MIRI (June 7): Every child is at risk of being infected with the Hand, Foot and Mouth Disease (HFMD), although the threat is greater when it comes to those with certain medical conditions, or undergoing treatment that may impair their immune system such as chemotherapy and long-term steroids.
In this regard Dr Chung Ghi Waie, the consultant paediatrician at Columbia Asia Hospital here, called upon parents to take extra precautions to prevent their children from being infected.
He said the HFMD could affect both children and adults, but 90 per cent of cases reported involved children aged five years old and below.
“There is no vaccine or medication to counter HFMD infection. Therefore, good personal hygiene, especially regular hand-washing, is important.
“Reduce person-to-person contact and avoid large crowds. Home cleanliness and good coughing etiquette are also important.
“If you suspect that your child has HFMD, bring your child to the nearest clinic or hospital for assessment. Based on that assessment, the doctor should be able to explain and provide the necessary management for your child,” he said during a question-and-answer (Q&A) session conducted by the private hospital recently.
Adding on, Dr Chung said should there be more than one child at home, and one of them had contracted HFMD, the parents must implement good personal hygiene, especially hand hygiene, and also stop the siblings from sharing utensils.
“Studies have shown that solution containing 95 per cent ethanol is required to kill 99.99 per cent of Enterovirus-71 (EV71) – one of the components in HFMD infection.
“Cleaning solution that contains 75 per cent ethanol and also hand-wash solution containing chlorhexidine gluconate in 70 per cent isopropanol, are not effective in killing EV71,” he said, adding that a child with HFMD would often eat or drink less than usual because their mouth ulcers could cause pain. Thus, he reminded the parents to ensure that their children would drink adequately, at regular intervals.
“Parents are encouraged to give their children cold drinks or semi-solids such as milk or other nutritious beverages, ice-cream, yogurt and jelly. Cooler liquid food is often soothing and very well-tolerated by the affected children.
“Doctors may prescribe your child with analgesic spray or gel for the oral ulcers, to relieve the pain,” he advised.
Dr Chung also said early medical attention would be necessary if the child did not pass urine more often than once every four hours, or if the colour of the urine appeared concentrated, and/or the volume was less than half of what would usually be.
“The affected child’s urinary habit should also be observed closely.”
Data from the Ministry of Health (MoH) stated that from the beginning of this year up to May 21, a total of 47,209 HFMD cases were reported nationwide.
“The majority of HFMD cases are mild and self-limiting. However, there are severe cases that can affect the heart, the lungs and the brain, and may even lead to death – although such severe cases are rare,” said Dr Chung.
According to him, HFMD is a virus infection, commonly caused by Coxsackie Virus A16 and EV71.
“The EV 71 was first isolated from a child with aseptic meningitis in California in 1969, and by 1974, the virus had been described as a new serotype of genus Enterovirus.
“In the years following the initial isolation of EV71, outbreaks occurred in the US, Australia, Sweden and Japan.
“In 1975, EV71 gained global attention when it was responsible for an outbreak in Bulgaria that resulted in 705 cases of poliomyelitis-like disease and the deaths of 44 people. Ninety-three per cent of the poliomyelitis-like disease cases occurred in children under the age of five,” he elaborated.
Dr Chung added that a similar outbreak occurred in Hungary in 1978, which also involved many cases of poliomyelitis-like disease and 47 deaths.
“Since this time, outbreaks of EV71 have continued to occur throughout the world. More recently there has been an increase in EV71 activity in the Asia Pacific region with several epidemics of HFMD being reported,” he said.
Dr Chung also pointed out that HFMD was ‘moderately contagious’, being able to be transmitted via person to person, spreading through direct contact with saliva and stools of an infected person who may even be completely asymptomatic, and spread through aerosol droplets.
It could also infect a child through contact with articles or surfaces contaminated with the causative enterovirus such as towels, toys, spoons, bottles and cups, he said.
“It is most contagious during the first week of illness. However, the virus may persist in stools for several weeks.”
Asked about the worst HFMD case that he had ever witnessed, he said it occurred seven years ago.
“An infant, who was brought in by the mother, was already at the severe stage of HFMD with multi-organ failures; the child later succumbed to the disease.”
Columbia Asia Hospital - Miri
MBBS (IMU), MRCPCH (UK)