What is hand-foot-and-mouth disease?

Hand, foot and mouth disease (HFMD) is caused by a virus (usually from the coxsackie group of enteroviruses, particularly coxsackie virus A16). It causes causes sores in or on the mouth and on the hands, feet, and sometimes the buttocks and legs. The sores may be painful. The illness usually doesn't last more than a week or so.

HFMD occurs mainly in children under ten years of age, but can also affect older children and adults. Outbreaks may occur in childcare settings. By the time they are adults, most people have been infected with the virus that causes this disease.

It is not the same as other diseases that have similar names: foot-and-mouth disease (sometimes called hoof-and-mouth disease) or mad cow disease. These diseases almost always occur in animals.

The virus spreads easily through coughing and sneezing. It can also spread through infected stool, such as when you change a diaper or when a young child gets stool on his or her hands and then touches objects that other children put in their mouths. Often the disease breaks out within a community.

It usually takes 3 to 6 days for a person to get symptoms of hand-foot-and-mouth disease after being exposed to the virus. This is called the incubation period.

Is hand, foot and mouth disease serious?

Usually not. The fever and spots usually clear within a few days. The mouth ulcers can be painful, and may last up to a week. The sore mouth may make a child miserable for a few days. In a very small number of cases, the virus affects the heart, lung or brain to cause a serious inflammation of the heart, lung or brain, which is fatal in some cases. But it has to be stressed - these serious complications are rare.

Signs & Symptoms

At first your child may feel tired, get a sore throat, or have a fever of around 101°F (38°C) to 103°F (39°C). Then in a day or two, sores or blisters may appear in or on the mouth and on the hands, feet, and sometimes the buttocks. In some cases a skin rash may appear before the blisters do. The blisters may break open and crust over.

In some cases there are no symptoms, or they are very mild. Parents may get the disease from their children and not even realize it.

In general, a child with HFMD may suffer from some of the following common signs and symptoms: 

• Fever. 
• Sore throat. 
• Ulcers in the throat, mouth and tongue. 
• Headache. 
• Rash with vesicles (small blisters 3–7 mm) on hands, feet and diaper area. The vesicles are typically on the palm side of the hands, the sole side of the feet and are very characteristic in appearance. The rash may also be present on the buttocks, arms and legs. 
• Poor appetite. 
• Lethargy. 

However, symptoms may vary between individuals, and at different stages of the disease. E.g. some may only have a rash or some individuals may show no symptoms at all.

Complications

Severe ulcers in the mouth can be very painful, interfering with the intake of food and drink. This could result in dehydration, as could persistent vomiting/diarrhoea, and a reduced fluid intake.

Occasionally, complications such as brain, lung or heart infections may occur. This is usually due to the EV71 virus and can be serious. Some signs and symptoms of complications include: 

• Severe headache, giddiness and neck stiffness. 
• Disorientation, drowsiness and/or irritability. 
• Fits. 
• Breathlessness or turning blue. 

Is hand, foot and mouth disease infectious?

Yes. The incubation period is 3-5 days. This means it takes 3-5 days to develop symptoms after being infected from another person. Most cases are passed on by coughing and sneezing which transmits the virus into the air. It is mainly infectious until the spots and mouth ulcers have gone. Sometimes small outbreaks occur in nurseries and schools.

Wash hand often

However, children can still be mildly infectious for several weeks longer, as the virus may be passed out with the faeces (stools) for several weeks after the symptoms have gone. Therefore, it is sensible to maintain good hygiene to reduce the chance of passing on the virus. For example: 

• Make sure that children wash their hands thoroughly after using the toilet. 
• Aim to keep mouth and nose covered when coughing and sneezing. Wipe the nose and mouth with disposable tissues. 
• Adults should take particular care when handling nappies and tissues. Wash hands thoroughly after handling nappies and tissues. 
• Soiled clothes, bedding, and towels should be washed on a hot cycle of the washing machine. 
• It is best not to share cups, eating utensils, towels, etc whilst ill with this infection and for several weeks afterwards. 
• Do not deliberately pierce blisters, as the fluid is infectious.                                                                    

How is hand-foot-and-mouth disease diagnosed?

A doctor can tell if your child has hand-foot-and-mouth disease by the symptoms you describe and by looking at the sores and blisters. Tests usually aren't needed.

Treatment for HFMD

HFMD is a mild illness that resolves within a few days. There is no specific treatment and usually none is required.

Use paracetamol (not aspirin) as directed for fever and any discomfort. Offer plenty of fluids, but avoid orange juice, which is acidic and may cause pain with mouth ulcers. Allow blisters to dry naturally. Do not pierce blisters, as the fluid within them is infectious.

If a child with HFMD complains of severe headache, if fever persists, of if there are any worrying symptoms, consult your local doctor immediately.

Prevention of HFMD

Good personal hygiene is essential to prevent the spread of HFMD to others, both for those infected and their carers. This includes: 

• Washing hands carefully with soap and water after contact with the blister-like lesions, after handling nose and throat discharges, and after contact with faeces such as with toileting and nappy changing. 
• Using separate eating and drinking utensils. 
• Avoid sharing items of personal hygiene (e.g. towels, washers and toothbrushes) and clothing (particularly shoes and socks). 
• Thoroughly wash and clean any soiled clothing and surfaces or toys that may have been contaminated. 
• Teach children about cough and sneeze etiquette, immediate disposal of tissues, and to wash hands afterwards. 

Children with HFMD should be excluded from school and childcare centres until all of the blisters have dried. To assist in prevention of spread, parents should report the illness to the director of the childcare centre or school principal.

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