Don’t shut schools over Hand, Foot and Mouth Disease. It’s usual and mild

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There are reports from many parts of Delhi and the National Capital Region (NCR) about schools being temporarily closed for physical classes because of the fear of diseases. The latest addition is a few cases of Hand, Foot and Mouth diseases (HFMD) in children. By now we know that even a slight spike in SARS CoV2 infections (not necessarily in school kids) fuels talk about school closure. Then there’s Monkeypox. School closures on alarmist fears are not only unscientific and irrational but a worrying trend as well.

The COVID-19 pandemic and related misinformation have anyway made the school management and parents excessively reactive and at times, unnecessarily worried. Any respiratory illness in school children or rashes is being seen as a danger sign.

HFMD is a common and long known viral infection, caused by a group of viruses, which includes coxsackievirus a16 and enterovirus 71. Though it can affect any age group, it is more common in children younger than five years. It is known for long and reported in all parts of the world. Common symptoms of HFMD are low grade fever, throat infection, blisters in the back of the mouth or in the tongue, reduced appetite, generalised weakness and tiredness. There can be visible red spots on knees, elbows and other body parts. Sometimes there are no spots on body parts but there can be painful sores in the mouth. In many cases, reduced eating and sleeping and/or child being cranky could be the only signs.

Though the name of the disease may give the wrong impression, in reality it is a very mild illness and, in most cases, the symptoms resolve without the need for any treatment. In rare cases, the symptomatic treatment can be given for reducing the fever, or for itching which accompanies rashes.

HFMD spreads through direct contact of various body fluids, i.e., fluids from blisters or mucus from nose and saliva, of the infected person/child. The sneezing and coughing or anything which means close contact can also pass on the virus. Though it can spread through touching surfaces, which have been freshly contaminated, the risk is low and depends upon the quantity of the infectious material. The infected are contagious mainly for the first seven days of the illness.

As for most other viral illnesses, no treatment or vaccine is available for HFMD. Antibiotics are not useful as it is a viral illness. The person recovers without any additional medication within seven to 10 days. Serious complications are possible but very rare. It is important to note that HFMD is not related to the foot-and-mouth disease (FMD) of animals.

For someone with HFMD and people around, good hand hygiene practices such as regular hand washing, covering the nose and mouth at the time of sneezing and coughing, regular cleaning of commonly touched surfaces and not sharing tables and utensils can reduce the risk of further spread. Children with HFMD should stay at home for around a week or till symptoms are under control. However, there’s no reason to be excessively worried.

In India, HFMD spreads mostly in the summer and monsoon. Practising physicians and pediatricians attend such patients on a regular basis. This year, comparatively more children in India with HFMDs, are attending doctor’s clinics arguably because of increased awareness about Monkeypox (an illness with rashes) and an improved care-seeking and reporting amongst the parents.

The regular closure of schools for various frivolous reasons is worrying for society. The pandemic-related prolonged closure has already impacted the education of children in India and across the low- and middle-income countries. The school closure should not become a routine “at the drop of the hat” response. A more structured and systematic approach is followed for continuity of the physical classes.

In the months ahead, when the emergence and reporting of infectious diseases is going to improve, such a situation may arise on a regular basis. Therefore, an institutional mechanism for coordination among parents, school management, health authorities and policy makers is needed.

Parents need to read about common illnesses from reliable sources and/or consult healthcare providers for further understanding. Social media and unconfirmed sources may be misleading and might cause undue stress. We also need to remember that Monkeypox is not an immediate concern for the general public and not a reason to consider the closure of schools. Monkeypox is a contact illness and does not spread through respiratory routes as was the case with SARS CoV2.

The newly emerging concerns and worries amongst parents’ mandates that there is more systematic attention and strengthening of school health services in both public and private schools. The easy access to health staff (the doctor and/or nurses) for the school children and for parents to seek advice need to be increased to ward off any concern in a real time manner. The onus now is on, with the departments of education and the policy makers to work upon strengthening school health services, immediately.

It is likely that in the weeks and months ahead, in the backdrop of COVID-19 surges and the ongoing monkeypox outbreak, more diseases will be reported and infections will be detected. A balanced and informed decision should be made on these aspects. It is time we, as a society, are guided by scientific evidence.

(Dr Lahariya is a physician and a vaccines and infectious diseases specialist. He tweets @DrLahariya)





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