The outbreak of a viral infection that manifests symptoms such as blister-like rashes on the hands, feet and mouth of children, particularly those between the ages of three and seven, has become a cause for concern among many parents in Dhaka. The condition, known as hand, foot and mouth disease (HFMD), has also put schools across the capital on alert.
Although the disease is highly-contagious, doctors say there is nothing to fear. The virus that triggers HFMD can be subdued within a matter of days, they say.
Nevertheless, experts stressed the need for caution and preventative measures without panicking. Parents should provide care to afflicted children at home, instead of sending them to school, advised Dr Mohammod Shahidullah, a paediatrician, and a few other physicians.
For the past few weeks, the number of HMFD cases at various schools in Dhaka has been increasing. One school has been closed for two days, owing to parents' concerns about the fast-spreading disease. Additional precautions have been taken in other schools as well.
A spike in patients with HMFD has also been reported at various medical facilities, including children's hospitals and the private chambers of doctors, reports bdnews24.com.
However, as the condition is not considered 'serious' or 'life-threatening', patients generally don't require hospitalisation. As a result, ABM Khurshid Alam, the director general of health services, believes there is no need to panic.
Health authorities noticed the spread of HFMD among schoolchildren a few weeks ago, he said. The Institute of Epidemiology, Disease Control and Research has been directed to investigate the outbreak. The health directorate is also working with experts to stem the spread of the disease.
According to doctors, HMFD is caused by a virus called coxsackievirus. Initial symptoms of the infection include a fever and a general feeling of discomfort. A rash then appears on the hands, feet, knees and face of the infected child within the next two or three days, coupled with body aches.
Many children also develop ulcers in the mouth and on the tongue, making it difficult to eat. The rash usually lasts a week before clearing up on its own.
The disease can affect children aged one to 10. But doctors said it is most prevalent among children aged three to seven.
On Thursday, many parents were seen waiting with their HFMD-afflicted children to consult Dr Shahidullah at his chamber in Dhanmondi.
Among them was a first-grader whose hands and face were covered in rashes. His father said he hadn't sent his son to school that week after learning that two other children at the institution had contracted the disease.
The child came down with a fever on Wednesday. A rash began appearing all over his body the next morning.
“His symptoms aren't severe. But a rash has covered his hands and face. I brought him to the doctor as a precaution."
A two-year-old child has also come with her parents from Kathalbagan to see the doctor.
According to her mother, her elder daughter, who is six years old, attends a local madrasa and the family are unsure whether she has passed on the infection to her younger sibling.
“She has a fever. In addition, there are rashes on her knees, elbows and back. I have heard that the children of some of our acquaintances have also contracted this disease.”
The worried mother of another first-grader at the waiting room said his school in Lalmatia has asked students with HFMD symptoms to stay at home.
However, a parent, asking to remain anonymous, said many children are still going to school while hiding their symptoms. School authorities later tested some children last Wednesday and found two positive cases.
Dr Shahidullah said around eight to 10 children are coming to his chamber every day with the disease.
The symptoms of HFMD tend to appear two to three days after catching the infection, according to him. These include fever, loss of appetite and rashes on hands, feet, back and mouth -- from which the disease derives its name.
The areas of the body where the rashes occur can be painful. Children cannot eat easily if they develop mouth ulcers.
But Dr Shahidullah played down concerns over the disease. "Children stop suffering from the disease after four or five days. They start getting better and the rash doesn't leave any scars on the body," he said.
There is no vaccine or any special treatment for the disease, he added. As such, the fever and the other symptoms have to be treated in the usual manner -- with medication such as paracetamol and allergy medicine for the itching, according to him.
The disease spreads very quickly from one person to another. Sometimes, it may take parents a couple of days to notice the symptoms.
“Unaware of the condition, they [parents] send their children to school. Then, the children pass it on to others. Through them, many more children are affected," said Dr Shahidullah.
"The spread of the disease cannot be easily prevented. Hence, it is difficult to take action against it," he added. But parents must remain alert, according to him.
Six students of AG Church School in Dhaka's Eskaton have contracted the disease, according to the authorities. As a result, students were given a two-day leave, while children with symptoms have been barred from attending school.
“Children who contracted the disease had accidentally come to school. So we announced a two-day holiday. We cleaned the whole school and also talked about the issue with doctors. Apart from those six, no one else has been infected. Doctors said they can come to school 10 days after recovery,” said Sheila, the school's secretary.
Children are coming to Dhaka Shishu Hospital every day with symptoms of HFMD, according to its Director Dr Md Jahangir Alam. They are treated in the outpatient department, he said.
"Their symptoms do not require hospitalisation. However, it is necessary to be careful as children feel uncomfortable as a result of the condition. Anyone who has the disease cannot be sent to school.”
HOW THE DISEASE SPREADS
The viruses that usually cause HFMD are coxsackievirus A16 and enterovirus 71.
Coxsackievirus A16 is mainly responsible for the spread of the disease in the United States. The A6 strain of coxsackievirus can also trigger the disease with more severe symptoms.
Enterovirus 71 has caused outbreaks of the disease in East and Southeast Asian countries.
According to the US Center for Disease Control, the virus can spread through an infected person’s nose and throat secretions, such as saliva, drool, or nasal mucus, fluid from blisters or scabs, and feces.
The infection can be transmitted through contact with respiratory droplets after an infected person sneezes or coughs.
Touching or making close physical contact with an infected child, such as kissing, hugging and sharing cups or eating utensils can also spread the disease.
It can also be contracted by touching objects and surfaces that have the virus on them, such as doorknobs or toys, and then touching your eyes, nose, or mouth.
PREVENTATIVE MEASURES
To prevent the spread of the disease, wash your hands thoroughly with soap for at least 20 seconds, particularly after:
- Changing diapers
- Using the toilet
- Blowing your nose, coughing, or sneezing
- Before and after caring for someone who is sick
Hand sanitizers can also be used as an alternative to soap.
Parents should also supervise children while they wash their hands and ensure that they do so often.
Asked whether a child with HFMD should be kept apart from everyone at home, Dr Shahidullah said, “Since contact with infected people spreads the virus, it is better to keep them isolated. But this can be very difficult to do with children and so, one has to be careful that the virus doesn't spread to others.”
