Dr. CKI Le Thi Truc Phuong, Medical Expert at the VNVC Vaccination System, issued this warning as the country has recorded over 110,000 cases of hand, foot, and mouth disease since the beginning of the year, a 2.5-fold increase compared to the same period. Many children have been hospitalized in severe condition, developing neurological, cardiovascular, and respiratory complications, requiring ventilators and dialysis. The following common misunderstandings about hand, foot, and mouth disease can cause parents to miss the illness or delay recognizing signs of worsening condition:

Misconception one: Only getting sick when blisters appear

Many parents only consider hand, foot, and mouth disease when their child develops obvious blisters. However, skin lesions can begin as small, flat, or slightly raised red spots, scattered and often causing little to no itching. This subtle presentation is easily mistaken for heat rash or skin allergies, leading to delayed medical examination for the child.

Blisters appearing on the hands of a child with hand, foot, and mouth disease receiving treatment at Quang Ninh Obstetrics and Pediatrics Hospital. Photo: Quang Ninh Obstetrics and Pediatrics Hospital

Blisters appearing on the hands of a child with hand, foot, and mouth disease receiving treatment at Quang Ninh Obstetrics and Pediatrics Hospital. Photo: Quang Ninh Obstetrics and Pediatrics Hospital

To recognize the disease, parents should observe the location of the lesions and accompanying symptoms. Heat rash typically appears when a child is hot and sweating heavily, concentrating on the neck, chest, back, or areas of restricted airflow, causing itching and a prickly sensation. Hand, foot, and mouth disease rashes, conversely, are commonly found on the palms of the hands, soles of the feet, and potentially on the buttocks, knees, arms, and legs.

Children may also experience fever, sore throat, fatigue, poor appetite, or oral lesions. These oral lesions can be small blisters or round to oval-shaped ulcers. When these signs appear, family members should seek medical attention rather than self-diagnosing as heat rash.

Red spots can progress into small blisters, but not all cases present with clear blisters. Oral lesions may start as red dots, form vesicles, and then break into painful ulcers, causing the child to drool, refuse feeding, or avoid eating. This is particularly easy to confuse during a child's teething phase, with parents often overlooking it as an initial symptom of hand, foot, and mouth disease. Waiting for blisters to appear before identifying the disease can delay treatment for the child.

Misconception two: Mouth sores are not hand, foot, and mouth disease

Many parents believe that a child with hand, foot, and mouth disease must exhibit both rashes on the hands and feet and mouth ulcers. Consequently, when a child only experiences mouth pain and difficulty eating without a visible rash, family members may assume the child has "internal heat," canker sores, or pharyngitis. In reality, symptoms do not always appear fully or simultaneously; some children only have oral lesions.

Lesions can appear on the tongue, inner cheeks, and oral mucosa, causing pain when swallowing. Young children, unable to express themselves, often drool excessively, cry when eating, refuse feeding, or reject their favorite daily foods. These signs still require attention even if no rash is visible on the hands or feet.

According to Dr. Phuong, isolated mouth ulcers are not enough to confirm hand, foot, and mouth disease, but the disease cannot be ruled out without skin rash. If a child has mouth pain, fatigue, or poor appetite, parents should take them for examination. Waiting for all "hand, foot, and mouth" symptoms to appear can delay disease detection.

A boy over one year old in TP HCM with EV71 hand, foot, and mouth disease rapidly progressed from stage one to stage four, requiring ECMO and continuous dialysis at Children's Hospital one. Photo: Bao Ngoc

A boy over one year old in TP HCM with EV71 hand, foot, and mouth disease rapidly progressed from stage one to stage four, requiring ECMO and continuous dialysis at Children's Hospital one. Photo: Bao Ngoc

Misconception three: Many rashes indicate severe illness

According to Dr. Phuong, many parents assess a child's condition by the number of rash spots, believing that more rashes mean more severe illness. In reality, hand, foot, and mouth disease is caused by various types of virus with differing levels of danger. Coxsackievirus A16 usually causes mild, self-limiting illness; Coxsackievirus A6 can cause widespread skin lesions. EV71 is more frequently associated with severe illness, neurological complications, and death. However, children infected with EV71 may have very few external skin lesions (unlike other types of hand, foot, and mouth disease) or rashes located in concealed areas such as the buttocks, groin, or areas covered by clothing or diapers. In April, Children's Hospital two (TP HCM) admitted two children with EV71 who suffered respiratory failure and cardiogenic shock but showed no clear erythema or mouth ulcers.

Misconception four: The disease is benign and easily cured

Hand, foot, and mouth disease has caused major outbreaks, such as during the 2011-2012 period, which resulted in over 200 child deaths; 31 child deaths in 2023 were primarily attributed to EV71. Additionally, children infected with EV71 have a 16-fold higher risk of severe progression compared to children infected with Coxsackieviruses like A6, A10, or A16.

EV71 has neurotropic properties, capable of causing encephalitis, brainstem encephalitis, meningitis, and acute flaccid paralysis. Severe cases can lead to autonomic nervous system dysfunction, resulting in respiratory failure, circulatory failure, acute pulmonary edema, and shock. The disease can worsen rapidly, with some severe cases leading to death within 24-48 hours after complications appear. Children who survive neurological damage may experience sequelae such as limb weakness or paralysis, muscle atrophy, tremors, unsteady gait, and attention deficit hyperactivity disorder. Approximately 20% of children hospitalized due to EV71 are recorded to be at risk of neurological or systemic sequelae.

Misconception five: Hand, foot, and mouth disease stage one is mild

A diagnosis of stage one indicates that at the time of examination, the child only has skin rash, mouth ulcers, and no neurological, respiratory, or cardiovascular complications have been recorded. However, the disease stage can change in the following days, especially when caused by EV71.

Initial signs of progression can include high or prolonged fever, poor response to antipyretics, frequent vomiting, lethargy, unusual fussiness, or startled jerks. As neurological complications worsen, the child may experience repeated startling, tremors, unsteady gait, or limb weakness. In stage three, children may have a rapid pulse, abnormal breathing, profuse sweating, cold extremities, and mottled skin; stage four can lead to respiratory failure, circulatory failure, acute pulmonary edema, and shock.

When caring for a child with stage one hand, foot, and mouth disease, parents still need to follow up with scheduled re-examinations and admit the child to the hospital promptly if they experience continuous startling, especially more than two times in 30 minutes; fever above 39 degrees Celsius lasting over 48 hours and difficult to reduce; unsteady gait, limb tremors, limb weakness; frequent vomiting, prolonged fussiness, lethargy, or unusual irritability.

Young children receiving hand, foot, and mouth disease vaccine at the VNVC Vaccination System. Photo: Binh An

Young children receiving hand, foot, and mouth disease vaccine at the VNVC Vaccination System. Photo: Binh An

Prevention methods

There is currently no specific treatment for hand, foot, and mouth disease. Treatment primarily focuses on symptom relief, close monitoring to detect signs of worsening condition, and timely management of complications.

Prevention methods include a combination of hand hygiene, cleaning toys and frequently touched surfaces, and proper waste disposal. Additionally, the Ministry of Health has approved a hand, foot, and mouth vaccine, available for service vaccination.

Dr. Phuong stated that the vaccine is for children from two months to under six years old, with VNVC launching its administration on 25/9 at nearly 300 centers nationwide. According to clinical trial results, the vaccine's protective efficacy and ability to prevent hospitalization due to EV71 range from nearly 97% to 100%. After 600 days of post-vaccination follow-up, no EV71 cases were recorded in the vaccinated group.

After two weeks of deployment, VNVC has administered over 70,000 doses and received tens of thousands of bookings. Dr. Phuong noted that children who have contracted EV71 hand, foot, and mouth disease can still be reinfected and are at risk of severe illness due to different subgroups. Children who have already had the disease are still recommended to get vaccinated to prevent reinfection after recovery and completion of the isolation period. Besides vaccination, children still need to continue hygiene measures to reduce the risk of hand, foot, and mouth disease caused by other agents.

Binh An