Essential Guide to Hand, Foot, and Mouth Disease (HFMD) in Singapore: Symptoms, Prevention, and Treatment for Children and Adults

Hand, Foot, and Mouth Disease (HFMD) is a common viral illness that mostly affects infants and young children, though adults can also catch it. In Singapore, HFMD is a significant concern, especially in childcare settings. This article will help parents understand HFMD, including its symptoms, preventive measures, and treatments.

What is Hand, Foot, and Mouth Disease?

HFMD is a very contagious viral infection caused by a group of enteroviruses such as the coxsackievirus, enterovirus, and echovirus. It commonly affects children below 5 years old, although adults can also be infected. As the name suggests, it typically causes rashes on the hands and feet, and ulcers in the mouth.

How Does HFMD Spread?

HFMD can be transmitted through saliva, mucus, fluid from the blisters, and faeces of the infected person. It spreads via direct physical contact such as hugging, kissing, sharing food and drinks, or through contaminated objects. The incubation period is about 3 to 5 days.

Dr. Jacquelyn Melody, Senior Family Physician at Oaklife Family Clinic, explains, "HFMD is often called the 'silent sufferer' for kids because the rashes and ulcers can cause significant discomfort without any prior warning."

How Common is HFMD in Singapore?

HFMD is quite common in Singapore, especially among children under five. According to the Ministry of Health (MOH), there were over 40,000 reported cases in 2019. The disease often peaks during the hotter months, with frequent outbreaks in kindergartens and childcare centers.

What are the Symptoms of HFMD?

HFMD symptoms usually appear 3 to 5 days after exposure to the virus.

Common symptoms include:

• Rashes: Usually found on the hands, feet, particularly the palms and soles, around the mouth, buttocks, elbows, and knees. They can be flat, rounded, or fluid-filled. The rashes on the palms and soles may be painful.

• Ulcers: Can be found anywhere in the mouth including the tongue and back of the throat. Children usually complain of throat or mouth pain, leading to poor oral intake and crankiness. Babies and toddlers with HFMD tend to drool more than usual.

• Fever: May be the first symptom that appears. It is not uncommon to reach a temperature of 40 degrees Celsius.

• Vomiting and diarrhoea

• Lethargy

However, symptoms vary; some may only experience one or two symptoms, while others develop more. Each symptom may also appear at different stages of the illness.

Dr. Jacquelyn Melody adds, "HFMD can cause significant discomfort in children, making it crucial for parents to recognize the symptoms early and provide appropriate care."

What are the Complications of HFMD?

The most common complication of HFMD is dehydration due to poor fluid intake. Certain strains of the virus, such as EV71, can cause serious complications to the heart, brain, and nervous system, but this is rare.

Worrying Symptoms

Parents should be concerned if their child exhibits:

• Poor feeding

• Lethargy

• Shortness of breath

• Drowsiness

• Confusion

• Severe headache

• Persistent vomiting

• Fits

If you notice any of these symptoms during the course of the illness, consult a doctor immediately.

How Long Will It Take for My Child to Recover from HFMD?

Recovery typically takes about 7 to 10 days. However, the virus is still shed in the faeces for about 12 weeks, meaning the faeces remain contagious for a while.

Can My Child Get Infected Again?

Yes, children can get infected again because there are different strains of enteroviruses which cause HFMD and Herpangina. Immunity to one strain may not protect against others.

HFMD in Adults

Although HFMD primarily affects young children, adults can also contract the disease, especially those who have close contact with infected individuals. HFMD in adults tends to present with milder symptoms, such as mild fever, sore throat, and small rashes on the hands and feet.

However, in some cases, adults may experience more severe symptoms, including painful mouth ulcers and prolonged fatigue. Proper hygiene, including frequent hand washing and avoiding direct contact with infected individuals, is crucial to preventing HFMD in adults.

What is the Treatment for HFMD?

The mainstay of treatment is symptomatic relief.

• Paracetamol and Ibuprofen are commonly used to manage fever and painful ulcers.

• Sometimes topical gels can be applied to the ulcers or pacifiers.

• At home, parents should provide a soft diet and plenty of fluids. Focus on fluid intake rather than solid intake to prevent dehydration. Offer cold fluids and popsicles to relieve painful ulcers and encourage fluid consumption.

• There is no special cream for the rashes.
  

Dr. Jacquelyn Melody advises, "Cool the food or drinks, including formula milk, before giving them to the child. Warm or hot foods can be more painful to the ulcers. Cold fluids and popsicles can help soothe the painful ulcers and encourage more fluid intake."

What Should Parents Do to Prevent HFMD?

Preventing HFMD involves good hygiene and awareness. Here are some tips for parents:

• Frequent Hand Washing

Teach your children to wash their hands regularly with soap and water, especially after using the toilet and before eating.

• Disinfecting Surfaces

Regularly clean and disinfect common surfaces like toys, doorknobs, and furniture.

• Avoiding Close Contact

If your child is infected, keep him/her  at home to prevent spreading the virus. Do not send him/her to school or daycare for the whole duration of the Medical Certificate (MC) or until he/she is certified fit to return to school by their doctor.

• Promoting Vaccination

While there is no specific vaccine for HFMD, ensuring your child is up-to-date on other vaccinations helps maintain overall health.

"Preventing HFMD starts with good hygiene practices. By educating parents and children about proper hand washing and disinfecting surfaces, we can reduce the spread of this contagious disease." says Dr. Jacquelyn Melody

One of our patients, Mrs. Tan, shared her experience: "When my toddler, Emily, first showed symptoms of HFMD, I was really worried. But with the guidance from Dr. Jacquelyn at Oaklife Family Clinic, we managed to keep Emily hydrated and comfortable. The cold popsicles were a lifesaver!"

FAQs on HFMD in Children and Adults in Singapore

Q: What are the first signs of HFMD?

A: The first signs are often fever and a sore throat, followed by a rash on the hands, feet, and ulcers in the mouth.

Q: Is there a vaccine for HFMD?

A: There is no specific vaccine for HFMD. Preventive measures focus on hygiene and avoiding contact with infected individuals.

Q: How do I know if my child is dehydrated from HFMD?

A: If your child drinks less than 50% of the usual total fluid intake in a day and doesn't pass urine for 6 hours, has persistent vomiting, looks very lethargic, has dry mouth or crying without tears, he or she they may be dehydrated. If you notice these symptoms, consult a doctor immediately.

Q: How long is HFMD contagious?

A: HFMD is most contagious during the first week of illness, but the virus can be shed in the faeces for several weeks after symptoms have resolved. So caregiver should still practise good hygiene when handling their faeces for the few weeks after they have recovered.

Q: Can HFMD be serious?

A: While most cases of HFMD are mild, certain strains of the virus can cause complications such as dehydration, and rarely,serious complications tothe heart, brain, and nervous system.

Q: Can adults get HFMD from children?

A: Yes, HFMD is highly contagious, and adults caring for infected children are at risk of contracting the virus.

Q: How long does HFMD last in adults?

A: Most adults recover within 7 to 10 days. However, the virus can still be present in faeces for weeks after recovery.

Q: Can adults go to work with HFMD?

A: It is recommended to stay home until symptoms resolve to prevent spreading the virus. Consult your employer about sick leave policies.

Q: Is HFMD more severe in adults?

A: While rare, adults can experience severe complications, especially if they have a weakened immune system. Seek medical attention if symptoms worsen.

Q: How can I prevent HFMD in an office environment?

A: Encourage frequent handwashing, disinfect common surfaces, and stay home if unwell. Offices with shared spaces should implement strict hygiene measures.

Hand, Foot, and Mouth Disease can be managed with the right knowledge and practices. Understanding its symptoms, practicing good hygiene, and knowing how to treat the disease can significantly reduce its impact.

For more information on child health, health screening, and vaccination, contact Oaklife Family Clinic. Our dedicated healthcare professionals are here to support you and your family’s health needs.