HFMD is commonly caused by viruses from the enterovirus family, particularly Coxsackievirus A16, A6 and Enterovirus 71 (EV-A71). The illness usually presents with mild symptoms such as fever, sore throat, and a characteristic blister-like rash on the hands, feet, and mouth, and most children recover within a week. However, HFMD can lead to severe complications in certain cases, including neurological and cardiopulmonary issues.
In Malaysia, HFMD is a significant public health concern, with 35,043 cases reported in 2022 alone. The Ministry of Health continues to monitor and address outbreaks, which tend to increase in frequency every other year. Globally, the incidence rate of HFMD has fluctuated between 98.81 cases per 100,000 in 2020 and 435.63 cases per 100,000 in 2018. These figures highlight the importance of understanding the broader implications of HFMD and implementing preventive measures to reduce transmission.
Dr. Wong Weng Keong
Consultant Paediatrician, Bukit Tinggi Medical Centre (BTMC)
Recurrent Infections and Immunity
One of the critical concerns surrounding HFMD is the possibility of recurrent infections. HFMD can be caused by different strains of viruses, meaning that a child who recovers from one infection can be reinfected by another strain. Dr Wong Weng Keong, Consultant Paediatrician at Bukit Tinggi Medical Centre (BTMC), explains that while recurrent infections are possible, there is no concrete evidence to suggest that children who have had recurrent or repeated HFMD infections are more susceptible to other viral infections. He emphasises that each infection helps the child’s immune system develop antibodies to fight off future exposures, but the risk of reinfection still exists due to the various viral strains involved.
To help strengthen a child’s immune system after recovering from HFMD, Dr Wong advises parents to ensure their child gets adequate rest, maintains a balanced diet rich in vitamins and minerals, and stays hydrated. “A healthy lifestyle is key to supporting the immune system, especially after a viral illness,” he adds.
Psychosocial Impact on Families
HFMD is not only physically challenging for children but also emotionally taxing for both children and their families. Children with HFMD may experience discomfort from the painful sores and confusion due to isolation during the recovery period. Dr Wong shares, “Children who are quarantined due to HFMD outbreaks often struggle with feelings of loneliness, frustration, or anxiety, especially if they do not fully understand why they must be separated from their friends and normal routines.”
For parents, managing both work and caregiving during an HFMD outbreak can be overwhelming. Dr Wong encourages parents to take steps to care for their own well-being during this time, suggesting that they get enough rest, eat well, and seek support from family members or friends., who can take turn to come for their ill child.
He adds, “Parents can help ease their child’s emotional distress by offering comfort, explaining the situation in simple terms, and providing distractions like favourite books or games.”
Nutritional Challenges and Hydration
One of the main complications of HFMD is dehydration, as the painful mouth sores can make it difficult for children to eat and drink. Dr Wong stresses the importance of keeping children well-hydrated to aid recovery and avoid complications. “Dehydration is a common issue with HFMD, as children may refuse to eat or drink due to the discomfort caused by the mouth sores.”
Parents can offer cold or lukewarm liquids, which may be more soothing for children. Soft foods that do not require much chewing, such as puddings, jellies, and even ice cream, are often recommended. Saltwater gargling or numbing sprays may also help older children manage the pain from mouth ulcers. Dr Wong advises avoiding spicy or acidic foods, as they can make mouth sores more painful. “Parents should be creative in encouraging their child to drink fluids, whether by using fun cups or offering ice pops.”
Preventive Measures and Outbreak Management
Preventing the spread of HFMD requires strict hygiene practices, especially in homes, schools, and daycare centres. Since HFMD is highly contagious and can spread through contact with saliva, stools, or blisters, it is important to implement hygiene measures even after recovery. Dr Wong highlights that the virus can still be shed in a child’s stools for several weeks after recovery, so maintaining hygiene is critical to prevent further spread.
At home, parents should ensure regular handwashing with soap for at least 20 seconds, especially after using the toilet, changing diapers, or blowing noses. Shared items like toys and utensils and towels should be washed or changed frequently. Children with HFMD should be kept away from school or daycare until they have fully recovered, typically within five to seven days, to minimise the risk of transmitting the virus to others. Schools and daycare centres must also implement strict hygiene protocols, regularly cleaning high-touch surfaces and ensuring that affected children remain in quarantine.
“Raising public awareness about HFMD is crucial in preventing its spread,” Dr Wong asserts. He encourages parents to educate their communities about the importance of hygiene practices and to remain vigilant for the symptoms of HFMD, such as fever, rash, and mouth sores.
HFMD continues to be a major concern for parents and healthcare providers, particularly with the rise in cases across Malaysia. While HFMD is generally a mild illness, its potential for complications and recurrent infections highlights the need for preventive measures and public education.
Dr Wong advises parents to be proactive in managing their child’s health and well-being, emphasising that by following good hygiene practices and keeping a close eye on symptoms, we can minimise the impact of HFMD on children and reduce the frequency of outbreaks.
For more information on HFMD, please visit Bukit Tinggi Medical Centre.
