Hand, Foot and Mouth Disease: All You Need to Know

Hand, foot, and mouth disease (HFMD) is a highly infectious disease that brings about painful mouth sores or an itchy rash on the body, particularly on areas like the hands, feet, legs, or buttocks. HFMD is most commonly associated with infants or young children below the age of five, but did you know that older children and adults may be affected as well? We speak with a doctor to find out all you need to know about HFMD.

Q: HFMD is a viral infection caused by a group of enteroviruses. What are enteroviruses and how do they lead to HFMD?
A: Enteroviruses are a group of viruses that can cause infectious illnesses and includes viruses like polioviruses, coxsackieviruses, and echoviruses.

HFMD  is usually caused by coxsackievirus A16, one of the most common viruses that lead to HFMD. Such cases are usually mild and have few complications. On the other hand, HFMD cases caused by enterovirus 71 often have more serious complications and may even be fatal. These viruses are easily spread from person to person.

Q: What are the signs and symptoms of HFMD, and do they vary between adults and children? If so, what signs and symptoms are more common among children?
A: HFMD signs and symptoms in adults are typically similar to that in children, although adults may display fewer signs and symptoms than children.

Common signs and symptoms include fever, sore throat, ulcers inside the mouth or on the sides of the tongue, rash (flat or raised red spots) or small blisters on palms of hands, soles of feet and sometimes buttocks, loss of appetite and lethargy.

It is possible for HFMD-infected persons not to show any signs or symptoms or only have rashes or mouth ulcers without any fever.

Q: Young children below five years old are more susceptible to HFMD. Why?
A: Young children below the age of five are more susceptible to HMFD than older children or adults because their immune systems are not as strong, and they have fewer antibodies.

Q: How long do these signs and symptoms usually last for?
A: A fever is usually the first sign of HFMD, preceding a sore throat, poor appetite, or general feeling of being unwell. Sores may start to develop in the mouth or throat within one or two days after the fever begins. These may be followed by a rash on hands and feet within one or two days. The duration of the signs and symptoms varies from person to person.

Q: The term “prolonged transmission” is often used in relation to HFMD. What does it refer to?
A: A transmission rate of more than 16 days is termed “prolonged transmission” and is usually used to refer to transmissions in areas such as childcare centres or kindergartens.

Q: What should I do if I suspect that my child has HFMD?
A: Seek medical attention immediately if you suspect that your child has HFMD. In addition, parents are advised to bring their child to the A&E departments of either KK Women's and Children's Hospital or National University Hospital if their child refuses to eat and drink, or has persistent vomiting or drowsiness, irritation and sleepiness.

Q: How is HFMD spread from person to person?
A: HFMD can be transmitted through direct contact with mucus, saliva, poop (such as when changing the diapers of infected babies) and blister fluids of an infected person. This may involve close personal contact or even indirect contact such as touching an infected doorknob without washing your hands after such contact.

Q: How is HFMD diagnosed?
A: Your doctor will ask about your child's symptoms and do a physical check of your child for rashes or sores. This is usually enough to help your doctor distinguish HFMD from other illnesses, but he/she may also take a throat swab or stool specimen to be sure of the type of virus that caused your child’s HFMD.

Q: What complications can arise from HFMD?
A: HFMD is generally mild, and complications are rare. Dehydration is the most common complication of HFMD and may arise due to the presence of sores in the mouth and throat leading to difficulty in swallowing. As such, ensure that your child is taking enough fluids to prevent dehydration.

Rare forms of HFMD may lead to serious complications like viral meningitis or encephalitis (infections of the brain and membranes around the brain).

Q: There is no specific treatment for HFMD. What can parents do to manage HFMD in their children?
A: You can help to relieve your child's discomfort by providing him with soft foods that do not require chewing, ice pops or ice water, and avoiding foods and beverages that could irritate the mouth/throat sores such as citrus fruits, fruit drinks, soda and salty or spicy foods. If you are worried about your child's fever, you may check with your doctor for medicine to bring down the fever. In addition, ensure that your child is getting enough rest and drinking plenty of fluids to avoid dehydration.

Q: What can adults do to manage HFMD if they contract it?
A: Adults can manage HFMD in much the same way as children, by ensuring they drink enough fluids and get enough rest as there is no specific HFMD treatment for adults. Similarly, you may use over-the-counter medications to manage your fever.

Q: How long does the HFMD virus typically stay in the body? For example, we read that the virus can stay in a person’s stools for several months even after the symptoms have passed.
A: HFMD generally clears up between seven and 10 days without medical treatment, but the virus can stay inside your stools for several weeks after the infection.

In addition, it is possible for you to be infected with HFMD and still not show any symptoms, which is why it is important for you to practise good hygiene to avoid the spread of HFMD.

Q: How do you prevent the spread of HFMD to others, including your family members?
A: If you have HFMD, you can do your part to protect others from the spread by:

• Practising good hygiene such as washing your hands regularly, especially before eating and after visiting the toilet. Hands should be washed with soap and water for at least 20 seconds
  
• Covering your mouth when you cough or sneeze
• Staying indoors and away from public spaces
• Avoiding close contact, including with your family members
• Not sharing food and drinks, as well as personal items such as toothbrushes, eating utensils, towels and clothes
  
• Putting on a face mask when feeling unwell and staying home until recovered
  

Q: When is an HFMD patient most contagious?
A: An HFMD patient is most contagious during the course of the illness.

Q: Most adults and children are kept from public spaces when they contract HFMD. When will HFMD patients be able to return to their normal routine (e.g. attending school or work)?
A: Generally, you or your child may return to work or school once your blisters have dried up and all your symptoms have cleared. You can do these four checks to ensure that you or your child is fit to return to work or school:

• Check for fever
• Check for blisters on the palms of hands and arms
• Check for mouth ulcers
• Check for rash or blisters on the soles of feet, legs and/or buttocks

Do check with your doctor if you are not sure whether you or your child can return to the daily routine.

Q: Is it true that: a) you can get HFMD more than once b) you can continue breastfeeding your child safe even if you have HFMD?
A: Yes, it is possible for you to get HFMD again even if you have contracted HFMD before. While you can develop immunity to the particular virus that has made you sick, you may still get HFMD as it can be caused by several types of viruses.

Yes, you can continue breastfeeding your child even if you have HFMD as the virus cannot be transmitted through breast milk.

Q: Is there any vaccine available for HFMD?
A: No, there is no vaccine available for HFMD in Singapore.

Q: What are early risk indicators for potential HFMD outbreaks?
A: One of the early risk indicators of an HFMD outbreak could be a warm and dry climate. The findings of one study indicated that the incidence of HFMD in Singapore may increase whenever the temperature increases above 32 degrees Celsius, and/or when weekly cumulative rainfall dips below 75 millimetres.

Q: Should parents take their children out of kindergarten or childcare if at least one student has HFMD? If yes/no, why?
A: No, it is not necessary to take your child out of school if only one student has HFMD. You may choose to take your child out of kindergarten or childcare if the centre/school has been identified to have more than 10 HFMD cases or an attack rate greater than 13 percent, and prolonged transmission.

Q: Finally, what can adults and children do to protect themselves from HFMD?
A: Here are five simple steps you can take to FIGHT the spread of infectious diseases such as HFMD:

• Frequent hand washing
• Immunisation
• Go to the doctor
• Home rest
• Tissues and masks

In addition, avoid sharing food and drinks or personal items such as toothbrushes, towels and eating utensils.