THE country is currently faced with what has been appropriately designated as a health threat, the hand foot and mouth disease (HFMD).

According to the Health Ministry, the disease has affected more than 300 children and approximately 100 of our public schools. There appears to be some misinformation and perhaps misunderstanding in the public domain concerning this malady.

It is therefore crucial that our public be given an opportunity to fully understand the true nature of this disease and how we may be able to assist in combating its spread.

The facts

Hand foot and mouth disease is a common human syndrome caused by a highly contagious intestinal virus. It most commonly affects children under the age of five, but it may also affect adults.

The symptoms include a mild fever followed by a rash of flat discoloured spots and bumps that may blister, involving the skin of the hands, feet, mouth, and occasionally the buttocks and genitalia.

HFMD is caused by a group of viruses known as Enteroviruses and infection via Coxsakievirus A71 is most common.

How is it spread?

The viruses that cause HFMD are spread through direct contact with the mucus, saliva or faeces of an infected person.

HFMD often occurs in small epidemics in nursery schools or kindergartens, usually during the summer or autumn months.

The viruses that cause hand foot and mouth disease can be found in an infected person’s:

* nose and throat secretions (such as saliva or nasal mucus);

* blister fluid; and

* faeces (stool).

An infected person may spread the viruses that cause hand foot and mouth disease to another person through:

* close personal contact;

* the air (through coughing or sneezing);

* contact with faeces;

* contact with contaminated objects and surfaces.

For example, you might get infected by touching someone who has hand foot and mouth disease or by touching a doorknob that has viruses on it then touching your eyes, mouth or nose.

Symptoms

Common symptoms include fever, nausea, vomiting, feeling tired, generalised discomfort, loss of appetite, and irritability in infants and toddlers.

Skin lesions frequently develop in the form of a rash of flat discoloured spots and bumps. This may be followed by vesicular sores with blisters on palms of the hands, soles of the feet, buttocks, and sometimes on the lips.

The rash is rarely itchy for children, but can be extremely itchy for adults.

Painful ulcers, blisters, or lesions may also develop in or around the nose or mouth.

Diagnosis

A diagnosis usually can be made by the typical signs and symptoms alone.

If the diagnosis is unclear, a throat swab or stool specimen may be taken to identify the virus. The common time between infection and onset of symptoms ranges from three to six days.

Generally, a person with HFMD is most contagious during the first week of illness. However, people can sometimes still be contagious for days or weeks after symptoms go away. Some people, especially adults, may not develop any symptoms, but they can still spread the virus to others. This is why people should always try to maintain good hygiene (eg handwashing, so they can minimise their chance of spreading or getting infections.

You should stay home while you are sick with hand foot and mouth disease. Talk with your doctor if you are not sure when you should return to work or school. The same applies to children returning to day-care.

Treatment

Medications are usually not needed as hand foot and mouth disease is a viral disease that typically gets better on its own. Currently, there is no specific curative treatment for HFMD. Care typically focuses on achieving relief of the symptoms.

Pain from the sores may be eased with the use of pain medications. Infection in older children, adolescents, and adults is typically mild and lasts approximately one week, but may occasionally run a longer course. Fever reducers and lukewarm baths can help decrease body temperature.

Complications

Complications from the viral infections that cause HFMD are rare, but require immediate medical treatment if present. HFMD infections caused by Enterovirus 71 tend to be more severe and are more likely to have brain or heart complications, including death, than infections caused by Coxsackievirus A16.

Viral or aseptic meningitis (inflammation of the lining of the brain) can occur with HFMD in rare cases and causes a fever, headache, stiff neck, or back pain.

The condition is usually mild and clears without treatment; however, hospitalisation for a short time may be needed.

Prevention

Preventive measures include avoiding direct contact with infected individuals (including keeping infected children home from school), proper cleaning of shared utensils, disinfecting contaminated surfaces, and proper hand hygiene. These measures have been shown to be effective in decreasing the transmission of the viruses responsible for HFMD.

Hand foot and mouth disease should not be confused with foot-and-mouth disease, (also known as hoof-and-mouth disease), which affects livestock. Foot-and-mouth disease is caused by a different virus which almost never infects humans.

Hand foot and mouth disease is not transmitted to or from pets or other animals.

Dr Mindi Fitz-Henley is a member of the executive of the Jamaica Medical Doctors Association (JMDA).