[Doctor’s Advice vol.3] About Hand, Foot, and Mouth Disease (HFMD), Now Also Spreading in Japan

[Doctor’s Advice vol.3] About Hand, Foot, and Mouth Disease (HFMD), Now Also Spreading in Japan


Hand, foot, and mouth disease (HFMD) is a viral infectious disease. In Singapore, it is among those diseases for which cases occur throughout the year, and now, in the summer of 2013, it has also been spreading in Japan.

HFMD is known as an infectious disease that commonly affects infants, but it can also be contracted by adults. While most cases of the disease are said to be mild, some cases have lead to aggravated symptoms and even death—it is by no means a disease to be taken lightly.

This time, we again consulted Dr. Keiichi Hayashi at Raffles Japanese Clinic to learn about HFMD.

Which viruses are responsible for causing HFMD?

The main viruses that cause HFMD are coxsackie virus A16 and enterovirus 71. Several other viruses can also cause the disease. It is not very much the case that outbreaks are caused by a different virus each season; rather, it is often the case that several viruses break out during the same period. This means that even if you have already caught the disease before, there is still a possibility that you could contract it again, unless you have immunity against the other virus types. In fact, there have been cases in Japan where people contracted HFMD several times in one summer.
In countries throughout Asia including Singapore, cases of HFMD occur almost throughout the entire year, while in Japan, outbreaks occur mostly during the summer.

What are the symptoms of HFMD?

A typical symptom of HFMD is the formation of small blisters on the palms of one’s hands or the soles of one’s feet. Some people go without developing blisters in their mouth, and approximately one half of patients are said to not experience fever. In some cases, a rash of small, red spots occurs instead of blisters. The severity of the symptoms vary among individuals—some people have mild symptoms and recover immediately, while others experience difficulty eating for a while due to pain inside their mouths. Although the manifestation of the symptoms are the same for infants and adults, they are often more severe for adults, and symptoms tend to become aggravated if the patient has a history of atopic dermatitis. Diarrhea can also be experienced. If there is a fever present, it usually goes away in 2–3 (1–2?) days; blisters disappear after approximately one week.
Experiencing nail loss after recovering from the illness is a common symptom of coxsackie virus A6. This virus can cause the patient to develop a rash not only in their hands, feet, and mouth, but sometimes also in their elbows, knees, and buttocks. For this reason, the illness is sometimes misdiagnosed as chickenpox.

How is HFMD treated?

There is no specific medicine for HFMD, and treatments are symptomatic. For example, antipyretics are prescribed for fever, intravenous therapy is given if patients cannot eat or drink at all, and skin care is administered if rashes are severe—the patient is then expected to wait it out and recover naturally on their own. There is no need to seek medical assistance if the symptoms are mild, but if you contract the illness for the first time or feel unwell, it is recommended that you see a doctor rather than following your own judgment.

How can you prevent HFMD?

The viruses that cause HFMD are transmitted through direct contact with a patient’s rash, by inhaling the aerosols produced by a coughing or sneezing patient, or if the viruses in a patient’s feces somehow make their way into another person’s mouth. Hand washing is fundamental to preventing infection. If family members or those close to you are infected by the illness, try to avoid contact with them as much as possible. Hand washing after using children’s toys or playrooms should definitely be exercised, as the viruses can be transferred through them also. Avoiding the use of public facilities during times when the virus is particularly prevalent is also recommended as a preventive measure.

Differences in attitudes toward HFMD in Singapore and in Japan

In Japan, HFMD is designated under the School Health and Safety Act as one of the infectious diseases for which schools are required to take preventive action, but there are no strict regulations on suspending infected pupils from attending school. In most cases, pupils are allowed to attend school or kindergarten if their whole body is in good condition and one day has passed since their fever has subsided, even if they still have blisters.
However, in other Asian countries, HFMD is regarded as a disease of high concern, as cases of death from HFMD caused by enterovirus 71 have been reported. HFMD caused by this particular virus has caused over 6,000,000 cases worldwide over the past 10 years, of which more than 2,000 cases were fatal. For this reason, kindergartens and nurseries in Singapore conduct health checks on their pupils every morning as they arrive, and children presenting symptoms are suspended from attendance. Sometimes, kindergartens and nurseries are closed down temporarily if multiple cases of the illness occur in the same institution. Currently, vaccines are also being developed in China and Taiwan.


Raffles Japanese Clinic
Doctor Keiichi Hayashi


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