2018 Malaysia HFMD outbreak

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. Since then, recurrent cyclical epidemics of HFMD have occurred in the country every two to three years. 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. 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. These individuals had also developed symptoms earlier on such as shock, pallor, cold extremities, delayed capillary refill and weak peripheral pulses. 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.