Dr Goh Chun Hwee, consultant paediatrician lists down all you should know about this disease to help you safeguard your child’s health.

There has been a recent rise in hand, foot and mouth disease (HFMD) cases within our community with children hospitalised and nurseries shut down due to clustered outbreaks. As of the 5th of May 2022, there are 22,463 cases reported in Malaysia, with 96% of cases (21,508 cases) involving children below the age of 6.

1. What causes HFMD?

It is generally a mild but contagious viral illness mainly caused by Coxsackievirus A16 & Enterovirus 71—transmitted via contact with bodily fluids such as saliva, feces, fluid discharges from blisters of infected patients.

Patients typically present with generalized papular rashes all over the body, specifically on the palms and soles. They also often have multiple painful ulcers in the mouth and tongue.

2. Why are young children more vulnerable?

HFMD mainly affects children below the age of 10 and often those under 5. Firstly, they have lower immunity and have the tendency to touch their face frequently or put their hands in their mouth without practising proper hand hygiene. Next, children in this age group are usually sent to nurseries and kindergartens while their parents are at work—increasing the risk of transmission at these centres.

3. What are the initial symptoms?

Fever is often the first sign—followed by a sore throat and rashes. The incubation period—from initial contact to onset of symptoms—is about 3 to 7 days. Two days after the onset of a fever, patients often start to develop painful, red, blister-like lesions or ulcers in the oral cavity, tongue, and lips—leading to a loss of appetite. This is often followed by red papules or fluid-filled blisters on the palms and soles, and possibly buttocks.

4. Why do cases seem to peak during certain months/seasons?

Many studies have found climate change to be linked to the peak of HFMD. In Malaysia, it is closely related to monsoon periods and geographical locations. Based on a local study published in 2020, researchers found that HFMD peaks during Southwest Monsoon season (May to August) in majority of the states, while the off-period of HFMD is during the Northeast Monsoon season (November to January).

5. How is an infected child usually treated?

HFMD is a viral infection and almost all patients recover without treatment within 7 to 10 days. They are usually given supportive treatment such as adequate hydration, paracetamol for pain relief and fever, oral hyaluronic sprays to promote faster ulcer healing, oral gels with anaesthetic effects to suppress the pain before meals.

However, there are a small number of patients who experience persistent high spiking fever, dehydration with poor fluid intake due to extensive oral ulcers, breathing difficulty or seizures. These patients are hospitalized for treatment.

6. Can the disease leave any long-lasting impact on children’s health?

Almost all HFMD patients recover fully without long lasting effects to their health. However, some patients who have HFMD due to enterovirus (EV71) infection, may have more serious complications such as brain infection (encephalitis), lung infection (pneumonitis with pulmonary edema) and heart inflammation (myocarditis). This small portion of patients might have a longer hospital stay and require more intensive therapy.

7. What are the best prevention methods to contain HFMD?

There needs to be greater public awareness and parents need to be fully educated on the matter.

• If their children exhibit signs of infection—do not bring them out in public and do not send them to nurseries or childcare centres. Seek medical treatment or advice and continue with home quarantine if symptoms are mild.
• Parents need to enforce strict hand hygiene especially after their children are exposed to public facilities (eg. playground).
• Children need to frequently wash their hands with soap or sanitizer.
• Parents should sanitize public tables and chairs with alcohol wipes.
• Frequently clean and disinfect toys and home furniture.
• Remind children to avoid sharing their personal belongings or food.

This article was contributed by Dr Goh Chun Hwee, Consultant Paediatrician at Pantai Hospital Ampang. To know more about where and when to see Dr Goh Chun Hwee at his clinic, click here.