PREPARED BY :
MOHD NOOR BIN ISMAIL
2ND YEAR STUDENT, CHARLES UNIVERSITY IN PRAGUE,
FACULTY OF MEDICINE IN HRADEC KRALOVE
COMMUNICABLE DISEASES INCIDENCE RATE MORTALITY RATE
AIDS 6.91 3.66
HIV 21.88 1.43
Cholera 0.89 0.01
Dengue Fever 64.37 0.01
Dengue Haemorrhagic Fever 4.10 0.25
Diphtheria 0.00 0
Dysentery (All Format) 0.39 0
Food Poisoning 26.04 0
Gonococcal Infections 1.90 0
Hand, Foot & Mouth Disease 19.30 0.02
Relapsing Fever 0 0
Syphilis (All Forms) 3.06 0.01
Tetanus Neonatorum 0.04 0.01
Tetanus (Adult) 0.06 0
Tuberculosis (All Forms) 62.56 5.37
Typhoid and Paratyphoid 0.77 0.02
Viral Hepatitis (All Forms) 9.37 0.18
Malaria 19.87 0.08
Measles 2.27 0
Whooping Cough 0.02 0
Hand-foot-mouth disease (HFMD) is endemic in
Sarawak. Prior to 1997, there was no baseline
data on the epidemiology of HFMD in Sarawak.
This is due to the fact that HFMD is not a notifiable
disease in Malaysia and in Sarawak.
Between 15 April and 30 June 1997, 31 previously
healthy infants and young children in Sarawak
died after a short febrile illness against a
background of an outbreak of HFMD in the State.
Sibu was badly affected during this outbreak as 11
of the death cases were reported from Sibu
followed by Sarikei with 7 death cases.
WHAT IS HAND, FOOT AND MOUTH
DISEASE (HFDM)? CO JE TO?
Hand, foot, and mouth disease (HFMD) is a common illness
of infants and children caused by a virus. It most often occurs
in children under 10 years old. It is characterized by fever,
sores/ulcers in the mouth, and a rash with blisters. The
blisters may appear in the mouth, palms of the hands and
soles of the feet. The rashes may also appear on buttocks
and on the legs and arms. The ulcers in the mouth usually
appear on the tongue, the sides of the cheeks, gums or near
WHAT CAUSES HFMD?
The most common causes of Hand, Foot
and Mouth disease are coxsackie virus
A16, enterovirus 71 (EV71) and other
enteroviruses. The enterovirus group
includes polioviruses, coxsackieviruses,
echoviruses and other enteroviruses.
WHEN AND WHERE DOES HFMD OCCUR?
Individual cases and outbreaks of HFMD occur
worldwide, more frequently in summer and early
autumn (in temperate countries). In the recent
past, major outbreaks of HFMD attributable to
enterovirus EV71 have been reported in Malaysia
in 1997 and in Taiwan in 1998. HFMD is endemic
in Malaysia and occurs every year. In Sarawak,
the number of cases of HFMD tends to increase
from February to June.
IS HFMD SERIOUS?
HFMD caused by coxsackie virus A16 infection is
a mild disease and nearly all patients recover
within 7 to 10 days. Complications are uncommon.
HFMD caused by Enterovirus EV71 may be
associated with neurological complications such
as aseptic meningitis and encephalitis. Cases of
fatal encephalitis which occurred during outbreaks
of HFMD in Malaysia in 1997 and in Taiwan in
1998 were caused by EV71.
IS HFMD CONTAGIOUS?
Yes, HFMD is moderately contagious. A person is
most contagious during the first week of the
illness. The virus can be transmitted from person
to person via direct contact with nose and throat
discharges, saliva, fluid from blisters, or the stool
of infected persons. The virus may continue to be
excreted in the stools of infected persons up till 1
month. HFMD is not transmitted to or from pets or
HOW SOON WILL SOMEONE BECOME ILL
AFTER GETTING INFECTED?
The usual period from infection to onset of
symptoms (incubation period) is 3 to 7
days. Fever is often the first symptom of
HFMD followed by blister/rash.
WHAT ARE THE CLINICAL SIGNS AND
HFMD begins with a mild fever, poor appetite,
malaise ("feeling sick"), and frequently a sore
throat. One or 2 days after the fever begins,
painful sores develop in the mouth. They begin as
small red spots that blister and then often become
ulcers. They are usually located on the tongue,
gums, and inside of the cheeks. The skin rash
develops over 1 to 2 days with flat or raised red
spots, some with blisters on the palms of the hand
and the soles of the feet. A person with HFMD
may have only the rash or the mouth ulcers.
Blister on the palm of the hand Blister on the dorsum of the feet
Blister on the soles of the feet
Blister then becomes ulcer on the
HOW FOOT, HAND AND MOUTH
Based on a complete history and physical examination of
your child. It is generally suspected on the appearance of
blister-like rash on hands, feet and mouth in children with a
mild febrile illness.
Usually, the doctor can distinguish between HFMD and other
causes of mouth sores based on the age of the patient, the
pattern of symptoms reported by the patient or parent, and
the appearance of the rash and sores on examination. A
throat and/or blister swab collected preferably within 2 days
of onset of HFMD may be sent to a laboratory to determine
which enterovirus caused the illness.
HOW IS HFMD TREATED?
Presently, there is no specific effective antivirul drugs and
vaccine available for the treatment of HFMD. Symptomatic
treatment is given to provide relief from fever, aches, or pain
from the mouth ulcers. Dehydration is a concern because the
mouth sores may make it difficult and painful for children to
eat and drink. Should their affected children be having fever,
the parents are advised to dress their children in light, thin
clothing, to do tepid sponging with water (room temperature)
as often as necessary, and to expose them under the fan.
Taking enough liquids is very important apart from body
WHO IS AT RISK FOR HFMD?
Mainly in children under 10 years old, but may
also occur in adults too. Everyone is at risk of
infection, but not everyone who is infected
becomes ill. Infants, children, and adolescents are
more likely to be susceptible to infection and
illness from these viruses, because they are less
likely than adults to have antibodies and be
immune from previous exposures to them.
Infection results in immunity to the specific virus,
but a second episode may occur following
infection with a different virus belonging to the
WHAT ARE THE RISKS TO PRAGNANT
WOMEN EXPOSED TO CHILDREN WITH
Because enteroviruses, including those causing HFMD, are very
common, pregnant women are frequently exposed to the virus as
well. As for any other adults, the risk of infection is higher for
pregnant women who do not have antibodies from earlier
exposures to these viruses, and who are exposed to young children
- the primary spreaders of enteroviruses.
Most enterovirus infections during pregnancy cause mild or no
illness in the mother. Although the available information is limited,
currently there is no clear evidence that maternal enteroviral
infection causes adverse outcomes of pregnancy such as abortion,
stillbirth, or congenital defects. However, mothers infected shortly
before delivery may pass the virus to the newborn. Babies born to
mothers who have symptoms of enteroviral illness around the time
of delivery are more likely to be infected. Strict adherence to
generally recommended good hygienic practices by the pregnant
woman might help to decrease the risk of infection during
pregnancy and around the time of delivery.
SUGGESTIONS FOR THIS PROBLEM
Frequent hand washing, especially after diaper
changes, after using toilet and before preparing
Maintain cleanliness of house, child care center,
kindergartens or schools and its surrounding
Cleaning of contaminated surfaces and soiled
items with soap and water, and then disinfecting
them with diluted solution of chlorine-containing
bleach (10% concentration)
SUGGESTIONS FOR THIS PROBLEM
Parents are advised not to bring young children
to crowded public places such as shopping
centers, cinemas, swimming pools, markets or
Bring children to the nearest clinic if they show
signs and symptoms.Refrain from sending them
to child care centers, kindergartens or schools
Avoidance of close contact (kissing, hugging,
sharing utensils, etc.) with children having
HFMD illness to reduce of the risk of infection