Numerous members of the Enteroviruses group of the family Picornaviridae e.g. coxsackievirus, echovirus, enterovirus (EV) 71.
3-5 days (range 2 days to 2 weeks)
Few days before onset of prodromal symptoms to about 1 week from the onset of illness.
Maximum duration of excretion: nasopharynx (3-4 weeks), faeces (6-12 weeks).
Faecal-oral route, direct contact with respiratory droplets, saliva, vesicular fluid or indirectly by articles/ fomites contaminated by secretions.
Infection leads to specific immunity against the particular virus but can be reinfected by a different virus from the enterovirus group.
After an epidemic of HFMD in Sarawak in 1997 and Taiwan in 1998, a system of surveillance for the disease, based on notifications from child-care centres was implemented in April 1998. Singapore experienced an epidemic of HFMD in September–October 2000 during which 3790 cases were reported. The predominant virus was EV71. There were four EV71- related deaths in 2000 and three in 2001. Reporting the disease was made legally mandatory on October 1, 2000. The outbreak was finally interrupted by a swift coordinated inter-agency response that led to the closure of all preschools from 1 Oct – 15 Oct.
During the period 2005-2009, there were between 15,257 and 29,686 reported cases per year, including one death in 2008. Coxsackievirus A 16 was the predominant circulating virus in 2005, 2007 and 2009, and EV 71 in 2006 and 2008.