22 May 2015

Hand, foot and mouth disease in the Western Pacific region

Japan has reported 15,285 cases of Hand, foot and mouth disease (HFMD)
Japan has reported 15,285 cases of hand, foot and mouth disease between 1 January and 8 April 2015. Weekly case numbers have increased since 12 March 2015 and are higher than the previous years [1]. Other countries in the Western Pacific region, including China (mainland, Hong Kong and Macau), Singapore and Viet Nam, have reported case numbers consistent with previous years or a decrease in numbers [1].

About Hand, foot and mouth disease

Hand, foot and mouth disease (HFMD) is caused by viruses belonging to the enterovirus group [2]. HFMD is not to be confused with foot-and-mouth disease which is caused by a different unrelated virus and affects cattle, sheep, and pigs.

HFMD is a common illness usually affecting young children. Outbreaks occur frequently around the world, particularly in the summer months in tropical and subtropical countries [2]. In recent years, outbreaks have been mostly reported from Asia. Cases are often associated with nursery and school settings, where the virus is easily spread amongst children from contact with infective saliva, blister fluid or stools.

The usual time from infection to onset of symptoms is 3-7 days [2]. Most people have mild symptoms and fully recover. A fever lasting 24-48 hours is often the first sign of disease, followed by malaise and sore throat and then painful mouth lesions and a vesicular rash on the palms, fingers, feet and occasionally the buttocks. Rarely, complications can develop in the brain, heart and lungs, which can be fatal [2].

Advice for travellers

The risk of HFMD to most travellers is low and can also occur in the UK. Those at greater risk include children attending nursery or schools during outbreaks, those working in such establishments and their close contacts, or those visiting and staying with friends and relatives.

There is no vaccine to protect against HFMD and treatment is symptomatic [3].

You can reduce the risk of HFMD by practising good personal hygiene precautions, particularly by hand washing before eating, after using the toilet, and after nappy changes [3]. Also, try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups with people who are sick.

Any contaminated surfaces should be cleaned with disinfectant; contaminated tissues and other materials should be disposed of appropriately.

If your child becomes unwell they should be kept away from school or nursery until they have fully recovered [3].  They should drink plenty of non-acidic fluids like water or milk, to prevent dehydration. Painful mouth ulcers may make drinking painful.  A number of over-the-counter preparations including mouthwashes are available to relieve the symptoms.

Seek advice from your GP if you think you or your child have HFMD, if cannot swallow liquids to stay hydrated or if the symptoms are severe or have lasted longer than seven days [3].

Advice for health professionals

When appropriate symptoms are present, a history of travel to the affected regions should act as a specific prompt for clinicians to evaluate for HFMD.

Information for health professionals assessing individuals with suspected hand, foot and mouth disease is available from the National Institute for Health and Care Excellence (NICE).

Resources

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