What Is Hand, Foot And Mouth Disease?

Overview

Hand, foot and mouth disease (HFMD) is an infectious disease commonly affecting preschool children and infants, although it can also occur in older children, adults and some animals.^1,2 

HFMD is typically caused by coxsackieviruses and enteroviruses and spreads through close contact with infected individuals, as well as contact with contaminated surfaces and respiratory droplets. 

HFMD is characterised by the development of small, painful sores or blisters on the hands, feet, and inside the mouth. Other symptoms may include fever, sore throat, reduced appetite, and general malaise.³ 

Causes of hand, foot and mouth disease

Hand, foot and mouth disease (HFMD) is primarily caused by two groups of Enterovirus: coxsackieviruses and enteroviruses. They are highly contagious and can spread easily from person to person. The main modes of transmission include:

1. Direct contact: Close contact with an infected person's saliva, nasal discharge, blister fluid, or faeces can transmit the virus. This typically occurs through activities such as kissing, sharing utensils, or changing diapers
2. Respiratory droplets: When an infected person coughs or sneezes, they release respiratory droplets containing the virus into the air. Inhaling these droplets can lead to infection
3. Contaminated surfaces: The viruses can survive on surfaces and objects for a certain period. Touching something contaminated and then touching the mouth, nose, or eyes can result in infection

HFMD outbreaks often occur in places with close contact, such as schools and daycare centres, where the virus can easily spread among young children. Additionally, poor hygiene practices and crowded environments can contribute to the rapid transmission of the disease.⁴

It is important to note that while the primary cause of HFMD is viral infection, there are other less common viruses that can also lead to similar symptoms and are sometimes categorised as ’atypical’ or ‘unclassified’ cases of HFMD.^4,5

Signs and symptoms of hand, foot and mouth disease

Hand, foot and mouth disease (HFMD) typically presents with the following signs and symptoms:

• Fever: HFMD often begins with a mild to high-grade fever, usually lasting for a few days
• Sore throat: Throat pain and discomfort may occur, leading to difficulty swallowing
• Mouth sores: Painful ulcers or blisters develop inside the mouth, particularly on the tongue, gums, and inner cheeks. These sores can be red or grey in colour and may cause discomfort while eating or drinking
• Skin rash: A characteristic rash may appear on the palms of the hands, soles of the feet, and sometimes on the buttocks. The rash consists of small red spots or blisters that may be tender, itchy and painful
• General malaise: Infected individuals may experience general feelings of malaise, fatigue, or irritability⁶

Not all individuals infected with HFMD will display all of these symptoms. Some cases may present with only a few symptoms, while others may experience the full range. The severity of symptoms can vary widely among individuals, with some cases being mild and self-limiting, while others may be more severe.

While complications of HFMD are rare, they can include dehydration, viral meningitis, nail loss, encephalitis (brain swelling), and paralysis.⁷

If you or someone you know experiences these symptoms and suspect HFMD, it is recommended to consult a healthcare professional for a proper diagnosis and guidance on management and care.

Management and treatment

The management and treatment of hand, foot and mouth disease (HFMD) primarily focus on relieving symptoms and promoting comfort. Here are some general measures that can be taken:

• Rest and hydration: Ensure the affected individual gets plenty of rest and drinks fluids to prevent dehydration. Offer frequent sips of water, oral rehydration solutions, or age-appropriate electrolyte solutions
• Pain relief: Over-the-counter pain relievers such as paracetamol or ibuprofen can help alleviate fever, sore throat, and discomfort. Follow the recommended dosage based on the individual's age and consult a healthcare professional if needed
• Mouth care: Provide cool and soothing foods, such as ice lollies, yogurt, or smoothies, to ease discomfort from mouth sores. Avoid acidic or spicy foods that may irritate the sores. Good oral hygiene, including gentle brushing of teeth and rinsing with warm saltwater, can help maintain oral health
• Skin care: Keep the skin clean and dry. Avoid scratching or popping the blisters to prevent secondary infections. Over-the-counter creams or ointments may be used to relieve itchiness
• Isolation and hygiene measures: To prevent the spread of HFMD, it is important to keep the affected individual away from school, daycare, or public places until they are no longer contagious. Encourage frequent handwashing with soap and water, especially after using the toilet, changing diapers, or encountering nasal or oral secretions

Currently, there are no widely approved specific vaccines available for HFMD. However, ongoing research and development efforts, particularly for the Enterovirus 71 strain, hold promise for the future availability of vaccines.^8,9 

It is crucial to consult a healthcare professional for a proper diagnosis and guidance on managing HFMD, particularly in cases of severe symptoms, complications, or if the individual has underlying health conditions. They can provide specific recommendations tailored to the individual's needs. 

Diagnosis

The diagnosis of hand, foot and mouth disease (HFMD) follows widely accepted criteria that rely on the patient's medical history, clinical symptoms, and additional tests to determine the cause or presence of the disease. 

Healthcare professionals consider factors such as the patient's exposure to known HFMD cases, characteristic symptoms like fever and rash, as well as the results of specific tests conducted to identify the causative virus. By combining these elements, a diagnosis of HFMD can be made, enabling appropriate management and treatment.

It is important to consult a healthcare professional for an accurate diagnosis and appropriate management of HFMD. They can guide you through the diagnostic process and provide necessary advice and treatment based on your specific situation.^8,10

Risk factors

Certain factors can elevate the risk of contracting Hand, Foot and Mouth Disease (HFMD). These include:

• Age: Children under 5 years old are more susceptible due to their developing immune systems and close contact with other children
• Close contact: Direct exposure to bodily fluids of infected individuals, such as saliva or blister fluid, increases the risk
• Crowded environments: Living or being in crowded places facilitates the spread of the virus
• Poor hygiene: Inadequate hand hygiene and unsanitary conditions contribute to the transmission
• Weakened immune system: Those with compromised immune systems are at a higher risk of experiencing severe HFMD symptoms

While these risk factors heighten susceptibility, anyone can contract HFMD. Practising good hygiene and preventive measures can help reduce the risk of infection.¹¹

Complications

Complications of hand, foot and mouth disease (HFMD) are generally rare but can include dehydration, viral meningitis, temporary nail loss, and encephalitis. Severe cases of HFMD can lead to dehydration due to difficulty in eating and drinking. ^11,12

Most cases of HFMD are mild and self-limiting, but seeking medical attention is important if severe symptoms or complications occur. 

FAQs

How can I prevent hand, foot and mouth disease?

To prevent hand, foot and mouth disease (HFMD), practise good hygiene by frequently washing hands with soap and water. Avoid close contact with infected individuals and refrain from sharing personal items. Regularly clean and disinfect frequently touched surfaces to minimise the spread of the virus. Cover your mouth and nose when coughing or sneezing, preferably with a tissue or the inside of your elbow. Stay home if you or your child have HFMD symptoms. Maintain proper sanitation and cleanliness in living spaces. Educate yourself and others about HFMD to raise awareness and promote preventive measures. These steps can help reduce the risk of HFMD transmission.

How common is hand, foot and mouth disease?

HFMD is generally considered a common childhood illness worldwide, including in the UK. The frequency of HFMD cases can vary depending on factors such as geographic location, season, and population density. In some regions, HFMD outbreaks may be more prevalent during certain times of the year, such as the spring and summer months. Outbreaks of HFMD can occur in communities, schools, and childcare settings. Maintaining good hygiene practices and following preventive measures can help reduce the spread of HFMD in the community.

When should I see a doctor?

It is generally recommended to seek medical attention if you or your child experience severe symptoms, dehydration, complications such as difficulty breathing or neurological symptoms, or if there are concerns about the diagnosis or atypical symptoms. It is important to seek medical attention for proper evaluation and guidance in managing the condition.

Summary

Hand, foot and mouth disease (HFMD) is an infectious disease that primarily affects preschool children, but can also occur in older children, adults, and some animals. It is caused by coxsackieviruses and enteroviruses, which spread through close contact, respiratory droplets, and contaminated surfaces. 

HFMD is characterised by fever, sore throat, mouth sores, skin rash, and general malaise. While complications are rare, they can include dehydration, viral meningitis, nail loss, and encephalitis. 

There are no specific vaccines for HFMD, but preventive measures such as good hygiene, avoiding close contact, and maintaining cleanliness can help reduce the risk. Seek medical attention for severe symptoms, complications, or concerns about the diagnosis.