Hand, Foot and Mouth Disease (HFMD)

I feel compelled to write something about Hand, Foot and Mouth Disease (HFMD) after listening to the woe of my friends whose children had or is having HFMD. The information I write here are a compilation from the internet with some analysis that I carried out.

1) Organism
Wikipedia entry mentioned that Hand, foot and mouth disease (HFMD) is a human syndrome caused by intestinal viruses of the Picornaviridae family. The most common organisms causing HFMD are Coxsackie A virus and Enterovirus 71 (EV-71). I understand that within that two species there are plenty of strains and new strain can also emerge. That should be why your child who has had HFMD did not develop immunity towards HFMD. Other strains may strike and when that happens, your child does not have immunity. If it is the same strain, most likely your child would be immune. Something in the line of why Flu vaccination has to be taken every year.

2) Victim
Basically it is infant and children who can fall ill to HFMD. However, although uncommon, healthy adult can also get HFMD. I had one colleague who actually contracted HFMD and although it was mild, she was absent from work.

3) Incubation period
The most commonly stated incubation period from infection to onset of symptoms are three to seven days although Singapore's MOH states in their website that the incubation period are between two to five days.

4) Symptoms
From US CDC website:
* The disease usually begins with a fever, poor appetite, malaise (feeling vaguely unwell), and often with a sore throat.
* One or 2 days after fever onset, painful sores usually develop in the mouth. They begin as small red spots that blister and then often become ulcers. The sores are usually located on the tongue, gums, and inside of the cheeks.
* A non-itchy skin rash develops over 1–2 days. The rash has flat or raised red spots, sometimes with blisters. The rash is usually located on the palms of the hands and soles of the feet; it may also appear on the buttocks and/or genitalia.
* A person with HFMD may have only the rash or only the mouth sores

Hence, it is important to check for those symptoms if you suspect your child to have contracted HFMD.

5) Transmission
The most common transmission route for HFMD is contact transmission. Meaning that the illness is passed through contact. So it is not something you get from breathing in the virus. It is something that has to get into your body. The virus causing HFMD can be found in nose and throat secretion, blister fluid, saliva and stool. Hence if a kid touch those infected fluid and get that fluid inside his/her body, he/she can be infected. Once the virus is inside the body, it does not necessarily cause a disease. However, children are with lower immunity compared to adult and hence, the chances of getting the disease after infection is more likely. It is also said that the first week of illness is the most infectious period. Disappearance of symptoms should also not be taken as a sign that the child is no longer infectious.

In fact, some people who are infected with HFMD may not have symptoms. Hence, it is very important to check your child's surroundings and friends to ensure that no one has had symptoms of HFMD and keep personal hygiene high. You should not let your guard down simply because there is no one with HFMD symptoms. This is specifically important if your child is in area where contact transmission is easier to happen, such as infant / toddler / child care, schools, etc.

5) Hygiene
It is important to inculcate good personal hygiene from young. Good personal hygiene will reduce the risk of infection but will never fully eliminate the risk.
Personal hygiene include (but not limited to):
- washing hand with soap and water before meal
- sneezing and coughing into tissue, handkerchief or the sleeves
- cleaning articles which may have come in contact with the body fluid of HFMD sufferers
- avoiding direct contact with HFMD sufferers

6) Vaccination
There is currently no vaccine available for HFMD. I am quite sure the inventor will earn quite a handsome amount of profit considering the economic loss from HFMD (e.g. parents taking leave to bring their child to doctor or even hospital).