Stopping Hand, Foot & Mouth Disease in Its Tracks


The Public Health Unit of the Government of the Virgin Islands is on a vigorous campaign to rid the Territory of a virus that is plaguing the islands, affecting mostly young children.

Hand, Foot and Mouth is a contagious viral illness caused by different strains of the coxsackievirus. It manifests primarily in children under the age of three years, with the usual symptoms being a lack of appetite, lethargy, fever, rashes on the palms and soles of the feet and oral cavity.

Prior to September 2019, Hand, Foot and Mouth was not a notifiable disease in the Virgin Islands. The viral infection was picked up centrally with the first reported case from a mother who mainly homeschooled her child/children, with some interaction in the daycare setting.

Since then, the condition, which is highly contagious and still very prominent, has been spreading, with new reports almost daily. At last count, the virus had affected over 100 children.

Harmony Brewley Massiah is the Territory’s first National Epidemiologist. Along with Chief Environmental Health Officer Lionel Michael, they explained that since the identification of Hand, Foot and Mouth in daycare centres here, they’ve seen an upsurge. Several children were rushed to the hospital, with at least one child being hospitalized.

Brewley Massiah said the cases they’ve seen are mostly rashes around the genitals, buttocks and knees.

She could not say whether there has ever been such an outbreak of Hand, Foot and Mouth disease in the Virgin Islands. Certainly, there has not been this many reported cases of the virus.

It is, however, not unusual during the summer months for this virus to be prevalent, but the officials are also noticing a peak in the cooler months as well.

“I’m not able to say whether it’s the first time the Hand, Foot and Mouth virus has been identified in the Virgin Islands to this extent, because it has to be a collaborative reporting from community healthcare practitioners, daycare centres and the general public and then the Ministry of Health would undertake active surveillance to do contact tracing,” the Epidemiologist stated.

In this instance, teams from the Public Health Unit have gone into the daycare centres to carry out inspections, educating on how the disease is transmitted and what measures they can take to prevent the contracting or spread of the virus. They have also been advising on how to properly clean surroundings and sanitization.

In addition, the unit has had four community sessions with members of the public, as they continue to hope the virus soon tapers off.

The Hand, Foot and Mouth virus is a hygiene issue. Mr. Michael said the focus of their interventions have been on preventative measures, such as proper washing of hands with soap and water when hands become dirty or after sneezing, coughing and bathroom use and proper drying of hands.

“Cleaning and sanitizing of the entire home and daycare centers is a key control measure,” he reiterated. He said caregivers should mix a solution including bleach in water and wipe down cribs, toys, cots, rails, walls, and floors and regularly wash towels, blankets and sheets.

Importantly, if parents notice children coming down with any of the symptoms, they should take them to the doctor immediately and keep them in isolation while they heal. Blisters would take about ten days to heal, as they must be fully dry.

“We have been addressing the main concerns of people who want to know how it’s transmitted and how to control it,” the Chief Environmental Officer said. “The unit’s main concern is ensuring that parents keep affected children at home. We know this can be a real challenge as parents have to go to work, but we have to realize that the disease is highly contagious, so this is something they must do.”

The ongoing series of public meetings, a collaborative effort between the Public Health Unit and Environmental Health Division in the BVI Health Services Authority, has been fairly well attended.  

“The sessions are aimed at helping to break the transmission, as once persons are aware, we have a better chance of that,” Michael said. The unit is also arranging sensitization sessions with private schools.

He pointed out that children can be reinfected with the Hand, Foot and Mouth virus and so the more parents and teachers are educated about preventative measures, the more they can protect themselves and halt the transmission.

As part of the information awareness campaign, videos are being uploaded to the Environmental Health Division’s Facebook Page and health officials are conducting several media interviews.

At this stage, the Epidemiologist stopped short of calling this outbreak an epidemic. She said there is no past data with which to compare. However, she reiterated the urgency and need to stop the spread of the virus, saying it can lead to neurological complications or even death.

As it relates to data collection, Ms. Brewley Massiah said she is working with local teams to bring the Virgin Islands databases up to globalized standards. She said sensitizing health care practitioners is crucial to this process, as they must understand the importance of accurate reporting of data.

Once there is data, officials would be able to do case investigations and conduct studies to better inform protocols and treatment and collaborate with different agencies on how best to protect the population.