http://www.hpb.gov.sg/diseases/article.aspx?

id=792

Hand, Foot & Mouth Disease

Hand, Foot & Mouth Disease (HFMD) is present all year round in Singapore. Outbreaks do occur in childcare centres, kindergartens and schools. Although usually a mild disease, it has been known to cause serious complications and even death in some instances.

Hand, Foot & Mouth Disease (HFMD) is caused by certain viruses. Among them, it is the EV71 virus that can give rise to serious complications.

Click to view a larger version of each photo. (Courtesy of KK Women's and Children's hospital.)

HFMD became legally notifiable on 1 October 2000.

How it is spread
HFMD is spread from person to person by direct contact with the nasal discharge, saliva, faeces and fluid from the rash of an infected person. Both adults and children can be affected, but young children below five years of age are particularly susceptible.

Signs & symptoms

A child with HFMD may suffer from some of the following symptoms:

fever sore throat ulcers in the throat, mouth and tongue headache

rash with vesicles (small blisters 3-7 mm) on hands, feet and diaper area. The vesicles are typically on the palm side of the hands the sole side of the feet and very characteristic in appearance. The rash may also be present on the buttocks, arms and legs.

loss of appetite vomiting and/or diarrhoea

Complications
Severe ulcers in the mouth can be very painful and this may interfere with intake of food and drink resulting in dehydration. Dehydration may also be caused by persistent vomiting/diarrhoea coupled with a reduced fluid intake.

Complications such as brain, lung or heart infections may occur occasionally, usually due to the EV 71 virus and can be serious. Some signs and symptoms of complications include:

severe headache, giddiness and neck stiffness disorientation, drowsiness and/or irritability fits breathlessness or turning blue

Screening & diagnosis

Laboratory testing is available to isolate and identify the causative agent. However, testing is usually not necessary as diagnosis of Hand, Foot and-Mouth Disease (HFMD) is typically based on clinical grounds.

Treatment
There is no specific treatment for the infection other than symptomatic relief of symptoms. Treatment with antibiotics is not effective and is not indicated. If you suspect your child has HFMD, please bring him/her to see the family doctor. Ease your childs discomfort and help your child recover :

Encourage your child to drink plenty of fluids Change to a soft diet (e.g. porridge, pureed fruit) if the mouth ulcers are a problem Give medications as prescribed by the doctor, e.g. paracetamol syrup to relieve fever and pain Ensure your child gets plenty of rest by keeping him/her at home

Keeping others safe

If your child has HFMD, please help to prevent the spread of HFMD to others:

Keep him home from school, kindergarten or childcare centre.

Keep him away from all public places including restaurants, playgrounds and shopping centres. Look out for signs and symptoms in other family members, both children and the adults. Keep his toys, books, eating utensils, towels and clothes separate from others. Inform the school, kindergarten or childcare centre as soon as possible. They can monitor other children closely and take additional precautions to prevent the spread of HFMD. Keep him at home until all the blisters have dried up and he has fully recovered, after the expiry of the medical certificate (MC) given by the family doctor.

Prevention
Advice for parents
Help protect your children from HFMD. Teach them good hygiene practices:

Wash hands with soap before eating and after going to the toilet. Cover mouth and nose when coughing or sneezing. Do not share eating utensils. Ensure that toys or appliances that are contaminated by nasal or oral secretions cleaned thoroughly before they are used again.

In addition, do follow these four steps before sending your child to the childcare centre every day. 1. 2. 3. 4. Take your childs Temperature (either orally or via the ear) Look for mouth Ulcers. Ask your child to open the mouth and say Ah. Shine a torch in the mouth and look for ulcers on the tongue, inner sides of the mouth and on the lips. Look for blisters on the Hands. Ask your child to hold out the hands and show his/her palms. Look for small pinkish/reddish bumps or tiny blisters with fluids. Then check for the same on the back of the hands. Look for blisters on the Feet. Check for bumps/blisters on the upper part of the feet first then the soles.

If you suspect any of the above, DO NOT send your child to the centre. Take him/her to a family doctor for a thorough examination. If your child is diagnosed with HFMD, please keep him/her at home until fully recovered. Your child should return to the centre only after the expiry of the MC given by the family doctor when he/she is well.