child care centers or nursery schools. This is because these children are younger and their immune system is not well developed. In other countries, most cases occur in the summer and early fall. Symptoms usually appear 3 to 7 days after exposure.

HFMD begins with the child getting fever, poor appetite, tiredness and a sore throat. One or two days after the fever appear, the child begins to develop painful sores in the mouth and throat. These sores begin as small red dots which the blisters and develop into ulcers. They are usually located on the tongue, inner side of the cheek and at the back of the throat. The skin rash appears around the same time the oral ulcers appear. These rashes may be just red dots but some may proceed to develop into blister with fluid in the center. The rash are not itchy and is usually located on the palms of the hand, the soles of the feet and around the buttocks region .Mild cases may only has the rash or oral ulcers.

The fever and oral ulcers create a lot of discomfort for the child. They are usually irritable and would be unable to eat even though they are hungry and thirsty. In mild cases, the oral ulcers will begin to heal in about 3-5 days and the fever subsides around the same time. Most children recover without medical treatment in 7 to 10 days.
Complications of HFMD are rare. A few children with coxsackievirus A16 infection may develop meningitis with fever, headache and stiff neck. These children will need to be hospitalized for treatment. Another virus that causes HFMD, EV71 may also cause meningitis and also may cause more severe complications like encephalitis, myocarditis (heart involvement) and polio-like paralysis. EV71 encephalitis may be fatal. Outbreak of fatal encephalitis HFMD by EV71 occurred in Malaysia in 1997 and Taiwan in 1998.

How do HFMD spread?
HFMD spread from person to person by direct contact with nose and throat secretions, saliva, fluid form blisters or the stool of infected children. The infection spread most easily during the acute phase of illness when people are feeling ill, but the virus can spread for several weeks after the onset of infection.

Is there any treatment for HFMD?
There is no specific treatment for HFMD. There is also no vaccine for HFMD. Symptomatic treatment is reducing fever by use of paracetamol or ibuprofen and relief from the pain of oral ulcers. The child should be brought to see a doctor if high fever persists in spite of medication, totally unable to eat and was lethargic all the time.

Can HFMD be prevented?
HFMD cannot be prevented but the risk of infection can be lowered by good hygiene habits such as:
Washing hands well, especially after going to the bathroom and after changing diapers.
Covering the mouth and nose when coughing or sneezing.
Frequent washing of toys.
Excluding children from child care or kindergarten if there is a fever, or ulcers in the mouth.

What can kindergarten and childcare facilities do?
HFMD occurs commonly in children who are in childcare facilities or kindergarten. Even if the children are checked daily and sent home if they have fever and oral ulcers, it may be too late as the virus would have spread before the signs of HFMD appear or after the infection. Adults who have no symptoms may be carrier of the disease. Nevertheless, it would be good if the following measures are to be taken especially during an outbreak:

· Daily examination of children before school starts. If the child has fever and oral ulcers, they are to be quarantine in a separate room until their parents or guardians come to pick them up.
· Child with HFMD should not be allowed in the kindergarten or childcare for 10 days.
· Toys and furniture in the kindergarten and childcare facilities should be cleaned using diluted solution of chlorine-containing bleach (made by mixing approximately one quarter cup of bleach with one gallon of water).