Hand, Foot and Mouth Disease (HFMD) versus

Monkeypox

Features HFMD Monkeypox

Enterovirus family such as

Causative Orthopoxvirus in the family
Coxsackievirus A16, A6, and
virus Poxviridae
Enterovirus A71 (EV71)

Does not occur naturally in

Malaysia. Cases can occur
Frequent outbreaks in
Occurrence through travel to endemic
Malaysia
countries and outbreak areas or
importing of infected animals

Transmitted
by Humans Animals and/or humans

Contact with an infected Contact with an infected animal

person through or person through:
nasal and throat body fluids
secretions, (such as saliva, skin lesion material
Source of nasal mucus) contaminated materials and
infection fluid from blisters surfaces, (example shared
stool towels, bedding, of which
respiratory droplets (after infectious body fluids/scabs
an infected person coughs may be present)
or sneezes) respiratory droplets

Endemic countries in Western and

Exposure Central Africa. Newly reported
Child care setting, schools
risks outbreaks in >20 countries (WHO,
21 May 2022)

Content created by Dr. Chew Cheng Hoon, Dr. Lim Kah Chuan and Dr. Toh Teck Hock.
Reviewed by Dr. Thahira Jamal Mohamed and Datuk Dr. Kalaiarasu M. Peariasamy.
Infographic by Medical and Scientific Affairs, Institute for Clinical Research (ICR), NIH.
ICR
MINISTRY OF HEALTH MALAYSIA
Research that matters to patients
Hand, Foot and Mouth Disease (HFMD) versus Monkeypox

Features HFMD Monkeypox

Often in children aged ten

years or younger with the
Who can commonest among those
get the Both children and adults
disease? less than five.
Rarely seen in adults

Average 4 - 14 days (up to 21

Incubation 3 - 6 days
days)

HFMD presents with fever,

mouth sores and skin rash.
Painful mouth ulcers develop Fever, flu-like symptoms,
1-2 days after fever. Rash swollen lymph nodes.
Symptoms
usually develop on palms of Rash occurs 1-4 days after
hands and soles of feet. onset of fever.
Sometimes poor appetite
and feeling unwell.

Rash Fast, 7 - 10 days Slow, 2 - 4 weeks

period

Usually flat red spots Uniformly progresses from

(macules or papules), and
sometimes filled with fluids
Rash
appearance (vesicles / blisters). When
they rupture, they leave
painless shallow ulcers that
do not scar
macules to papules, vesicles
and pustules, then to scabs
and scars.
(This is in contrast to chickenpox
rash that appears in various
stages of development)

Content created by Dr. Chew Cheng Hoon, Dr. Lim Kah Chuan and Dr. Toh Teck Hock. Reviewed by
Dr. Thahira Jamal Mohamed and Datuk Dr. Kalaiarasu M. Peariasamy. Infographic by Medical and
Scientific Affairs, Institute for Clinical Research (ICR), NIH.
ICR
MINISTRY OF HEALTH MALAYSIA
Research that matters to patients
Hand, Foot and Mouth Disease (HFMD) versus Monkeypox

Features HFMD Monkeypox

On palms of the hands and soles

Starts on head; more dense on
Rash of the feet. Can also appear on
face and limbs; appears on palms
distribution knees, elbow, buttocks and
and soles
genitals.

Lymph-
adenopathy Usually absent Present (swollen lymph nodes)

Duration of Long, usually between 3 and 4

Short, between 7 and 10 days
disease weeks

Clinical diagnosis.
Tests generally not performed
unless for surveillance or
PCR (Best specimen is swab of
Laboratory diagnostic purposes in ill
the vesciular lesion - fluid, roof or
test individuals. Test, PCR of fluids
crust)
from mouth ulcers/blisters,
throat/rectal swab, CSF or biopsy
specimens. Blood serology.

Most cases are usually mild.

In some cases HFMD caused by Self-limiting disease.
EV71 can lead to serious Rare complications include
Complications complications including viral superimposed bacterial infection,
meningitis, myocarditis, as well as eyes, lungs, and brain
encephalitis, acute flaccid complications.
paralysis.

Newborns/very young children,

High risk Newborns/ infants and individuals
pregnant women, and those with
groups with weakened immune systems
weakened immune system.

ICR
C o n t e n t c r e a t e d b y D r . C h e w C h e n g Ho o n , D r . L i m K a h C h u a n a n d Dr . T o h T e c k Ho c k .
R e v i e we d b y D r . T h a h i r a J a ma l Mo h a me d a n d D a t u k D r . K a l a i a r a s u M. P e a r i a s a my .
I n f o g r a p h i c b y Me d i c a l a n d S c i e n t i f i c A f f a i r s , I n s t i t u t e f o r C l i n i c a l R e s e a r c h ( I C R ) , NI H. MINISTRY OF HEALTH MALAYSIA
Research that matters to patients
Hand, Foot and Mouth Disease (HFMD) versus Monkeypox

PREVENTION

Wash hands frequently with

soap and water before Cover your mouth when you
eating, after visiting the cough or sneeze
toilet

Disinfect surfaces and

Do not share food, drinks fomites (e.g. toys), avoiding
and personal items e.g. close contact and the
utensils, toothbrushes, sharing of personal items
towels, clothes with infected persons

Stay at home if infected and Avoid contact with wild

avoid close contact animals or animals imported
from endemic countries

If you have travelled from a

Thoroughly cook all foods country that has a
containing meat or parts monkeypox outbreak, please
properly before eating monitor your health and
symptoms for 21 days in the
MySejahtera app.

Seek medical attention if you

are unwell or have any
doubts.

C o n t e n t c r e a t e d b y D r . C h e w C h e n g Ho o n , D r . L i m K a h C h u a n a n d Dr . T o h T e c k Ho c k .
R e v i e we d b y D r . T h a h i r a J a ma l Mo h a me d a n d D a t u k D r . K a l a i a r a s u M. P e a r i a s a my .
I n f o g r a p h i c b y Me d i c a l a n d S c i e n t i f i c A f f a i r s , I n s t i t u t e f o r C l i n i c a l R e s e a r c h ( I C R ) , NI H.
ICR
MINISTRY OF HEALTH MALAYSIA
Research that matters to patients