Hand-Foot-Mouth disease: a concern for our little ones
A disease that inevitably strikes fear in the hearts of parents with kids of kindergarten or primary school age whenever an outbreak occurs, Hand-Foot-Mouth disease (HFMD) is a contagious viral condition affecting young children mostly under the age of 10
Thailand’s sees an outbreak almost every year with the Public Health Ministry recording some 18,000 cases in the first half of 2013.
The pathogen is a virus that belongs to the group known as enteroviruses. The most common is the coxsackievirus A but other strains can also be involved. While the infection confers long-term immunity, it’s only against the responsible agent so recurring HFMD can occur. However, most children do develop a protective immunity as they get older.
HFMD is prevalent everywhere but it is more frequent in tropical countries. Infestation arises from person-to-person contacts with an infected individual either from dirty hands stained with faeces or through inhalation of contaminated droplets from coughing or from touching surfaces, which have been sullied by the throat discharge or residues from stools. The contamination can also result from contact with the fluids of an infected child’s saliva or skin lesions.
Following a 3-to 6-day silent incubation period, HFMD symptoms usually begin with minor cold-like manifestations including moderate fever (around 38-39?C) with sore throat, loss of appetite and a general ill feeling. Typical signs of HFMD then appear and consist of painful mouth ulcers and a red rash characterised by small liquid-filled blisters (vesicles) mainly found on the hands and feet and sometimes buttocks, knees, genitalia and arms. In most cases and as long as the child can eat and drink normally, all signs and symptoms spontaneously disappear within a week.
Complications are rare and affect mostly infants 1 to 2 years of age and those with immune deficiency. The sores in the oral cavity may render drinking and swallowing extremely difficult exposing them to the risk of dehydration that may require intravenous fluids.
In epidemics and especially in tropical areas, more aggressive virus strains known as enterovirus 71 (EV71) can occasionally cause neurological complications. Examples are viral meningitis or inflammation of the protective layers surrounding the brain, which is often transitory and rarely leaves sequelae, and encephalitis, an extensive virus-induced inflammation of the brain that is potentially life-threatening.
HFMD is often diagnosed clinically, which means by the simple evaluation of the symptoms and the context of contamination.
In most cases, all symptoms improve without treatment within 5 to 7 days. Medications such as topical oral anesthetic are provided to relieve the pain associated with mouth sores and paracetamol may be given if fever is not well tolerated. All irritant beverages (soda, artificial juices) need to be avoided and cold water or ice creams are recommended to lessen the soreness. Soft foods are preferable to facilitate swallowing. Importantly, the mouth of the child needs to be rinsed with warm water after each meal to provide a soothing effect and prevent possible secondary bacterial infection of the mouth ulcers.
Although a vaccine against the dangerous EV71 strain is in development, no effective vaccine is available today against HFND and the prevention essentially relies on proper cleanliness. Children should be trained early to practice good hygiene especially washing their hands before eating and after going to the toilet, and avoid placing their fingers in the mouth. Despite obvious challenges, stringent hygienic rules need to be implemented in childcare centres to prevent and/or limit the spread of the disease. Common areas and shared objects need to be regularly disinfected with such solutions as sodium hypochlorite (bleach).
Although keeping a mildly infected child out of school is not an obligation in some countries, parents are advised to keep their child at home for a week until recovery. In Asia, exclusion from school is often required by the school administration during the first week contagious period. In serious epidemic situations, a 10-day class or even school closure may be decided to allow a break in the disease transmission.
Dr Gerard Lalande is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at [email protected],
