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Hand Foot and Mouth Disease

Hand, foot and mouth disease (HFMD) is usually a mild illness that occurs mainly in young children but can also affect older children and adults. It is caused by a number of different viruses of the “enterovirus’ group, and the symptoms can vary depending on the virus. Some people can be infected but not develop symptoms of the disease, and rarely some can develop a more serious illness.

Outbreaks occur frequently among groups of children in childcare centres and schools. To help prevent spread, the affected infant/child should not attend childcare or school until well and the blisters have dried-out. To further assist in prevention of spread, parents should report the illness to the director of the childcare centre or school principal.

HFMD is not related to the foot- and-mouth disease that affects cattle, sheep and pigs.

Signs and Symptoms: 
Hand, foot and mouth disease usually begins with fever, feeling unwell, loss of appetite, sore throat and mouth, with blisters/ulcers in the throat, mouth and on the tongue. The ulcers can be painful and make eating, drinking and swallowing difficult.

After the ulcers appear, a rash made up of small, raised red spots may appear on the fingers, the backs or palms of the hand, the soles of the feet, and occasionally on the knees, elbows, buttocks and groin. The spots and blisters can sometimes be itchy and sore and may last up to 10 days. It is normal for palms and soles to peel sometimes up to 3 weeks after the infection. Not everyone gets them on their hands, feet, and mouth.

Dehydration can sometimes occur as the pain from the blisters may stop the person from eating and drinking.

In rare cases, those infected with hand, foot and mouth disease caused by Enterovirus 71 may develop a more severe disease such as meningitis (inflammation of the lining of the brain), encephalitis (inflammation of the brain itself), or paralysis.

If a child with HFMD complains of severe headache, if fever persists, of if there are any worrying symptoms, consult your local doctor immediately.

Treatment: 
No specific treatment is required or available for mild hand, foot and mouth disease. Paracetamol or ibuprofen can be given to relieve fever and discomfort. Aspirin should not be given to children due to the risk of Reye’s syndrome, a rare but very serious post-viral illness affecting brain and liver function.

It is important to make sure that children get enough fluids so that they don't get dehydrated. Cold foods can help to numb the pain and soft foods are easier to swallow.

Transmission: 
The infection can be spread by close person to person contact and contact with contaminated surfaces. It usually takes between three and five days after exposure to the virus before symptoms develop.

The virus can spread from an infectious person to others by contact with:

  • infectious fluid in the blisters
  • saliva, drool, nasal mucus (also spread by coughing and sneezing)
  • faeces (poo)
  • contaminated objects or surfaces.

A person with hand, foot and mouth disease is most infectious in the first week of the illness. Skin blisters are no longer infectious when they have crusted over, but the virus can be spread in faeces for several weeks after the person has recovered.

Prevention: 

The best protection against HFMD is maintaining good hygiene measures that prevent contact with infectious substances from an infectious person.

  • Wash hands with soap and water for at least 20 seconds and dry thoroughly before handling food; and after going to the toilet, touching soiled linen and articles and changing nappies.
  • Clean and disinfect frequently touched surfaces and soiled items, including toys.
  • Avoid sharing cups, eating utensils, items of personal hygiene (e.g. towels, washers and toothbrushes), and clothing (especially shoes and socks).
  • Teach children about cough and sneeze etiquette.
  • Cough and sneeze into the elbow (rather than hands) or cover with a tissue; Put used tissues in the bin straight away after use then wash hands.

Health outcome: 

Pregnancy

There is no clear evidence that HFMD causes any problems with pregnancy or the unborn baby in utero. However, pregnant women may pass the virus to the baby if they are infected shortly before delivery or have symptoms at the time of delivery. After birth, newborn babies infected with the virus can, very rarely, develop serious illness.

Help and assistance: 

Please contact your local doctor/healthcare provider, 13 HEALTH (13 43 25 84) or nearest public health unit 

References

Esposito, S., Principi, N. Hand, foot and mouth disease: current knowledge on clinical manifestations, epidemiology, aetiology and prevention. Eur J Clin Microbiol Infect Dis 37, 391–398 (2018)

• Bennett, J., Dolin, R., Blaser, M., Mandell, G. & Douglas, R. (2014). Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases (8th edition). Philadelphia, PA: Elsevier/Saunders, pp. 2082-2083.

• NHS Scotland. Hand, foot and mouth disease. About hand, foot and mouth disease (2020). NHS Inform, Scotland. 

• Centre for Disease Control and Prevention, Hand, Foot, and Mouth Disease (HFMD)[viewed on line 04/03/2021] Page last reviewed: February 2, 2021 National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases

Victoria State Government Better Health Channel, Hand, foot and mouth disease {viewed online 04/03/2021}