Hand, foot and mouth disease #HFMD, and #monkeypox are virus infections presenting with different types of vesicular lesions and clinical course. This document provided a quick explanation of the differences between hand, foot and mouth disease (HFMD) and Monkeypox. 

1. Features HFMD Monkeypox
Causative
virus
Enterovirus family such as
Coxsackievirus A16, A6, and
Enterovirus A71 (EV71)
Orthopoxvirus in the family
Poxviridae
Occurrence
Frequent outbreaks in
Malaysia
Does not occur naturally in
Malaysia. Cases can occur
through travel to endemic
countries and outbreak areas or
importing of infected animals
Transmitted
by Humans Animals and/or humans
Sourceof
infection
nasal and throat
secretions, (such as saliva,
nasal mucus)
fluid from blisters
stool
respiratory droplets (after
an infected person coughs
or sneezes)
Contact with an infected
person through
body fluids
skin lesion material
contaminated materials and
surfaces, (example shared
towels, bedding, of which
infectious body fluids/scabs
may be present)
respiratory droplets
Contact with an infected animal
or person through:
Exposure
risks Child care setting, schools
Endemic countries in Western and
Central Africa. Newly reported
outbreaks in >20 countries (WHO,
21 May 2022)
Hand, Foot and Mouth Disease (HFMD) versus
Monkeypox
ICR
MINISTRY OF HEALTH MALAYSIA
Research that matters to patients
Content created by Dr. Chew Cheng Hoon, Dr. Lim Kah Chuan and Dr. Toh Teck Hock.
Reviewed by Dr. Thahira Jamal Mohamed and Datuk Dr. Kalaiarasu M. Peariasamy.
Infographic by Medical and Scientific Affairs, Institute for Clinical Research (ICR), NIH.

2. Features HFMD Monkeypox
Who can
get the
disease?
Often in children aged ten
years or younger with the
commonest among those
less than five.
Rarely seen in adults
Both children and adults
Incubation 3 - 6 days
Average 4 - 14 days (up to 21
days)
Symptoms
HFMD presents with fever,
mouth sores and skin rash.
Painful mouth ulcers develop
1-2 days after fever. Rash
usually develop on palms of
hands and soles of feet.
Sometimes poor appetite
and feeling unwell.
Fever, flu-like symptoms,
swollen lymph nodes.
Rash occurs 1-4 days after
onset of fever.
Rash
period Fast, 7 - 10 days Slow, 2 - 4 weeks
Rash
appearance
Usually flat red spots
(macules or papules), and
sometimes filled with fluids
(vesicles / blisters). When
they rupture, they leave
painless shallow ulcers that
do not scar
Uniformly progresses from
macules to papules, vesicles
and pustules, then to scabs
and scars.
(This is in contrast to chickenpox
rash that appears in various
stages of development)
ICR
MINISTRY OF HEALTH MALAYSIA
Research that matters to patients
Content created by Dr. Chew Cheng Hoon, Dr. Lim Kah Chuan and Dr. Toh Teck Hock. Reviewed by
Dr. Thahira Jamal Mohamed and Datuk Dr. Kalaiarasu M. Peariasamy. Infographic by Medical and
Scientific Affairs, Institute for Clinical Research (ICR), NIH.
Hand, Foot and Mouth Disease (HFMD) versus Monkeypox

3. Features HFMD Monkeypox
Rash
distribution
On palms of the hands and soles
of the feet. Can also appear on
knees, elbow, buttocks and
genitals.
Starts on head; more dense on
face and limbs; appears on palms
andsoles
Lymph-
adenopathy Usuallyabsent Present(swollenlymphnodes)
Durationof
disease Short,between7and10days
Long, usually between 3 and 4
weeks
Laboratory
test
Clinicaldiagnosis.
Tests generally not performed
unless for surveillance or
diagnostic purposes in ill
individuals. Test, PCR of fluids
from mouth ulcers/blisters,
throat/rectal swab, CSF or biopsy
specimens.Bloodserology.
PCR (Best specimen is swab of
the vesciular lesion - fluid, roof or
crust)
Complications
Mostcasesareusuallymild.
In some cases HFMD caused by
EV71 can lead to serious
complications including viral
meningitis, myocarditis,
encephalitis, acute flaccid
paralysis.
Self-limitingdisease.
Rare complications include
superimposed bacterial infection,
as well as eyes, lungs, and brain
complications.
Highrisk
groups
Newborns/ infants and individuals
withweakenedimmunesystems
Newborns/very young children,
pregnant women, and those with
weakenedimmunesystem.
ICR
MINISTRY OF HEALTH MALAYSIA
Research that matters to patients
Content created by Dr. Chew Cheng Hoon, Dr. Lim Kah Chuan and Dr. Toh Teck Hock.
Reviewed by Dr. Thahira Jamal Mohamed and Datuk Dr. Kalaiarasu M. Peariasamy.
Infographic by Medical and Scientific Affairs, Institute for Clinical Research (ICR), NIH.
Hand, Foot and Mouth Disease (HFMD) versus Monkeypox

4. ICR
MINISTRY OF HEALTH MALAYSIA
Research that matters to patients
Content created by Dr. Chew Cheng Hoon, Dr. Lim Kah Chuan and Dr. Toh Teck Hock.
Reviewed by Dr. Thahira Jamal Mohamed and Datuk Dr. Kalaiarasu M. Peariasamy.
Infographic by Medical and Scientific Affairs, Institute for Clinical Research (ICR), NIH.
PREVENTION
Wash hands frequently with
soap and water before
eating, after visiting the
toilet
Do not share food, drinks
and personal items e.g.
utensils, toothbrushes,
towels, clothes
Cover your mouth when you
cough or sneeze
Disinfect surfaces and
fomites (e.g. toys), avoiding
close contact and the
sharing of personal items
with infected persons
Thoroughly cook all foods
containing meat or parts
properly before eating
Avoid contact with wild
animals or animals imported
from endemic countries
Stay at home if infected and
avoid close contact
Seek medical attention if you
are unwell or have any
doubts.
Hand, Foot and Mouth Disease (HFMD) versus Monkeypox
If you have travelled from a
country that has a
monkeypox outbreak, please
monitor your health and
symptoms for 21 days in the
MySejahtera app.