From the beginning of March this year, Hand, Foot and Mouth Disease (HFMD) started to spread from Anhui Province. On May 9th, there were 25,000 cases reported in China, and 34 reported dead. From the beginning of this year to May 6th, there have been 1988 reported cases in Shanghai, but no deaths. It is thought that this disease will reach it's peak in the coming summer months, and the Ministry of Health has advised that good personal hygiene will help to prevent the spread of this disease.
• HFMD is caused by one of several types of viruses
HFMD is a virus mostly caused by coxsackie virus A16, enterovirus 71 (EV71) viruses

• HFMD is usually spread through person-to-person contact
It can spread through nasal discharge, saliva, feces, fluid from blisters, and any food and water that have been infected. The most common place for the spread of this disease is via children in day-care or schools, especially from toys and unclean hands. It is not transmitted from pets or other animals.

• The symptoms are similar to the common cold with a rash
HFMD may cause some or all of the symptoms listed below:
• Fever
• Sore throat
• Painful red blister-like lesions on the tongue, mouth, palms of the hands or soles of the feet
• Headache
• Fatigue
• Irritability in infants and toddlers
• Loss of appetite, and loss of willingness of infants to eat solid food
Fever is often the first sign of the disease, accompanied by a feeling of malaise and a sore throat, often with poor appetite. One or two days after the fever begins, sores may develop in the mouth or throat. The initial infection time usually lasts for 7-10 days and is the time to be most careful not to pass it on to others. Rash on the hands and feet and/or buttocks can follow which looks similar to chickenpox but without the itching.

• Adults as well as children can catch HFMD
Young children are primarily affected, but it may be seen in adults who will more than likely show milder symptoms. Most cases occur in the summer and early fall. Outbreaks may occur among groups of children especially in child care centers or nursery schools. Symptoms usually appear 3 to 5 days after exposure.

• HFMD is very contagious but usually a mild infection
HFMD is definitely contagious especially during the first month. The fever and spots usually clear within a few days, but can be quite uncomfortable. In a very small number of cases, the virus affects the heart muscle or brain to cause a serious inflammation of the brain (meningoencephalitis) or heart (myocarditis) which can be fatal.

• Screening and diagnosis will involve a throat swab taken by your doctor
Diagnosis depends on these things:
• The age of the affected person
• The pattern of signs and symptoms
• The appearance of rash or sores
A throat swab or stool specimen may be taken and sent to the laboratory to determine which virus caused the illness. However, your doctor probably won't need this type of testing to diagnose HFMD.

• Treatment does not yet include a vaccine
Currently there is no vaccine or anti-viral treatment for this disease, although symptoms, such as headaches, fever, ulcers etc, can be treated to provide temporary relief. Dehydration is usually the most common problem since it can be difficult and painful to swallow with ulcers and sores in the mouth.

• Pregnant women must pay particular attention
Most enterovirus infections during pregnancy cause mild or no illness in the mother, however if a mother is infected during the time of delivery, there could be a chance of passing it to the newborn child. Pregnant women are urged to be very particular when it comes to hygiene, especially if you are around children of a young age.

• Imroved hygiene will help prevent HFMD
Help prevent and control the spread of hand, foot, and mouth disease by:
• Washing hands frequently, especially after going to the bathroom, changing diapers and/or handling diapers or
other stool soiled material.
• Covering mouth and nose when coughing or sneezing.
• Washing toys and other surfaces that have saliva on them.
• Keep ventilation clean and open windows where possible.
• Excluding children from child care or school settings if the child has a fever, uncontrollable “hand to mouth”
behavior, not able to contain their secretions, such as ulcers in the mouth and the child is drooling, or draining
sores that cannot be covered.

Dr. Charu Palta, the pediatrician at Shanghai East International Medical Center in Pudong is keeping up-to-date information on the virus and is happy to answer any questions about HFMD. She is also available for consultations should you have any concerns regarding the symptoms or prevention of this disease. Although Shanghai is taking proactive action with preventative measures already set in place, please be aware that this virus is highly contagious, so in order to prevent any further spread of HFMD, early detection is essential.