Hand, Foot and Mouth Disease (HFMD): An Update

Abstract

Hand, foot, and mouth disease (HFMD) also known as vesicular stomatitis with exanthema, first reported in New Zealand in 1957 is caused by Coxsackie virus A16 (CVA16), human enterovirus 71 (HEV71) and occasionally by other HEV-A serotypes, such as Coxsackie virus A6 and Coxsackie virus A10, are also associated with HFMD and herpangina. While all these viruses can cause mild disease in children, EV71 has been associated with neurological disease and mortality in large outbreaks in the Asia Pacific region over the last decade. It is highly contagious and is spread through direct contact with the mucus, saliva, or feces of an infected person. This is characterized by erythrematous papulo vesicular eruptions over hand, feet, perioral area, knee, buttocks and also intra-orally mostly in children, typically occurs in small epidemics usually during the summer and autumn months. HFMD symptoms are usually mild and resolve on their own in 7 to 10 days. Treatment is symptomatic but good hygiene during and after infection is very important in preventing the spread of the disease. Though only small scale outbreaks have been reported from United States, Europe, Australia Japan and Brazil for the first few decade, since 1997 the disease has conspicuously changed its behavior as noted in different Southeast Asian countries. There was sharp rise in incidence, severity, complications and even fatal outcomes that were almost unseen before that period. There are reports of disease activity in different corners of India since 2004, and the largest outbreak of HFMD occurred in eastern part of India in and around Kolkata in 2007and Bhubaneswar, Odisha in 2009. In recent years there are cases of HFMD have been seen in Bangladesh also. Although of milder degree, continuous progress to affect larger parts of the neighboring may indicate vulnerability of Bangladesh from possible future outbreaks.Bangladesh J Child Health 2016; VOL 40 (2) :115-119

Emerging Hand Foot Mouth Disease in Bangladeshi Children- First Report of Rapid Appraisal on Pocket Outbreak: Clinico-epidemiological Perspective Implicating Public Health Emergency

“…However, HFMD CA16 outbreak in Singapore also occurred periodically: in 2002, 2005 and 2007 but in 2006 but it was caused by EV71 11 . HFMD outbreaks were also reported from Orissa 12 and Calcutta 13 in India that borders with Bangladesh but strange is no published data or report exist in Bangladesh, yet (until June 2018) 23 .…”

“…DD includes chickenpox, scabies, measles, erythema multiforme, herpangina, herpetic gingivitis, drug eruption and others 4,14,17,22 . Laboratory diagnosis is usually not essential 12,19,23 , and has been described by the World Health Organization (WHO) as optional 1 . Conversely, the sophisticated laboratory tests used for definitive diagnosis (virus isolation, molecular analysis, PCR, genotyping) 1,13, 24 are not available in most resource-constrained countries 3,12,13 like Bangladesh.…”

Emerging Hand Foot Mouth Disease in Bangladeshi Children- First Report of Rapid Appraisal on Pocket Outbreak: Clinico-epidemiological Perspective Implicating Public Health Emergency

“…HFMD outbreaks were also reported in the Indian districts of Orissa 12 and Calcutta 13 , bordering with Bangladesh. It is therefore strange that no data or published reports exist in Bangladesh yet then, as Prabir et al commented rightly and in-time 23 . Despite epidemiological forecasts that HFMD outbreaks occur in a 2-3-year cyclical pattern 11 , two large epidemics broke out in 2 consecutively years: one in Malaysia during 1997 and the other in Taiwan, the following year 9 .…”

“…Laboratory diagnosis is usually not essential 12, 23 to confirm a readily diagnosed HFMD case based on rational judgement of existing clinical features. Even, lab diagnosis often remains unnecessary 19 .…”

“…Laboratory tests, such as serotyping, molecular, PCR and genotyping 3 and virus culture 1,13,24 , may not be feasible, available and more importantly not affordable in resourceconstrained countries 12,13 like Bangladesh, particularly in hard-to-reach/remote areas. Although few studies report high WBC count or blood glucose, as associated with HFMD severity [13][14][15][16][17][18][19]23,24 , it remains scarcely seen in recent literature. Furthermore, rise in blood glucose level may be due to other viral diseases rather than HFMD, and may well remain confounded by a wide range of infections and/or inflammatory processes.…”