What is hand, foot and mouth disease?
Hand, foot, and mouth disease, also known as HFMD, is a highly contagious yet mild viral infection. It is characterised by a rash on the hands (palms), feet (soles) and occasionally the buttocks or genitals as well as sores on the inside of the patient’s mouth. The illness occurs due to infection with one of the nonpolio enteroviruses, with coxsackievirus A type 16 being the most common cause.
It is important to note that hand, foot, and mouth disease should not be confused with foot and mouth, or hoof and mouth disease which is caused by a different virus and affects sheep, cattle and swine.
The hand, foot and mouth virus does not have a specific treatment and most commonly infects infants and children but can also occur in adults. You can reduce the risk of contracting the infection through the use of good hygiene practices and educating children on how to wash their hands properly and keep clean.
What causes hand, foot and mouth disease?
Hand, foot, and mouth disease is caused by a collection of viruses known as nonpolio enteroviruses, with the most common cause being the coxsackievirus A16 (CV-A16). Other strains of the coxsackie virus related to hand, foot and mouth disease include A 5, 7, 9 and 10 as well as B 2 and 5.
In some rarer cases, the cause of the disease is enterovirus 71 (EV-71), in these instances patients may experience some rare symptoms such as the involvement of their central nervous system leading to neurological complications or encephalitis and aseptic meningitis. Outbreaks of hand, foot and mouth disease caused by EV-17 has been seen most often in Southeast Asia in recent years.
When the coxsackievirus is the infectious agent, the symptoms and cases are very similar.
Ingesting the virus orally is the most common way of it spreads, other ways of spreading it involve personal contact with infected bodily fluids such as:
- Throat discharge
- Nasal secretions
- Stools (when changing diapers/nappies or if one’s hands come into contact with faecal matter when using the bathroom and hands are not properly washed thereafter or if a child touches faeces and then other objects and then puts these into their mouth).
- Respiratory droplets (coughing and sneezing)
Commons places children are infected
The virus commonly appears in childcare settings due to the frequent changing of diapers, potty training and children often sucking on their fingers or putting their hands in their mouths after touching infected objects.
Your child is at their most contagious stage during the initial week of contracting the infection, however, the virus can remain in their body for a number of weeks after the signs and symptoms have resolved, meaning others can still get infected from your child.
In some cases, particularly when adults are infected, the virus may be passed on to someone else without having any of the symptoms and signs of hand, foot, and mouth disease.
The disease is commonly seen in places where temperate climates are common in autumn and summer. In the more tropical climates, outbreaks can occur all year-round.
Different from foot-and-mouth disease
As previously mentioned, HFMD is not related to hoof-and-mouth disease, also known as foot-and-mouth disease, as this is a viral infection that infects farm animals such as sheep, cattle and swine. You are not able to contract this virus from animals or pets and you are unable to transmit hand, foot, and mouth disease to them.
How does HFMD spread?
We briefly touched on how the viral infection can spread, but to get into more detail, HFMD is spread through person-to-person contact. The virus is commonly found in the throat and nasal passages, but it can also be found in the stools or blister fluid of someone who is infected.
The virus is able to survive on surfaces that are inanimate, such as desks, tables, handles, toilets etc. Therefore, the virus can spread when someone touches a surface that is contaminated and then touches their mouth, nose or eyes before they wash their hands. Similarly, if you are changing an infected infant’s diaper and do not wear gloves or wash your hands, you are able to transmit the virus. The virus can also live in water.
Women infected just before they give delivery, are able to pass the infection onto their baby. This baby will normally have a mild version of the disease, however, they will be closely monitored as in some rare cases, further complications have developed.
An infected person can carry the virus in their intestinal or respiratory tracts for a couple of weeks and even months after their symptoms have resolved. Therefore, it is possible that others can become infected from someone showing no signs of the condition.
How long will it take for someone to show symptoms of hand, foot, and mouth disease?
Once someone is exposed to HFMD, they will start to show symptoms within one to three days. The patient is most contagious in their first week of infection.
Is there an incubation period for hand, foot, and mouth disease and how long will someone with it be contagious?
The virus is only moderately contagious. The incubation period is normally when the person’s symptoms are at their most prominent point, this is during the first three to six days from initial infection. Therefore, the most contagious period is the first week.
How long does hand, foot, and mouth disease last for?
HFMD lasts for about a week. The first symptoms will present themselves one to three days after infection, these being a reduced appetite, fever and sore throat. One or two days after this, painful sores will develop in the mouth. During the last and final stage, the virus will manifest into tender and small red spots appearing on the palms of hands and soles of feet, this can rarely include the buttocks, genitals and limbs (arms and legs).
What are the symptoms of hand, foot and mouth disease?
HFMD (hand, foot and mouth disease) has been known to cause some of the below symptoms and sometimes all of them. These include:
- Sore throat
- Malaise (general feeling of being sick or unwell)
- Red sores inside of the mouth
- Red sores transgressing into a rash on feet and hands
- Loss of appetite
When to see a doctor
HFMD is usually a minor illness that will result in a few days of fever coupled with some relatively mild symptoms and signs. It is best if you phone your doctor if your child cannot drink liquids due to their sore throat and if their symptoms progress after the first week of infection.
What are the complications of hand, foot and mouth disease?
Dehydration is the most typical and common complication associated with hand, foot and mouth disease. The sores in the child’s mouth from the virus can also make it difficult and painful to eat and swallow liquids.
You will need to ensure your child is frequently sipping water and other fluids throughout the day whilst they are sick. If they develop dehydration and it is severe, then your doctor may recommend they have fluids given to them intravenously.
Symptoms of dehydration can include:
- Dry skin
- Muscle cramps
- Lack of sweat
- Dark yellow coloured urine
HFMD is normally just a minor illness and only results in a few days of relatively mild symptoms and fever. However, in some rare cases, the coxsackievirus has been known to involve the patient’s brain and can result in some other complications such as:
- Viral meningitis – This involves inflammation of the meninges and the cerebrospinal fluid that surrounds the spinal cord and brain.
- Encephalitis – This is more severe and can be life-threatening as it involves the inflammation of the brain. This is a very rare condition.
It has also been found that children may lose finger or toe nails within four weeks of having the disease.
What are the risk factors for hand, foot and mouth disease?
Younger children are most at risk for the condition. Their risk of contracting HFMD is increased if they attend a childcare or a school as the virus is able to quickly spread in various ways in these facilities due to close quarters and frequent personal contact. This is the reason why the virus rarely infects those who are older than 10 years old. There is, however, still a possibility that adults and older children can contract the virus, particularly if they suffer from a weakened immune system.
Can adults get hand, foot, and mouth disease?
We answered this above, but yes, adults can get hand, foot and mouth. To elaborate, an adult who has been exposed to the HFMD virus is able to develop the typical signs and symptoms of the disease such as the vesicular rash (blisters on the skin) and fever. What is interesting is that most adults who have been exposed to the enterovirus family seem to not show any symptoms of being infected, they are, however, still contagious and can spread the virus to another person.
How is hand, foot and mouth disease diagnosed?
Your doctor will typically distinguish between hand-foot-and-mouth disease and other viruses that have the same symptoms through evaluating the following:
- The pattern of the physical symptoms and signs
- The patient’s age
- The appearance of the sores and rash
It is also possible that your doctor will take a stool specimen or throat swab to send to a lab for further testing to determine what virus is the cause of the illness.
How is hand, foot and mouth disease treated?
Hand-foot-and-mouth disease does not have a specific treatment. The symptoms and signs of the disease tend to clear up within seven days, or 10 at most. Typically, a topical anaesthetic can be administered orally to help in relieving any pain in the patient’s mouth from the sores. OTC (over-the-counter) pain medications can also help. These include:
- Ibuprofen (Advil, Motrin IB)
- Acetaminophen (Tylenol)
Home and lifestyle remedies
There are some foods and liquids that have been known to cause irritation to the throat or mouth when experiencing the ulcer-like sores associated with hand, foot and mouth. The following tips may help in making it easier to eat and drink so as to not aggravate the blisters:
- Sucking on ice cubes
- Eating soft and cold foods such as custard or ice cream or custard
- Drinking cold drinks such as ice water
- Avoiding acidic beverages and foods such as fruit drinks, soda and citrus fruits
- Avoiding spicy or salty foods
- Rinsing your mouth after meals with warm water
If you notice that your child is able to rinse their mouth without swallowing the liquid, then salt mixed in warm water can sometimes be soothing for your child’s sore mouth. This can be done a number of times a day as it aids in reducing inflammation and pain.
What is the outlook for hand, foot, and mouth disease?
The outlook and prognosis for hand-foot-and-mouth disease is normally very positive, given that the patient has the routine virus and symptoms without complications. The symptoms are more bothersome than debilitating.
The medications that can aid in reducing the fever and pain are often very helpful. If you give your child soft foods to eat, this helps in soothing the sores in their mouth and can be deemed as a special treat (i.e. Ice cream), which has psychological benefits.
Why isn’t hand, foot, and mouth disease talked about more?
The recognition of the virus is quite recent as the first reported case was in 1956 in Australia, compared to chickenpox, mumps and measles, for example, this is a recent discovery. In the early 1960s, the virus was deemed a common childhood infection worldwide.
Due to this and the fact that it is a relatively mild virus with complications rarely arising, it is often overlooked when it comes to media attention.
How does hand, foot, and mouth disease affect pregnancy and the baby?
In most cases, HFMD affects children who are 10 years old and younger. Adults who had a brief exposure to the condition as children will have a natural immunity against it. The information about foetal exposure to the virus is limited. There is currently no solid evidence on the effects on the baby if the mother is infected with the virus. In cases when the baby is infected during birth, the newborn will be monitored as they may develop a severe infection that involves some of the vital organs such as the heart, liver and brain, which can be fatal.
When can children with hand, foot, and mouth disease return to school?
Children can often return to school once the fever has subsided, this is normally within three to four days from the first signs of infection. If a child has prolific blisters then it is advisable to wait until these have dried before returning to school.
Is it possible to prevent hand, foot, and mouth disease?
Currently, there is no vaccine that allows for HFMD to be prevented. Following a regimen of strict hygiene is the best and primary strategy for limiting the spread of the virus. It is best to teach your child about the basics of hygiene. It is also advisable to avoid contact with anyone who is infected. If there are children infected at your child’s day-care, then speak to the teachers or assistants about disinfecting all toys and work surfaces as well as wearing disposable gloves when changing diapers.