Co-organized by the Institute of Molecular and Cell Biology (IMCB), part of the Agency for Science, Technology and Research (A*STAR) Singapore, the Consortium of Hand, Foot, Mouth Disease/Enterovirus 71 Studies in Asia (CoHESIA) and the Singapore Society of Microbiology and Biotechnology (SSMB), an international conference for Hand, Foot and Mouth Disease (HFMD) was held in Singapore on 24th to 25th of July 2016.
The aim of the event was to foster interaction and collaborations between different countries in translational research to fulfil the unmet clinical needs in the management of this disease. Scholars and healthcare practitioners from all over the world, including Singapore, gathered in HFMDIC2016 to highlight the latest developments in research with regards to vaccines, host-pathogen interaction, epidemiology and clinical perspectives.
In conjunction with this, an educational session for the public was held on 26th of July that specifically involved management personnel from local childcare centres, including administrators, parents and teachers, to give elucidation on the basics of HFMD, such as preventive measures and effective ways to manage the disease should an outbreak occur.
What is Hand, Foot and Mouth Disease?
It is a highly contagious infection, spreading from person to person by direct contact with an infected person’s unwashed hands, saliva, fluid from blisters, feces or respiratory droplets from the air after sneezing or coughing.  The most at risk would be children younger than 5 years of age, especially if their immune system is weak. Over time, the body will be able to build immunity against it but this isn’t to rule out that adults can contract it as well. HFMD is more commonly caused by the two viruses namely Enterovirus 71 (EV71) and Coxsackievirus. Both from the genus Enterovirus in the family Picornaviridae .
Symptoms of Hand, Foot and Mouth Disease
About 50 to 80% of HFMD cases are asymptomatic, but they can still be contagious. The symptoms that do manifest will start 3-5 days after first becoming infected. These may come in the form of the following:
-Fever (38-39°C for 1-4 days)
-Poor or loss of appetite
-Runny nose, sore throat, vomiting, diarrhea
-Mouth ulcers or red blisters in the mouth
-Skin rashes (flat or raised spots) on palms, soles, legs and buttocks 
Should these symptoms appear, the doctor may take a throat swab or stool sample to confirm the diagnosis. The incubation period for HFMD is 3-5 days so the infected person’s recovery may range from 2 days to 2 weeks, depending on the severity. The afflicted person should feel better within ten days. If the symptoms worsen, call a doctor immediately.
Treatment for HFMD
Sometimes it is best to let the immune system repair and take care of the body while the disease runs its course. However, there are ways to ease and soothe the blisters such as topical ointments for the skin, pain medication for headaches and taking lozenges or swishing warm water and salt in the mouth for sore throats.
For children, since they may find the mouth sores extremely uncomfortable, more interesting remedies could be to suck on ice or popsicles, drinking cold drinks, and eating ice cream. It is advisable to avoid citrus fruits or spicy food at this time.
HFMD in Childcare Centres and Daycare
Since toddlers and young children are the most susceptible to HFMD, most cases of this spread in daycare or childcare centres. In Singapore, outbreaks of HFMD has occurred in 2000, 2008, 2012, 2013 and 2016. According to a speech given by Dr. Hishamuddin Badaruddin , the key in preventing and controlling the spread of HFMD among children is to focus on routine early detection and isolation of cases.
He enumerated factors that contribute to preventing HFMD that include: maintenance of good personal and environmental hygiene through targeted education, consideration of immunization, enhancement of surveillance for HFMD, and centralisation of electronic health records among hospitals and health centers island-wide to pull up data for HFMD cases in real time.
He also mentioned tips that we could easily execute in order to keep this disease at bay. Parents need to be positive role models for their children to practice good hygiene. We also need to cover our mouth and nose while sneezing or coughing. Regular and frequent disinfection of common areas in the home. Avoid sharing food and drinks among children. And the most crucial step is to properly wash your hands with soap and water after eating and/or using the rest room. Singapore General Hospital has released a video on the 8-step handwashing technique to ensure good hygiene. To watch the video, you may check it out at https://www.youtube.com/watch?v=ybk3DDhbhnA. 
Updates on HFMD from MOH
The list of daycare centres with prolonged HFMD transmission is updated regularly at the MOH’s website. This will help parents to check their children are showing signs of HFMD infections. The website also provides a comprehensive guideline for schools and childcare centres to control the spread of infection. For more information, kindly check https://www.moh.gov.sg for FAQs and the latest news on HFMD.
by Catherine Domingo Ong
Catherine is a writer whose guilty pleasure is lounging
in a peaceful location with a good book (or several) and a latte at hand.
- Hand, Foot and Mouth Disease by Marissa S. and Elizabeth Boskey, PhD. https://www.healthline.com/health/hand-foot-mouth-disease
- Enterovirus, Coxsackie and echovirus, https://en.wikipedia.org/wiki/Enterovirus
- Hand, Foot and Mouth Disease Symptoms https://www.moh.gov.sg/content/moh_web/home/diseases_and_conditions/h/hfmd.shtml
- Dr. Hishamuddin Badaruddin, https://sg.linkedin.com/in/hishamuddin-badaruddin-a8173541
- Reel Health #19 – 8 Steps to Hand Hygiene https://www.youtube.com/watch?v=ybk3DDhbhnA