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 for 2-3 days
Sore throat and runny nose
Rash (flat or raised red spots, some with blisters) on palms of hands, soles of feet, or buttocks
Mouth ulcers
Poor appetite
Vomiting and diarrhoea
Tiredness and weakness ("feeling sick")

A person is infectious throughout the duration of the illness.

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

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

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

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.

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;
• maintain good air circulation;
• 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. .

Transmission of enterovirus infections is increased by poor hygiene and overcrowded living conditions.

The Ministry of Health has alerted all hospitals and doctors in Singapore to look out for cases of this infection. These cases are to be notified to the Ministry of the Health for epidemiological investigations.

Guidelines for proper specimen collection in suspected cases for virus isolation has also been issued to all hospitals and paediatricians.

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.

The decision to close a centre is based on several factors which include number of cases/attack rate, length of transmission period, the classes/levels affected and whether the majority of the cases were recently infected.  Due to the number of cases at this moment (April2008), the closure of centres may be considered if there is more than 15 days of transmission together with either more than 13 cases or more than 18% of enrolment.

We are most concerned when the circulating strain is EV71 because it is associated with more complications.  MOH and the licensing authorities, MCYS (MCYS_Child_Care_Link@mcys.gov.sg) and MOE (MOE_QSM@moe.gov.sg), will also send out alert letters to the childcare centre/kindergarten/preschool/school with reported clusters of HFMD cases to remind them to put in place measures to curb disease transmission.  They are advised to observe good hygiene practices, and work closely as well as update the situation to the licensing authorities for their necessary action.

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.

In the guidelines, it states that a child should not be allowed to attend the child care facility if the child does not appear well enough to participate in activities as usual and/or has any conditions as detailed in Appendix D (of the Guidelines) requiring removal from the child care setting. In Appendix D, one of the conditions stated is 'mouth sores with drooling, until a medical practitioners determines the condition is non-infectious'.

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.