Hand, Foot and Mouth Desease (HFMD)

Once again we are seeing cases of HFMD.
Last year there was a very bad outbreak in our area and many parents also got it from their children.
Overview:
HFMD is a common viral illness that usually affects infants and children younger than 5 years old. However, it can sometimes occur in adults. Symptoms of include fever, blister-like sores in the mouth and a skin rash.
It is caused by coxsackieviruses and enteroviruses.
Coxsackievirus is the most common cause.  Enterovirus has also been associated with outbreaks of this disease.
HFMD is often confused with foot-and-mouth disease (also called hoof-and-mouth disease), a disease of cattle, sheep, and swine. However, the two diseases are caused by different viruses and are not related. Humans do not get the animal disease, and animals do not get the human disease.


Signs & Symptoms:
HFMD usually starts with a fever, poor appetite, a vague feeling of being unwell (malaise), and sore throat. One or two days after fever starts, painful sores usually develop in the mouth. They begin as small red spots that blister and that often become ulcers. The sores are often in the back of the mouth. A skin rash develops over one to two days. The rash has flat or raised red spots, sometimes with blisters. The rash is usually on the palms of the hands and soles of the feet; it may also appear on the knees, elbows, buttocks or genital area.
Some children, may get dehydrated if they are not able to swallow enough liquids because of painful mouth sores.
Transmission:
The viruses can be found in an infected child’s:
nose and throat secretions (such as saliva, sputum or nasal mucus)
blister fluid, and
faeces (stool)


An infected child may spread the viruses disease through:
close personal contact
the air (through coughing or sneezing),
contact with faeces,
contaminated objects and surfaces
For example, you might get infected by kissing someone who has HFMD or by touching a doorknob that has viruses on it then touching your eyes, mouth or nose.
Generally, a child with HFMD is most contagious during the first week of illness. Children can sometimes be contagious for days or weeks after symptoms go away. Some people, especially adults, who get infected with the viruses may not develop any symptoms. However, they may still be contagious. This is why people should always try to maintain good hygiene (e.g. hand washing) so they can minimize their chance of spreading or getting infections.
You should stay home while you are sick.  The same applies to children returning to day care.
HFMD is not transmitted to or from pets or other animals.


Diagnosis:
HFMD is one of many infections that cause mouth sores. Health care providers can usually tell the difference between mouth sores caused by HFMD and other causes by considering —
how old the patient is
what symptoms the patient has and
how the rash and mouth sores look.
Depending on how severe the symptoms are, samples from the throat or stool may be collected and sent to a laboratory to test for the virus.
Complications:
Complications are not common.  Some include:
Dehydration.
Viral or “aseptic” meningitis can occur but it is rare. It causes fever, headache, stiff neck, or back pain.
Inflammation of the brain (encephalitis) can occur, but this is even more uncommon.
Fingernail and toenail loss have been reported, occurring mostly in children within 4 weeks of their having HFMD
Prevention & Treatment:
Prevention:
There is no vaccine to protect against the virus
A person can lower their risk of being infected by washing hands
Cleaning and disinfecting frequently touched surfaces and soiled items, including toys.
Avoiding close contact such as kissing, hugging or sharing eating utensils or cups with people with HFMD
If a child has mouth sores, it might be painful to swallow. However, drinking liquids is important to stay hydrated. If a child cannot swallow enough liquids, they may need to be admitted to hospital and given IV fluids.
Treatment:
There is no specific treatment. However, some things can be done to relieve symptoms, such as taking over-the-counter medications that contains paracetamol and or ibuprofen .
Using mouthwashes or sprays can numb mouth pain.
Make sure your child takes enough fluids.
Parents who are concerned about their child’s symptoms should contact their health care provider.
See the attached images of blisters on the hands , feet and mouth.

Dr Willem Smit

Paediatrician

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