In the wake of the COVID-19 pandemic, the world has become increasingly vigilant about infectious diseases, both old and new. Among the illnesses making an unexpected comeback is Hand, Foot, and Mouth Disease (HFMD)—a highly contagious viral infection that primarily affects infants and young children. While HFMD has been a recurring public health concern in many countries, a notable and unseasonal rise in cases has recently caught the attention of health authorities across Asia, particularly in countries like China, Malaysia, Singapore, and Thailand.
This article explores the post-pandemic dynamics of HFMD, including the reasons behind the surge, its implications for healthcare systems, and what it signals for the future of infectious disease control in a post-COVID world.
Understanding HFMD: A Common Yet Concerning Disease
Hand, Foot, and Mouth Disease is caused primarily by viruses from the enterovirus group, including Coxsackievirus A16 and Enterovirus 71 (EV71). The infection is spread through direct contact with bodily fluids, including saliva, nasal mucus, blister fluid, and feces. HFMD is particularly prevalent in young children under the age of five due to their developing immune systems and close contact in settings like daycares and kindergartens.
Symptoms include:
- Fever
- Painful sores in the mouth
- Skin rash or blisters on the hands, feet, and buttocks
- Loss of appetite
- General malaise
Though most cases are mild and resolve within 7–10 days, severe complications can arise, especially with EV71, including viral meningitis, encephalitis, and even fatal outcomes in rare cases.
The Post-Pandemic Resurgence: What’s Happening Now?
After a relatively quiet period during the height of the COVID-19 pandemic, HFMD cases are now surging—often outside their typical seasonal peaks. Traditionally, HFMD peaks during warm, humid months (often late spring through summer), but recent reports indicate spikes in colder months and regions where the disease is usually less common.
Countries Reporting Spikes:
- Singapore saw a dramatic rise in cases in late 2024 and early 2025, prompting government advisories.
- China reported over 1 million HFMD cases in the first quarter of 2025 alone, a figure higher than pre-pandemic levels.
- Malaysia and Thailand also noted early and intense outbreaks, especially in urban centers.
Health experts believe the phenomenon is a direct consequence of pandemic-era hygiene practices and social isolation. During COVID-19 lockdowns and movement restrictions, children had limited exposure to common viruses, resulting in reduced immune development against pathogens like HFMD. With schools and public spaces reopening, susceptible children are now being exposed to these viruses en masse, leading to a larger-than-normal outbreak cycle.
The Immunity Gap: A Consequence of Isolation
The “immunity debt” or “immunity gap” theory posits that because children were not exposed to common viruses during the lockdown, their immune systems did not have the opportunity to build natural resistance. This is now playing out across the globe—not just with HFMD but also with RSV (Respiratory Syncytial Virus), influenza, and even measles.
HFMD, which thrives in environments where children share toys, learning materials, and bathroom facilities, is now spreading rapidly in schools, kindergartens, and daycare centers. Health officials are particularly concerned because older children—who typically have stronger immunity—are now being affected in greater numbers, likely due to delayed first-time exposure.
Public Health Response and Hospital Readiness
Pediatric hospitals and clinics are already experiencing capacity strain, especially in high-density urban regions. Emergency rooms in places like Beijing, Kuala Lumpur, and Singapore have reported higher-than-average admissions for children with HFMD, some of whom require IV fluids or hospitalization due to dehydration or complications.
Public health systems are responding with:
- Early detection campaigns in schools and daycares
- Isolation protocols for infected children
- Increased hygiene messaging through media and community outreach
- Enhanced reporting systems to monitor outbreak trends in real-time
Authorities are also calling for greater public awareness around symptoms and transmission, emphasizing handwashing, surface sanitation, and avoiding shared items like utensils or towels.
A Global Health Wake-Up Call
This unexpected HFMD surge is a stark reminder that communicable diseases don’t disappear—they shift. The COVID-19 pandemic changed how the world interacts with viruses, but it also disrupted the natural rhythm of childhood exposures, setting the stage for outbreaks of other illnesses once considered manageable or predictable.
The situation calls for:
- Integrated disease surveillance systems
- Cross-border collaboration on early warning and data sharing
- Continued investment in pediatric care infrastructure
- Renewed discussion about HFMD vaccination, especially for high-risk regions
Conclusion: Learning from the Past to Protect the Future
The current wave of Hand, Foot, and Mouth Disease underscores a larger lesson in post-pandemic global health management: when one virus leaves, others may take its place. The world must remain vigilant, not just for emerging pathogens, but also for re-emerging familiar ones that exploit immunity gaps in vulnerable populations.
With proper awareness, surveillance, and community action, this surge can be controlled. But it will take cooperation between parents, educators, healthcare providers, and policymakers to ensure children are protected—not just from COVID-19, but from the many other diseases waiting in the wings.