Hand, Foot & Mouth Disease (HFMD): A Closer Look

HFMD is a common illness that afflicts children but can occur in adults too and is currently seeing record number of incidences in Singapore and Asia. According to statistics from the Singapore Ministry of Health, the weekly number of HFMD cases recorded in Singapore has reached a four-year high between 8 May and 14 May totalling 1,317. There has also been growing incidences of HFMD cases in Malaysia, China, Hong Kong, Japan and Singapore as stated by a WHO report.

HFMD is a commonly prevalent childhood viral infection which is caused by a group of enteroviruses, including Coxsackievirus A16 (CA16) and Enterovirus 71 (EV71). Of the two viruses, EV71 is a more severe virus strain as it has a high mortality rate. EV71 could lead to seizures due to neurological complications and even cardiovascular complications.

On the other hand, CA16 is milder as it causes self-limiting HFMD, that could lead to skin rashes, sore throat, appetite loss, vomiting and fever. That being said, the milder forms of HFMD  can be just a fever with a bad sore throat with no other sores on your body OR just a rash on your foot with no other symptoms. The incubation period of HFMD is 3 to 5 days (with a range from 2 days to 2 weeks). Both adults and children can be affected, but young children below 5 years old are more susceptible.

According to Dr. Leong Hoe Nam, an infectious disease expert, “Every adult in Singapore would have had Hand Foot Mouth Disease at least one time in their lives, they just might not have even realised it was HFMD.”

Furthermore, HFMD is a symptomatic disease that does not have a treatment yet. Since there are no vaccines for HFMD yet, we have to rely on prevention through good hygiene practices. The good news is that Singapore does not have the EV71 strain of virus circulating, so if children do get the disease it is most likely from the CA16 virus which is milder and not fatal. Since CA16 and EV71 are from the same group of viruses, contracting HFMD due to CA16 strain will actually provide you with cross-protection from the more dangerous EV71 strain of the virus.

Screen Shot 2016-06-18 at 9.38.00 AM

Cross-protection with CA16 Credit: Biotechin.Asia

HFMD from CA16 is also highly contagious disease that spreads through contact. It spreads through direct contact with the nasal discharge, saliva, faeces, and fluids from the rash of an infected person. For example, a toddler with HFMD uses a toy and shares that toy with their friend, there is a high chance that the friend could end up with HFMD. This toddler could then pass the disease to their siblings and even the parents.

The severity of HFMD increases with increasing infective doses that a child/adult gets. In other words, if you get exposed to the virus from contact with a stranger you might get a very mild case of the symptoms of HFMD or sometimes no symptoms at all. However if HFMD is spreading within the family, the infective doses you are exposed to due to constant interaction increases, resulting in a worse case of HFMD.

Parents who have experienced children having HFMD might notice how the disease becomes more severe as it spreads to more family members. This is due to the increase in the infective doses from other family members with HFMD. There have been cases where mothers’ who had to take care of their children during the child’s struggle with HFMD, end up contracting the virus themselves resulting in a very severe form of the disease.

The best and most effective way to prevent HFMD is by following good hygiene practices especially good hand hygiene. Dr. Leong advises that the environment is full of bacteria and we need to ensure that they do not enter our body by ensuring that our hands that come into contact with our face and mouth often, remains clean with good hand hygiene. It is best to wash hands before eating, after playing with animals or bathroom breaks or sneezing.

Even so, HFMD is caused by enteroviruses that are non-enveloped viruses that are resistant to many disinfectants we use that are alcohol and phenol based, especially the more fatal EV71 virus. Antiseptic hand washes like BETADINE which contain  Povidone iodine (PVP-I) is a good way to ensure the CA16 and EV71 viruses are killed. Read more about this, in this  article.


Dr. Leong, an infectious dieases expert, with an action plan.

If you do get HFMD, do not panic, you probably contracted the milder CA16 virus which will give you cross-protection against the more fatal EV71 virus strain. Visit the doctor ASAP to ensure there are no complications. After that the only thing to do is get rest for 5-7 days until the illness runs its course, make sure you are adequately hydrated and keep up with your medication to find relief.

Remember that the transmission will spread and ensure you are socially responsible by keeping yourself isolated from others.

This article was written based on a lecture by Dr. Leong at  Mundipharma


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