HFMD – Four simple letters that have been proven to strike fear in the hearts of parents in Singapore. Even if you’re not the type to worry, maybe it's time to start.
The Straits Times has reported a surge in the number of cases of HFMD and is still expecting a record number of patients to be infected by this virus.
As of August 2016, there are 25,327 cases recorded by the Ministry of Health (MOH), an increase of about 50% compared to the 16,626 recorded for the same period last year. Although the strain of the virus spreading this time round is generally non-lethal, there has been an increase in the number of patients hospitalised due to high fever, dehydration and febrile fits.
As a parent, I can't help but think of the major inconveniences the HFMD virus causes, starting from the two-week quarantine period, trying to stop the sick and whiny child from scratching the blistering and infected rashes, coaxing them to eat soft foods and some liquids to prevent dehydration (not an easy feat if they have ulcers in the mouth and throat) and, that’s not even considering the cleaning, scrubbing and disinfecting of everything that they touch, so that no one else in the household will get infected.
With no treatment or medication to speak off, I can’t help but wonder if there’s a bubble we can keep our kids in to keep the virus at bay, but until such a device is invented, understanding how it is transmitted and taking precautionary measures is probably the next best option.
We spoke to Dr Leong Hoe Nam, an infectious diseases specialist with over 20 years of infectious disease expert experience from Mount Elizabeth Novena Hospital, to pick up tips on preventing children and adults from getting infected by the HFMD virus.
Is HFMD a new virus?
Dr Leong: HFMD has always been around but not many people knew about it previously because there was not much attention from the media. In 1998, there was an outbreak of HFMD in Taiwan which eventually led to a dangerous form of the virus EV71 being brought to Singapore. EV 71 behaves like any other HFMD viruses except that it kills in a small proportion of young children.
How does it spread?
Dr Leong: The HFMD virus largely spreads through contact with body discharge from an infected person ( i.e. saliva, fluids from a rash, nasal discharge etc.). It also remains on the surface of an object, for e.g. on a toy or on someone’s hands etc. Unlike other viruses, it is very difficult to get rid off HFMD viruses and even cleaning with alcohol-based cleansers may not do the job.
Why is hand washing important? How does cleansing our hands prevent germs from spreading?
Dr Leong: An appropriate antiseptic cleanser can kill the virus and minimise its spread. The more an individual is exposed (touched) to the virus, the worse disease the individual develops. In other words, the severity of the illness is proportional to the amount of virus transmitted. The only way of breaking this chain is with hand hygiene and a good sanitizer. However, the HFMD virus is a more resistant type of virus that is harder to remove and kill. Ordinary alcohol sanitizers are insufficient.
Parents should use effective antiseptic cleansers. Hand sanitizers with povidone-iodine also marketed as BETADINE® are proven to be effective against the HFMD virus when combined with the proper handwashing techniques. This involves the seven simple steps of handwashing.
The Communicable Diseases Centre (CDC) and the World Health Organization (WHO) recommends hand hygiene as a preventive measures for HFMD. In your opinion, is this sufficient?
Dr Leong: Hand washing is a key pillar to controlling the spread, but unfortunately routine handwashing by itself may not sufficient if someone is in contact with an infected person during an outbreak. However, this is still one of the easiest and most cost efficient method, and outbreaks can still be minimized with regular handwashing.
Why is the HFMD virus so resistant and is there any treatment for HFMD?
Dr Leong: The HFMD virus is a type of virus which is more resistant to water and regular cleansers. Unlike normal viruses like the influenza virus which can be easily washed off with water, the HFMD virus stays on a surface until a proper cleanser is used to remove it. The outer structure of the HFMD virus confers the virus resistance against detergents and alcohol. The non-enveloped nature gives it the protection. In contrast, the influenza virus or most cold viruses are enveloped. They are susceptible to regular soap and detergents, making it easier to kill.
This means that once an infected person touches a surface, he can indirectly infect multiple people who later touch that same surface. This is why HFMD is so prevalent in childcare centres where children share toys and toilets. However the spread can definitely be minimized with a proper cleanser and handwashing system.
Unfortunately, there is no treatment for HFMD currently. However, it is important to ensure adequate hydration. Patients usually feel better when adequately hydrated. My advice to parents would be to ensure that their children take in liquids in any form, be it popsicles or even drinks containing a little sugar. One way to check adequate hydration is to check that the urine is clear or only has a tinge of yellow in it
What is your opinion about the level of hand hygiene among Singaporeans? How can we improve the quality of hand washing to limit the spread of infectious diseases?
Dr Leong: The hand hygiene standards are still clearly inadequate in Singapore.
There was a study in 2007 which showed that 3 out of 10 Singaporeans didn't wash their hands after using the toilet. Our schools have been teaching our children hand washing techniques, it’s just that we tend to get complacent after that. We should continue practicing the seven steps of handwashing to ensure all the areas of the hands are actively washed. A cycle of hand hygiene takes 30 seconds to 1 minute.
There are so many products in the market. In your opinion, how should we select the appropriate hand wash for HFMD or virus related outbreaks?
Dr Leong: I would suggest a cleanser containing povidone –iodine, like the BETADINE® Skin Cleanser, not only because it has been proven to eliminate the HFMD virus and meet European test standards for virus-killing products, but also because its unique golden-brown tinge in the suds makes it easier for both adults and children to ensure that all surfaces of their hands are washed thoroughly. It is also gentle in comparison to other hospital grade antiseptics.
With Singapore’s dense population, you can never know where these germs may lurk and should never be too cautious in protecting your family from the spread of infectious diseases.
For tough, water-resistant germs (like HFMD), it is important to use an antiseptic cleanser that has been proven to kill and remove germs. Tests have shown that in comparison to regular alcohol-based cleanser, the BETADINE® Skin Cleanser, with its 7.5% povidone-iodine formulation, has been proven to kill a substantial portion of infectious germs from hands and surfaces. This antiseptic cleanser is gentle enough to be used several times daily and its golden-brown suds clearly shows which sections of your hands have not been properly cleansed. It will not cause permanent staining on fingernails, skin and hair and can easily be washed off natural fibres clothes e.g. cotton.
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1 WHO Hand, Foot and Mouth Disease Information Sheet accessed on 31st May: www.wpro.who.int/emerging_diseases/hfmd.information.sheet/en/
2 Omaña-Cepeda et al. BMC Res Notes (2016) 9:165