Hand foot and mouth disease (HFMD)

Hand foot and mouth disease is a febrile illness of young children characterized by the development of vesicular enanthem on the oral mucosa and a papulovesicular exanthema on the distal extremities and buttocks (1).

• frequently seen in children under the age of ten but adult cases are not unusual
• peaks during summer and early autumn months
• outbreaks are frequently seen in groups of children e.g. – in a nursery school
• incubation period is 3-5 days (1).

It is usually caused by viruses belonging to human enteroviruses A (HEVA), especially coxsackie viruses A16 which in majority of patients causes a mild self limiting illness (1).

On rare occasions human enterovirus (HEV 71) and other group A and group B coxsackie viruses may be responsible (1,2).

• there have been large epidemics of hand foot and mouth disease in the Asia-Pacific region caused by HEV 71 which was associated with a rapid fulminant course, severe neurological complications and a large number of fatalities (1).
• a similar clinical illness is seen initially in coxsackie viruses A16, but neurological and other severe complications are rarely present when compared to HEV 71 infection (1)

Transmission of the disease occurs through:

• direct contact with nose and throat discharges
• aerosol spread e.g. coughing and sneezing (1)
• direct contact with fluid from blisters
• direct contact with the stool of an infected persons (1)
• from mother to foetus – if infection occurs late in the pregnancy (3)

An infected person who is asymptomatic may shed the virus in faeces and saliva for several weeks (1).

There is no specific treatment for the condition. Only symptomatic treatment is necessary. Patients should be informed that the disease is not connected to foot and mouth disease of animals (1) and transmission does not occur to or from pets or other animals (4).

Infected persons develop immunity to the specific virus but recurrence of the disease may be caused by a different member of the enterovirus group (1).

Click here for an example image of hand foot and mouth disease rash

References:

1. Saguil A, Kane SF, Lauters R, et al. Hand-foot-and-mouth disease: rapid evidence review. Am Fam Physician. 2019 Oct 1;100(7):408-14.
2. Lee TC, Guo HR, Su HJ, et al. Diseases caused by enterovirus 71 infection. Pediatr Infect Dis J. 2009;28:904-910.
3. Frydenberg A and Starr M. Hand, foot and mouth disease. Australian Family Physician 2003;32(8)
4. Center for Disease Control and Prevention (CDC) 2024. National Center for Immunization and Respiratory Diseases - Division of Viral Diseases. Hand, foot, and mouth disease (HFMD)