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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.



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.

He acknowledged, however, the emergence of the more virulent EV-71 at a bigger number compared to the usual pattern we've seen for the past few years", when the Coxsackie virus was more widespread.

Checks in Penang found that trolleys were among the causes of the spread of HFMD



While the Ministry of Health has reported a "slight increase" in the proportion of EV-71 cases here, the Coxsackie virus type A remains the predominant strain, like in past years.

The total number of HFMD cases - at 31,015 so far - is a 28 per cent increase from the same period last year. The last peak was in 2016, when reported cases hit 42,000 for the whole year.



Wash your hands frequently, before and after meals and also after using the toilet. When you cough or sneeze, cover your mouth or nose, advised Assoc. Prof Chong.

"Try not to share food and drinks. Don't share personal items as well, for example your toothbrushes and towels. And if the child is infected, avoid kissing and hugging the child,"

she said.

Associate Professor Chong Chia Yin

While wet wipes may be suitable for cleaning the surfaces of doorknob or tables, a hand sanitiser is still needed, she added.



There is no approved antiviral drug or vaccine in Singapore, but Associate Professor Justin Chu from the National University of Singapore's Yong Loo Lin School of Medicine is working on a vaccine that may be viable in five years' time.

He is also leading a team of researchers who have developed an HFMD test kit that could soon allow children to be tested at home or their childcare centre - with just their saliva.

This kit takes as quickly as about two hours to turn around the results, and can be used before symptoms of the virus appear.

Associate Professor Justin Chu's team is now testing the kit on a larger group – the earlier study involved 82 children – to increase the sensitivity and specificity of the test

It is estimated that each kit will cost about S$2, but there is two or three years to go before it hits the market.



Yes. Ms Glynisia Yeo's four-year-old son has caught HFMD thrice over a span of two years, and she was badly hit in 2016 when she contracted the disease from him.

She could not eat for a few days because of the mouth ulcers; she could not walk properly because of the sores on her feet; she had painful rashes on her hands, and her skin started to peel.

After she was discharged from hospital, she thought the worst was over. A few weeks later, the base of one of her fingernails started peeling off".

Ms Glynisia Yeo

Over the next few weeks, her fingernails and toenails fell off, and she suffered from hair loss too.

"I did a check with my doctor, and he said (those) could be some of the after-effects because the virus that I was hit with was pretty severe,"

said the 42-year-old, who has since recovered.

"To me, (HFMD) is quite scary now. So I'm very worried, and sincerely hope that my son wont catch it again."


Watch this episode of Talking Point here. New episodes every Thursday at 9.30pm on Mediacorp Channel 5.

About one in 10 HFMD cases in Singapore involve adults and youth above the age of 15


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