Bracing for return of HFM

The Health Department here is carrying out early vigilance and preparation in anticipation of the three-year cycle of hand, foot and mouth (HFM) infection that might return next year.

A source from the department said since the 1997 outbreak that killed over 30 children in Sarawak, a trend had been established through studies that the viral infection would hit every three years. For the past decade, there had been an increased incidence of HFM - in 1997, 2000, 2003 and 2006.

The officer said they were already going to schools, kindergartens and nurseries to check on the children, and to promote awareness among them and their parents through the persons-in-charge and the teachers.

“We are looking out for the cases and we are stepping up the precautionary measures to prevent a spread.”

He confirmed they had received such a directive from their headquarters this month, requiring them to check and step up the precautionary actions.

“We have, in fact, started with the vigilance since a month ago. The situation now is normal. An average of three cases are reported weekly but all the patients have recovered with supportive treatments at the hospital.”

He called on the parents not to be alarmed by these cases, saying that HFM infection was a very common sickness. Despite being also mostly non-fatal, he said the l997 outbreak should be a lesson to all. He hoped the teachers and persons-in-charge of primary schools, kindergartens and nurseries would be on the alert, saying that when a case was detected, parents of the children must be notified.

“Promote personal hygiene among the children as well,” he said.

HFM infection is a common illness characterised by fever, sores in the mouth and rashes with blisters. It normally begins with a mild fever, poor appetite, malaise (feeling sick), and frequent sore throat. One or two days after the fever begins, painful sores develop in the mouth.
They begin as small red spots before becoming ulcers.

In the 1997 HFM outbreak in Sarawak, the World Health Organisation (WHO) said it sparked after a 19-month old boy was admitted to the Sibu Hospital on April 14.
The toddler had a three-day history of fever and oral ulcers. He had poor peripheral perfusion and tachycardia, and this developed into heart failure. The boy died the next day.

In the next two months, 26 more children in Sarawak died, also of heart failure because of the infection, and two others who were brought in dead were suspected to have died of similar cause.
Eighteen (62 per cent) of the 29 children were male. Their mean age was 1.6 years (seven months to six years); 23 (79.3 pct) of them were less than two years old.

The 27 admitted to the hospitals developed signs of shock, including pallor, cold extremities, delayed capillary refill and weak peripheral pulses. In most instances, children died within seven days of the onset of illness, and death usually ensued within 24 hours of admission.

In several cases, family members said children who died had been in contact with other children with hand, foot, and mouth infection two to five days before the onset of their own illness.
This prompted the Health Ministry to call for the isolation of all children in Sarawak then.

Viruses from the group called Enteroviruses cause HFM infection. The most common cause is Coxsackie virus A16. Sometimes, it is caused by Enterovirus 71 or other Enteroviruses.