This report discusses what Hand, Foot and Mouth Disease (HFMD) is how it is spread as well as the precautions one should take to avoid getting HFMD. There have been recurrent outbreaks of HFMD over the last few years and similar outbreaks of HFMD have also occurred in the region, namely in Brunei and Sarawak. In the recent outbreak in March this year, the number of HMFD cases in Singapore reached a peak of 785 cases a week.
With the recurrent outbreaks of HFMD in Singapore and the region, and the potentially serious effects of the disease, particularly on children, the Ministry of Health (MOH) has tightened its guidelines on the procedures for the management of HFMD in child care centres in Singapore. In fact, HFMD is one of 30 ‘notifiable’ diseases which means that general physicians, polyclinics and hospitals have to inform MOH about every case of HFMD.
Owing to the major impact HFMD has on public health, this report serves to highlight several important aspects of HFMD and is submitted to Dr Mark Lim, lecturer of Public Health (PH) at Dover Polytechnic, in partial fulfilment of the PH module. 2. Background of HFMD 2. 1 Definitions of HFMD Hand, foot and mouth disease (HFMD) is a human syndrome caused by intestinal viruses of the picornaviridae (small RNA virus) family. And it is endemic in Singapore. 2. 2. Symptoms of HFMD.
People who have been infected with HFMD will normally show symptoms such as having fever for 2-3 days, sore throat, rashes (which are flat or raised red spots, sometimes with blisters) on palms of hands, soles of feet, or buttocks , mouth ulcers, poor appetite, vomiting and diarrhoea, tiredness and weakness (“feeling sick”) 2. 3. Causes of HFMD HFMD is an illness caused by intestinal viruses; commonest being Coxsackie virus and Enterovirus 71. The enterovirus called Coxsackie virus A16 is the most common cause of HFMD. Also, another strain of the virus is the potentially deadly Enterovirus-71 (EV71).
However, in some cases, other enteroviruses can also cause HFMD. 2. 4. Age group that is more susceptible to HFMD Children under 10 years old are more prone to infection of HFMD, but adults are also at risk of being infected. Not everyone who is infected becomes ill and shows symptoms, and everyone is at risk of being infected. Infants, children, and adolescents are more prone to infection and becoming ill from these viruses, because they are young and they are not immune as they have not been exposed to the specific kind of virus before.
The infection leads to immunity to the specific strain of virus, but there might be a relapse in HFMD by a different strain of virus. 2. 5. Complications of HFMD HFMD is usually mild and self-limiting. However, some of the serious implications caused by the virulent strain include Myocarditis (an inflammation of the heart muscle), Viral Pneumonitis (an infection that causes irritation, swelling and congestion in the lungs), Asceptic Meningitis (the inflammation or irritation of the brain lining), Encephalitis (an inflammation of the brain), All of these conditions are potentially fatal.
3. Transmission of HFMD HFMD is usually spread from person to person by direct contact with the nasal discharge, saliva, fluid from blisters and faeces of an infected person. A person may also be infected indirectly through indirect contaminants such as contaminated towel. A person is most contagious during the first week of the illness and the incubation period of HFMD is 3 to 5 days (with a range from 2 days to 2 weeks). Illness will normally last for 10 days if no serious implications occur. 4. Prevention of HFMD.
4. 1. Methods of prevention Currently, there is no specific prevention for HFMD or other non-polio enterovirus infections, but the risk of infection can be lowered by good hygienic practices. Preventive measures include frequent hand washing, especially after contact with contaminants such as the child’s diapers. Contaminated surfaces and soiled items should be cleaned first with soap and water, and then disinfecting them by diluted solution of chlorine-containing bleach (made by mixing approximately ?cup of bleach with 1 gallon of water).
Risk of infection can also be reduced by preventing any close contact such as kissing, hugging, sharing utensils, with children infected by HFMD. Also, children can be checked daily for tell-tale signs of HFMD such as blisters on palms and soles of children, and ulcers on tongue and in mouth of children. 4. 2 Advise to parents with infected child It is best to consult a doctor early if their child has symptoms of HFMD.
Parents should also be aware of any changes to their child’s normal behaviour, e. g. irritation and sleepiness. If the child refuse to eat or drink, have persistent vomiting or drowsiness, parents should bring their child immediately to the Accident and Emergency (A&E) Departments of either the National University Hospital (NUH) or the Kandang Kerbau Hospital (KKH), to avoid complications.
4. 3 Prevention for family members of infected child Other than keeping proper hygiene of the infected child, family members should also be more alert and keep up the good hygiene standard such as hand washing frequently with soap and running water before eating and after going to the toilet, covering mouth and nose when coughing or sneezing, maintaining good air circulation, cleaning the premises and toys or appliances that are handled by the infected child or are contaminated by his/her nasal or oral secretions with 0. 5% sodium hypochlorite solution. Sodium hypochlorite is the active ingredient in most household bleaches.
(If your bleach contains 5. 25% of sodium hypochlorite, you need to dilute one part of your bleach in ten parts of water to get 0. 5% sodium hypochlorite solution. ). Lastly, prevent from sharing eating utensils. (Health Promotion Board, 2012) 4. 4 Treatment plans For now, there is no specific treatment for the infection other than symptomatic relief of symptoms. Also, treatment with antibiotics has been unproductive. If the child is doubt to have been infected with HFMD, please consult the family doctor as soon as possible.
The symptoms and discomfort can be reduced by drinking plenty of fluids, changing to a soft diet such as porridge if the mouth ulcers are painful, take medicine such as paracetamol syrup to relieve fever and pain prescribed by the family doctor, and staying at home to get plenty of rest. 5. Conclusion In conclusion, Hand, Foot, Mouth disease is a serious disease caused by intestinal viruses of the picornaviridae (small RNA virus) family. It is serious and the young children aged 10 and below are more prone to infection.
The virus attacks their weak immune system as they have never been exposed to similar viruses. One of the more obvious symptoms of children being infected with HFMD includes blisters on hands and feet, with ulcers in the mouth. Some of the serious complications include Myocarditis, Viral Pneumonitis, Asceptic Meningitis, and Encephalitis. Transmission methods include direct contact with the nasal discharge, saliva, fluid from blisters and faeces of an infected person.
The infection can be prevented by washing hands frequently, and family members of infected kids should also keep up the good hygiene standard in the family and avoid sharing utensils. Kindergarten can also prevent transmission by checking the mouth, hands and feet of children daily when they attend school. Also, parents should consult their family doctor immediately when they suspect cases of HFMD in the family, especially young children. Treatment plans are currently unavailable and medicines can only be given to relieve painful symptoms.
6. Reference 1. Health promotion board, 2012, Hand, Foot & Mouth Disease, [online], Singapore, Available from http://www. hpb. gov. sg/HOPPortal/dandc-article/792, [Assessed date 14/5/2013] 2. Kwai Peng Chan,* Kee Tai Goh,† Chia Yin Chong,‡ Eng Swee Teo,§ Gilbert Lau,§ and Ai Ee Ling* ,2012, Epidemic Hand, Foot and Mouth Disease Caused by Human Enterovirus 71, Singapore, [online], Singapore, available from http://www. ncbi. nlm. nih. gov/pmc/articles/PMC2873753/, [assessed date 14/5/2013].