Hand, foot, and mouth disease

What is Hand, Foot, and Mouth Disease (HFMD)?

HFMD is a common childhood disease caused by various enteroviruses. The disease can affect people of all ages, particularly children below 5 years old. HFMD is endemic in Singapore with cases occurring throughout the year.

Infection with one enterovirus strain provides immunity only against that specific strain. Reinfection can occur through exposure to a different strain of enterovirus.

How is HFMD transmitted?

HFMD is primarily transmitted via the faecal-oral route (i.e. through food, water or other objects that are contaminated with the stool of an infected person) and through direct contact with respiratory secretions, saliva or fluid from blisters or indirectly via contaminated surfaces.

The incubation period is typically 3 to 5 days, ranging from 2 to 14 days.

What are the symptoms of HFMD?

Most cases of HFMD are mild and self-resolving.

Common symptoms of HFMD include:

• Rash and blisters on hands and feet

• Mouth ulcers

• Fever

• Poor appetite

• Fatigue/lethargy

• Sore throat

HFMD infection can lead to rare complications including:

• Aseptic meningitis (inflammation of the membrane surrounding the brain and spinal cord not caused by bacteria)

• Encephalitis (inflammation of the brain)

• Paralysis

• Dehydration

• Loss of toenails or fingernails

Young children are at higher risk of serious infection. If you suspect your child has HFMD, and symptoms are accompanied by changes in their normal behaviour, like drowsiness, persistent vomiting or refusal to eat/drink, take your child to a medical practitioner.

What are the risk factors?

Risk factors include:

• Children below the age of 5

• Children in congregated settings (e.g. childcare or pre-school settings)

How is HFMD treated?

There is no specific treatment for HFMD. Treatment focuses on managing and relieving the symptoms of the disease. Treatment may involve supportive interventions to address the complications of the disease for example, managing seizures.

How to prevent HFMD?

There is currently no approved vaccine against HFMD in Singapore.

Preventive measures include:

• Practise good personal hygiene at all times.

• Wash your hands regularly with soap, especially before handling food or eating, after going to the toilet, or when hands are dirty from coughing or sneezing.

• Avoid touching your face, including eyes, nose and mouth with unwashed hands.

• Avoid sharing food/drinks or eating utensils.

In high-risk settings such as childcare centres and preschools, HFMD outbreaks can be prevented by:

• Early identification and isolation of cases. Unwell staff or children should be sent home and seek medical treatment immediately.

• Parents should inform their child’s school immediately if their child has HFMD, so that other children can be closely monitored for symptoms and additional precautions can be taken.

• Unwell children and staff should stay at home until blisters have dried up, or until they have fully recovered, or after the expiry of the medical certificate (MC) given by the medical practitioner.

• Proper cleaning and disinfection of communal areas and potentially contaminated items (e.g. toys or appliances) should be conducted regularly.

Please refer to Health advice for travellers for additional precautions to take when travelling.