• Badrul Hisham Abd Samad Assistant Director (Epidemiology), Johar Health Department
  • Nooraini Baba Principal Assistant Director (Epidemiology), Johar Health Department
  • Mohd Raili Suhaili Deputy Director of Health (Public Health), Johar Health Department
  • C. Prathapa Senan Director of Health, Johar Health Department
  • Daud Abd. Rahim Health Officer, Johar Bahru Health Department



Hand, foot, and mouth disease (HFMDJ, enteroviruses, Johor, Malaysia


The hand, foot, and mouth disease (HFMDJ outbreak occurred in the state of Johar, Malaysia in the months of October and November 2000 after the HFMD outbreak started in Singapore in September 2000. The HFMD notification and investigation forms sent to the Epidemiology Unit of the Johar Health Department from district health offices and hospitals during the outbreak were analysed. Patients' specimens were sent to the Institute for Medical Research, Kuala Lumpur and the Universiti Malaya Medical Centre, Kuala Lumpur for viral isolation. A total of 1,122 HFMD cases were notified during the outbreak period with 2 deaths giving 0.2% case-fatality rate. From all the cases, 544 (48.5%) patients were admitted to the hospital while the rest were treated as outpatients. Majority (81.7%) of children with HFMD were aged below 5 years old with the commonest age group (46.9%) being between I to 2 years old. Sixty-eight patients had positive specimens for viral isolation belonging to enteroviruses namely Enterovirus 71 (43 cases), Coxsackievirus Type A16 (II), Echovirus 7 ( 3 ), and Coxsackievirus Type B (2 ); and non-enteroviruses namely Herpes Simplex Virus Type I (5), and Adenovirus (4). Fever and mouth ulcer were the two most common symptoms among HFMD children but vesicles on palms and soles were more common than rashes in children with positive enteroviral isolation.


1. Fields, B.N., Knipe, D.M., Howley, P.M. Fields Virology. 1996. Philadelphia: Lippincott-Raven

2. Schmidt, N.J., Lennette, E.H., Ho, H.H. An Apparently New Enterovirus Isolated From Patients With Diseases Of The Central Nervous System. J. Infect. Dis. 1974. 129 : 304 -309

3. Shindarov, L.M., Chumakov, M.P., Voroshilova, M.K., et al. Epidemiological, Clinical And Pathomorphological Characteristics Of Epidemic Poliomyelitis-Like Disease Caused By Enterovirus 71. J. Hyg. Epidemiol. Microbial. Immund. 1979. 23 : 284 - 295

4. Nagy, G., Takastsy, S., Kukan, E., et al. Virological Diagnosis Of Enteroviruses Type 71 Infections: Experience Gained During An Epidemic Of Acute CNS Diseases In Hungary In 1978. Arch. Viral. 1982. 71 : 217 -227

5. Cardosa, M.J., Krishnan, S., Tio, P.H., et al. Isolation Of Subgenus B Adenovirus During A Fatal Outbreak Of Enterovirus 71-Associated Hand, Foot, And Mouth Disease In Sibu, Sarawak. The Lancet. 1999. 354 (9183) : 987 - 991

6. Shimizu, H., Utama, A., Yoshii, K., et al. Enterovirus 71 From Fatal And Nonfatal Cases Of Hand, Foot, And Mouth Diseases Epidemics In Malaysia, Japan And Taiwan In 1997 -1998. J. Infect. Dis. 1999. 52 (1) : 12 -15

7. Ho, M., Chen, E.R., Hsu, K.H., et al. An Epidemic Of Enterovirus 71 Infection In Taiwan. The New England Journal of Medicine. 1999; 341 (13): 929-935

8. Chan, K.P., Goh, K. T., Chong, C. Y., et al. Epidemic Hand, Foot And Mouth Disease Caused By Human Enterovirus 71, Singapore. Emerging Infectious Disease. 2003; 9 (1) : 78-85.

9. Liu, C.C., Tseng, H.W., Wang, S.M., et al. An Outbreak Of Enterovirus 71 Infection In Taiwan, 1998: Epidemiologic And Clinical Manifestations. Journal of Clinical Virology. 2000; 17 (I): 23-30




How to Cite

Badrul Hisham Abd Samad, Nooraini Baba, Mohd Raili Suhaili, C. Prathapa Senan, & Daud Abd. Rahim. (2003). THE HAND, FOOT AND MOUTH DISEASE (HFMD) OUTBREAK IN THE STATE OF JOHOR, MALAYSIA IN THE YEAR 2000 . Malaysian Journal of Public Health Medicine, 3(1), 68–72.