Hand, Foot and Mouth Diseasea

Causative agent
Hand, foot and mouth disease (HFMD) is a viral infection commonly seen in infants and children. It is usually caused by a group of viruses called enteroviruses. The most common causative agent is coxsackie virus A. Enterovirus 71 (EV 71) is also one of the causative agents for HFMD. Individual cases and outbreaks occur worldwide, more frequently in summer and early autumn.

Mode of transmission
Direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons (who may be asymptomatic).

Incubation period
The incubation period is 3-7 days.

Clinical features
The main symptoms of HFMD are fever, sores in the mouth, and a rash with blisters.
Usually it begins with fever, poor appetite, malaise and sore throat.
One to two days later, painful sores develop in the mouth. The sores are characterised by small red spots with blisters which then often become ulcers. They are usually located on the tongue, gums, and inside of the cheeks.
The non-itchy skin rash manifests as flat or raised red spots. The rash is usually found on the palms of the hands and soles of the feet.

Management
No specific treatment is available for HFMD. In most cases, the illness is self-limiting. Symptoms including fever, rash and ulcers subside spontaneously in one week. Symptomatic treatment is given to provide relief from fever, aches or pain from the ulcers. Those who handle nose or throat discharges, faeces and soiled articles should wash hands promptly afterwards. Parents are advised to seek prompt medical attention if their children develop a high fever, decrease in alertness or deterioration of general condition.

Complication
Complications of HFMD are very rare, but it may be associated with viral meningitis. Rarely, EV71 may cause more serious diseases, such as encephalitis, or a poliomyelitis-like paralysis.

Prevention
Strict personal hygiene should be observed by frequent handwashing, covering mouth and nose when coughing or sneezing, and avoidance of close contact with HFMD patients.
The risk of infection can be lowered by good environmental hygiene. It includes cleaning of contaminated surfaces and soiled items, and maintaining good indoor ventilation.
Children with HFMD should be excluded from schools or any group settings until fever has subsided and all the vesicular lesions have dried and crusted.

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Source: Department of Health VI/vn/No. 54 (6-2008)