The Health July/August 2022 | Page 16

Not all children have the same symptoms and must be monitored closely in case their condition worsens



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Alert ! Hand , Foot and Mouth Disease strikes again

Not all children have the same symptoms and must be monitored closely in case their condition worsens


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 .
Seven steps of handwash technique adapted from UKK @ MOH
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 .