Most parents know hand, foot, and mouth disease (HFMD) as a virus that affects infants and young children. Outbreaks are commonplace in kindergartens and childcare centres the world over. The virus gets its name from the non-itchy rash and blisters that develop on the palms of the hands and soles of feet, which can be painful when touched. Tiny ulcers with red, raw edges may also appear on the throat, tongue, tonsils and mouth.
Fortunately, for most kids the symptoms of HFMD illness are usually short-lived and mild – a fever, headache, loss of appetite, and a sore throat.
But, there's been a worrying recent development throughout Asia and the Pacific – including Australia – with the appearance of C4a, a genogroup of a HFMD strain called human enterovirus 71 (EV71). The strain can result in more severe illness, including rare but potentially fatal cases of meningitis or encephalitis.
EV71, which was first identified in Cambodia, is now the principal strain across Asia, where it occurs mainly between April and July. Epidemics have resulted in millions of cases and hundreds of deaths in recent years in China, Vietnam, Japan, Macao, Hong Kong and Singapore, according to the WHO.
In its May 29 update, the WHO said cases are now increasing in Asia.
Paralysis in Aussie kids
In Australia, C4a recently caused paralysis in 5 children in NSW and Victoria, while 27 children were admitted to hospital in NSW last month with meningitis or encephalitis as a result of HFMD infection.
Not surprisingly, the source of the virus was probably an infected traveller, said Dr Bruce Thorley, of the Victorian Infectious Diseases Reference Laboratory, who has studied the new strain. Dr Thorley alerted the Australian media and provided details to ProMED, the reporting network of the International Society of Infectious Diseases.
Coincidentally, New Zealand has also experienced a recent spike in HFMD infections, with as many as 3 patients a day being admitted to Auckland's Starship Children's Hospital, local media reported last week. The particular strain responsible for the NZ outbreak was this week identified as Coxsackie virus A6 (CV6), and what is unusual is that it has affected adults as well as children.
"HFMD virus can occur anywhere at any time – it's very contagious and spreads very easily," Travelvax Australia Medical Director, Dr Eddy Bajrovic, said.
"For most people, HFMD is a mild disease, but EV71 infection has led to many children needing hospital treatment. In a relatively small number of some cases, it has been fatal.
"With so many outbreaks in recent years, parents travelling to Asia with small children should be mindful of good hygiene. Hand washing is particularly important to lower the risk of getting HFMD and other illnesses like travellers' diarrhoea and flu."
What parents should know about HFMD
HFMD is an enterovirus. (HFMD is a different infection from foot-and-mouth disease, which affects cattle, sheep and pigs.)
While the EV71 strain is now prominent, the most common cause of HFMD is the coxsackie virus A16.
KIDS ARE MAINLY AT RISK: While children under 10 are most susceptible, adolescents and adults can also be infected. A child may get infected more than once, but usually not twice in the same outbreak season. Having been exposed during childhood, most adults are immune to coxsackie viruses. Infection in adults also tends to be milder than in children.
IT'S USUALLY 'HANDED' ON: The virus may come from pets, but typically is spread from person-to-person. An infected person carries the virus in their saliva or mucus, the fluid in blisters that may develop on their hands and feet, and in faeces. People who touch an object or surface that's been touched by an infected person literally pick up the virus. The final link in the chain of infection occurs when virus-laden fingers go into or near their mouth, nose, or eyes. A person infected with HFMD is most contagious during the first week of the illness, but the virus can stay in the stool for weeks after symptoms disappear. People with HFMD do not always show signs of infection, but can still pass the virus on to others.
TRAVEL RISK – WHERE & WHEN: While major epidemics occur mainly across South-East and South Asia, the virus is present in every developed and developing country. The most common seasons for HFMD are summer and early autumn.
TREATING HFMD: There is no specific therapy for HFMD: Antibiotics are ineffective and are not recommended. Adults or children can be given over-the-counter (OTC) medications such as Nurofen or Panadol to relieve pain and fever, or to reduce any inflammation. (Caution: Aspirin should NOT be given to children) To soothe the throat, gargle with salt and warm water, or use OTC mouthwashes or sprays, such as Betadine and Difflam. Anti-inflammatory lozenges like Strepsils are also an option. HYDRATION – It's important to drink plenty of liquids to maintain adequate hydration. Water and cold milk products are best – fruit juice and sodas should be avoided as they may burn throat ulcers, causing discomfort.
CONSIDER SEEING A DOCTOR IF...
- Fever is persistent or difficult to control.
- You have concerns about the severity of the illness.
- You or your child cannot swallow liquids. If the problem persists, fluids may need to be given intravenously.
- You notice neurological changes. (i.e. if the person's mental state becomes altered, or they become unresponsive.)
HFMD CAN LAST A WEEK: Illness usually disappears in 5-7 days without any specific treatment and with no lasting ill effects. Occasionally dehydration, high fever, febrile seizures, or secondary bacterial infections can occur. In rare cases, viral (aseptic) meningitis may require a child to be hospitalised.
PREVENTING INFECTION: As yet, there is no vaccine to protect against HFMD. However, Chinese scientists recently announced success with a trial vaccine which proved highly protective against the potentially severe EV71 strain, according to a Reuters report. The vaccine must undergo more extensive safety and clinical trials and is not likely to be available for some time. In the meantime, the best way of avoiding HFMD is through basic good hygiene. We recommend:
– Washing your hands often with soap and water, especially after using the toilet or changing a nappy. (Alcohol-based gel is handy for times when soap and water are not available, but the product should contain at least 60% alcohol. Gels don't kill all types of germs and are less effective when hands are dirty.)
– Disinfecting dirty surfaces and soiled items. First wash the items with soap and water; then disinfect them with a solution of chlorine bleach (made by mixing 1 tablespoon of bleach and 4 cups of water). Don't forget to include toys.
– Avoiding close contact such as kissing, hugging, or sharing eating utensils or cups with people with hand, foot, and mouth disease.
KEEP YOUR HANDS CLEAN: For travellers in particular, poor hand hygiene can not only lead to HFMD, but to diseases ranging from hepatitis A to traveller's diarrhoea. It's important to wash your hands:
– Before, during, and after preparing food.
– Before eating food.
– Before and after caring for someone who is sick.
– Before and after treating a cut or wound.
– After using the toilet.
– After changing nappies or cleaning up a child who has used the toilet.
– After blowing your nose, coughing, or sneezing.
– After touching an animal or animal waste.
– After handling pet food or pet treats.
– After touching garbage.
Find out more about the health risks and travel vaccinations for the destination you will be visiting by calling Travelvax Australia's travel health advisory service on 1300 360 164.