Hand, foot and mouth disease is amongst our children again

Rashes and blisters on the hand are the most common sign of HFMD. — Photos: Filepic

As restrictions due to the Covid-19 pandemic are relaxed and the public return to their pre-pandemic activities, we are seeing a worrying rise in the number of hand, foot and mouth disease (HFMD) cases.

HFMD is a common illness in childhood.

Although it may affect people of any age, it is mostly seen in children below five years old, and is especially prevalent in closed settings such as nurseries and kindergartens.

There are several types of viruses responsible for causing HFMD, including enterovirus 71 and coxsackievirus A16.

Enterovirus 71 is associated with a higher risk of complications.

HFMD is easily transmitted through direct contact with secretions, rash blister fluid or faeces from the affected person.

If a healthy child shares playthings or touch common surfaces contaminated through touch, coughing, sneezing or fluid from the ruptured blisters, the child may contract the disease.

After the virus enters the body, there is a period of time when the person has no symptoms.

This incubation period lasts between three to seven days.

After this period of time, the earliest symptom that arises is fever, followed by the rashes typical of HFMD 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, the wrists and ankles.

Lesions are almost always present on the hands and may be the only manifestation of the illness.

In some cases, the rash only affects the oral cavity, which may make it difficult to differentiate HFMD from other common childhood illnesses such as herpangina or tonsillitis.

Mouth rashes in particular, may be very painful to the child, resulting in them completely refusing all forms of feeding.

This in turn, causes the child to become dehydrated, and thus, tired, irritable and have reduced passage of urine.

If left untreated, the dehydration may progress to adversely affect the organs.

In fact, dehydration is by far the most common complication seen in HFMD.

Dangers and management

One of the most serious complication of HFMD is aseptic meningitis, which is inflammation of the meninges layer of the brain.Mouth rashes can be very painful and cause the child to avoid eating and drinking, which triggers other problems like dehydration.Mouth rashes can be very painful and cause the child to avoid eating and drinking, which triggers other problems like dehydration.

The affected child may demonstrate a high unremitting fever, develop a seizure, or have significant changes in behaviour, becoming confused or disorientated.

This is a condition that requires immediate attention at the hospital.

Thankfully, it is a rare complication.

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.

Such cases do not generally require hospital admission and can be treated on an 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:

  • Adequate fluid hydration and rest.
  • Isolating the affected child at home and not allowing them to attend nursery or kindergarten for seven to 10 days from the start of their symptoms.
  • Observing proper handwashing, especially after changing diapers or toileting.
  • Not sharing personal items such as cups and utensils, which should be washed with detergent after use.

Please seek immediate medical attention if the following occur:

  • Child is unable to tolerate oral feeding, has reduced passage of urine and appears dehydrated.
  • Child appears very ill and tired.
  • Persistent fever (more than 38°C) for more than 48 hours.
  • Suspicion of brain involvement, e.g. seizures, abnormal change in behaviour or drowsiness.
  • 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 HFMD.

Dr Yeap Jo Wearn is a consultant paediatrician. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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