What is this article about?

This article reviews global evidence on HFMD and applies it to the South African context, using the 2025 KwaZulu-Natal outbreak to highlight gaps in surveillance, diagnostics, and public awareness. It recommends ways to strengthen South Africa’s HFMD response without diverting resources from other health priorities.

Why does this matter?

Because HFMD is not a notifiable condition in South Africa, and the 2025 KwaZulu-Natal HFMD outbreak occurred with limited data. The outbreak response highlighted challenges in case definitions, laboratory confirmation and public communication, adding pressure to already stretched health services. The article outlines practical, resource-conscious ways to strengthen preparedness for future outbreaks.

 How did this article come about?

As a medical officer at the NICD, I was part of the team that supported KwaZulu-Natal with technical guidance, training and outbreak response. That work highlighted how limited the published information on HFMD specific to South Africa was. My co-authors and I therefore wanted to consolidate what we had learned and recommend ways to generate data that can inform future outbreak responses.

 What was your role in the development of this article?

As the first author, I led the literature review and drafted the article. My co-authors contributed valuable input and recommendations, drawing on their extensive outbreak-management experience. My direct involvement in the outbreak response brought firsthand observations into the analysis, rather than relying only on secondary sources.

 Why should people read this article?

The article combines global evidence on HFMD with firsthand experience from a local outbreak. It translates that experience into practical, low-cost recommendations that South Africa can take to generate better data. The data can help guide the monitoring, management, and communication of future HFMD outbreaks.

What impact do you hope this article will have on public health policy and healthcare access? 

I hope the article encourages a more deliberate approach to HFMD, rather than a reactive response driven mainly by outbreaks as they occur. At a minimum, I hope this article supports clinical training on HFMD, helping healthcare workers recognise and manage cases more confidently while reducing unnecessary public anxiety and referrals.

Dr Saffiya Umar is a registrar in Clinical Microbiology and Infectious Diseases at the National Health Laboratory Service.

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