INTRODUCTION

 Caused by viruses that belong to the Enterovirus genus (group).

Yhis virus includes polioviruses, coxsackieviruses, echoviruses and
enteroviruses.
 Currently, the most common group of viruses in Malaysia are
Coxsackievirus A16 and Enterovirus 71.
 Usually affects infants and children younger than 5 years old.
 Can sometimes occur in adults.
CASE DEFINITION
 Any cases with history of maculopapular or vesicular rash over the
palm and sole with or without fever.

 Outbreak / cluster of cases:

 When there are 2 or more cases in one locality within the incubation period.
 SIGN & SYMPTOMS
 Rashes (maculopapular / vesicles) on the palm and sole
 Mouth and tongue ulcer
 With or without fever
 URTI symptoms – cough
 Subsided within 7-10 days
 Complications:
 Aseptic or viral meningoencephalitis
 myocarditis
HFMD
MODE OF TRANSMISSION
 Transmission from human to human through direct contact and feacal-oral
route.
 Can be detected in the body fluid such as saliva, sputum, or nasal mucus, fluid
in the blisters and faeces of the pt.
 Can spread when infected pt touch objects and surfaces.
 The incubation period: 3-6 days (can up to 14 days)
 Contagious period is within the first week of the illness and can stay weeks in
the body without having any symptoms.
 Means that the infected person can still transmit the disease even though
he/she already well and asymptomatic.
TREATMENT
 No specific treatment for HFMD

 Symptomatic treatment
 Taking over-the-counter medications to relieve pain and fever.
 Using mouthwashes or sprays that numb mouth pain.
 If a person has mouth sores, it might be painful to swallow, may need to be
given through an IV in their vein to prevent dehydration.
PREVENTION
 No vaccine to protect against the viruses that cause HFMD
 A person can lower their risk of being infected by:
 Washing hands often with soap and water, especially after changing diapers
and using the toilet.
 Disinfecting dirty surfaces and soiled items including toys with
disinfectants.
 Avoid close contact such as kissing, hugging, or sharing eating
utensils or cups with people withy HFMD.
DYNAMIC OF DISEASE
TRANSMISSION
Portal of exit Portal of entry

Source or Modes of Susceptible

reservoir transmission host
PREVENTIVE STRATEGIES :
HOST
 Break the transmission
 To improve the people’s hygienic behavior
 Handwashing
 Diapers changing
 Take bath twice daily
 Screening of children before entering kindergarten or gatekeeping.
 Isolation of cases until all the blisters and ulcers well healed (crusted & peel
off)
PREVENTIVE STRATEGIES :
HOST
 Break the transmission
 Do not share things
 Towel, hankerchief
 Cups, glasses, plate, spoon etc
 toys
 Cough etiquette
 Health education
 Parents
 Children
 Child care center (employees)
PREVENTIVE STRATEGIES :
AGENT
 Prevent growth of viruses
 Disinfection of the surfaces (e.g: toilets, kitchens, hall, common places)
 Hand sanitizer – 70% alcohol
 The most common method to kill microorganisms in water supply is
oxidation with chemical such as sodium hypochlorite.
PREVENTIVE STRATEGIES :
ENVIRONMENT
 Reduce the spread of HFMD
 Daily disinfection of:
 Disposal of diapers and tissues used by the infected children in a closed bin.
 Inspection of child care center on cleanliness and garbage disposal.
PREVENTION AND CONTROL
OF OUTBREAK
 Active case detection
 Child care center
 Carer’s house

 Closure of premises such as child care center with 2 or more cases

within the incubation period.
 Under control and prevention of communicable disease act, 1988.

 Disinfection of the whole premises including equipments.

PREVENTION AND CONTROL
OF OUTBREAK
 Health education to carers on:
 Hand washing
 Personal hygiene
 Regular disinfection of premises and equipments
 Daily check on children’s health such as temperature, sign of HFMD and
others.
 Isolation of children with illness
 Hands-on training on hand washing and personal hygiene to children.
PREVENTION AND CONTROL
OF OUTBREAK
 Notification by Drs
 Under CDC Act 1988
 Can detect increase number of cases through surveillance of cases.

 Parent’s role
 Advised not to send their sick children to the child care center.
 Avoid public places during outbreak.

 Interagency collaboration
 Regular check on child care center
PREVENTION AND CONTROL
OF OUTBREAK AT HEALTH
CARE SETTINGS
 Active case detection
 Isolation of cases
 Disinfection of the whole premises including equipments
 Health education to HCW on
 Hand washing
 Personal hygiene
 Using disinfectants
 Daily check on other children’s health in the setting
PREVENTION AND CONTROL
OF OUTBREAK AT HEALTH
CARE SETTINGS
 Hands-on training on hand washing and personal hygiene to parents
/ guardians.

 Notification of disease to nearest District Health Offices.

THANK YOU