Hand, foot and mouth disease (HFMD) is a mild but contagious viral infection that is characterized by sores in the mouth and a rash on the hands and feet. This disease is not related to the disease with a similar name, which affects animals particularly cattle and swine and other cloven-hoofed ruminants.

Typical lesions around the mouth of an 11-month-old boy Attribution: MidgleyDJ at en.wikipedia

Young children are most commonly affected, while older children and adults may also get infected. In adults, there is often a milder form of the illness.

The cause of HFMD is the Coxsackie A16 virus. Some cases are caused by enterovirus 71, a different but related virus.

Young children are most commonly affected, while older children and adults may also get infected. In adults, there is often a milder form of the illness.

How can one get infected with HFMD?

Hand, foot, and mouth disease is transmitted by person-to-person contact. Ingestion of the virus is the main source of infection. Transmission is by direct contact with an infected person’s saliva, nasal secretions, blister fluids, stool, and respiratory droplets. It is not transmitted to or from pets or animals.

Three to seven days after the initial infection, fever is usually the first

Lesions caused by the Hand, Foot and Mouth Virus on a 36 year old male. Author KlatschmohnAcker

symptom to appear. This is followed by sore throat, poor appetite, and malaise. After a couple of days, the characteristic blisters and rashes appear. Painful sores may develop in the mouth and throat, as well as rashes on the hands and feet. The flat pink patches on the hands and feet may be followed by small elongated grayish blisters. These resolve by peeling off within a week, without leaving scars.

How is HFMD diagnosed?

Health care providers can usually identify the disease by the symptoms as well as the characteristic mouth sores and rash. Sometimes, samples from the throat or stool are collected and sent to the laboratory for identification of the virus.

In infected children, blood tests may show increased white cell count, raised serum CRP, atypical lymphocytes, and positive serology for the virus.

How is HFMD treated?

There is no specific treatment for hand-foot-and-mouth disease. Supportive treatments to ease the symptoms are given until the condition improves. Paracetamol or ibuprofen is given to lower the temperature and relieve pain and soreness in the mouth, fluids to prevent dehydration, lidocaine gel to numb the mouth area. In most patients, the infection will resolve in a week or two without treatment.

HFMD Outbreaks

Outbreaks of HFMD can easily occur in confined places. Thus, day care centers and colleges would be most at risk.

In 1998, there was an outbreak in Taiwan estimated to have affected 1.5 million people. An outbreak in China in 2008 led to 25,000 infections, another in 2010 where more than 70,000 children were infected. In 2012, there was an unusual type of outbreak in Alabama which affected teenagers and older adults.

In August 2016, there have been reports of HFMD at high schools in Indiana, Vermont, and New Jersey. The University of Colorado at Boulder also experienced several cases on campus. In mid-September of 2016, Florida State University Health Services has identified more than a dozen cases of HFMD and reports say there are around 22 cases so far this semester.

Preventing HFMD

Hand-foot-and-mouth disease is most contagious before the rash appears, so it can be difficult to avoid catching it. People infected with HFMD may also remain contagious for weeks and can spread the virus to others. Therefore, it is important to maintain good hygiene to minimize the chances of getting the disease.

1. Wash hands often and use hand sanitizers if possible.
   

   Hand washing with soap. Author Serenity, Wikimedia commons

2. Clean and disinfect common areas (e.g. bathrooms) and frequently touched objects (e.g. doorknobs, tables, toys, counter tops) with chlorine bleach and water.
3. Avoid touching your mouth, eyes, and nose with unwashed hands.
4. Avoid close contact with people infected with HFMD (such as kissing or hugging) and avoid sharing utensils, cups.

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