Rise in HFMD cases, what is it and how to protect your children?

Hand, Foot, and Mouth Disease (HFMD) can be caused by viruses from the Enterovirus genus, most commonly the Coxsackievirus. It is common in young children and is contagious but usually mild. The symptoms are fever, a skin rash with ‘red spots’ on the palms and soles of the feet (sometimes small blisters) and sores in the mouth. The painful sores or ulcers in the mouth may make the child drink or eat less.

There is no specific treatment for HFMD but symptoms of mouth pain and fever can be treated with paracetamol. Most children get better within 7 to 10 days. Rarely HFMD can cause severe disease, including involvement of the heart (myocarditis) or brain (neurological complications). You should see a doctor if your child is lethargic, drowsy, not able to drink, fever is high and persists for more than 2-3 days, or your child looks ill to you.

Of concern is the recent press statement by the Health Ministry (MOH) that reported a large rise in cases this year compared to previous years (see graph). (https://kpkesihatan.com/2022/05/17/kenyataan-akhbar-kpk-17-mei-2022-penularan-jangkitan-penyakit-berjangkit-tangan-kaki-dan-mulut-hfmd-dan-denggi-di-malaysia-me-19-2022/)

Trend of HFMD cases based on ME from 2019 to ME19/2022

It is important to note that HFMD cases were dramatically reduced during the past two years when we had lockdowns and children were not able to go to kindergartens and primary schools (41 weeks of school closure). In addition, in the past two years there has been a heightened awareness of hygiene, widespread mask use and extensive use of hand and surface alcohol disinfection. This meant that many children who would have got HFMD during that period did not get infected. Now with the reopening of education services and greater mixing of children, with a more ‘relaxed’ approach to standard operating policies (SOPs), we can expect that many susceptible (previously spared) children will get infected.

Some suggestions to protect our children include:

1. Recognise that HFMD is spread easily by close personal contact - through coughing or sneezing, touching contaminated objects or surfaces, and via faeces. So good hand-washing or hand disinfection is useful to reduce spread, including when using the toilet.
2. Any child with signs of HFMD should not go to school or kindergarten until they have recovered. They should see a doctor.
3. If one child is unwell with HFMD, they should not sleep with other children in the family but with an adult (preferably limit contact with other children in the home).
4. Pre-school education staff should consider monitoring children for signs and symptoms of HFMD daily on arrival.
5. Pre-school education staff should ensure that children do not share eating or drinking utensils.
6. Limit unnecessary contact with other children in public areas.

Dato' Dr Amar-Singh HSS, Consultant Paediatrician and Advisor