9 things you never knew about HFMD

Think you know everything there is to know about HFMD? Think again! Wise up to these lesser-known facts.

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Hand, foot and mouth disease is never very far from the news. In fact, most childcare centres conduct stringent health checks that include daily temperature taking of their preschoolers to prevent an outbreak of this highly contagious disease.

In the first three weeks of 2017 alone, Singapore had more than 1,700 HFMD cases, compared to about 1,500 during the same period a year ago. This infectious illness is spread by bodily fluids, faeces and discharge from the rash of the infected person.

Symptoms of HFMD include a fever, a sore throat, lethargy and a loss of appetite. You’ll find blister-like spots on the palms of your child’s hands, the soles of her feet and possibly her buttocks, as well as ulcers on the insides of her mouth and side of her tongue.

There is no known treatment, although medication may be given to ease the pain and the fever. In the meantime, the best way to curb the spread of the virus is practising good hygiene.

Here are obscure HFMD facts:

1. It was first identified in Singapore in 1972

HFMD was first identified here in 1972 by Dr Tay Chong Hai, now a rheumatologist at Mount Elizabeth Medical Centre. Back then, there were only around 100 cases in three months. Dr Tay’s wife, who was a polyclinic doctor, had told him that she noticed more children with mouth ulcers and rashes. After studying one of the stool samples, Dr Tay identified the patient to have the Coxsackie A16 virus ― which led to the identification of HFMD, which had already been found in the US, Canada and Britain.

The virus can stay in the stools for several months, even after the symptoms have passed.

2. Watch those diapers

It’s not just about washing your hands and keeping the infected child away from others, you need to watch out for those poopy diapers, too! If your child has HFMD, be sure to wash your hands in hot water and soap immediately after ― and dispose of the soiled diapers immediately, preferably outside, wrapped up in a plastic bag. The virus can stay in the stools for several months, even after the symptoms have passed.

3. It likes warmer climates

A moderately warm climate promotes the transmission of the HFMD virus. A 2011 study found that a maximum daily temperature above 32 deg C and rainfall up to 75mm is likely to increase the HFMD incidence in the following one or two weeks. These weather parameters can be used as early risk indicators for potential HFMD outbreaks.

4. You can get it more than once

HFMD is caused by a number of different enteroviruses, including enterovirus 71 and coxsackie A16. A child with a healthy immune system will form antibodies against the enterovirus, so he will probably not get infected again if he is re-exposed to the same virus. However, he can get re-infected if he is exposed to a different strain of the virus.


You’ll be surprised at how long the virus can linger on for… read on!

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5. Adults can get it, too

It’s not just the little ones who are at risk of the virus ― adults can get it, too. In fact, one in 10 HFMD patients are over the age of 15. An adult’s symptoms are similar to that in kids. Worse, those with an existing condition that impairs their immunity may face potential complications. Genevieve Chong, mum to Nathan, 4, and John, 5, caught the virus from her sons last year. “As an adult, you think you can’t get it, but you can. I didn’t have a choice, though, because I had to be in direct contact with my sons all the time,” she says.

6. It can linger

The HFMD incubation period (from the time of infection to when the symptoms first appear) is three to five days, and the patient is most contagious during the first week of illness. And while symptoms usually last between seven days and two weeks, the virus can remain for weeks after: The Coxsackievirus A16 has been found in the stools of infected children even after six weeks, while Enterovirus 71 can last 10 weeks.

Your doctor is bound by law to notify the Ministry of Health of all clinical cases of HFMD.

7. It’s a legally notifiable disease

Your doctor is bound by law to notify the Ministry of Health of all clinical cases of HFMD. Even your child’s preschool, kindergarten and childcare centre is required to report any outbreak. If your child contracts HFMD, he is required to undergo a mandatory 10-day quarantine. MOH will order a mandatory closure of childcare centres that report more than 10 HFMD cases, or has an attack rate greater than 13 per cent, and a transmission period of more than 16 days. This is done to break the chain of transmission.

8. Your finger and toe nails may fall off

This can happen post-infection. Some patients also report that their hair started falling out in clumps. While it can be a traumatic experience, the good news is that it all starts to grow back in a few weeks, without needing any medical treatment.

9. You can breastfeed even if you or your baby has HFMD

You can’t transmit the virus through your breastmilk. Instead, you’ll be providing your baby with wonderful antibodies against the disease, thereby protecting him from it! If your baby is the one with HFMD, breastfeeding him will soothe him, particularly if he cannot swallow anything else because of his mouth ulcers. If you have twins, or if you are breastfeeding more than one child, just make sure to clean up after each feed, since HFMD can be transmitted via saliva.

Photos: iStock


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