Hand, Foot & Mouth Disease (HFMD)
Hand, foot, and mouth disease is a common viral illness of infants and children, and sometimes seen in adults and older children too. HFMD causes fever and blister-like sores in the mouth and-or skin rash. HFMD is often confused with foot-and-mouth (also called hoof-and-mouth) disease, a disease of cattle, sheep, and swine; however, the two diseases are not related—they are caused by different viruses. Humans do not get the animal disease, and animals do not get the human disease.
- The disease usually begins with a fever, poor appetite,
a general sick feeling, and often with a sore
throat. More detailed health information is located at
the hand foot
and mouth disease organization website.
- 1 or 2 days after HFMD fever onset, painful sores usually
develop, often starting in the mouth. They begin as small red spots that
blister and then often become ulcers. The sores are usually
located on the tongue, gums, and inside of the cheeks.
- A non-itchy skin rash develops over 1–2 days. The
rash has flat or raised red spots, sometimes with blisters.
The rash is usually located on the palms of the hands and
soles of the feet; it may also appear on the buttocks and/or
- A person with HFMD may have only the rash or only the mouth sores.
What Causes HFMD
- HFMD is caused by viruses that belong to the enterovirus
genus (group). This group of viruses includes polioviruses,
coxsackieviruses, echoviruses, and enteroviruses.
- Coxsackie virus A16 is the most common cause of this disease,
but other coxsackieviruses have been associated with the
- Enteroviruses, including enterovirus 71, have also been associated with HFMD and with outbreaks of the disease.
How Is HFMD Spread
- Infection is spread from person to person by direct contact
with infectious virus. Infectious virus is found in the
nose and throat secretions, saliva, blister fluid, and stool
of infected persons. The virus is most often spread by persons
with unwashed, virus-contaminated hands and by contact with
- Infected persons are most contagious during the first
week of the illness.
- The viruses that cause HFMD can remain in the body for
weeks after a patient's symptoms have gone away. This means
that the infected person can still pass the infection to
other people even though he/she appears well. Also, some
persons who are infected and excreting the virus, including
most adults, may have no symptoms.
- HFMD is not transmitted to or from pets or other animals.
Factors that Increase the Chance for Infection or Disease
- Everyone who has not already been infected with an enterovirus
that causes HFMD is at risk of infection, but not everyone
who is infected with an enterovirus becomes ill with HFMD.
- HFMD occurs mainly in children under 10 years old but
can also occur in adults. Children are more likely to be
at risk for infection and illness because they are less
likely than adults to have antibodies to protect them. Such
antibodies develop in the body during a person’s first
exposure to the enteroviruses that cause HFMD.
- Infection results in immunity to (protection against) the specific virus that caused HFMD. A second case of HFMD may occur following infection with a different member of the enterovirus group.
- HFMD is one of many infections that result in mouth sores.
However, health care providers can usually tell the difference
between HFMD and other causes of mouth sores by considering
the patient’s age, the symptoms reported by the patient
or parent, and the appearance of the rash and sores.
- Samples from the throat or stool may be sent to a laboratory to test for virus and to find out which enterovirus caused the illness. However, it can take 2–4 weeks to obtain test results, so health care providers usually do not order tests.
Treatment and Medical Management
There is no specific treatment for HFMD.
Symptoms can be treated to provide relief from pain from mouth sores and from fever and aches:
- Fever can be treated with antipyretics (drugs that reduce
- Pain can be treated with acetaminophen, ibuprofen, or
other over-the-counter pain relievers.
- Mouthwashes or sprays that numb pain can be used to lessen
- Fluid intake should be enough to prevent dehydration (lack of body fluids). If moderate-to-severe dehydration develops, it can be treated medically by giving fluids through the veins.
Prevention of HFMD
A specific preventive for HFMD is not available, but the risk of infection can be lowered by following good hygiene practices.
- Good hygiene practices that can lower the risk of infection
- Washing hands frequently and correctly and especially
after changing diapers and after using the toilet
- Cleaning dirty surfaces and soiled items, including toys,
first with soap and water and then disinfecting them by
cleansing with a solution of chlorine bleach (made by adding
1 tablespoon of bleach to 4 cups of water)
- Avoiding close contact (kissing, hugging, sharing eating utensils or cups, etc.) with persons with HFMD
Vaccination Recommendations for HFMD
No vaccine is available to protect against the enteroviruses that cause HFMD.
- Complications from the virus infections that cause HFMD
are not common, but if they do occur, medical care should
- Viral or "aseptic meningitis can rarely occur with
HFMD. Viral meningitis causes fever, headache, stiff neck,
or back pain. The condition is usually mild and clears without
treatment; however, some patients may need to be hospitalized
for a short time.
- Other more serious diseases, such as encephalitis (swelling
of the brain) or a polio-like paralysis, result even more
rarely. Encephalitis can be fatal.
- There have been reports of fingernail and toenail loss occurring mostly in children within 4 weeks of their having hand, foot, and mouth disease (HFMD). At this time, it is not known whether the reported nail loss is or is not a result of the infection. However, in the reports reviewed, the nail loss has been temporary and nail growth resumed without medical treatment.
Trends and Statistics
- Individual cases and outbreaks of HFMD occur worldwide.
In temperate climates, cases occur more often in summer
and early autumn.
- Outbreaks of HFMD caused by enterovirus 71
have been reported in Asia and Australia.
- HFMD caused by coxsackie virus infections is a more mild
disease. Nearly all patients recover in 7 to 10 days without
special meds or physician treatment.
- HFMD caused by enterovirus 71 has shown a higher incidence
of neurologic (nervous system) involvement.
- Fatal cases of encephalitis (swelling of the brain) caused by enterovirus 71 have occurred during outbreaks.