This report discusses what Hand, Foot and Mouth Disease (HFMD) is, how it is spread as well as the precautions one should take to avoid getting HFMD. There have been recurrent outbreaks of HFMD over the last few years and similar outbreaks of HFMD have also occurred in the region, namely in Brunei and Sarawak. In the recent outbreak in March this year, the number of HMFD cases in Singapore reached a peak of 785 cases a week.
With the recurrent outbreaks of HFMD in Singapore and the region, and the potentially serious effects of the disease, particularly on children, the Ministry of Health (MOH) has tightened its guidelines on the procedures for the management of HFMD in child care centres in Singapore. In fact, HFMD is one of 30 ‘notifiable’ diseases, which means that general physicians, polyclinics and hospitals have to inform MOH about every case of HFMD.
Owing to the major impact HFMD has on public health, this report serves to highlight several important aspects of HFMD and is submitted to Dr Mark Lim, lecturer of Public Health (PH) at Dover Polytechnic, in partial fulfilment of the PH module. What HFMD is Definition HFMD is defined as Hand, Foot, and Mouth Disease. It is caused by intestinal viruses, with Coxsackie virus and Enterovirus-71 being the most common. Out of the 80 different strains of HFMD, enterovirus-71 is the most infective Victims HFMD affects both children and adults although it is most commonly found to infect children under the age of 10 years old.
Anyone is at risk of being infected with the HFMD virus but not everyone who is infected becomes ill. Unlike adults, infants, children and adolescents have fewer antibodies that cause them to be immune from exposure. This causes them to be more prone to infection and illness from the HFMD virus Symptoms After infection, symptoms begin to show around the 3rd-7th day. This is known as the ‘incubation period’. Fever is often the first symptom of HFMD. Other symptoms include sore throat, rash or blisters (on hands, soles of the feet, or buttocks), mouth ulcers, poor appetite, vomiting, diarrhoea and fatigue. Impact Enterovirus-71 killed several children during the Singapore outbreak in 2000, along with an average of 1,140 cases reported each week (Lee, 2005). Consequently, nurseries, kindergartens, enrichment centers and play areas in fast-food restaurants or shopping centers were closed for two weeks to prevent the disease from spreading further. In 2006, there were usually 220 cases of HFMD a month throughout the year. How it is spread The HFMD virus is transmitted from person to person through physical contact with the nasal discharge, saliva, faeces and fluid from the rash of an infected person.
It can also be transmitted indirectly from contaminated items such as utensils and toothbrushes. An infected individual is more contagious during the incubation period or the first week of infection. Chances of transmission of this enterovirus are increased by poor hygiene and also overcrowded living conditions. This is why it is advised for children who display any symptom of the infection to avoid visiting public areas and remain within their own homes after consulting medical check-up. Treatment and Prevention There is neither specific treatment to cure HFMD nor is there vaccine to prevent it.
However, there is treatment to relieve the symptoms of the illness known as symptomatic treatment. Since the disease is mild and self-limiting, most patients will recover in 7 to 10 days but it may lead to rare complications such as inflammation of the brain and heart. The risk of infection can be lowered by practicing good hygiene. This includes washing hands with soap under running water frequently and disinfecting them afterwards with chlorine-containing bleach. In addition, avoiding close contact such as kissing and hugging with an infected person is another precaution.
Furthermore, areas or items handled by the infected individual or are contaminated by his nasal or oral secretions should be cleaned and disinfected thoroughly with sodium 0. 5% hypochlorite solution, an active ingredient in many household types of bleach. In fact, the MOH has implemented a measure where childcare centres and kindergartens with more than 16 HFMD cases or an attack rate greater than 23%, and a transmission period of more than 24 days will be closed for 10 days in attempt to stop the transmission chain. (Ministry of Health, 2013). Conclusion In conclusion, HFMD impacted Singapore greatly.
Although it may be self-limiting, it is a highly contagious disease that is capable of causing critical illness and eventually death. Up till today, HFMD cases are continuously being reported to MOH. This epidemic is a global situation alongside bird-flu, H1N1 and other types of deadly contagious diseases. From this report, it is understood that prevention is much more effective than treatment since there is no fixed cure for HFMD. This report also clearly states that it is a team effort by all Singaporeans to counter such a crisis, not just the government’s responsibility but the citizens’ individual responsibility as well.