PREPARED BY : MOHD NOOR BIN ISMAIL

1. CURRENT HEALTH DISEASE IN MALAYSIA HAND, FOOT AND MOUTH DISEASE PREPARED BY : MOHD NOOR BIN ISMAIL 2ND YEAR STUDENT, CHARLES UNIVERSITY IN PRAGUE, FACULTY OF MEDICINE IN HRADEC KRALOVE

3. INTRODUCTION • Hand-foot-mouth disease (HFMD) is endemic in Sarawak. Prior to 1997, there was no baseline data on the epidemiology of HFMD in Sarawak. This is due to the fact that HFMD is not a notifiable disease in Malaysia and in Sarawak. • Between 15 April and 30 June 1997, 31 previously healthy infants and young children in Sarawak died after a short febrile illness against a background of an outbreak of HFMD in the State. Sibu was badly affected during this outbreak as 11 of the death cases were reported from Sibu followed by Sarikei with 7 death cases.

6. WHAT IS HAND, FOOT AND MOUTH DISEASE (HFDM)? CO JE TO? • Hand, foot, and mouth disease (HFMD) is a common illness of infants and children caused by a virus. It most often occurs in children under 10 years old. It is characterized by fever, sores/ulcers in the mouth, and a rash with blisters. The blisters may appear in the mouth, palms of the hands and soles of the feet. The rashes may also appear on buttocks and on the legs and arms. The ulcers in the mouth usually appear on the tongue, the sides of the cheeks, gums or near the throat.

7. WHAT CAUSES HFMD? • The most common causes of Hand, Foot and Mouth disease are coxsackie virus A16, enterovirus 71 (EV71)and other enteroviruses. The enterovirus group includes polioviruses, coxsackieviruses, echoviruses and other enteroviruses.

8. WHEN AND WHERE DOES HFMD OCCUR? • Individual cases and outbreaks of HFMD occur worldwide, more frequently in summer and early autumn (in temperate countries). In the recent past, major outbreaks of HFMD attributable to enterovirus EV71 have been reported in Malaysia in 1997 and in Taiwan in 1998. HFMD is endemic in Malaysia and occurs every year. In Sarawak, the number of cases of HFMD tends to increase from February to June.

9. IS HFMD SERIOUS? • HFMD caused by coxsackie virus A16 infection is a mild disease and nearly all patients recover within 7 to 10 days. Complications are uncommon. HFMD caused by Enterovirus EV71 may be associated with neurological complications such as aseptic meningitis and encephalitis. Cases of fatal encephalitis which occurred during outbreaks of HFMD in Malaysia in 1997 and in Taiwan in 1998 were caused by EV71.

10. IS HFMD CONTAGIOUS? • Yes, HFMD is moderately contagious. A person is most contagious during the first week of the illness. The virus can be transmitted from person to person via direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons. The virus may continue to be excreted in the stools of infected persons up till 1 month. HFMD is not transmitted to or from pets or other animals.

11. HOW SOON WILL SOMEONE BECOME ILL AFTER GETTING INFECTED? • The usual period from infection to onset of symptoms (incubation period) is 3 to 7 days. Fever is often the first symptom of HFMD followed by blister/rash.

12. WHAT ARE THE CLINICAL SIGNS AND SYMPTOMS? • HFMD begins with a mild fever, poor appetite, malaise ("feeling sick"), and frequently a sore throat. One or 2 days after the fever begins, painful sores develop in the mouth. They begin as small red spots that blister and then often become ulcers. They are usually located on the tongue, gums, and inside of the cheeks. The skin rash develops over 1 to 2 days with flat or raised red spots, some with blisters on the palms of the hand and the soles of the feet. A person with HFMD may have only the rash or the mouth ulcers.

13. Blister on the palm of the hand Blister on the dorsum of the feet Blister on the soles of the feet Blister then becomes ulcer on the inner gum

14. HOW FOOT, HAND AND MOUTH DISEASE DIAGNOSED? • Based on a complete history and physical examination of your child. It is generally suspected on the appearance of blister-like rash on hands, feet and mouth in children with a mild febrile illness.Usually, the doctor can distinguish between HFMD and other causes of mouth sores based on the age of the patient, the pattern of symptoms reported by the patient or parent, and the appearance of the rash and sores on examination. A throat and/or blister swab collected preferably within 2 days of onset of HFMD may be sent to a laboratory to determine which enterovirus caused the illness.

15. HOW IS HFMD TREATED? • Presently, there is no specific effective antivirul drugs and vaccine available for the treatment of HFMD. Symptomatic treatment is given to provide relief from fever, aches, or pain from the mouth ulcers. Dehydration is a concern because the mouth sores may make it difficult and painful for children to eat and drink. Should their affected children be having fever, the parents are advised to dress their children in light, thin clothing, to do tepid sponging with water (room temperature) as often as necessary, and to expose them under the fan. Taking enough liquids is very important apart from body temperature monitoring.

16. WHO IS AT RISK FOR HFMD? • Mainly in children under 10 years old, but may also occur in adults too. Everyone is at risk of infection, but not everyone who is infected becomes ill. Infants, children, and adolescents are more likely to be susceptible to infection and illness from these viruses, because they are less likely than adults to have antibodies and be immune from previous exposures to them. Infection results in immunity to the specific virus, but a second episode may occur following infection with a different virus belonging to the enterovirus group.

17. WHAT ARE THE RISKS TO PRAGNANT WOMEN EXPOSED TO CHILDREN WITH HFMD? • Because enteroviruses, including those causing HFMD, are very common, pregnant women are frequently exposed to the virus as well. As for any other adults, the risk of infection is higher for pregnant women who do not have antibodies from earlier exposures to these viruses, and who are exposed to young children - the primary spreaders of enteroviruses. • Most enterovirus infections during pregnancy cause mild or no illness in the mother. Although the available information is limited, currently there is no clear evidence that maternal enteroviral infection causes adverse outcomes of pregnancy such as abortion, stillbirth, or congenital defects. However, mothers infected shortly before delivery may pass the virus to the newborn. Babies born to mothers who have symptoms of enteroviral illness around the time of delivery are more likely to be infected. Strict adherence to generally recommended good hygienic practices by the pregnant woman might help to decrease the risk of infection during pregnancy and around the time of delivery.

18. SUGGESTIONS FOR THIS PROBLEM • Frequent hand washing, especially after diaper changes, after using toilet and before preparing food • Maintain cleanliness of house, child care center, kindergartens or schools and its surrounding • Cleaning of contaminated surfaces and soiled items with soap and water, and then disinfecting them with diluted solution of chlorine-containing bleach (10% concentration)

19. SUGGESTIONS FOR THIS PROBLEM • Parents are advised not to bring young children to crowded public places such as shopping centers, cinemas, swimming pools, markets or bus stations • Bring children to the nearest clinic if they show signs and symptoms.Refrain from sending them to child care centers, kindergartens or schools • Avoidance of close contact (kissing, hugging, sharing utensils, etc.) with children having HFMD illness to reduce of the risk of infection