Health Matters

I am a Paediatrician specialising in Infectious Diseases and one of the greatest joys of treating children is to know that the majority of them get well from their sicknesses, and return to their normal lives. This is no different even in the case of Hand-Foot-and-Mouth Disease (HFMD).

Toddler “Joe” (not his real name) and his family were suffering from HFMD. Joe came to KKH feverish and really dehydrated. The poor child was crying in pain due to his oral ulcers, and had an unusual florid presentation of HFMD blisters all over his body. We quickly rehydrated him and gave him pain and fever relief. It took several days before the pain and fever finally subsided and Joe regained his appetite. His elder brother had similar symptoms while his father had mild oral ulcers and blisters. While Joe’s condition was definitely “serious” to his parents, in medical terms, the outcome was excellent for Joe.

Close to 99% of all HFMD sufferers will eventually recover with no adverse long-term effects from the infection. Of this, the majority would have been infected without even knowing it (the so-called “silent infections”). Those who develop clinical disease may have a combination of the usual painful throat ulcers and blistering rashes on palms or soles (although in many children, the rashes often extend to the legs, buttocks, sometimes even the torso, rarely on the face, and almost never on the scalp). A few may require hospitalisation for rehydration therapy if they are unable to retain fluids at home.

A very small number (less than 1%) can develop more serious complications such as meningitis or encephalitis (inflammation of the brain), myocarditis (inflammation of the heart) or widespread disease, which may then be fatal. Unfortunately, medical science has not developed to a stage where we can predict which patient is likely to develop these severe manifestations, and there is currently no available effective “treatment” for HFMD – in most cases the patients develop immune cells and antibodies to kill off the virus in their bodies; current medical therapy mainly supports the body during this period (e.g. with fluids or antibodies) and prevent further complications.

Evidence reveals that out of the 70-odd strains of the family of Enteroviruses that cause HFMD, a few may be more deadly. The most notorious strain is EV71 which is a genetically diverse and rapidly evolving virus. Singapore saw large outbreaks of this strain in the past decade or so, with year 2000 being the worst. But besides EV71, many strains of HFMD are now well established in Singapore.

I would like to stress the importance of the old and tested mantra of teaching our children to practice good hand hygiene, cover our mouths and noses when we sneeze or cough, avoid contact with infected people, and avoid passing the infection to others. This will keep all of us safe not just from HFMD, but from many other deadly germs too.

In the past 2 to 3 months, I’ve noticed the attendance at the KKH Children’s Emergency Department with HFMD cases doubling before tripling, but the most reassuring piece of data is that the proportion of children requiring admission has consistently stayed at around 10% with no severe cases in intensive care (yet).

Data from National Public Health Laboratories’ surveillance cultures show that most of the HFMD strains are non-EV71. Hopefully, with good quarantine and control measures, a heightened sense of awareness, personal hygiene and social responsibility, we’ll see this epidemic plateau and pass.

Some final words of wisdom by one of my respected clinical mentors that you certainly won’t find in medical textbooks: we sometimes say that the more blisters you have on your body, the less likely you may have severe disease – better to have it in your skin than your brain or heart.

DR THOON KOH CHENG

Head and Consultant
Infectious Diseases Service
Department of Paediatrics
KK Women’s and Children’s Hospital