7 things to know about the more virulent strain of HFMD that’s killed 2

Updated: Nov 10, 2018

With the outbreak of the Enterovirus 71 strain in Malaysia and its proportion of cases increasing in Singapore, Talking Point finds out more about the nasty virus and how to protect against it.

SINGAPORE: When her 17-month-old boy was afflicted with fever, she gave him some medication for the night.

His fever persisted into the next evening, so mother Mazlin Khairudin took him to a doctor, who told her it was "a normal fever with a little rash on his throat", recalled the Penang resident. "That's all."


Two days later, her boy's condition deteriorated, and she rushed him to a hospital, where he died from hand, foot and mouth disease (HFMD), a common viral illness.

Toddler Yusuf Danial had become the first Malaysian victim of the Enterovirus 71 (EV-71) HFMD strain - a more virulent strain that is also on the increase in Singapore.

Yusuf Danial

"His lungs were filled with virus," Mdm Mazlin told the programme Talking Point. "The doctor said he'd try his best to treat Danial. He gave antibiotics, but Danial's body rejected them. Around 8.48pm, his heart stopped beating." (Watch the episode here.)


In Malaysia, HFMD has soared to near epidemic levels this year - over 55,000 cases as of Aug 27 - with the outbreak in Penang rising to more than 3,700 cases.

Of these, the EV-71 strain has claimed the lives of two: Danial, in June, and a 27-month-old child in Sarawak, in July.

In Singapore, more than 31,000 HFMD cases have been reported to date. This is what you need to know about the EV-71 strain in particular.

A three-dimensional reconstruction of EV-71



Some of the symptoms of this strain are vomiting, irritability, seizures and breathing difficulties, said KK Women's and Children's Hospital senior consultant (Infectious Diseases) Chong Chia Yin.

"The other thing you can look out for is lethargy. (If) the child refuses to eat and drink, then you also have to come in (to hospital). If the urine output is already reduced, you'd have to come in (too) because the child is showing signs of dehydration,"

she explained.

If your child has a lot of bubbles and blisters on the hands and feet, it's less likely to be EV-71.


In Danial's case, he experienced flu symptoms, breathing difficulties and mouth ulcers. He died three days after receiving treatment in hospital, and Mdm Mazlin regrets not getting him admitted earlier.

Mdm Mazlin Khairudin
"Parents, please pay attention to your child. If there's something different about your child, and the fever doesn't seem to go down in one or two days, better send your child for a blood test or X-ray straightaway because this virus is everywhere,"

she beseeched.

READ: Toddler dies from HFMD in Penang; first fatality in Malaysia



HFMD is usually mild, with few complications, but the EV-71 strain can be fatal because of its severe complications, which include neurological, respiratory and cardiovascular problems.

It is also more infectious than the Coxsackie virus, the most common cause of HFMD.

Associate Professor Chong said a child with a Group A Coxsackie virus, for example, would usually spread it to 2.4 other children. But a child with EV-71 would usually spread it to 3.5 other children.

Coxsackie is a type of enterovirus



By mid-July, the number of HFMD cases this year was twice the number in the same period last year “ an outbreak Penang Health Committee chairman Afif Bahardin described then as "beyond the danger level".

But there is "a tremendous decline now". The state's Health Department had, in July, directed shopping malls to sanitise their trolleys, child rides and public benches. At one hawker centre popular with tourists, nightly cleaning sessions are still going on.

"(For) those who are visiting Penang, what's important is to keep a self-awareness of cleanliness," said Dr Afif.