HFMD is an illness caused by intestinal viruses, commonest being Coxsackie virus and Enterovirus 71. A person with HFMD usually presents with the following symptoms:

Fever
Sore throat
Rash (flat or raised red spots) or small blisters on palms of hands, soles of feet, or buttocks
Mouth ulcers
Poor appetite
Lethargy

HFMD is spread from person to person by direct contact with the nasal discharge, saliva, faeces and from the blisters of an infected person.

The incubation period of HFMD is 3 to 5 days (with a range from 2 days to 2 weeks).

As HFMD is a common childhood infection caused by a family of viruses, infection with one strain will provide protection against only on that particular strain, as the child will develop immunity to that specific virus. Future infection by other strains is possible.  Hence, your child may come down with HFMD again. 

You are advised to take precautions such as having your child wash his hands regularly, washing and disinfecting toys and other objects that might have germs on them, and trying to avoid sharing food and utensils with other children. Sick children should stay away from schools/centres and crowded public places.

A child infected with HFMD is contagious throughout the duration of the illness.  They generally stop to be contagious when their illness resolves.

Most cases of HFMD are mild. Occasionally, serious complications involving the nervous system and heart can occur.

No. Both adults and children can be affected but young children, particularly those under the age of 5 are most susceptible.

HFMD is usually mild and self-limiting. No specific treatment is available, however, treatment can be given to relieve the symptoms of the disease.

HFMD is endemic in Singapore. It became legally notifiable on 1 October 2000. The public may refer to the MOH Weekly Infectious Diseases Bulletin for the current situation of HFMD.

Parents are advised to consult a doctor early if their child has symptoms of HFMD.

They should also be alert to any change in their child's normal behaviour, eg irritation and sleepiness. Should they refuse to eat or drink, have persistent vomiting or drowsiness, parents should bring their child immediately to the A&E Departments of either NUH or KKH, whichever is closer to their home.

To minimise the risk of HFMD, it is important to adopt the following good hygiene practices:

• wash hands with soap before eating and after going to the toilet;
• cover mouth and nose when coughing or sneezing; and throw the tissue away into a bin immediately;
• clean toys or appliances which are contaminated by nasal or oral secretions thoroughly;
• do not share eating utensils; and
• do not share any food or drinks.

Children suffering from HFMD should not attend the centre but should stay at home.  They should avoid contact with other children until they have recovered.  They should be kept away from crowded public places (schools, preschools, play groups, markets, public transport etc.) if they show signs of infection.

Since 1 October 2000, medical practitioners are required to notify all clinical cases of HFMD.  Childcare centres, kindergartens and schools are also required to report to the relevant authorities on HFMD outbreaks.

MOH, together with MCYS and MOE, will continue to closely monitor the number of HFMD cases, analyse the disease trends, provide guidance to childcare centres and kindergartens, and ensure that these institutions exercise high vigilance in their management of HFMD.

HFMD is contact-transmissible disease and is not water-borne.

Public swimming pools are regulated by National Environment Agency and have to meet strict conditions to maintain environmental hygiene and sanitation standards. There is also a dilution effect that would make it unlikely for transmission to occur through water in a swimming pool.

Currently, childcare centres and kindergartens which meet either of the following criteria will be mandatorily closed for 10 days.

a) Transmission period > 24 days with number of cases > 16
b) Transmission period > 24 days with attack rate > 23%

While children and adults are both at risk of HFMD infection, adults tend to have much less severe infection. The reasons may have to do with antibodies from previous exposures to the enteroviruses.

The centres and doctors are required to notify MOH for new cases of HFMD, and so a counter checking mechanism is in place to monitor and check for discrepancies to avoid under-reporting.

Schools follow general hygiene Guidelines for the prevention of transmission of infectious diseases issued by MOH.

The key point is that the overall health of the children should be checked daily upon arrival at the child care centre. Children with any unusual symptoms or behaviour should be removed from the child care setting for further assessment. This is an important measure in preventing the transmission of infectious diseases to other children.

For more information on HFMD, pictures of symptoms and links to posters and booklets, please refer to the Health Promotion Board's FAQs on HFMD.