Hand, Foot, and Mouth Disease: What Parents Need to Know

Hand, foot and mouth disease (HFMD) is a common infection in infants and children under 5 years. It is caused by a group of viruses known as non-polio enteroviruses. It usually begins with fever and feeling generally unwell (malaise). 

HFMD is commonly confused with Foot and Mouth Disease which affects livestock like cattle, sheep and pigs but not humans.

This is then followed by the appearance of flat, reddish spots after one or two days. HFMD signs and symptoms can also include flat lesions, or maculopapular (flat and raised skin lesion) or blisters.

Majority of infected children have mild symptoms lasting between 7 and 10 days. 

HFMD Signs and Symptoms

Clinical illness with HFMD usually lasts about a week. The incubation period is short, lasting for about 1 to 3 days.

HFMD signs and symptoms are initially non-specific and include:

• Fever
• Loss of appetite
• Malaise
• Sore throat

After a day or two, the painful sores which are characteristic of the illness develop in the mouth. The last stage of the illness is marked by spots and blisters in the mouth, palms and soles.

These skin lesions might rarely appear on the buttocks and genitals, as well as the arms and legs.

There would be additional signs of painful swallowing like drooling more than normal and selectively consuming only cold fluids.

The rash that develops might form blisters. When this blister heals, the causative organisms may persist in the subsequent scabs. Avoid contact with the scabs and ensure they are kept clean.

HFMD Statistics

In temperate countries, HFMD is commonly associated with warmer months. However, in tropical countries such as the Philippines, infections can happen all year round.

Majority of HFMD cases occur in infants and children under 5. In the early 2018 surveillance report, the DOH discovered that of the 156 recorded cases, 70% were in this group. The group with the next highest prevalence was children between 5 and 9. Those aged 20 and above made up the 3rd largest population but was still a minute percentage.

It often occurs as small outbreaks in daycares and nursery schools. Since 1997, larger outbreaks have been happening in Asia. Outbreaks have been reported in Japan, China, Malaysia, Vietnam etc. 

Common Childhood Illnesses in the Philippines

How Does HFMD Spread?

There are a number of ways HFMD can spread, including

• contact with infected body fluids. This is most commonly through aerosols when a person coughs or sneezes.
• through the fluid that forms within the blisters, which is one of the HFMD signs and symptoms
• can be acquired from contact with the stool of an infected person.
• the virus can survive on inanimate objects, such as faucets and cell phones. This enables transmission when such a surface comes in contact with your nose, eyes or mouth.
• contaminated hands can facilitate the spread of this condition.
• contaminated water can also cause the spread of HFMD.
• Maternal to child transmission is possible during childbirth if the mother gets infected around this period.

In such cases, the newborn usually has mild signs and symptoms of HFMD but should be monitored closely. Newborns have a higher risk of developing serious complications from the disease.

Infected persons are at their most contagious during the first week of contracting the illness. Causative viruses are able to persist in a person’s intestinal or respiratory tract for months after illness resolution. This means it is possible for an individual without the signs and symptoms of HFMD to spread it.

Infected adults may be asymptomatic but still able to transmit the disease to susceptible children.

How is HFMD Treated?

Often HFMD  signs and symptoms are mild and can be managed at home without medications.

Just like most viral illnesses, the disease usually resolves spontaneously. There is currently no specific cure and management usually rests on addressing the signs and symptoms of HFMD.

Since the sores are painful, analgesics can be administered. Infection in older age groups might last more than a week. Fever can be addressed with lukewarm sponge baths and over-the-counter medication, like paracetamol.

A few people might develop complications and require hospital admission. Adequate fluid intake is important to prevent dehydration.

Currently, antiviral agents to treat this disease are under research and so far, results are promising.

Complications 

These are rare but when they do occur, urgent medical care is necessary.

Enterovirus71 tends to cause more severe neurologic or cardiac complications, such as myocarditis (inflammation of the heart muscle).

Viral meningitis is one of the most common complications and is due to the inflammation of tissue covering the brain.

Viral meningitis is characterized b:

• fever
• headache
• neck stiffness
• photophobia or light sensitivity

More serious complications include encephalitis where brain tissue is inflamed or flaccid paralysis.

Between 4 to 8 weeks after infection with diseases, there have been reports of loss of finger and toenails . It is unclear why this occurs but is not severe and nail loss is only temporary.

Prevention

Steps to ensure prevention of disease spread include:

• Avoiding direct contact with individuals showing signs and symptoms of HFMD
• Decontamination of objects that have been used by infected individuals
• Good hygiene
• Exclusive breastfeeding in the first 6 months of life has been shown to reduce severity of cases.
• The EV71 vaccine has been available in China since 2015 but is not presently available in the Philippines.

Key Takeaways

HFMD is a common disease in the Philippines and predominantly affects children under 5. The signs and symptoms of HFMD are usually mild and do not often need medical intervention.

They might rarely result in complications necessitating hospital admission. Currently, there is no specific curative treatment for the disease but symptomatic treatment is usually sufficient. Like most viral diseases, HFMD usually resolves on its own.