Hand, foot and mouth disease

Hand, foot and mouth disease (HFMD) is a common viral illness, most often caused by a virus from the coxsackie group of enteroviruses, particularly coxsackie virus A16. It is generally mild and clears up on its own within 7 to 10 days.

The illness is named for the rash it causes: blisters on the hands and feet, sores in the mouth, and often a rash in the nappy (diaper) area.

Despite the similar name, HFMD has no connection to the foot and mouth disease that affects cattle and some other animals.

Who gets it and how it spreads#

HFMD occurs mainly in children under 10 years of age, but it can also affect older children and adults. It tends to spread easily between children, and outbreaks may occur in childcare and other group settings. By adulthood, most people have already been infected with the virus at some point.

The infection spreads through:

• direct contact with fluid from the skin blisters
• nose and throat discharges, including saliva, sputum and nasal mucus
• droplets from coughing and sneezing
• contact with feces (poo)

The skin blisters remain infectious until they crust over and no longer contain fluid. The virus can also be shed in the feces for several weeks after the blisters have healed, so good hygiene matters even after a child seems better.

Symptoms#

Symptoms usually appear 3 to 7 days after infection. The most common include:

• blister-like sores inside the mouth and along the sides of the tongue
• blisters on the palms of the hands, the fingers and the soles of the feet
• a rash in the nappy area
• fever and a sore throat
• irritability, tiredness and reduced appetite

Affected children are often unsettled and may go off their food. Very rarely, the virus can affect the lining of the brain or spinal cord, leading to more serious symptoms such as seizures, confusion or unsteadiness.

Diagnosis#

A doctor usually diagnoses HFMD from the symptoms and the appearance of the rash. Further tests are not normally needed, although throat or feces samples are occasionally taken.

Treatment#

There is no specific treatment for HFMD, and usually none is needed because the illness settles within about a week. To ease symptoms:

• Use paracetamol (acetaminophen), not aspirin, as directed for fever and discomfort.
• Offer plenty of fluids. Avoid orange juice and other acidic drinks, which can sting mouth sores.
• Let the blisters dry naturally. Do not pierce them, as the fluid inside is infectious.

See a doctor promptly if the fever persists, if a child complains of a severe headache, or if any other worrying symptoms develop.

Preventing spread#

Good personal hygiene is the best way to limit the spread of HFMD, both for the person who is unwell and for those caring for them. Wash hands thoroughly with soap and water:

• after contact with the blister-like sores
• after handling nose and throat discharges
• after toileting and nappy changing

Other helpful steps:

• Use separate eating and drinking utensils.
• Avoid sharing personal items such as towels, washcloths and toothbrushes, and clothing such as shoes and socks.
• Wash and clean any soiled clothing, surfaces or toys that may have been contaminated.
• Teach children to cover coughs and sneezes, dispose of tissues straight away, and wash their hands afterwards.

Children with HFMD should stay away from school and childcare until all of the blisters have dried. To help prevent further spread, let the childcare director or school know about the illness.

Key points#

• HFMD is a usually mild viral illness causing blisters on the hands and feet, sores in the mouth and often a rash in the nappy area.
• It spreads easily between children and outbreaks can occur in childcare settings.
• It mainly affects children under 10, but older children and adults can also get it.
• Most people have been infected by the time they are adults.
• Good personal hygiene is important to prevent spreading the infection to others.

Where to get help and trusted information#

For evidence-based global health guidance, see Source: World Health Organization (WHO).