| Hand,
Foot, & Mouth Disease |
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What
is hand, foot, and mouth disease?
Hand, foot, and mouth disease (HFMD) is a common illness of infants and
children. It is characterized by fever, sores in the mouth, and a rash
with blisters. HFMD begins with a mild fever, poor appetite, malaise ("feeling
sick"), and frequently a sore throat. One or 2 days after the fever
begins, painful sores develop in the mouth. They begin as small red spots
that blister and then often become ulcers. They are usually located on
the tongue, gums, and inside of the cheeks. The skin rash develops over
1 to 2 days with flat or raised red spots, some with blisters. The rash
does not itch, and it is usually located on the palms of the hands and
soles of the feet. It may also appear on the buttocks. A person with HFMD
may have only the rash or the mouth ulcers.
Is
HFMD the same as foot-and-mouth disease?
No. HFMD is often confused with foot-and-mouth disease of cattle, sheep,
and swine. Although the names are similar, the two diseases are not related
at all and are caused by different viruses. For information on foot-and-mouth
disease, please visit the web site of the US Department of Agriculture
at http://www.aphis.usda.gov/lpa/issues/fmd/fmd.html
What
causes HFMD?
Viruses from the group called enteroviruses cause HFMD. The most common
cause is coxsackievirus A16; sometimes, HFMD is caused by enterovirus
71 or other enteroviruses. The enterovirus group includes polioviruses,
coxsackieviruses, echoviruses and other enteroviruses.
Is
HFMD serious?
Usually not. HFMD caused by coxsackievirus A16 infection is a mild disease
and nearly all patients recover without medical treatment in 7 to 10 days.
Complications are uncommon. Rarely, the patient with coxsackievirus A16
infection may also develop "aseptic" or viral meningitis, in
which the person has fever, headache, stiff neck, or back pain, and may
need to be hospitalized for a few days. Another cause of HFMD, EV71 may
also cause viral meningitis and, rarely, more serious diseases, such as
encephalitis, or a poliomyelitis-like paralysis. EV71 encephalitis may
be fatal. Cases of fatal encephalitis occurred during outbreaks of HFMD
in Malaysia in 1997 and in Taiwan in 1998.
Is
HFMD contagious?
Yes, HFMD is moderately contagious. Infection is spread from person to
person by direct contact with nose and throat discharges, saliva, fluid
from blisters, or the stool of infected persons. A person is most contagious
during the first week of the illness. HFMD is not transmitted to or from
pets or other animals
How
soon will someone become ill after getting infected?
The usual
period from infection to onset of symptoms (“incubation period”)
is 3 to 7 days. Fever is often the first symptom of HFMD.
Who
is at risk for HFMD?
HFMD occurs mainly in children under 10 years old, but adults may also
be at risk. Everyone is susceptible to infection, but not everyone who
is infected becomes ill. Infection results in immunity to the specific
virus, but a second episode may occur following infection with a different
member of the enterovirus group.
When
and where does HFMD occur?
Individual cases and outbreaks of HFMD occur worldwide, more frequently
in summer and early autumn. In the recent past, major outbreaks of HFMD
attributable to enterovirus 71 have been reported in some South East Asian
countries (Malaysia, 1997; Taiwan, 1998).
How
is HFMD diagnosed?
HFMD is one of many infections that result in mouth sores. Another common
cause is oral herpesvirus infection, which produces an inflammation of
the mouth and gums (sometimes called stomatitis). Usually, the physician
can distinguish between HFMD and other causes of mouth sores based on
the age of the patient, the pattern of symptoms reported by the patient
or parent, and the appearance of the rash and sores on examination. A
throat swab or stool specimen may be sent to a laboratory to determine
which enterovirus caused the illness. Since the testing often takes 2
to 4 weeks to obtain a final answer, the physician usually does not order
these tests.
How is HFMD treated?
No specific treatment is available for this or other enterovirus infections.
Symptomatic treatment is given to provide relief from fever, aches, or
pain from the mouth ulcers.
Can
HFMD be prevented?
Specific prevention for HFMD or other enterovirus infections is not available,
but the risk of infection can be lowered by good hygienic practices. Preventive
measures include frequent handwashing, especially after diaper changes
(see “Handwashing” in: “An Ounce of Prevention: Keeps
the Germs Away” at http://www.cdc.gov/ncidod/op/handwashing.htm),
cleaning of contaminated surfaces and items by diluted solution of chlorine-containing
bleach (made by mixing approximately ¼ cup of bleach with 1 gallon
of water), and washing soiled articles of clothing. (See more about cleaning
and disinfecting in general at http://www.cdc.gov/ncidod/op/cleaning.htm).
Children are often excluded from group settings during the first few days
of the illness, which may reduce the spread of infection, but will not
completely interrupt it.
Hand, Foot,
and Mouth Disease in the Child Care Setting
HFMD outbreaks in child care facilities usually coincide with an increased
number of cases in the community. If an outbreak occurs in the child care
setting:
- Make
sure that all children and adults use good handwashing technique (see
above), especially after diaper changes.
- Thoroughly
clean contaminated surfaces and items using dilute solution of chlorine-containing
bleach (see above). Wash soiled articles of clothing.
- CDC
has no specific recommendations regarding the exclusion of children
with HFMD from child care programs, schools, or other group settings.
Children are often excluded during the first few days of the illness,
which may reduce the spread of infection, but will not completely interrupt
it. Exclusion of ill persons may not prevent additional cases since
the virus may be excreted for weeks after the symptoms have disappeared.
Also, some persons excreting the virus, including most adults, may have
no symptoms. Some benefit may be gained, however, by excluding children
who have blisters in their mouths and drool or who have weeping lesions
on their hands.
For more information on enterovirus infections see:
Non-Polio Enterovirus Infections
Viral (Aseptic Meningitis)
For further
information, please contact the Respiratory and Enteric Viruses Branch,
National Center for Infectious Diseases, at 404-639-3607 (telephone) or
404-639-4960 (facsimile).
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This page last reviewed
August 20, 2001
Centers for Disease Control and Prevention
National Center for Infectious
Diseases
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