Hand Foot and Mouth Disease: Brief information and prevention

Recently, Malaysians have been made aware of a significant rise of hand foot and mouth disease (HFMD) cases throughout the country. The outbreak recorded more than 47,000 cases in year 2022 as of May. The number was reported to be 20 times more than previous year within the same period.

HFMD is an important health issues among infants and children which was identified to be caused by viruses from enterovirus family. Specifically, enterovirus A71 (EV71) and coxsackievirus A16 (CA16) are the most common pathogens found in patients diagnosed with HFMD. Though HFMD is mostly a self-limiting disease, infection caused by EV71 is known to be associated with complications including neurological and cardiorespiratory problems.

HFMD common initial presentation is low-grade fever [s1] followed by ulcers in the mouth, rash or blisters on hands, sole of feet and buttocks. These symptoms may be accompanied by reduced appetite and general malaise. The viruses can be transmitted through fecal-oral, oral-oral and respiratory droplet, [s2] which means, any direct contact (i.e., hugging, kissing) or exposure to respiratory droplets (i.e., cough or sneezing) from an infected person carries risk of developing HFMD. This explains the occurrence of outbreaks in nurseries and schools.

There is no specific treatment for HFMD, most patients spontaneously recover within a few days. The management of HFMD is mostly supportive, focussing on relieving pain, controlling fever and hydration. Prevention of HFMD plays a major role in controlling the disease. Practices such as washing hand regularly, uses of hand sanitiser and disinfectant, covering mouth when coughing and sneezing as well as avoiding close contact (e.g., kissing, hugging or sharing utensils) with infected people, helps in reducing transmission of the disease.

As of today, the vaccine for HFMD is yet to be available. Thus, the best prevention options are the practices mentioned above. With these simple steps, children may have safer and healthier environment for their daily live.


1.  Esposito S, Principi N. Eur J Clin Microbiol Infect Dis. 2018;37(3):391-398.Li PW et al. PLoS One. 2021 Mar 25;16(3):e0248916.
2. Saguil A, Kane SF, Am Fam Physician. 2019;100(7):408-414.

Position of Herbal Medicine in Current Healthcare System

Traditional medicine remains as a part of the healthcare throughout human civilization, predates the current modern medicine. In fact, a part of modern medicine originates from traditional medicine, which includes Ayurveda, Chinese Medicine, Unani Medicine and Kampo.

One of the main components in traditional medicine is the use of herbs for the treatment of illnesses as well as for prevention purposes and general health. Various health problems have been known to be well-treated by herbal remedies from common acute illnesses such as cough, flu and fever to chronic illnesses such as diabetes and hypertension.1,2,3 Some of the herbal preparations are regularly consumed as supplementation for general well-being. The remedies are widely practised in modern world either as complementary to modern medicine or exclusive therapy.

Worldwide prevalence of herbal medicine use increased throughout the years. In Malaysia, at least 33.9% Malaysia used herbal medicine within 12-month period as reported by a local study.4 Another study has reported about 55.5% of Malay women used herbs as one of their health remedies.5 The actual numbers may even be higher than of that reported by the study.

Generally, herbal medicine will be used once it is identified to possess promising efficacy, mostly through years of experience. However, similar to pharmaceutical products, they come with potential side effects. Thus, consequences of side effects must be carefully assessed before considering the use of any herbs as medicine. Currently, a lot of these herbs have been studied scientifically due to increased awareness of their role in maintaining a good health state.

Regulatory bodies in many countries have implemented a set of regulations to ensure the safety aspect of herbal products. These includes countries like United States, countries of European Union, Australia, India and many others.6 In Malaysia, herbal or traditional products are considered regulated products which need to undergo registration process. Each product will be thoroughly assessed by National Pharmaceutical Regulatory Agency. Only products with acceptable safety profile can be fully registered and distributed. Thus, consumers can continue to use herbal medicine with better confidence in term of safety as well as effectiveness of the registered products.


  1.  Mousa HA. J Evid Based Complementary Altern
  2.  Kumar S. et al. Curr Diabetes Rev. 2021.
  3.  Steven GC. & George SC. Curr Hypertens Rep. 2017.
  4. Aziz Z. & Tey NP. Complement Ther Med. 2009.
  5. Tengku Mohamad TAS et al. Patient Prefer Adherence. 2019.
  6. Sanjay S. J Pharm Bioallied Sci. 2015.


Covid-19 and Mental Health in Malaysia

Covid-19 has been dominating the headlines since its outbreak started in late 2019. Presently, it is still taking a toll in majority of the countries around the world including Malaysia. The physical impact of the pandemic is well-documented by Ministry of Health as the main source of health information in Malaysia. News column and social media are full by the number of cases and mortalities. However, the impact of the pandemic on mental health is rarely featured in these platforms.

During the early phase of Covid-19 outbreak, Malaysia underwent their first Movement Control Order (MCO), which came as a sudden hit on different aspects of Malaysian’s life especially social and economic part. Being restricted to social isolation have negatively affected many people’s mental health and created new challenges for people with existing mental illness and substance use disorders. Fear, anxiety and depression were among complaints reported during the MCO. Financial difficulties were also affecting a proportion of the population. These burden had created an unhealthy condition for mental health.

Authority has reported 266 people have committed suicide during the first MCO from March 18 to October 30, last year. 1 The suicide cases were reported to be caused by debt, family problems and marriage problems. In a local study conducted during the pandemic, reports of depressive (59.2%), anxiety (55.1%) and stress (30.6%) symptoms were found to be high.2 People with poor health status, students, females and people with poor financial conditions were found to be more vulnerable to mental health symptoms.

The impact of Covid-19 among Malaysia is a real health concern. Interventions should be taken to provide a proper solution to the affected individuals or communities. Some initiatives such as telehealth, suicide decriminalisation movement, awareness campaigns are excellent progress, however, more holistic approaches are still needed to curb the increasing trend. These require supports from every level within government agencies, non-profitable organization and community.


  1. Daily Express. 266 commit suicide during movement restrictions (one everyday). 16 Nov 2020. Available at: https://www.dailyexpress.com.my/news/161783/266-commit-suicide-during-movement-restrictions-one-everyday-/
  2. Li PW et al. PLoS One. 2021 Mar 25;16(3):e0248916.

Vitamin C and Immune System

Immune system is defined as complex network of cells, tissues, organs, and substances that helps the body fights infections caused by a range of pathogen, such as bacteria, viruses, fungi and parasites. Development of a good immune system is essential and requires a healthy diet and lifestyle. One of the micronutrients that have been long associated with strong immune system is vitamin C.

Vitamin C, also known as ascorbic acid, can be easily obtained from consumption of citrus fruits, such as oranges and orange juice, peppers, strawberries, blackcurrants, broccoli, brussels sprouts and potatoes.1 Vitamin C is one of the essential vitamins – vitamins that cannot be synthesized by human. It has multiple roles in our body systems which include:

  • Boosting immune system
  • Helps in collagen formation
  • Helps to maintain capillaries, bones and teeth
  • Aids in the absorption of iron
  • Act as antioxidant
  • Helps in wound healing.

Lack of vitamin C may lead to poor wound healing, weakened collagenous structure and impaired immunity.2 Individuals with vitamin C deficiencies are more vulnerable to more severe infections.3

Vitamin C acts as a support for various cell functions of both innate and adaptive immune system. One of the functions is to promote anti-oxidant activity of skin, resulted in prevention of oxidative stress induced by environmental pollutants. Through collagen formation, vitamin C is also responsible for development of healthy skin which act as the first barrier against any external pathogen. Its role in wound healing also play a vital function in preventing infection from entering the body.

Vitamin C was reported to accumulate in phagocytic cells, such as neutrophils which will assist in process of engulfing microbes. Furthermore, vitamin C also helps in automated cell death process which will clear used neutrophils from the site of infection. This will result in decreasing necrosis and potential tissue damage.

Sufficient vitamin C is essential for each one of us as it is one of important micronutrients that our body needs to ensure good health. A healthy diet with fruits and vegetables rich with vitamin C is sufficient for required vitamin C intake. For individuals with vitamin C deficiency, supplement intake may help to improve the vitamin C level.


  1. Recommended Nutrients Intakes for Malaysia, A Report of the Technical Working Group on Nutritional Guidelines, MOH, 2017
  2. Carr AC & Maggini S. Nutrients. 2017 Nov; 9(11): 1211.
  3. Hemilä H. Nutrients. 2017 Mar 29;9(4):339



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