Hand-Foot-and-Mouth Disease (HFMD) and how it worries parents

Hand-Foot-Mouth disease (HFMD) is a contagious viral infection common in children under 5 years of age. Sometimes it is possible for adolescents and adults to get the disease. Pregnant women can also acquire the virus but there is no clear evidence that HFMD during pregnancy increases the risk of severe complications. HFMD occurs throughout the year, the outbreaks peak in August, September, October.

What causes it?

The disease is caused by a variety of intestinal viruses, the most common of which are coxsackie virus and enterovirus (EV). Especially, EV71 might cause severe complications and even death in children with HFMD. In 2018, the EV71 strain tends to be increasingly identified.

Signs and symptoms of HFMD

- Mild or high fever
- Getting startled or crying during sleep
- Reduced appetite due to sores in mouth
- Mouth ulcers, throat ulcers
- Red rash or blisters on palms, soles of the feet, knees, elbows, buttocks or genitals

The symptoms are sometimes unclear, and possibly mistaken for skin allergies, gingivitis due to Herpes or chicken pox, etc.

How is HFMD transmitted?

- Close personal contact, such as hugging, kissing, or sharing eating utensils with infected people
- Through the air when an infected person coughs or sneezes
- Contact with buttocks (feces) when changing diapers of an infected person
- Contact with fluid from blisters
- Contact with contaminated objects and surfaces

Transmission of infection in the pediatric clinics is of increasing concern. At American International Hospital (AIH), for the purpose of preventing cross-contamination, the pediatric clinic is properly designed and divided into two separate areas: area for symptomatic children and area for well children. Children with suspected symptoms will be quickly removed from common waiting area and placed in a separate examination room on arrival.

Progress of the disease

Most HFMD patients recover after the acute phase of the disease. Most cases are benign and nearly all patients can recover in 7 to 10 days without treatment and without serious complications.

Severe symptoms of HFMD

- Continuous high fever
- Continuously crying or being tired, lethargic
- Continuous myoclonic jerks
- Weak limbs, tremor, walking unsteadily
- Breathing fast and exhaustedly
- Vomiting
- Convulsion, coma, cyanosis

Hand-Foot-and-Mouth disease evolves very fast. In some cases, it can cause cardiovascular, respiratory or neurological complications with high risks of death. The rate of complications depends on the natural disposition of the body and types of virus but complications are not common (occurring in under 5% of infected people).

Treatment of HFMD at home

90% of children with HFMD can be treated at home or re-examined at a nearby medical facility as most of the cases are at grade I and grade IIA of HFMD (mild levels). There is no specific treatment for HFMD.

To take care of HFMD children at home, parents should feed them with enough nutrients. It is suggested that children eat diluted and soft food, drink much water; avoid hot and spicy food, and drinks that contain acid e.g. fruit juices. If their skin is blistering, they should not avoid bathing but keep hygiene and do not apply any medication on the blisters. Parents can have their children use pain killer or fever reliever to deal with sore throat/mouth or fever.

When to see a doctor?

When there is any severe sign of HFMD, the child should be taken to the nearest medical facility for examination and admission or transfer to a higher-level hospital. Upstream transfer is required when the child has complications at grade IIB or above.

How to prevent?

Parents should wash their hands thoroughly prior to initiating any contact with children. Especially, their toys should be cleaned frequently to prevent children from being infected with viruses.

Children should wash their hands with soap before and after school. Parents must not let children with HFMD go to school to avoid spreading to others.

When a child has HFMD, parents should inform the child’s school. In case there are many children in the area suffering from the disease at the same time, local preventative health centers should be involved in preventing the spread of disease.

Pham Cong Luan, MD., MSc.
Deputy Head of Pediatrics Department, American International Hospital (AIH)