Hand foot and mouth disease (HFMD) is a generally mild but highly contagious disease caused by a virus. It usually affects children below 10 and in particular those below 5, however it is also possible for adults to get the disease. Hand foot and mouth disease is commonly caused by a coxsackievirus, but other types of enteroviruses can cause it too; the signs and symptoms of HFMD are the same even if the infection is caused by a different virus.
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Hand foot and mouth disease (HFMD) signs and symptoms
After an incubation period of 3 to 6 days, the first symptoms to show up are generic and common with other illnesses like the common cold or the flu:
- Fever
- Sore throat
- Loss of appetite
- Irritability
- Malaise
One or two days after the fever begins, the other characteristic signs of hand foot and mouth disease become evident:
- Mouth sores. They usually start as small red spots on the gums, sides of the tongue, palate or inner cheeks; they then develop into painful blisters
- A skin rash on the hands and feet that looks like flat red spots. Sometimes the rash may show up also on the elbows, knees and buttocks area. The red spots are itchy and may turn into blisters.
Hand, foot and mouth disease is usually a mild illness most commonly seen in summer and fall; symptoms are worst in the first few days and resolve without treatment in 7 to 10 days. Blisters generally leave no permanent mark.
Mouth sores may make it painful to drink, eat and swallow. Refusing to eat or drink, with a fever, can sometimes be the only sign of hand foot and mouth disease in young babies. Cold water may be helpful by keeping the child hydrated and providing some relief from the discomfort or pain in their mouth.
In rare cases, the virus may cause serious complications such as, myocarditis, meningitis, encephalitis, polio-like syndromes and is potentially fatal. In the past two decades, several outbreaks and epidemics of a particularly severe form of hand foot and mouth disease caused by enterovirus-71 were reported around Asia accounting for most of the serious complications and deaths due to the disease.
Adults often don’t show any sign of the disease when infected.
When to see a doctor
The youngest are those at higher risk for serious complications from hand foot and mouth disease. It is advised to see your doctor if any of the following signs are present:
- Persistent fever (with HFMD it should only last a couple of days)
- Dehydration or inability to keep the child hydrated due to painful mouth sores
- Abnormal movements
- Rapid breathing
- Drowsiness
Other reasons to seek your doctor’s attention are if:
- The symptoms are severe
- The child is very young, especially if under 6-12 months
- The patient is immunocompromised
- Worsening of the symptoms after a few days or no improvement after 7-10 days
Hand foot and mouth disease (HFMD) transmission and contagious period
The virus is highly contagious and can spread easily. HFMD transmits through contact with an infected person’s:
- Saliva
- Mucus from nose or lungs
- Fluid from blisters
- Feces
Contact with infected surfaces or airborne infection through saliva droplets is possible as well.
The virus is most contagious during the first week from the onset of symptoms, but a person with hand foot and mouth disease may be contagious for several weeks following the infection and those who don’t experience any symptom at all, like it often happens in adults, are still carriers and can spread the virus.
It is advised for children to stay at home until the symptoms disappear to avoid spreading the disease.
Persons who had hand foot and mouth disease develop an immunity to it, but the immunity is limited to the specific virus which caused the illness. It is still possible to get HFMD again from a different virus.
Hand foot and mouth disease treatment and care
There is no available treatment for hand foot and mouth disease. A vaccine and antiviral drugs are under development and are not available yet. Being a viral infection, antibiotics have no effect on it and won’t help.
Fever tends to last 1-2 days only. The other symptoms clear on their own in 7 to 10 days from the onset of the disease, without leaving any trace.
It is still possible to treat the symptoms of hand foot and mouth disease as well as to ease them with the following:
- You can treat fever and pain with ibuprofen or acetaminophen. Numbing sprays are available OTC and they may provide relief for mouth sores. Never give aspirin to children as it is linked to the development of Reye Syndrome when fighting off a viral infection. Adults can take aspirin. Consult your physician first.
- Avoid hot, spicy, salty or acidic foods and drinks. These can make the sores inside the mouth more painful.
- Drinking cold liquids may ease the discomfort and help avoiding dehydration.
- Ice-creams, yogurts, smoothies and popsicles may be a good choice to provide relief and some energy.
- Soft foods like soups may be easier to eat.
- Other gels, sprays, mouthwashes and creams are available OTC for treating the pain or discomfort from the rashes and blisters or sores. Ask your GP and/or your pharmacist for an advice.
Prevention strategies for HFMD
To prevent the spread of hand foot and mouth disease and to lower the chances of catching it you should follow these simple steps:
- Wash your hands with soap and water frequently. This is important not only for the prevention of hand foot and mouth disease, but for many more diseases as well. Teach your kids how to wash their hands and instruct them to do so before eating and after going to the toilet.
- Teach your children not to put their hands or objects like toys in their mouth.
- Teach your kids to cover their mouth when they cough or sneeze with a disposable tissue or with the sleeve of their shirt.
- If sick, stay home from school or work until symptoms resolve to avoid spreading the disease. After 7-10 days you may have no symptoms but still be contagious. You can go back to work or your child can go back to school, but you should be extra careful not to share forks, spoons, drinking bottles or glasses, with others. You should also be careful not to rub your nose, mouth and eyes, and wash your hands frequently.
- If you have multiple siblings and one is sick, keep them separated until resolution of the symptoms. Disinfect any surface that is touched frequently, toys included. Avoid kissing and hugging.
Sources
- American Academy of Dermatology
- American Academy of Pediatrics
- UK National Health Service
- Center for Disease Control and Prevention (CDC)
- Fitzpatrick’s Dermatology – 9th edition
S Kang – McGraw-Hill, 2019 - The Current Status of the Disease Caused by Enterovirus 71 Infections: Epidemiology, Pathogenesis, Molecular Epidemiology, and Vaccine Development.
PC Chang, SC Chen, KT Chen – International Journal of Environmental Research and Public Health, Sep 2016
