14 March 2006

Hand, Foot and Mouth Disease in Malaysia and Brunei

According to media reports, an increase in cases of hand, foot and mouth disease (HFMD) is occurring amongst young children in Malaysia and Brunei [1,2].

In the Malaysian province of Sarawak in Borneo, a total of 942 cases of HFMD occurred between 1 January and 18 February 2006, including three deaths. This represents an increase compared with the same period last year, when 270 cases were reported. The increased number of cases has prompted the Malaysian Health Ministry to close 488 kindergartens for a two week period in an attempt to control the outbreak.

The Ministry of Health in Brunei has reported a total of 17 cases of HFMD. The majority have been mild infections; however the death of a two year old boy was reported on 6 March.

HFMD clinical infection  

HFMD is a common illness amongst infants and children, which is caused by viruses of the enterovirus family. The most common cause is coxsackievirus A16, but other viruses of the same family can also cause HFMD. The causative agent of the cases in Malaysia is reported to be enterovirus 71. 

HFMD occurs worldwide as individual cases or as outbreaks, most frequently in summer and early autumn. Major outbreaks of HFMD due to enterovirus 71 have previously been reported in Malaysia, Singapore and Taiwan [3-5].

Following an incubation period of three to seven days, the infection presents with mild fever, malaise, and sore throat. One or two days later painful vesicular lesions appear in the mouth, which frequently develop into ulcers. These occur most commonly on the buccal mucosa and the tongue.

A skin rash of red papules also develops on the palms of the hands and soles of the feet and may turn into vesicles.

HFMD is usually a mild infection and most patients will recover without medical intervention within seven to ten days. However, complications of aseptic meningitis, encephalitis, and a syndrome of paralysis similar to that caused by poliovirus, have been seen with enterovirus 71 [4]. Many of the fatal cases with enterovirus 71 have had brain stem encephalitis [6,7].

HFMD can be transmitted from person to person through contact with nose and throat secretions, saliva, fluid from blisters, and stools of an infected person. 

Advice for travellers

The risk of HFMD can be reduced by taking good personal hygiene precautions.

• Wash hands frequently, especially before eating, after using the toilet, and after nappy changes.
• Ensure contaminated surfaces are cleaned with disinfectant.
• Ensure contaminated tissues and other materials are disposed of appropriately.

References

1. ProMED-mail. Hand, foot and mouth disease - Malaysia (Sarawak) (02).  2006; 4 March: 20060305.0712 [cited 10 March 2006] Available at: http://www.promedmail.org/pls/promed/f?p=2400:1001:

2720147287696598342::NO::F2400_P1001_

BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1010,32247

2. ProMED-mail. Hand, foot and mouth disease - Brunei. 2006;

7 March: 20060308.0744 [cited 10 March 2006] Available at: http://www.promedmail.org/pls/promed/

f?p=2400:1001:2720147287696598342::NO:

:F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:

1010,322793.

3. WHO. Outbreak of hand, foot and mouth disease in Sarawak. WER 1997; 28: 211-212. Available at: http://www.who.int/docstore/wer/pdf/1997/wer7228.pdf

4. CDC. Deaths among children during an outbreak of hand, foot and mouth disease - Taiwan, Republic of China, April - July 1998. MMWR 1998; 47: 629-632. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00054640.htm

5. Chan KP, Goh KT, Chong CY, et al.  Epidemic hand, foot and mouth disease caused by human enterovirus 71, Singapore.  Emerg Infect Dis  2003;9:78-85.

6.Wang SM, Liu CC, Tseng HW, et al.  Clinical spectrum of enterovirus 71 infection in children in southern Taiwan, with an emphasis on neurological complications.  Clin Infect Dis  1999;29:184-90.

7. AbuBakar S, Chee HY, Al-Kobaisi MF, et al.  Identification of enterovirus 71 isolates from an outbreak of hand, foot and mouth disease (HFMD) with fatal cases of encephalomyelitis in Malaysia.  Virus Res  1999;61:1-9.