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Expatriate Malaysia Health Guide -  
Hand Foot Mouth Disease HFMD info, symptoms, transmission, prevention, treatment in Malaysia


What is hand, foot, and mouth disease (HFMD)?

Hand, foot, and mouth disease (HFMD) is a common illness of infants and children caused by a virus. It most often occurs in children under 10 years old. It is characterized by fever, sores/ulcers in the mouth, and a rash with blisters. The blisters may appear in the mouth, palms of the hands and soles of the feet. The rashes may also appear on buttocks and on the legs and arms. The ulcers in the mouth usually appear on the tongue, the sides of the cheeks, gums or near the throat.

What causes HFMD?

The most common causes of Hand, Foot and Mouth disease are coxsackie virus A16, enterovirus 71 (EV71) and other enteroviruses. The enterovirus group includes polioviruses, coxsackieviruses, echoviruses and other enteroviruses.

When and where does HFMD occur?

Individual cases and outbreaks of HFMD occur worldwide, more frequently in summer and early autumn (in temperate countries). In the recent past, major outbreaks of HFMD attributable to enterovirus EV71 have been reported in Malaysia in 1997 and in Taiwan in 1998. HFMD is endemic in Malaysia and occurs every year. In Sarawak, the number of cases of HFMD tends to increase from February to June.

Is HFMD serious?

HFMD caused by coxsackie virus A16 infection is a mild disease and nearly all patients recover within 7 to 10 days. Complications are uncommon. HFMD caused by Enterovirus EV71 may be associated with neurological complications such as aseptic meningitis and encephalitis. Cases of fatal encephalitis which occurred during outbreaks of HFMD in Malaysia in 1997 and in Taiwan in 1998 were caused by EV71.

Is HFMD contagious?

Yes, HFMD is moderately contagious. A person is most contagious during the first week of the illness. The virus can be transmitted from person to person via direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons. The virus may continue to be excreted in the stools of infected persons up till 1 month. HFMD is not transmitted to or from pets or other animals.

How soon will someone become ill after getting infected?

The usual period from infection to onset of symptoms (incubation period) is 3 to 7 days. Fever is often the first symptom of HFMD followed by blister/rash.

Hand Foot Mouth Disease HFMD SymptomsHand Foot Mouth Disease HFMD SymptomsHand Foot Mouth Disease HFMD Symptoms
Blister on the palms on the hand, foot and ulcer on the inner gums

What are the clinical signs and symptoms?

HFMD begins with a mild fever, poor appetite, malaise ("feeling sick"), and frequently a sore throat. One or 2 days after the fever begins, painful sores develop in the mouth. They begin as small red spots that blister and then often become ulcers. They are usually located on the tongue, gums, and inside of the cheeks. The skin rash develops over 1 to 2 days with flat or raised red spots, some with blisters on the palms of the hand and the soles of the feet. A person with HFMD may have only the rash or the mouth ulcers.

How is hand, foot and mouth disease diagnosed?

Hand, foot and mouth disease is usually diagnosed based on a complete history and physical examination of your child. It is generally suspected on the appearance of blister-like rash on hands, feet and mouth in children with a mild febrile illness.
Usually, the doctor can distinguish between HFMD and other causes of mouth sores based on the age of the patient, the pattern of symptoms reported by the patient or parent, and the appearance of the rash and sores on examination. A throat and/or blister swab collected preferably within 2 days of onset of HFMD may be sent to a laboratory to determine which enterovirus caused the illness.

How is HFMD treated?

Presently, there is no specific effective antivirul drugs and vaccine available for the treatment of HFMD. Symptomatic treatment is given to provide relief from fever, aches, or pain from the mouth ulcers. Dehydration is a concern because the mouth sores may make it difficult and painful for children to eat and drink. Should their affected children be having fever, the parents are advised to dress their children in light, thin clothing, to do tepid sponging with water (room temperature) as often as necessary, and to expose them under the fan. Taking enough liquids is very important apart from body temperature monitoring.

Who is at risk for HFMD?

HFMD occurs mainly in children under 10 years old, but may also occur in adults too. Everyone is at risk of infection, but not everyone who is infected becomes ill. Infants, children, and adolescents are more likely to be susceptible to infection and illness from these viruses, because they are less likely than adults to have antibodies and be immune from previous exposures to them. Infection results in immunity to the specific virus, but a second episode may occur following infection with a different virus belonging to the enterovirus group

Can HFMD be prevented?

Specific prevention for HFMD or other non-polio enterovirus infections is not available, but the risk of infection can be lowered by good hygienic practices. Preventive measures include:

  • Frequent hand washing, especially after diaper changes, after using toilet and before preparing food

  • Maintain cleanliness of house, child care center, kindergartens or schools and its surrounding

  • Cleaning of contaminated surfaces and soiled items with soap and water, and then disinfecting them with diluted solution of chlorine-containing bleach (10% concentration)

  • Parents are advised not to bring young children to crowded public places such as shopping centers, cinemas, swimming pools, markets or bus stations

  • Bring children to the nearest clinic if they show signs and symptoms. Refrain from sending them to child care centers, kindergartens or schools.

  • Avoidance of close contact (kissing, hugging, sharing utensils, etc.) with children having HFMD illness to reduce of the risk of infection.

Always consult a physician regarding health problems or medical conditions 

Other health related articles:

Dengue Fever info, symptoms, transmission prevention, treatment in Malaysia

Chikungunya fever, symptoms and the prevention in Malaysia

Bird/Avian Flu information and facts

Medical Services in Malaysia for Expatriates

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