The cases of Hand, foot, and mouth disease (HFMD) in Malaysia have been rising since the beginning of 2022 and have exceeded the warning level. Preschools and kindergartens are closing one by one to curb the spread of this disease.
Statistics
An upward trend of 20-fold is shown from 2021 up till May 25th 2022. This may be due to the reopening of preschools, kindergarten, nurseries and day-care centres after COVID-19 lockdown.
What is HFMD?
Hand, foot, and mouth disease, or HFMD is a highly contagious illness. HFMD is mainly caused by a type of virus called Enterovirus (specifically non-polio Enterovirus species A) with the majority of the cases being from Coxsackievirus A16 and Enterovirus 71 (E71).
Enteroviruses such as Coxsackievirus A16 and Enterovirus 71 are members of the Picornavirus (pico=small; rna=ribonucleic acid) family. They are generally small, with only 25-30 nm in diameter (approx.) and icosahedral in shape in which generally most viruses are of this shape (Refer to the figure below). The viruses lack an envelope (membrane), which results in relatively high resistance to environmental factors and alcohol.
“Humans are the only hosts for the non-polio enteroviruses”
“EV71 and Coxsackievirus A16 are very closely related”
The illness can affect anyone but children aged below 6 are more likely to get infected. The virus can spread from person to person through direct contact with saliva, liquid from blisters, respiratory particles (cough, sneeze and spit) and faeces. Public facilities with many children including preschool, kindergarten, and day-care are at higher risk of infection.
Symptoms
Similar to chickenpox, you will notice dots and more dots, but on the hands, feet, and the insides of the mouth. These blisters and rashes usually go off on their own in a few days.
Symptoms will appear within 3 to 6 days of infection. This period is known as the incubation period. When the symptoms appear, the child might experience:
- Fever
- Sore throat
- Headache
- Loss of appetite
- Malaise (feeling unwell)
- Painful blisters on the insides of the mouth (tongues as well)
- Rashes around the hands and feet
Diagnosis
Doctors can diagnose HFMD through a physical examination. They will check for the appearance of blisters and rashes around the soles of the feet and palms. Besides that, the doctor may perform a throat swab or stool test to confirm the diagnosis.
Treatment
There are currently no specific medications for HFMD and in most cases, the infection will go away without treatment within 7 to 10 days. Doctors may recommend treatments to ease the pain and discomfort. The treatments are:
- Over the counter prescriptions (creams/ gels or calamine) to soothe blisters and rashes
- Mouthwash
- Lozenges and throat spray
- Painkillers (ibuprofen, acetaminophen, non-aspirin fever reducer)
Drink plenty of water to avoid dehydration. Take milk-based drinks and cold foods such as ice cream and popsicles which are easier to swallow and can ease the pain.
Prevention
There is no vaccine for HFMD. Hence, in order to prevent the spread of HFMD, the most important step is to keep your hands clean at all times (i.e., after using the toilet, preparing food, changing diapers, etc). Follow the 7 steps of handwashing with soap and regular use of hand sanitizer. Besides keeping your hands clean, regularly clean the contacted surface with disinfectant as the virus can live on the surface for several days. The Centers for Disease Control and Prevention (CDC) recommends washing the surfaces with soap and water, followed by a solution of a tablespoon of chlorine bleach to 4 cups of water.
Practice a 7-to-10-day quarantine period if you or your child has HFMD or showing related symptoms. Avoid going to crowded and public places as the virus can be easily spread to other people.
Bottom line
Although individuals that are infected with HFMD will build their immunity against the virus, HFMD is caused by multiple types of viruses. You may be immune to one virus but might catch another. Hence, regular hand washing, sanitization, and cleaning remain a top priority to prevent the spread of HFMD.
References
1. Alifah, Z. 2022. Expert: ‘Foolish’ To Report 20-fold HFMD Case Rise From 2021. CodeBlue. Accessed on 1st June 2022 from https://codeblue.galencentre.org/2022/05/27/expert-foolish-to-report-20-fold-hfmd-case-rise-from-2021/.
2. Anon. 2021. Hand, foot and mouth disease. NHS. Accessed on 30th May 2022 from https://www.nhs.uk/conditions/hand-foot-mouth-disease/.
3. Anon. Genetic: Hand-Foot-And-Mouth-Disease. Encyclopedia.com. Accessed on 30th May 2022 from https://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/genetic-hand-food-and-mouth-disease.
4. Crider, C. 2022. What is the Hand, Foot, and Mouth Disease Quarantine Period? Healthline. Accessed on 30th May 2022 from https://www.healthline.com/health/hand-foot-and-mouth-quarantine-period#fa-qs.
5. FMT Reporters. 2022. HFMD cases ip by 19% in a week. Free Malaysia Today. Accessed o on 31st May 2022 from https://www.freemalaysiatoday.com/category/nation/2022/05/31/hfmd-cases-up-by-19-in-a-week/.
6. Selner, M. 2022. What is Hand,Foot, and Mouth Disease (HFMD)? Healthline. Accessed on 30th May 2022 from https://www.healthline.com/health/hand-foot-mouth-disease#treatment.
7. Steven L. Percival, Marylynn V. Yates, David W. Williams, Rachel M. Chalmers, Nicholas F. Gray, Microbiology of Waterborne Diseases (Second Edition), Academic Press, 2014, Pages 493-504,ISBN 9780124158467,https://doi.org/10.1016/B978-0-12-415846-7.00025-1.
8. Zhou, Y., Van Tan, L., Luo, K. et al. Genetic Variation of Multiple Serotypes of Enteroviruses Associated with Hand, Foot and Mouth Disease in Southern China. Virol. Sin. 36, 61–74 (2021). https://doi.org/10.1007/s12250-020-00266-7.
