Baby & ToddlerHealth & Medical DiaryAn Insight IntoHand, Foot andMouth Disease (HFMD)The Hand, Foot and Mouth Disease (HFMD) is considered an endemic disease in Malaysia asit tends to manifest sporadically in mass outbreaks, predominantly affecting young children.This year alone, between January 1 and June 18, a total of 106,477 cases have been reported,marking a 39-fold increase compared with the same period in 2021 whichrecorded only 2,710 cases.In this segment, we slide HFMD under the microscope as Dr Melanie Majaham,Consultant Paediatrician – Sunway Medical Centre Velocity sheds light on the disease,its symptoms, treatment and prevention methods.8 BabyTalk | September 2022
Baby & ToddlerHealth & Medical DiaryDr Melanie MajahamConsultant Paediatrician,Sunway Medical Centre VelocityWho are susceptible?Young children below age 5 are usuallymore prone to contracting HFMD.However, adults and older children canalso be affected.Cleanliness is next to godliness, goesthe age-old adage. And indeed so. Ifthere’s anything we have learnt thesepast few years since the menace thatis Covid-19 turned world economiesand lives topsy-turvy, it’s that it allboils down to prevention – prioritizingcleanliness is the key to keepingCovid-19 steadily at bay.And that rings true for a string ofdiseases endemic in Malaysia, includingthe Hand, Foot and Mouth Disease(HFMD), rearing its ugly head in analarming way of late with Selangorhaving documented 29,880 cases (atpress time), followed by Kuala Lumpurand Putrajaya with a collective 11,687cases, Perak 10,938 cases, Johor 7,052cases, and Kelantan 6,532 cases.Eighty-nine percent of these casesinvolved children aged six and below,with 56% reported having occurredin nurseries, kindergartens and preschools,followed closely by privateresidential units (40%) and child carecentres (3%).What is HFMD, and howdoes it present itself?Hand, Foot and Mouth Disease (HFMD)or ‘enteroviral vesicular stomatitis withexanthem’ is a common viral infectionthat affects, as the name clearlysuggests, the hand, foot and mouth.It leads to rashes on the hands andfeet that may be red spots or blisters,which can sometimes be confusedwith chicken pox. One of the hallmarksof the condition is extensive multipleulcers that can be seen on the roof ofthe mouth, tongue and lips.Causes and earlysymptomsHFMD is commonly caused by theEnterovirus Coxsackie A-16 and EV-71.Coxsackie A16 tends to lead to a morebenign course, and thankfully is thetype most often seen here in Malaysia.Severe HFMD that leads to brain andheart inflammation and mortality isusually associated with E-71.HFMD – common orseasonal?The disease is generally endemic inMalaysia, previously seen to peakduring the Southwest Monsoonseason particularly between Januaryand March, usually coinciding withthe opening of the new school term.However, following the Covid-19pandemic, we have seen a ratherexaggerated increase of cases this year,which is likely due to the opening ofborders and the sudden movement ofpeople across states, the reopeningof physical schools and daycare,which create a domino effect leadingto a marked increase of all commonchildhood infections, including HFMD.Is it contagious?HFMD spreads easily via contact withrespiratory droplets, saliva, fluids fromthe blisters and infected feces. It isusually most contagious during thefirst week of symptoms. However,less commonly, a child can remaininfectious for weeks after recovery.The stages of HFMDHFMD usually starts with vague nonspecificsymptoms such as fever, lackof appetite, sore throat and tiredness.At this stage, it mimics any viralinfection. Subsequently, 1 to 2 dayslater, the child will develop spots orblisters mainly on the hands and feet,as well as multiple painful oral ulcers.BabyTalk | September 2022 9