Hand-Foot-Mouth Disease

Roo CHANGIZI, Associate Chief Medical Officer, Chair of Center for Family Medicine and Integrative Health Care, Family Medicine Physician

What is it and how can you prevent it?

An outbreak of hand-foot-mouth disease (HFMD) in children, caused by enterovirus 71, recently occurred in Fuyang City, Anhui Province. This strain of the disease has caused deaths resulting from encephalitis. It is important to recognize, however, that this is a rare complication of HFMD.

So what is HFMD and how can you prevent it? Keep reading to find out more…

What is HFMD?

HFMD is a common illness of infants and children. It is characterized by fever, sores in the mouth, and a rash with blisters. HFMD begins with a mild fever, poor appetite, malaise (feeling sick), and frequently a sore throat. One or two days after the fever begins, painful sores develop in the mouth. They begin as small red spots that blister and then often become ulcers. They are usually located on the tongue, gums, and the inside of the cheeks. The skin rash develops over one or two days with flat or raised red spots, some with blisters. The rash does not itch, and it is usually located on the palms of the hands and soles of the feet. It may also appear on the buttocks. It is possible for a person with HFMD to have only the rash or the mouth ulcers.

What causes HFMD?

Viruses from the group called enteroviruses cause HFMD. The enterovirus group includes polioviruses, coxsackieviruses, echoviruses and other enteroviruses. The most common cause of the disease is coxsackievirus A16, but sometimes HFMD is caused by EV71 or other enteroviruses.

Is HFMD serious?

Usually not. The most common form of HFMD is from coxsackievirus A16 infection and is usually mild. Nearly all patients recover with minimal medical treatment in seven to ten days. Complications are uncommon. Rarely, the patient with coxsackievirus A16 infection may also develop “aseptic” or viral meningitis, in which the person has a fever, headache, stiff neck, or back pain, and may need to be hospitalized for a few days.

Another cause of HFMD is the virus called EV71. This may also cause viral meningitis and rarely more serious diseases such as encephalitis or a poliomyelitis-like paralysis. EV71 encephalitis may be fatal. Cases of fatal encephalitis occurred during outbreaks of HFMD in Malaysia in 1997 and in Taiwan in 1998.

IsHFMD contagious?

Yes, HFMD is moderately contagious. Infection is spread from person to person by direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons. A person is most contagious during the first week of the illness. HFMD is not transmitted to or from pets or other animals. The usual period from infection to onset of symptoms (incubation period) is 3 to 7 days. Fever is often the first symptom of HFMD.

Who is at risk for HFMD?

HFMD occurs mainly in children under 10 years old, but can also occur in adults. Everyone is at risk of infection, but not everyone who is infected becomes ill. Infants, children, and adolescents are more likely to be susceptible to infection and illness from these viruses because they are less likely than adults to have antibodies from previous exposures and be immune. Infection results in immunity to the specific virus, but a second episode may occur following infection with a different member of the enterovirus group.

Can HFMD be prevented?

Specific prevention for HFMD or other non-polio enterovirus infections is not available, but the risk of infection can be lowered by good hygienic practices. Preventive measures include frequent hand washing, especially after diaper changes. Clean contaminated surfaces and soiled items first with soap and water, then disinfect them using a diluted solution of chlorine containing bleach (made by mixing approximately ¼ cup of bleach with 1 gallon of water). Avoiding close contact (kissing, hugging, sharing utensils, etc) with children with HFMD may also help to reduce of the risk of infection to caregivers.

HMFD in the childcare setting

HFMD outbreaks in childcare facilities occur most often in the summer and fall months and usually coincide with an increased number of cases in the community.

There are no specific recommendations regarding the exclusion of children with HFMD from childcare programs, schools, or other group settings. Children are often excluded from group settings during the first few days of the illness, which may reduce the spread of infection, but will not completely interrupt it. The exclusion of ill persons may not prevent additional cases since the virus may be excreted for weeks after the symptoms have disappeared. Also, some persons excreting the virus, including most adults, may have no symptoms. Some benefit may be gained, however, by excluding children who have blisters in their mouths and drool or who have weeping lesions on their hands.