Dr Amar answers questions on HFMD

Copyright: frank600 / 123RF Stock Photo

How worried should you be? You have a little one in kindergarten and you keep hearing stories about Hand, Foot and Mouth Disease (HFMD). The name alone is enough to strike fear in your heart. Senior Consultant Paediatrician Dato’ Dr Amar-Singh HSS takes time to answer some questions about the disease.

What are the symptoms and signs of HFMD?

Children infected with HFMD usually have fever, a sore throat with a reduced appetite and a general feeling of unwellness. After 1-2 days, they develop painful mouth and throat ulcers and small blisters or red spots on the palms of their hands and soles of their feet, sometimes on the buttocks. The disease may vary between children, with some having a milder form or no symptoms.

What causes it? Who normally gets it? How is it transmitted?

HFMD is caused by a group of viruses called Enterovirus. Of these, the common ones that infect our children are the Coxsackie viruses, especially Coxsackie A16. However the virus that causes a more severe disease in our region is Enterovirus 71.

Usually children under 5 years are infected but it can affect children up to 10 years of age.

HFMD is transmitted by contact with the nasal discharge or saliva, fluids from the blisters and stools of an infected person. The person who is infected is most likely to transmit HFMD during the first week of illness, especially during the early stages of the disease. Hence, we get HFMD by close contact like kissing or sharing eating utensils, when someone infected coughs or sneezes near us, when changing a nappy and touching objects or surfaces that have been contaminated by the virus.

Can older kids and adults get it too?

Although it generally affects younger children, older children and adults can also be infected. Some of the older children or adults may not show any symptoms but have the ability to pass the virus to others. Many of us have been infected with HFMD in the past or as children but are not aware of it.

Is HFMD serious at all? What are the risks or complications, if any?

Most children with HFMD will have a mild illness and recover with no complications. Some children, due to the painful mouth and throat ulcers, may not drink sufficiently and can get dehydrated. Rarely children might get a severe complication like viral meningitis or encephalitis (viral brain infection), pulmonary oedema (fluid in the lungs), or heart failure. This especially occurs to younger children, under 2 years of age, infected with EV71.

What is the treatment? How long is the recovery period?

There is currently no specific medication or treatment for Enteroviruses. But we do need to treat the complications of HFMD. Children who are not drinking well might need to be admitted to receive adequate fluids via a drip (intravenous fluids). It may be useful to use some paracetamol to help relieve pain and fever. Most children recover after 7-10 days, many earlier.

If my child looks reddish and is feverish, how do I know it’s not just because of the heat? When should I suspect HFMD?

It’s difficult to suspect HFMD in the early stages when they have just fever. Once they have ulcers in the mouth/throat or blisters/red spots on the palms and soles you can be fairly sure they have HFMD. There is no quick blood or other tests to diagnose HFMD; viral samples take too long to come back. Remember that by the time the child has the classical rash or ulcers they have been contagious for a few days.

When should I take my child to the doctor?

Most children will have a mild illness that will settle within a week. Children who should be brought for medical attention/care are those with what we call “danger signs” – signs that the child might need urgent medical care. These include:

1. Those who are not able to take orally well, vomiting or passing less urine.

2. Those who look lethargic and weak.

3. Have high or persistent fever for more than 2-3 days.

4. Exhibit rapid breathing.

5. Children who are drowsy (difficult to wake your child up) or irritable.

6. Any fits, abnormal body movements or weakness of any part of the body.

If you are concerned for your child’s wellbeing, do consult a doctor.

Should my child be quarantined? Can I leave my child in school if my child has any symptoms?

Any child who has HFMD should not go to public places including schools, kindergartens or nurseries to limit the spread of the infection. There is some data that suggests that the siblings at home (especially younger ones) may get a worse viral infection than the child who was infected in kindergarten/nursery. This could be because the viral dose they receive is much higher at home due to closer and extended contact time. The measures we should take at home include:

1. Don’t let the child infected with HFMD sleep with the other children – it is best the child with HFMD sleep with an adult in a separate room.

2. Avoid sharing food, eating utensils, towels and toothbrushes between the children and adults.

3. Wash your own hands more often with soap and water, especially after caring for the child infected with HFMD. Teach your children to wash their hands more often.

4. Have a good diaper hygiene practice – use disposable nappies, dispose of them correctly and disinfect the surface where the nappy change occurred.

5. Have a routine to disinfect surfaces and objects that have been frequently touched by the child with HFMD. Avoid stuffed animals/soft toys that are harder to clean.

Can I take my child to school if I hear there are cases of HFMD in that school?

This decision should be made with the school authorities.

How safe is it for my child to play with other kids with HFMD spreading?

It is difficult to isolate children completely, especially for long periods. Definitely children who are infected with HFMD should not meet or play with other children until they are well, i.e., no more fever, mouth ulcers, blisters or red spots/rash on palms and soles.

The news says there is an outbreak in Penang, is it safe for my family to go there?

HFMD is a common infection that occurs throughout the year. In any large state we would expect 1,000-2,000 cases reported yearly. So, it is happening all the time with seasonal increases. Occasionally, we get an outbreak, as we are seeing in Penang right now. This should not stop us from visiting the region and the children most at risk are the ones living there.

How do I protect my child? What can we as a community and country do to fight HFMD?

Parents, the public and staff/teachers looking after nurseries, kindergartens, preschools and schools should work together to limit the spread of HFMD during an outbreak. The measures we can take include:

1. Staff should inform the heath authorities if they note a rise in HFMD in their centre.

2. Parents should ensure that children infected with HFMD should not attend any of these facilities until they are fit.

3. Staff at these premises should daily screen all children coming for signs of HFMD.

4. Train staff and children to practise good personal hygiene, especially hand washing after contact with another child.

5. Staff should adhere to a clear policy on cleanliness of premises and carry out routine disinfection on chairs, tables, bathrooms, toys and appliances used by children.