Hand Foot & Mouth Disease

Hand foot and mouth disease

 Hand foot and mouth disease is a mild, infectious viral illness that most frequently occurs in childhood.  Its characteristic symptoms are fluid-filled blisters that appear on the hands, feet and inside of the mouth, making diagnosis relatively straight-forward. No specific medical treatment is required as hand foot and mouth disease is usually short-lasting. Over-the-counter medications may help to relieve symptoms.

General information

Hand foot and mouth disease (HFMD) is a viral infection that most commonly affects children under the age of ten years, particularly pre-schoolers. Outbreaks often occur in child-care centres and schools, where there are large groups of children in close quarters, and most often in summer and early autumn. HFMD only occurs in humans and is unrelated to the virus that causes foot-and-mouth disease in cattle, sheep and pigs. The condition hand-foot syndrome, which results in swelling in the hands and feet, is also unrelated.

Transmission and incubation period

The virus that causes HFMD is transmitted from person to person by direct contact with the fluid in the child’s blisters or from direct contact with secretions from their nose and throat. The virus is also present in the child’s faeces, so inadequate hand washing after toileting or changing a nappy can also cause the virus to be spread.  

Once infection with the HFMD virus has occurred, the time until symptoms appear (incubation period) is usually between three and six days.

HFMD is most contagious in the first week after symptoms appear or while there is fluid in the affected child’s blisters. However, the virus can remain present in the faeces for several weeks.

It is caused by enteroviruses, most commonly coxsackie virus subtypes. In 2013, for example, doctors were alerted to an outbreak of HFMD caused by the coxsackie virus A6 strain in Auckland and other parts of the North Island. 

Signs and symptoms

Initial symptoms of HFMD often appear suddenly and include a mild fever and sore throat. A headache may also be present. One to two days later the following symptoms develop:  

• Painful ulcer-like blisters in the mouth - particularly on the lining of cheeks, roof of the mouth, gums and tongue.
• A rash with small fluid-filled blisters on the pads of the fingers and palms of the hands and/or soles of the feet.  Occasionally the rash and blisters appear on the buttocks.

In addition, children are often tired and irritable. They may also refuse food and fluids due to the painful blisters in the mouth. HFMD can be confused with chickenpox . The main difference is that with chickenpox a rash will be seen over most of the body.

Diagnosis

A diagnosis of HFMD can usually be made based on its characteristic symptoms. If a diagnosis is in doubt, samples can be taken to test for the presence of the virus in the fluid of blisters, nose and throat secretions, or faeces.

Treatment

HFMD is usually a mild, self-limiting disease that resolves by itself seven to 10 days after symptoms first appear, although some strains of the virus may present more severe symptoms.  Recommended treatment may include: 

• Medications such as paracetamol that relieve pain and reduce fever.
• Antiseptic mouthwashes that can soothe the discomfort in the mouth.
• Preventing infection of the blisters by trimming children’s fingernails short and washing hands frequently with soap and warm water.
• Encouraging adequate fluid intake - ice chips and iceblocks can be soothing on the mouth as well as providing fluid intake.
• Rest is also important in assisting overall recovery.

There are no anti-viral medications available for treatment of HFMD.

Complications

HFMD is usually a mild condition and complications are rare. However, the illness can be severe when it is caused by a virus called enterovirus 71 which has been associated with the development of viral meningitis and encephalitis (inflammation of the brain).

It is therefore important to watch for any signs of complications. Consult a doctor if the fever is particularly high or persists for more than 24 hours. Consult a doctor immediately if the child seems very sick, confused or difficult to wake, has trouble walking or has a stiff neck.

Prevention

The most effective way of preventing the transmission of the virus is effective hygiene. Hand washing after toileting, changing nappies and before preparing or eating food is particularly important. Avoiding contact with the fluid-filled blisters and discouraging the sharing of drinks and toys (particularly in young children) is also recommended.

In order to help prevent the spread of the condition, it is usually recommended that children are kept home from school or childcare while the blisters in the mouth and on the hands and/or feet are present.   There is no vaccine available for the prevention of HFMD.

Further information and support

For further information and support about HFMD contact your GP, public health unit, practice nurse, or contact:

Healthline Freephone: 0800 611 116 (operates 24 hours a day, 7 days a week)

Plunketline  Freephone: 0800 933 922 (operates 24 hours a day, 7 days a week)

References

Akoorie, N. Doctors on alert over virus strain (Web Page). New Zealand Herald (30 May 2013). Auckland: NZME Publishing Ltd. http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10887235 [Accessed: 22/08/16] 
DermNet New Zealand (1998). Hand foot and mouth disease (Web Page). Hamilton: DermNet New Zealand Trust. http://www.dermnetnz.org/topics/hand-foot-and-mouth-disease/ [Accessed: 22/08/16] 
Canterbury District Health Board Community and Public Health (2012). Hand, foot and mouth disease (Pamphlet). Christchurch: Canterbury District Health Board. http://www.cph.co.nz/wp-content/uploads/med0006.pdf 
Carson-De Witt, R. and Wells, K. R. (2006). Hand-foot-and-mouth disease. The Gale Encyclopedia of Medicine, Third Edition. Jacqueline L. Longe, Editor. Farmington Mills, MI: Thompson Gale. 
Ministry of Health (2016). Hand, foot and mouth disease (Web Page). Wellington: Ministry of Health. Available from: http://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/hand-foot-and-mouth-disease [Accessed: 22/08/16] Last Reviewed -  August 2016