Hand, Foot and Mouth Disease (HFMD)

Hand, Foot and Mouth Disease (HFMD)

Hand, Foot and Mouth Disease (HFMD) is a viral infection that commonly affects infants and young children. The disease is characterized by symptoms such as fever, mouth sores, and clear blisters on the hands, feet, and body. In Thailand, HFMD is frequently caused by the Coxsackie virus A, which is usually not severe and can resolve on its own. However, if the disease is caused by Coxsackie virus B or Enterovirus 71, it can lead to more severe symptoms such as inflammation of the brain and heart muscle or paralysis. Enterovirus 71 is an example of the virus that has been found in Singapore.

HFMD is caused by a group of viruses known as Enteroviruses, which has over 100 strains. The most common strains that cause HFMD are Coxsackievirus A16 and Enterovirus 71. Infants and young children under 5 years old are at higher risk of developing the disease and experiencing more severe symptoms. However, adults can also contract the disease.

The disease can be spread through direct contact with respiratory secretions, such as mucus from the nose and throat, and fluid from the blisters. The virus can also be found in the stool of infected individuals, particularly during the first week of symptoms. The virus can be transmitted through contaminated objects or surfaces, as well as through coughing and sneezing. It is therefore important to practice good hygiene, such as washing hands regularly, to prevent the spread of the disease.

Hand, Foot, and Mouth Disease can be directly transmitted through contact with the secretions from the nose, throat, saliva, and fluid from blisters of infected individuals, as well as feces containing the virus. It can also be indirectly transmitted through contact with contaminated surfaces, toys, and food and drinks. Places where outbreaks of the disease commonly occur include child care centers and preschools, especially during the transition from rainy to cold seasons. However, the disease cannot be transmitted from humans to animals or vice versa.

It is possible for the disease to recur because the immunity developed in patients who have recovered from one strain of the virus may not be effective in preventing infection from other strains, even though they belong to the same subgroup of viruses.

Symptoms and complications of hand, foot, and mouth disease:

The initial symptoms of hand, foot, and mouth disease are similar to those of a cold (it should be emphasized that it is similar to a cold). This includes the appearance of clear blisters or warm sores on several areas in the mouth, as well as red rash or small blisters, about the size of a pencil eraser, on the palms, fingers, soles, or buttocks. The patient may also have a low-grade fever and experience fatigue and joint pain for 5-7 days before the rash and blisters appear, usually within 12-24 hours. Children may also experience discomfort in the mouth and refuse to eat once the sores develop in the mouth, tongue, cheeks, or throat, which are usually found in clusters of 5-10 sores, with the most common locations being the roof of the mouth, tongue, and the soft tissues inside the cheeks.

The mouth sores initially appear as small, red spots or bumps that later become small, grayish blisters with yellow centers and a surrounding red halo (these can be painful and make it difficult for the child to eat, as well as cause swelling and redness of the tongue, but usually disappear within 5-10 days). Clear blisters may also be found on the palms and soles, usually about 3-7 millimeters in size and will heal on their own within 7 days. Skin rashes may occur simultaneously with or after the mouth sores, which may be present in only 2-3 spots or more than 100 spots, with the hands more often affected than the feet. The rash may appear as small, red bumps ranging from 2-10 millimeters in diameter, with small gray blisters often arranged in a line along the skin and a surrounding red rash. The rash may be itchy and last for several days, but will usually resolve without treatment.

However, hand, foot, and mouth disease can cause severe complications, such as inflammation of the brain or encephalitis, brain inflammation, soft and wet muscle paralysis, or even heart muscle inflammation leading to death. The complication symptoms are not related to the number of sores or blisters found on the hands and feet. In cases where severe complications occur, there may be only a few spots or blisters in the throat or just a few blisters on the hands and feet. Therefore, parents should closely monitor their child during the first 1-2 weeks, even if the rash and sores in the mouth have disappeared. Warning signs of severe complications that parents should immediately take the child to see a doctor include:

1. The child has a persistent low mood, does not play, and refuses to eat or drink milk.
2. The child complains of severe headache, which they cannot tolerate.
3. The child has a speech disorder, alternating with a low mood, or sees strange images.
4. The child has neck pain, stiffness, confusion, and vomiting.
5. The child has tremors, shaking, or some numbness in their arms or hands.
6. The child has a cough, fast breathing, looks breathless, has a pale face, and produces a lot of mucus, with or without a fever.

Moreover, hand, foot, and mouth disease may manifest in various systems, such as:

1. Respiratory system: symptoms similar to a cold, cough, clear runny nose, and sore throat.
2. Skin: blisters or rashes on the skin.
3. Nervous system: such as the brain, brain covering, or brain inflammation.
4. Digestive system: such as diarrhea, loose stool, headache, and vomiting.
5. Eyes: commonly found chemosis and conjunctivitis.
6. Heart: can cause heart muscle or covering inflammation.

Treatment:

Treating the symptoms involves administering fever-reducing medication when there is a fever. The blisters on the hands and feet usually do not itch or hurt. However, the sores in the mouth can be very painful, causing young children to refuse to suckle or eat. In such cases, a spoon or a dropper may be used to feed the child milk or to administer medication gradually. It is recommended to consume cold milk, suck on small ice cubes or eat ice cream, which can alleviate the pain and provide the child with hydration and some nutrients. This is particularly important for young children.

Prevention of Hand, Foot, and Mouth Disease:

This involves maintaining good hygiene practices and receiving vaccinations to protect against the severe EV71 virus strain that causes hand, foot, and mouth disease. It is recommended to vaccinate children between the ages of 6 months and 5 years 11 months. Parents can prevent the disease and potential life-threatening complications by:

• Avoiding close contact between their child and infected individuals.
• Maintaining personal hygiene, particularly by washing hands thoroughly before handling food for the child to consume and consuming fresh, clean, and cooked food without fruit flies. Drinking clean water is also essential.
• Avoiding the use of shared utensils, especially spoons, plates, bowls, glasses, and bottles.
• Quickly washing hands after cleaning a child's runny nose or saliva.
• Promptly washing and disposing of soiled diapers or clothing in a covered bin without disposing of them in the drainage system.
• Seeking medical attention immediately if the child exhibits symptoms of hand, foot, and mouth disease. Once diagnosed, the child must stop attending school for at least one week or until the sores have healed.

In cases of severe hand, foot, and mouth disease infections, such as Enterovirus 71, which can result in fatalities, childcare centers and kindergartens may need to implement more stringent prevention measures. These could include closing the entire school for at least two weeks, cleaning classrooms and toys, screening out sick children at the entrance, and promoting handwashing and sanitization.

Furthermore, hand, foot, and mouth disease is a notifiable disease, so any organizations or agencies that identify cases must report them using a reporting card number 506.

For parents and caregivers, it is important to maintain cleanliness and hygiene, keep nails trimmed short, frequently wash hands with soap and water after using the bathroom and before eating, use a communal spoon, and avoid sharing items like cups, straws, face towels, and handkerchiefs.

Childcare centers and kindergartens must provide handwashing stations and sanitary facilities that meet hygiene standards, regularly maintain cleanliness and hygiene of the premises and equipment, and properly handle and dispose of children's excrement to prevent the spread of the disease to other children. In case of sick children, immediate measures must be taken to prevent the transmission of the disease to others.