A cause for alarm

Being less attentive to re-emergence of HFMD amongst factors behind spike in number of infections reported in Malaysia of late

A child with HFMD may get skin rashes on the palms of their hands; flat, red spots that sometimes come with blisters. — Photo courtesy of Dr Florence Bakon

ITCHY rashes on the hands and feet along with sores in the mouth of a child are tell-tale signs of an illness dreaded by parents.

Such symptoms often mean that the child has caught the Hand, Foot and Mouth Disease (HFMD) – a contagious viral infection usually affecting infants and young children.

According to the World Health Organisation (WHO), outbreaks of HFMD occur every few years in different parts of the world and over the last decade, many of these outbreaks have been reported in countries across the Western Pacific Region.

The organisation noted that recently, countries that registered a spike in the number of cases in Asia included China, Japan, Hong Kong, Republic of Korea, Singapore, Thailand, Vietnam and Malaysia.

Specifically, Malaysia reported a significant rise in HFMD infections this year with the number of cases increasing at an alarming rate, where the most recent figures from the Ministry of Health (MoH) showed the country had recorded a total of 106,477 HFMD cases as at the 24th Epidemiology (EPID) Week (June 12 to 18).

Health director-general Tan Sri Dr Noor Hisham Abdullah, in a statement, said this was an increase of 39 times over the number recorded in the same period last year, which was during the Covid-19 pandemic, at 2,710 cases.

He also said Selangor had logged the highest number of cases with 29,880 infections, followed by Kuala Lumpur and Putrajaya with 11,687 cases, Perak (10,938 cases), Johor (7,052 cases) and Kelantan (6,532 cases).

While Sarawak was among states with lower number of cases, at 4,262, it placed among the top three states that recorded the highest number of outbreaks.

Dr Noor Hisham said a total of 2,012 HFMD outbreaks were reported in Malaysia as at June 21 this year, with Kuala Lumpur and Putrajaya recording the most outbreaks, at 650 or 32.3 per cent, followed by Sarawak with 312 outbreaks (15.2 per cent), and Selangor with 252 outbreaks (12.5 per cent).

Several factors involved

Dr Florence Bakon

Dr Florence Bakon, a paediatrician at KPJ Kuching Specialist Hospital, said the spike in HFMD cases in the country involved several factors.

“They include the movements after the reopening of social activities and schools, as well as negligence in terms of maintaining good level of hygiene among the parents and the children’s guardians.

“It seems like most people are now very much at ease compared to the situation in the past two years, where there was social restrictions due to the Covid-19 pandemic,” she told thesundaypost in Kuching.

She added that parents might have been less attentive to the re-emergence of HFMD as well.

Dr Florence said Sarawak’s higher number of outbreaks than those reported in other states could also be attributed to the festive season of Gawai, where there were many gatherings and visiting activities in early June.

“The number of cases has shown a spike with the opening of schools after the festive season,” she said, noting that the outbreaks were mostly occurring at daycare nurseries, kindergartens and schools.

It is known that HFMD is spread through contact with respiratory droplets containing the virus particles after a sick person coughs or sneezes.

“HFMD is the result of a viral infection. It is caused by viruses that belong to the Enterovirus family such as Enterovirus 71(EV 71) and Coxsackievirus.

“Enterovirus 71 (EV-A71) has been associated with cases and outbreaks in East and Southeast Asia.

“A person can also catch HFMD by touching an infected person or making other close contacts such as kissing, hugging, or sharing cups or eating utensils; being in contact with the faeces of an infected person such as changing diapers, then touching your eyes, nose, or mouth; or touching objects and surfaces that have the virus on them, like doorknobs or toys, then touching your eyes, nose, or mouth,” said the paediatrician.

Mostly affecting young kids

According to her, HFMD mainly affects children below the age of 10 and often, those under five, due to their level of immunity.

“Children at these ages are more susceptible because they have lower immunity and have the tendency to put their hands in their mouths.”

Dr Florence also said caregivers in close contact with a sick child were also at risk of getting infected. She further pointed out that the HFMD symptoms would usually emerge around three to seven days after first contact with the virus.

“The first noticeable symptom is being down with fever and sore throat for one to two days.

“Other symptoms include rashes on the feet and hands, and painful blisters around the mouth. This will cause feeding difficulties and lead to loss of appetite.

Rashes may also appear on the soles of the feet of a child with HFMD. — Photo courtesy of Dr Florence Bakon

“In severe cases, the illness would lead to dehydration, which would require hospitalisation.

“Although rare, the EV-A71 has been associated with more severe diseases such as encephalitis (swelling of the brain) and heart inflammation, which had occurred during the HFMD outbreak in Sarawak back in 1997,” she said.

Nonetheless, Dr Florence pointed out that most children with HFMD would get better on their own, taking between a week and 10 days.

“There is no specific medical treatment for HFMD, but medications to relieve fever and pain caused by mouth sores should be helpful.

“Paracetamol and oral aid may be used to numb the soreness of mouth ulcer.”

She said as the presence of mouth sores could lead to difficulty in swallowing – resulting in children not wanting to eat or drink, she advised parents to make sure that their child would drink enough to stay hydrated.

One of the symptoms of HFMD is sores or ulcers inside or around the mouth. — Photo courtesy of Dr Florence Bakon

No vaccine for HFMD

Presently, there is no vaccine that could fight the very contagious HFMD.

However, there are a few simple steps that can help prevent a person from catching or spreading this disease such as washing hands regularly with soap and water for at least 20 seconds each time, using an alcohol-based hand sanitiser, and always washing the hands after changing diapers, using the toilet, blowing one’s nose, coughing or sneezing.

The best way to prevent HFMD is to practise good hygiene such as washing hands regularly. — Bernama photo

“We must also help children wash their hands, teach them how to wash them thoroughly and ensure that they wash their hands often.

“Another step would be to frequently clean and disinfect any touched surfaces and shared items, including toys and doorknobs,” said Dr Florence.

She said a child could get infected with HFMD if they had the virus on their hands and they proceeded to touch their eyes, nose, or mouth.

“To lessen the chance of getting sick, advise children not to touch their eyes, nose, and mouth with unwashed hands.

“We should also avoid touching someone who has HFMD such as hugging or kissing them.

“Stay home if you are sick with HFMD,” she reminded.

Dr Florence also advised parents to talk with their healthcare providers if they were unsure about returning to work, or when their child should return to school or the daycare centre.

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