An incredible outbreak of Hand Foot and Mouth Disease (HFMD) in Malaysia is not only ransacking children under the age of 6, the country is also experiencing a 20 fold increase in cases compared to 2021 amid a doubling and tripling week over week.
Exponential curve
According to New Straits Times, Malaysian Director General of Health Tan Sri Dr Noor Hisham Abdullah told media that 47,209 HFMD cases had been reported year-to-date, a staggering figure in light of only 2,237 being reported by the same time last year.
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Additionally, new infections counted in the authority’s 20th Epidemiology Week (EW) amounted to 15,548 compared to 7,526 during EW 19, an almost 107 percent increase.
Data from a May 11 article by Free Malaysia Today evidences that the exponential jump is not in isolation, revealing that EW19 was already a 349 percent increase over EW18, which posted 1,676 cases.
Kids hardest hit
Abdullah also revealed another alarming characteristic of the outbreak: 92.6 percent, or 43,736, of all cases this season, afflicted children under the age of 6.
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Of the remainder, 2,765 cases hit kids aged between 7 and 12.
Viral characteristics
The official stated that three different types of virus were attributed to the 1,168 outbreak clusters nationwide so far:
- Coxsackie A16 (CA16)
- Coxsackie A6 (CA6)
- Enterovirus 71 (EV71)
An English-language guidance document posted on the Ministry of Health website from 2007 states that although HFMD is an endemic disease in the country, it has become an “important public health disease” because of “its tendency to cause large outbreaks and deaths among children and infants.”
The document adds that human enteroviruses are part of the Picornaviridae family, which also includes rhinoviruses and polioviruses.
It further states that A16 infections are “usually uneventful, with full recovery,” with only three known deaths in history.
EV71, on the other hand, “can be more severe and may be complicated with meningitis, encephalitis and neurogenic pulmonary edema.”
Furthermore, the document stated that for EV71 infections, typical HFMD symptoms were only the first of four stages. The other stages involved central nervous system degeneration and failure, cardiopulmonary failure, and convalescence.
According to another Government of Malaysia website dated 2020, HFMD primarily targets kids aged 5 and under.
The site states that symptomatic HFMD begins with a fever and a loss of appetite before ulcers quickly manifest in the mouth. In some, red spots spread to the palms and soles of the feet, which then may begin to blister, hence the name Hand Foot and Mouth Disease.
“The symptoms vary among infected children. While some children develop the typical signs and symptoms, others may just have the skin rash or mouth ulcers. Some infected children experience no signs and symptoms,” the website states.
The 2007 Guidance states that, “If the disease is confined to the oral cavity it is almost indistinguishable from primary herpetic gingivostomatitis.”
Transmissibility and treatment
According to the Ministry of Health, the viruses are found in the mouth and nose, blister and ulcer fluid, and feces of the infected, a significant caveat for parents of children who are still in diapers.
The website states that the disease is usually treated based on symptoms, which tend to resolve after 7 to 10 days as a regularly functioning human immune system generates antibodies.
“There are no specific medicines that can kill the viruses. Healthcare providers prescribe fever medicines and pain killers to reduce the fever and pain in the mouth. It is important to give the child adequate fluids during the course of illness,” it adds.
Although HFMD is regarded by the Ministry as a “generally mild infection,” the site notes: “Rarely, some viruses, especially EV71, may affect the brain and the heart. The severe form of HFMD may lead to permanent damage to the body or even death.”
The event is significant enough that the Crisis 24 branch of global security firm GardaWorld issued a May 11 alert, stating that the last significant outbreak of HFMD in Malaysia was in 2016.
