Hand foot and mouth disease (HFM) is a viral infection characterized by fever and a typical rash most frequently seen on the palms of the hands, soles of the feet, and inside the mouth. It should not be confused with foot (hoof) and mouth disease that affects cattle, sheep, and swine.
What are the symptoms and signs of hand foot and mouth disease?
HFM is most commonly an illness of the spring and fall seasons. Initial symptoms of mild fever (101 F-102 F) and malaise are followed within one or two days by a characteristic rash. Small (2 mm-3 mm) red spots that quickly develop into small blisters (vesicles) appear on the palms, soles, and oral cavity.
The gums, tongue, and inner cheek are most commonly involved in the mouth. The foot lesions may also involve the lower calf region and rarely may appear on the buttocks. Oral lesions are commonly associated with a sore throat, difficulty eating and diminished appetite.
What causes hand foot and mouth disease?
HFM is caused by several members of the enterovirus family of viruses. The most common cause is Coxsackie virus A-16; less frequently enterovirus 71 is the infectious agent.
The clinical manifestations of routine HFM are the same regardless of the responsible virus. However, patients infected with enterovirus 71 are more likely to experience rare complications (for example, viral meningitis or cardiac muscle involvement).
When to see your GP
Hand, foot and mouth disease is a self-limiting condition, which means it will get better on its own without treatment. The symptoms will usually pass within seven days.
However, speak to your GP or call NHS 111 if you’re unsure whether your child has hand, foot and mouth disease.
You should also contact your GP if your child isn’t drinking any fluid or their symptoms last longer than seven days.
Treating hand, foot and mouth disease
There is currently no cure for hand, foot and mouth disease, so treatment involves making your child feel as comfortable as possible while waiting for the infection to take its course.
Possible treatment options include:
- using paracetamol, ibuprofen and mouth gels to relieve the pain of mouth ulcers
- drinking plenty of fluids to help relieve a high temperature
What causes it?
Hand, foot and mouth disease is caused by a group of viruses known as enteroviruses. The most common types of viruses that can cause the condition are:
- coxsackievirus A16, A6 or A10
- enterovirus 71
- Enterovirus 71 carries a higher risk of causing serious complications.
How the infection spreads
A person with hand, foot and mouth disease is highly contagious until about a week after the symptoms begin. The infection can be spread if:
- contaminated droplets are transferred from an infected person – for example, if an infected person coughs or sneezes, the droplets can be inhaled by another person or can contaminate surfaces, leading to the spread of infection
- fecal matter (stool) is transferred from an infected person – for example, if an infected person doesn’t wash their hands properly after going to the toilet and then contaminates food or surfaces (the viruses can live for up to four weeks in a person’s stools)
- you come into contact with the fluids of an infected person’s blisters or saliva
Because of the way the infection is spread, outbreaks of hand, foot and mouth disease can occur in places where groups of children need to have their nappies changed or use a potty, such as nurseries or childcare centres.
You should keep your child away from school or nursery while they are unwell. However, there’s no need to wait until the last blister has gone before your child can return to school or nursery, providing they are otherwise well.
However, some schools and nurseries may reserve the right to refuse to take your child until the condition has cleared up completely.
It is rare, but possible, to get hand, foot and mouth disease more than once, although not during the same outbreak. As they get older, most children will develop immunity to the viruses that cause the condition.
It’s important to make sure that anyone with hand, foot and mouth disease keeps drinking fluids to avoid becoming dehydrated.
Dehydration can often occur because the mouth ulcers can make drinking fluids painful.
Life-threatening complications such as brain infections (encephalitis) have been reported during epidemics of hand, foot and mouth disease caused by the enterovirus 71. However, these complications are very rare and they have been limited to the Asia-Pacific region.
What is the incubation period for hand foot and mouth disease?
HFM is moderately contagious and spreads from person to person. It cannot be spread by animals. Usually the virus is passed via oral secretions (nasal discharge, saliva, etc.) or via stool.
There is a short four- to six-day incubation period between exposure and development of initial symptoms (fever and malaise). A person is most contagious during the first week of illness.
When does hand foot and mouth disease usually occur?
Spring and fall are the most frequent seasons for community epidemics of HFM. While anyone exposed to the viral causes of HFM may develop disease, not everyone infected will develop symptoms.
How does hand foot and mouth disease affect pregnancy and the baby?
Commonly HFM is an illness of children less than 10 years of age; adults generally were exposed during childhood and maintain a natural immunity.
Information regarding fetal exposure to HFM during pregnancy is limited. No solid evidence exists that maternal enterovirus infection is associated with complications such as spontaneous abortion or congenital defects.
However, should a baby be born to a mother with active HFM symptoms, the risk of neonatal infection is high. Typically, such newborns have a mild illness. Rarely, overwhelming infection involving vital organs such as liver, heart, and brain can be lethal.
What is the course of hand foot and mouth disease?
The illness is characteristically self-limited and is usually resolved within a week, particularly when due to its most common cause, Coxsackie virus A-16.
In those outbreaks due to enterovirus 71, the illness may be more severe with complications such as viral meningitis and encephalitis and paralytic disease. As a rule, HFM is generally a mild and self-limited illness.
Why haven’t we heard more about hand foot and mouth disease?
Recognition of hand foot and mouth disease is relatively recent (as compared to mumps, measles, and chickenpox, for example). HFM was first reported in 1956 in Australia. By the early 1960s, it had emerged as a common childhood illness around the world.
How is hand foot and mouth disease diagnosed?
Usually, the diagnosis of HFM is made on a combination of clinical history and characteristic physical findings. Laboratory confirmation is rarely necessary unless severe complications develop.
What is the treatment for hand foot and mouth disease?
Therapy for HFM is directed toward symptomatic relief of fever and sore throat. Antibiotics are not indicated for this viral disease.