Causative Agent
Numerous members of the Enteroviruses group of the family Picornaviridae e.g. coxsackievirus, echovirus, enterovirus (EV) 71.
Incubation Period
3-5 days (range 2 days to 2 weeks)
Infectious Period
Few days before onset of prodromal symptoms to about 1 week from the onset of illness.
Maximum duration of excretion: nasopharynx (3-4 weeks), faeces (6-12 weeks).
Transmission
Faecal-oral route, direct contact with respiratory droplets, saliva, vesicular fluid or indirectly by articles/ fomites contaminated by secretions.
Epidemiology
Infection leads to specific immunity against the particular virus but can be reinfected by a different virus from the enterovirus group.
After an epidemic of HFMD in Sarawak in 1997 and Taiwan in 1998, a system of surveillance for the disease, based on notifications from child-care centres was implemented in April 1998. Singapore experienced an epidemic of HFMD in September–October 2000 during which 3790 cases were reported. The predominant virus was EV71. There were four EV71- related deaths in 2000 and three in 2001. Reporting the disease was made legally mandatory on October 1, 2000. The outbreak was finally interrupted by a swift coordinated inter-agency response that led to the closure of all preschools from 1 Oct – 15 Oct.
During the period 2005-2009, there were between 15,257 and 29,686 reported cases per year, including one death in 2008. Coxsackievirus A 16 was the predominant circulating virus in 2005, 2007 and 2009, and EV 71 in 2006 and 2008.
- Rapid diagnosis can be performed by sending a nasopharyngeal throat swab or stool sample for enterovirus PCR.
- Stool/rectal swab, swab of vesicle fluid or oral ulcers can be sent for enterovirus isolation which takes 5-6 weeks. The yield of virus isolation is highest from the stool followed by vesicles and throat swabs.
- Patients with signs and symptoms of severe disease should be referred to hospital for further management; e.g. prolonged hyperpyrexia, tachycardia, tachypnoea, poor feeding or severe vomiting, lethargy.
- Symptomatic measures: anti-pyretics, tepid sponging, IV drip for rehydration.
- Hospitalisation for treatment of complications.
- Antibiotics (especially versus Staphylococcus) are used when there is evidence of secondary bacterial infection; e.g. raised total white counts.
