HFMD (hand, foot and mouth disease, or penyakit tangan, kaki dan mulut) is a common viral infection that mainly affects children under 5, causing fever, painful mouth ulcers and a rash of spots or blisters on the hands and feet. It is caused by enteroviruses, most often coxsackievirus A16 and enterovirus A71, and usually gets better on its own in 7 to 10 days. There is no medicine that cures it, so care focuses on fluids, soft foods and pain relief. HFMD spreads easily through coughs, sneezes, poo and blister fluid, so handwashing is the best protection. In Malaysia, more than 350,000 cases were reported between 2009 and 2019. Rarely, especially with enterovirus A71, it can cause serious complications, so know the warning signs.
What is HFMD?
HFMD is a common viral illness of childhood. It is caused by a group of viruses called enteroviruses, mainly coxsackievirus A16 and enterovirus A71 (EV-A71). In recent years, other types such as coxsackievirus A6 and A10 have also become more common. Children under 5 are most often affected, but older children and adults can get it too, and you can get HFMD more than once.
HFMD is not the same as foot-and-mouth disease that affects farm animals.
HFMD in Malaysia. HFMD is endemic in Malaysia:
- a study of national surveillance data recorded 354,769 cases between 2009 and 2019, with outbreaks often happening at the same time across districts within Peninsular Malaysia and within East Malaysia;
- a large outbreak caused by EV-A71 in 1997 led to 41 deaths among young children, and EV-A71 outbreaks have recurred every 2 to 4 years since.
Most HFMD is mild, but this history is why Malaysian parents and health authorities take outbreaks seriously.
HFMD symptoms: what are the signs?
Symptoms usually start about 3 to 5 days after catching the virus (the range is 2 to 10 days). According to the NHS, HFMD develops in two stages:
| Stage | Symptoms |
|---|---|
| First stage | Sore throat, high temperature, not wanting to eat |
| A few days later | Painful mouth ulcers; a raised rash of spots on the hands and feet, and sometimes the groin and bottom. Spots can look pink, red or darker than the surrounding skin and may turn into painful grey or pale blisters |
Symptoms are usually mild and are the same in adults and children. Painful mouth ulcers often make young children refuse food and drink, which is the main thing to watch at home.
Some children, particularly when HFMD is caused by coxsackievirus A6, may have more widespread blisters, and peeling skin on the palms and soles or nails that come loose a few weeks later.
A sore throat and fever alone are more often caused by a cold or throat infection; see our guide to sakit tekak. A high fever with severe headache, pain behind the eyes and body aches may be demam denggi instead.
How HFMD spreads
According to the NHS, HFMD is easily passed on through:
- coughs and sneezes;
- poo, for example during nappy changes;
- the fluid in the blisters;
- shared towels, cups, cutlery and toys.
You can spread HFMD from a few days before symptoms appear, and you are most likely to spread it in the first 5 days after symptoms start. Because people can pass it on before they feel ill, it spreads easily in nurseries and kindergartens.
To reduce the spread:
- wash hands often with soap and water, and wash children's hands too, especially after using the toilet, changing nappies and before eating;
- use tissues for coughs and sneezes and throw them away quickly;
- do not share towels, cups or cutlery;
- wash soiled bedding and clothes on a hot wash;
- clean toys and surfaces that children touch often.
How to care for HFMD at home
HFMD usually gets better on its own in 7 to 10 days. Antibiotics do not work, and there is no specific antiviral medicine for HFMD. The NHS recommends:
- cool drinks to soothe the mouth and prevent dehydration, but avoid acidic drinks such as fruit juice;
- soft foods such as yoghurt or plain porridge (bubur), and avoiding hot, salty and spicy foods;
- paracetamol or ibuprofen to ease a sore mouth or throat and fever, using a children's formulation and dose;
- asking a pharmacist about mouth ulcer gels, sprays or mouthwashes suitable for your child's age.
Offer small sips often if swallowing hurts. Watch how much your child is drinking and how often they pee.
Be careful with home remedies or products claiming to cure HFMD. If you want to use any supplement or traditional product, ask your doctor or pharmacist first and check that it is registered (see how to verify KKM registration).
Warning signs: when HFMD is dangerous
Most children recover fully. But HFMD caused by EV-A71 is more likely to cause complications, which can rarely affect the brain (such as encephalitis or meningitis), cause weakness of the limbs, or affect the heart and lungs. Reviews have linked a longer-lasting fever and vomiting to more severe disease.
Go to a clinic or emergency department urgently if your child with HFMD:
- has a very high temperature, or a fever that does not settle after a few days;
- is vomiting repeatedly;
- is unusually sleepy, floppy or hard to wake;
- has sudden jerky movements, a seizure, or weakness in the arms or legs;
- is breathing fast or with difficulty;
- is peeing much less than usual or refuses to drink, which can mean dehydration.
See a doctor if symptoms do not improve after 7 to 10 days, if you are worried about your child, or if you are pregnant and get HFMD.
Pregnancy. HFMD usually poses no risk to the pregnancy, but getting it shortly before birth can mean the baby is born with a mild form. Avoid close contact with anyone who has HFMD, and speak to your doctor if you have been exposed.
School, nursery and preventing outbreaks
Keep your child at home while they are unwell. The NHS says children can return to school or nursery once they feel better, without waiting for all the blisters to heal, because keeping them away longer is unlikely to stop the spread. In Malaysia, nurseries, kindergartens and schools may follow their own rules during outbreaks, so check with them and follow the advice of your doctor or district health office.
In the Malaysian surveillance study, HFMD transmission was linked more to how many children had already been infected and to school closures than to the weather. Good hygiene in nurseries and kindergartens, including handwashing, cleaning shared toys and keeping sick children at home, helps protect other families.
Vaccine. Vaccines against EV-A71 have been approved and are used in mainland China. Ask your doctor whether any HFMD vaccine is available in Malaysia.
Frequently asked questions (FAQ)
What is HFMD (penyakit tangan, kaki dan mulut)?
HFMD (hand, foot and mouth disease) is a common viral illness, mostly in children under 5, caused by enteroviruses such as coxsackievirus A16 and enterovirus A71. It causes fever, painful mouth ulcers and a rash of spots or blisters on the hands and feet. It usually gets better on its own in 7 to 10 days. It is not the same as foot-and-mouth disease in farm animals.
What are the symptoms of HFMD?
HFMD often starts with a sore throat, a high temperature and not wanting to eat. A few days later, painful mouth ulcers and a raised rash of spots appear on the hands and feet, and sometimes the groin and bottom. The spots can turn into blisters. Symptoms are usually mild and are the same in adults and children.
How long is HFMD contagious?
HFMD spreads through coughs, sneezes, poo and the fluid in blisters. You can spread it from a few days before symptoms start, and you are most likely to spread it in the first 5 days after symptoms begin. Careful handwashing, especially after nappy changes and using the toilet, helps stop the spread.
What is the best ubat HFMD?
There is no antibiotic or medicine that cures HFMD. Treatment eases symptoms: give cool fluids and soft foods, avoid acidic, salty or spicy food, and use paracetamol or ibuprofen for pain or fever. A pharmacist can suggest mouth ulcer gels or sprays suitable for children.
When is HFMD dangerous?
Most cases are mild, but HFMD caused by enterovirus A71 can rarely affect the brain, heart or lungs. Get urgent medical help if a child has a high fever that does not settle, repeated vomiting, is unusually sleepy or floppy, has jerky movements, seizures or weak limbs, breathes fast or with difficulty, or is peeing much less than usual.
Can adults get HFMD?
Yes. HFMD is most common in young children, but adults can get it too, and the symptoms are usually the same. You can also get HFMD more than once, because several different viruses can cause it. Pregnant women should avoid close contact with anyone who has HFMD and speak to a doctor if they have been exposed.
When can my child go back to school or nursery?
Keep your child at home while they are unwell. The NHS says children can go back once they feel better, without waiting for all the blisters to heal. In Malaysia, nurseries, kindergartens and schools may have their own rules during outbreaks, so check with them and follow your doctor's or district health office's advice.
Disclaimer
This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor or pharmacist. Health supplements are not intended to diagnose, treat, cure or prevent any disease.
References
- Hand, foot and mouth disease — NHS
- Cox VM, et al. Spatio-temporal dynamics of hand, foot and mouth disease in Malaysia, 2009-2019. PLoS Negl Trop Dis. 2025;19(6):e0013174.
- Chua KB, Kasri AR. Hand foot and mouth disease due to enterovirus 71 in Malaysia. Virol Sin. 2011;26(4):221-228.
- Kalam N, Balasubramaniam V. Changing epidemiology of hand, foot, and mouth disease causative agents and contributing factors. Am J Trop Med Hyg. 2024;111(4):740-755.
- Leung AKC, et al. Hand, foot, and mouth disease: a narrative review. Recent Adv Inflamm Allergy Drug Discov. 2022;16(2):77-95.
