2018 Malaysia HFMD outbreak

Beginning in January 2018, an outbreak of hand, foot, and mouth disease (HFMD) occurred among children nationwide across Malaysia. Nearly 38,000 cases were recorded between January 1 and July 26,[3] and by August 14 the total number of cases had risen to 51,000.[1] Among the states and federal territories affected by the outbreak, Selangor recorded the highest cases with 11,349, Kuala Lumpur with 4,428 and Sarawak with 4,412 cases as reported in July 2018.[3] At least two children in Sarawak and Penang died from complications caused by the virus.[4][5]

2018 Malaysia HFMD outbreak
DiseaseHand, foot, and mouth disease
Virus strainCoxsackievirus A16[1] and Enterovirus 71[2]
Index caseJanuary 2018
Confirmed casesmore than 50,000[1]

Background and history

HFMD transmission outbreak in Malaysia was first reported in the state of Sarawak in 1997 where between 28 and 31 children died as a result of infection by the Enterovirus 71 (EV-A71) virus.[6][7] Since then, recurrent cyclical epidemics of HFMD have occurred in the country every two to three years.[6] While the root cause behind the recurrence of the disease remains a mystery, another factor that has been identified as increasing the spread of the disease among children is travel to neighbouring countries with high infection rates.[7] Through autopsies performed on deceased individuals, death has been attributed to several symptoms linked to the disease such as poor peripheral perfusion, tachycardia and cardiac failures.[7] These individuals had also developed symptoms earlier on such as shock, pallor, cold extremities, delayed capillary refill and weak peripheral pulses.[7] In 1998, the Ministry of Health acknowledged that the disease was endemic in the country with periodic outbreaks among young children. Since the first outbreak, the Ministry of Health has periodically ordered the closure of affected kindergartens and schools which are likely to be the source area of the disease. A further outbreak of 1,178 cases, mostly in kindergartens nurseries, was reported in the state of Johor in 2000 following an outbreak in neighbouring Singapore a month before.[7]

Authorities response

In July 2018, Malaysian Health Ministry Disease Control Division director Chong Chee Keong said toys were among the cause of immediate spread of the virus to other children.[8] The Health Ministry further reported that HFMD disease cases had exceeded warning levels.[9] To prevent spread, the Ministry urged parents to act as "gate-keepers" in order to ensure children infected with the disease did not go to school and to seek immediate treatment if their children showed signs of infection.[10] The Education Ministry issued a letter to every school to monitor the health of their students.[11] The Health Ministry also considered the use of vaccines from other countries, though research on vaccines had to be carried out before they could be approved for local use.[12] As infection rates increased among children, the local health department of Penang ordered all supermarkets and shopping complexes in the state to disinfect trolleys, toys and benches on their premises.[13] Disinfection was also carried out in all villages, schools and preschools in a district in Sarawak.[14]

See also

Further reading

  • L. G. Chan; Umesh D. Parashar; M. S. Lye; F. G. L. Ong; Sherif R. Zaki; James P. Alexander; K. K. Ho; Linda L. Han; Mark A. Pallansch; Abu Bakar Suleiman; M. Jegathesan; Larry J. Anderson (2000). "Deaths of Children during an Outbreak of Hand, Foot, and Mouth Disease in Sarawak, Malaysia: Clinical and Pathological Characteristics of the Disease". Clinical Infectious Diseases. 31 (3): 678–683. doi:10.1086/314032. PMID 11017815 via Oxford Academic.
  • "Hand Foot and Mouth Disease (HFMD) Guidelines" (PDF). Ministry of Health, Malaysia. Archived (PDF) from the original on 29 August 2019. Retrieved 29 August 2019.


  1. Martin Carvalho; Hemananthani Sivanandam; Rahimy Rahim; Loshana K Shagar (16 August 2018). "Over 50,000 cases of HFMD recorded, virus strain relatively benign". The Star. Retrieved 29 August 2019. Over 50,000 cases of hand, foot and mouth disease (HFMD) stemming from the Coxsackie virus have been reported since the outbreak of the disease.
  2. "Malaysia reports increase in Hand, Foot and Mouth Disease". Outbreak News Today. 10 June 2018. Retrieved 29 August 2019. For the year 2018, up to 316 nurseries/kindergartens/pre-schools reported HFMD clusters at their premises, which is 52% of the total epidemic reported. HFMD virus surveillance also found an increase in enterovirus-71 (EV71) activity in the environment since March 2018.
  3. "HFMD cases near 38,000 nationwide since January [NSTTV]". Bernama/NSTP. New Straits Times. 28 July 2018. Retrieved 29 August 2019.
  4. Katrina Khairul Azman (29 July 2018). "A 2-Year-Old Boy In Sarawak Suffering From HFMD Has Died". Says.com. Archived from the original on 29 August 2019. Retrieved 29 August 2019.
  5. "17-month-old boy's death in Penang due to HFMD". The Star. 30 July 2018. Retrieved 29 August 2019.
  6. Yoke Fun-Chan; I-Ching Sam; Kai-Li Wee; Sazaly Abu Bakar (2011). "Enterovirus 71 in Malaysia: A decade later" (PDF). Neurology Asia. 16 (1). Archived (PDF) from the original on 29 August 2019. Retrieved 29 August 2019 via University of Malaya.
  7. Nur Najihah Hasan (2017). "Assessing the Prevalence of Hand, Foot and Mouth Disease (HFMD) Using Geospatial Density and Distribution Techniques" (PDF). Faculty of Geoinformation and Real Estate: 2–3 [18–35]. Archived (PDF) from the original on 29 August 2019. Retrieved 29 August 2019 via Universiti Teknologi Malaysia.
  8. "Toys among agent causing spread of HFMD between children: Health Ministry". Bernama. New Straits Times. 11 July 2018. Retrieved 29 August 2019.
  9. "HFMD cases exceed warning levels, says ministry". The Star. 12 July 2018. Retrieved 29 August 2019.
  10. "HFMD can cause death if not immediately treated: Malaysian health ministry". Bernama. Channel NewsAsia. 27 July 2018. Archived from the original on 29 August 2019. Retrieved 29 August 2019.
  11. "Situasi Semasa Kejadian Penyakit Tangan, Kaki Dan Mulut (HFMD) Di Malaysia" [Current Situation of Hand, Foot and Mouth Disease (HFMD) In Malaysia] (Press release) (in Malay). Ministry of Education, Malaysia. 12 July 2018. Archived from the original on 29 August 2019. Retrieved 29 August 2019.
  12. Farhana Syed Nokman (31 July 2018). "HFMD outbreak: Health Ministry considering use of vaccine from other countries". New Straits Times. Retrieved 29 August 2019.
  13. "Penang supermarkets, shopping malls ordered to carry out disinfection as HFMD cases rise". Bernama. Channel NewsAsia. 24 July 2018. Archived from the original on 29 August 2019. Retrieved 29 August 2019.
  14. Peter Boon (3 August 2018). "All-out effort to curb HFMD". The Borneo Post. Archived from the original on 29 August 2019. Retrieved 29 August 2019.
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