Hand, Foot and Mouth Disease

Hand, foot and mouth disease is a viral infection with symptoms that include mild fever and blisters. Most commonly found in babies and young children under 5, the infection is often spread in nurseries or kindergartens and is most prevalent during the rainy season and winter months. While the symptoms will usually clear up in a week or so, the infection can sometimes lead to potentially fatal complications and should therefore be monitored closely. 

In the early stages, hand, foot and mouth disease can be mistaken for the flu as the symptoms include fever that lasts for 2-4 days and muscle pain. As the infection spreads, small red blisters appear, mostly on the inside of the mouth, palms of the hands, and soles of the feet – hence the name ‘hand, foot and mouth disease’. The blisters contain small bubbles of fluid, which eventually break and turn into ulcers.  
In the majority of cases, the symptoms will disappear after 5-7 days. However, hand, foot and mouth disease can cause severe and potentially fatal complications, including meningitis, encephalitis, paralysis, and myocarditis. Please note that the potential for these complications is not related to the number of blisters a patient has, so children should be monitored closely during the first 1-2 weeks of the illness, even if the blisters have cleared up.  
Take your child to see a doctor immediately if you observe any of these symptoms:
  • Vague feeling of being unwell, loss of appetite
  • Apathy, tired and pale appearance
  • Severe headaches
  • Nausea, vomiting
  • Confusion, hallucinations
  • Neck pain, stiff neck
  • Startle reflex; shaking of the body, arms or hands
  • Coughing, rapid breathing, and excessive phlegm, with or without fever
Hand, foot and mouth disease is caused by a group of over 100 enteroviruses.  The infection can be spread through either direct contact with the virus – such as in droplets discharged from the nose or throat, fluids leaked from skin blisters, and feces – or indirect contact through touching contaminated toys, surfaces, food or drink, or the hands of anyone in contact with an infected person, such as a nanny. 
In patients with rashes on the palms, it is first important to exclude nummular eczema, chickenpox and other viral rashes.  Generally, the doctor can diagnose hand, foot and mouth disease from observable symptoms.  However, in case of severe complications, the doctor may use additional tests to detect the virus in specimens, such as secretions and/or stool (Results take about 1-7 days, depending on which of the following testing methods are used):
  • Polymerase Chain Reaction (PCR)
  • Virus Culture
Currently, there is no specific treatment for hand, foot and mouth disease. It will usually clear up by itself in a week without treatment, so disease management typically focuses on relieving the symptoms.  If a patient has trouble eating due to an excessively sore throat, they should be given lots of water, milk and soft food. In more severe cases where the patient becomes exhausted, they should be admitted to the hospital where they can receive intravenous fluids.  
Once the condition has cleared up, there is always a chance that it can return because, even though anyone infected with hand, foot and mouth disease will develop immunity to the specific strain of the virus they have contracted, this does not prevent them from becoming infected by a different strain of the virus.
As with all diseases, prevention is better than cure. Since no vaccine currently exists, the most important preventive measure is to maintain good hygiene and make sure your children follow these steps: 
  • Avoid close contact with infected people
  • Wash their hands before eating; eat only freshly cooked food; and drink only clean water
  • Avoid sharing eating utensils, such as spoons, plates, bowls, glasses, or milk bottles 
As a parent, you should also follow these steps:
  • Wash your hands thoroughly and immediately after wiping your child’s nose and/or mouth
  • Wash cloth nappies or clothes contaminated by feces. After washing, pour contaminated water down the toilet and not down a drain 
  • Keep your child away from school for one week or until the sores clear up if he/she is diagnosed by a doctor with hand, foot and mouth disease
Above all, consult a doctor immediately if your child develops any of the symptoms, and monitor your child carefully if he/she is diagnosed with hand, foot and mouth disease.

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