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5 April 2017
Hand, Foot and Mouth Disease  

Causative agent

Hand, Foot and Mouth Disease (HFMD) is a common disease in children caused by enteroviruses such as coxsackieviruses and enterovirus 71 (EV71). The EV71 infection is of particular concern as it more likely associates with severe outcomes (like viral meningitis, encephalitis, poliomyelitis-like paralysis) and even death. The usual peak season for HFMD in Hong Kong is from early summer to autumn and a smaller peak may also occur in winter.

Clinical features

The disease is mostly self-limiting and resolves in 7 - 10 days. It usually begins with fever, poor appetite, tiredness and sore throat. One to two days after fever onset, painful sores develop in the mouth. They begin as small red spots with blister and then often become ulcers. They are usually located on the tongue, gum, and inside of the cheeks. There may also be skin rash that is non-itchy and, some with blisters. The rash is usually located on the palms of the hands and soles of the feet; it may also appear on the buttocks and/or genitalia. A person with HFMD may not have symptoms, or may have only the rash or only mouth ulcers.

Infection will result in immunity to (protection against) the specific virus that has caused HFMD. However, a second attack of HFMD may occur following infection with a different member of the enterovirus group.

Mode of transmission

The disease mainly spreads by contact with an infected person’s nose or throat discharges, saliva, fluid from vesicles or stool, or after touching contaminated objects. The disease is most contagious during the first week of the illness and the viruses can be found in stool for weeks.

Incubation period

About 3 - 7 days

Management

  • There is no specific drug treatment for HFMD. Patients should drink plenty of water and take adequate rest, and may receive symptomatic treatment to reduce fever and pain from oral ulcers.
  • Sick children should stay away from school or gatherings till all vesicles have dried up to avoid spreading the disease. If infection is caused by enterovirus 71, the patient is advised to stay at home for two more weeks after recovery from the disease (i.e. fever and rash have subsided, and vesicles have dried).
  • Parents should monitor the child’s condition closely and seek medical advice immediately if there is persistent high fever, decrease in alertness or deterioration in general condition.

Prevention

There is no effective vaccine. Good personal and environmental hygiene are the mainstay of prevention. While in Hong Kong or during travel, members of the public are advised to:

  • maintain good personal hygiene;
  • wash hands with liquid soap and water especially:
    • before touching nose and mouth;
    • before eating or handling food;
    • after touching blister;
    • after using the toilet;
    • when hands are contaminated by respiratory secretions e.g. after coughing or sneezing;
    • after changing diapers or handling soiled articles;
  • cover nose and mouth with tissue paper when sneezing or coughing, and wash hands thoroughly afterwards. Dispose of soiled tissue paper in a lidded rubbish bin;
  • do not share towels and other personal items;
  • regularly clean and disinfect frequently touched surfaces such as furniture, toys and commonly shared items with 1:99 diluted household bleach (mixing 1 part of 5.25% bleach with 99 parts of water), leave for 15 - 30 minutes, and then rinse with water and keep dry. For metallic surface, disinfect with 70% alcohol;
  • use absorbent disposable towels to wipe away obvious contaminants such as respiratory secretions, vomitus or excreta, and then disinfect the surface and neighbouring areas with 1:49 diluted household bleach (mixing 1 part of 5.25% bleach with 49 parts of water), leave for 15 - 30 minutes and then rinse with water and keep dry. For metallic surface, disinfect with 70% alcohol;
  • avoid group activities when HFMD outbreak occurs in the school or institution. Besides, minimise staff movement and arrange the same group of staff to take care of the same group of children as far as possible; and
  • avoid close contact (such as kissing, hugging) with infected persons.

*For detailed information about Enterovirus 71, please refer to
http://www.chp.gov.hk/content.asp?lang=en&info_id=12431&id=24&pid=9

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