Singaporean Flu, does not attack only the Singapore

Prof Ariyanto Harsono MD PhD SpA(K)

Prof Ariyanto Harsono MD PhD SpA(K) 2

Introduction

"Singaporean Flu" is not listed in the ICD diagnosis. The actual name is: "Hand Foot and Mouth Disease" (HFMD). In Indonesia is called Singaporean Flu for the first time outbreak in Singapore. After then outbreak in some parts of Asia and parts of Australia and Africa occurred.

Prof Ariyanto Harsono MD PhD SpA(K) 3

Key words: epidemiology, symptom, etiology, risk factor, complication, diagnosis, treatment, prevention, myth.

There are other diseases that are similar but not the same:"Foot and Mouth Disease" is sometimes called "Hoof and Mouth Disease", which is an infectious viral disease found in cattle that cannot be passed from pets or other animals to humans, and are not from human infect animals.HFMD is a mild disease that causes only a few days of fever and other signs and symptoms are relatively mild. But if mouth sores or sore throat should keep children drink adequate fluids. Need to contact doctor if after a few days, the signs and symptoms worsen.

Prof Ariyanto Harsono MD PhD SpA(K) 4

Epidemiology:

The disease is highly infectious and often occurs in the summer. HFMD is a disease that often occurs in dense groups and affects children aged 2 weeks to 5 years (sometimes up to10 years). Adults are generally more resistant to entero viruses, although it could be affected.Transmission through the faecal-oral (digestion) and respiratory tract, i.e. from droplets (droplets of saliva), runny nose, saliva, feces, fluid vesicles (skin disorders such as tiny bubbles filled with fluid) or excreta. Indirect contact transmission through the goods, towels, clothes, food equipment, and toys that are contaminated with secretions. But there is no vector (carrier) such as flies and cockroaches.It gives specific disease immunity, but the child may be exposed to viruses HMFD again by other entero-virus strains.

Prof Ariyanto Harsono MD PhD SpA(K) 5

Symptoms of Disease

The incubation period is three to seven days. Fever is often the first sign, followed by a sore throat and sometimes a lack of appetite and malaise. One or two days after the fever begins, painful sores can occur in the mouth or throat. Rashes on the hands and feet and possibly on the buttocks can follow within a day or two

Prof Ariyanto Harsono MD PhD SpA(K) 6

Prof Ariyanto Harsono MD PhD SpA(K) 7

Begin as small red spots that blister and then often become ulcers on the tongue, gums and inside the cheeks.

Prof Ariyanto Harsono MD PhD SpA(K) 8

Skin rash starts out as flat, red spots that turn into blisters may also appear after one or two days.The rash does not itch, and usually appear on the palms and soles of the feet.HFMDcan cause some or all of the signs and symptoms of the following:•Fever•Sore throat•feeling unwell (malaise)•Pain, red, blister-like lesions on the tongue, gums and inside of cheek•red rash, no itching but sometimes with pain, in the palms, soles and sometimes buttocks •Irritability in infants and toddlers•Loss of appetite

Prof Ariyanto Harsono MD PhD SpA(K) 9

Etiology

The most common cause of HFMD is coxsackie virus A16 infection. A group of viruses including enterovirus coxsackie virus non polio. Other entero viruses can sometimes cause, there are reports of isolation of some strains of enterovirus 71 in outbreaks of disease.

Prof Ariyanto Harsono MD PhD SpA(K) 10

coxsackie virus A16

Prof Ariyanto Harsono MD PhD SpA(K) 11

A child who previously infected so it can be a carrier and continues to be a source of infection for other children, spread the virus, even if he has recovered well.Oral transmission is the main source of coxsackie virus infection. The disease is spread by person-to-person when an infected person is:•Nasal secretions or throat swabs•Saliva•Fluid from the blisters•Feces•Sprays breathing air after coughing or sneezingCommonly occurs in child day care.Although most contagious during the first week of illness, the virus can remain in the body for weeks after the signs and symptoms disappear. That means children can still infect others.Some people, especially adults, can transmit the virus without showing any signs or symptoms of disease.Outbreaks of this disease is more common in summer and autumn in the United States and other temperate regions. In tropical climates, outbreaks occur throughout the year.

Prof Ariyanto Harsono MD PhD SpA(K) 12

Risk factors

HFMD mainly affects children younger than age 10. Children in child care centers are particularly vulnerable to outbreaks because the infection spread by person-to-person, and children are the most vulnerable. Children usually have immunity to the disease as they get older to build antibodies after exposure to the virus that causes the disease.

Prof Ariyanto Harsono MD PhD SpA(K) 13

ComplicationHFMD’s most common complication is dehydration. This disease can cause sores in the mouth and throat, making swallowing painful and difficult.HFMD is usually a mild illness that causes only a few days of fever and other signs and symptoms are relatively mild. However, a rare form and coxsackie virus sometimes serious complications to the brain and can cause:•Viral meningitis. It is an infection and inflammation of the membranes (meninges) and cerebrospinal fluid that surround the brain and spinal cord, usually mild and self-limiting.•Encephalitis. This severe disease and potentially life-threatening inflammation involving the brain caused by a virus, but encephalitis is rare.

Prof Ariyanto Harsono MD PhD SpA(K) 14

Tests and diagnosis

To distinguish disease from other types of viral infection by evaluating:•The pattern of signs and symptoms•The emergence of a rash or soresA throat swab or stool specimen may be taken and sent to a laboratory to determine which virus caused the disease, can only be done at the Great Hospital.

Prof Ariyanto Harsono MD PhD SpA(K) 15

Care and TreatmentThere is no specific treatment for HFMD. Signs and symptoms of the disease usually resolves in seven to 10 days.To help reduce the discomfort, it is recommended:•Rest•Drinking milk-based fluids may be easier than liquid acids, such as juice or soda•Drinking pain killer other than aspirin, such acetaminophen or ibuprofen, if necessary, but not necessary for mild fever•Using mouth wash or oral spray to reduce pain mouth/throat. Certain foods and drinks can irritate the blisters on the tongue or in the mouth or throat. Try these tips to help make the pain less intrusive and more tolerable eating and drinking:•Eating ice cream or sherbet•Drink cool beverages, such as milk or ice water•Avoid acidic foods and beverages, such as fruit juice, fruit drinks and soda•Avoid salty or spicy foods•Eat soft foods that do not require much chewing•Rinse mouth with warm water after a meal

Prof Ariyanto Harsono MD PhD SpA(K) 16

PreventionCertain precautions can help reduce the risk of infection:•Wash hands carefully. Be sure to wash hands frequently and thoroughly, especially after using the toilet or changing diapers, and before preparing food and eating. When soap and water are not available, use hand wipes or gel alcohol.•Teach good hygiene. Show the children how to practice good hygiene and how to keep self clean. Explain to them why it's best not to put their fingers, hands or other objects in the mouth.•Isolate infectious person. Because the disease is highly contagious, people with the disease should limit their exposure to others while they have signs and symptoms of active disease.

Prof Ariyanto Harsono MD PhD SpA(K) 17

Myths and Facts About Flu Singapore

1. Myth: Children with flu Singapore banned bath. Fact: in order to speed up the healing process, the body of the child should be clean by bathing.2. Myth: Children with the Singapore flu should wear powder, so bump-bump in his body disappear fast. Fact: The powder can be deposited on the wounds, so can be contaminated by other virus such as chicken pox which can slow the healing process.3. Myth: Exposure to wind can exacerbate children with Singapore flu. Fact: a gust of wind will not aggravate the health conditions of children, but can transmit flu to others.

Prof Ariyanto Harsono MD PhD SpA(K) 18

Thank you