Hand-Foot-and-Mouth Disease

Definition

Hand-foot-and-mouth disease (HFMD) is a contagious virus infection

most likely to affect children below the age of ten. Its most noticeable

symptoms are sores in the mouth and a rash on the hands, soles of the

feet, and sometimes the buttocks. HFMD should not be confused with

foot-and-mouth (sometimes called hoof-and-mouth) disease, which is a

virus infection that affects cattle, pigs, and sheep. Humans cannot get the

animal disease, and they cannot transmit HFMD to household pets or

other animals.

Description

Hand-foot-and-mouth disease is largely a disease of young children in the

United States. It often spreads rapidly in schools, day care centers, and

other places where large numbers of children may be in close contact. The

viruses that cause HFMD belong to a group of viruses called enteroviruses,

which get their name from the fact that they are commonly found

in the human digestive tract. The two most common enteroviruses that

cause HFMD are called enterovirus 71 (EV71) and coxsackievirus A16,

named for the town in New York where it was first identified in 1948.

The enteroviruses that cause HFMD are spread by contact with the

mucus, tears, saliva, blister fluid, or feces of an infected person. The most

common methods of transmission are contact with the unwashed hands

of a person with HFMD or with a toy, drinking glass, or other object the

infected person has touched. Infected children and adults are most contagious

during the first week of illness; the virus can, however, remain

in the intestines for about a month after the illness.

HFMD has an incubation period of three to seven days. The first

symptoms of illness are usually fever and a sore throat, followed by loss

of appetite. About two days after the fever begins, the patient develops

painful sores in the mouth. A rash with blisters also appears on the palms

of the hands, the soles of the feet, and sometimes on the buttocks or genitals.

Some people have only the rash and some have only the mouth

sores. The rash and mouth sores last for about a week or ten days and

then clear completely.

Children and adults who have been infected with HFMD are

immune to the specific virus that caused their symptoms after they

recover. They can, however, develop a second case of HFMD if they are

infected with a different enterovirus known to cause the disease.

Demographics

Hand-foot-and-mouth disease is a common disease around the world,

with millions of cases each year. It is primarily a disease of young

children, although young adults sometimes get infected. Older adults

rarely get HFMD unless they have weakened immune systems.

There are epidemics of HFMD in the United States about every

three years, most often in late summer or early fall. The disease affects

both sexes and all racial and ethnic groups equally.

Causes and Symptoms

Hand-foot-and-mouth disease is caused by at least fourteen different

enteroviruses, the two most common in the United States being enterovirus

71 and coxsackievirus A16.

The most common symptoms of HFMD include:

•

Low-grade fever (101°F [38.3°C])

•

Sore throat

•

Loss of appetite

•

soles of the feet and palms of the hands

Painful reddish ulcers or blisters around or in the mouth or on the

•

Headache

•

Tiring easily or sleeping more than usual

•

Some children may also:

Crankiness in infants and toddlers

•

Drool

•

Develop muscle aches

•

Have pains or cramping in the abdomen

Diagnosis

The diagnosis of hand-foot-and-mouth disease is usually based on the

doctor

Blood tests or other laboratory studies are rarely done because the illness

is usually mild. It is possible to identify the viruses that cause HFMD by

taking stool samples or by swabbing the patient

culturing the virus in the laboratory, but these tests can take between two

and four weeks to yield results.

’s observation of the patient’s age, history, and visible symptoms.’s mouth and throat and

Treatment

There is no specific medication that can cure hand-foot-and-mouth disease,

as antibiotics are not effective against virus infections. Treatment is

intended to ease the pain and discomfort of the fever, mouth sores, and

other symptoms of HFMD. To bring down the fever and relieve muscle

pain, children can be given acetaminophen, ibuprofen, or another nonaspirin

fever reducer or pain reliever. The doctor may recommend a

mouthwash, throat lozenge, or throat spray that contains a mild anesthetic

to relieve pain caused by blisters inside the mouth or throat.

Another treatment that can help to ease throat pain is to gargle with a salt

water rinse made by adding half teaspoon of salt to an 8-ounce glass of

warm water.

It is important to make sure that the patient drinks plenty of fluids.

Children with HFMD sometimes become dehydrated because the sores

inside the mouth and throat hurt when the child tries to drink fruit juice,

soft drinks, tea, or other drinks that contain acid. Milk-based drinks or

cold foods like ice cream or popsicles are often less painful for the child

to swallow. Children who do become dehydrated may need to be taken

to the hospital for treatment with intravenous fluids.

Children with blisters on the hands and feet should keep the areas

clean by washing gently with soap and water, then patting the skin dry

to avoid breaking the blister and spreading the infection. If the blister

does open, it should be covered with a small bandage.

Prognosis

Most people in any age group with HFMD recover completely in about a

week. In a few cases, children have developed encephalitis, meningitis, or

pneumonia; in rare cases, HFMD can cause death. An epidemic in

Taiwan in 1998 that affected 1.5 million children resulted in 405 severe

complications and seventy-eight deaths. An outbreak of HFMD in

China that began in the spring of 2008 led to 25,000 reported cases and

twenty-two deaths by early May.

Pregnant women who become infected with HFMD are at increased

risk of losing the baby.

Prevention

There is no vaccine against HFMD. The most effective preventive measure

is frequent and thorough hand washing, particularly after using the

toilet, changing a diaper, before meals, and before preparing food.

Another preventive measure is routinely cleaning shared toys in day care

centers as well as in the home with a disinfectant, because the viruses that

cause HFMD can live on objects for several days. The Centers for Disease

Control and Prevention (CDC) recommends washing toys (or soiled

countertops and other surfaces) with soap and water, followed by using a

solution of one tablespoon of chlorine bleach added to four cups of

water.

Children with HFMD should stay home from child care or school

until the fever has gone and the mouth sores and other blisters have

healed. Adults with the disease should stay home from work.

The Future

Hand-foot-and-mouth disease is likely to continue to be a common

infection because there are so many different enteroviruses that can cause

it, and because these viruses are the second most common family of

viruses

widespread.

Researchers are presently working on a rapid diagnostic test that

would allow doctors to distinguish quickly between coxsackievirus A16

and enterovirus 71 in patients with symptoms of HFMD. Such a test

would be helpful during epidemics because EV71 infections are more

likely to lead to complications than coxsackievirus infections.

—only the viruses that cause the common cold are more

SEE ALSO

Encephalitis; Meningitis; Pneumonia

For more information

BOOKS

Litin, Scott C., ed.

HarperResource, 2003.

Mayo Clinic Family Health Book. 3rd ed. New York:

PERIODICALS

Jacobs, Andrew.

May 3, 2008. Available online at http://www.nytimes.com/2008/05/03/

world/asia/03china.html?_r=1&oref=slogin (accessed October 20, 2008).

“Virus Kills 22 Children in Eastern China.” New York Times,

WEB SITES

Centers for Disease Control and Prevention (CDC).

Disease (HFMD): Fast Facts

dvrd/revb/enterovirus/hfhf.htm (accessed October 20, 2008).

Mayo Clinic.

mayoclinic.com/health/hand-foot-and-mouth-disease/DS00599 (accessed

October 20, 2008).

Nemours Foundation.

http://kidshealth.org/parent/infections/bacterial_viral/hfm.html (accessed

October 20, 2008).Hand, Foot, and Mouth. Available online at http://www.cdc.gov/ncidod/Hand-Foot-and-Mouth Disease. Available online at http://www.Hand, Foot, and Mouth Disease. Available online at

Hand-Foot-and-Mouth Disease