Hand, foot and mouth disease
|Hand, foot and mouth disease|
|Classification and external resources|
Typical lesions around the mouth of an 11-month-old boy
Hand, foot and mouth disease (HFMD) is a human syndrome caused by intestinal viruses of the picornaviridae family. The most common strains causing HFMD are coxsackie A virus and enterovirus 71 (EV-71).
HFMD usually affects infants and children, and is quite common. It is moderately contagious and is spread through direct contact with the mucus, saliva, or feces of an infected person. It typically occurs in small epidemics in nursery schools or kindergartens, usually during the summer and autumn months. The usual incubation period is 3–7 days.
It is less common in adults, however it is still possible to catch it especially if never exposed to the virus previously. HFMD is not to be confused with foot-and-mouth disease (also called hoof-and-mouth disease), which is a separate disease affecting sheep, cattle, and swine (both are caused by members of the picornaviridae family, but are not trans-communicable between humans and livestock).
Signs and symptoms 
Symptoms of HFMD include:
- Referred ear pain
- Sore throat
- Painful oral, nasal, or facial lesions, ulcers or blisters
- Body rash, followed by sores with blisters on palms of hand, soles of feet, and sometimes on the lips. The rash is rarely itchy for children, but can be extremely itchy for adults 
- Sores or blisters may be present on the buttocks of small children and infants
- Irritability in infants and toddlers
- Loss of appetite.
The common incubation period (the time between infection and onset of symptoms) is from three to seven days.
Early symptoms are likely to be fever often followed by a sore throat. Loss of appetite and general malaise may also occur. Between one and two days after the onset of fever, painful sores (lesions) may appear in the mouth or throat, or both. A rash may become evident on the hands, feet, mouth, tongue, inside of the cheeks, and occasionally the buttocks (but generally, the rash on the buttocks will be caused by the diarrhea).
There is no specific treatment for hand, foot and mouth disease. Individual symptoms, such as fever and pain from the sores, may be eased with the use of analgesics. HFMD is a viral disease that has to run its course; many doctors do not prescribe medicine for this illness. Infection in older children, adolescents, and adults is typically mild and lasts approximately 1 week, occasionally longer. Fever reducers and luke-warm baths can help bring temperature down.
Only a very small minority of sufferers require hospital admission, mainly as a result of uncommon neurological complications (encephalitis, meningitis, or acute flaccid paralysis) or pulmonary edema/pulmonary hemorrhage.
- Complications from the virus infections that cause HFMD are not common, but if they do occur, medical care should be sought.
- 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), 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.
Notable outbreaks 
- In 1998, there was an outbreak in Taiwan, affecting mainly children. There were 405 severe complications, and 78 children died. The total number of cases in that epidemic is estimated to have been 1.5 million.
- An outbreak in China, beginning in March in Fuyang, Anhui, led to 25,000 infections, and 42 deaths, by May 13. Similar outbreaks were reported in Singapore (more than 2,600 cases as of April 20, 2008), Vietnam (2,300 cases, 11 deaths), Mongolia (1,600 cases), and Brunei (1053 cases from June–August 2008)
- 17 children died in an outbreak during March and April 2009 in China's eastern Shandong Province, and 18 children died in the neighboring Henan Province. Out of 115,000 reported cases in China from January to April, 773 were severe and 50 were fatal.
- In China, an outbreak occurred in southern China's Guangxi Autonomous Region as well as Guangdong, Henan, Hebei and Shandong provinces. Until March 70,756 children were infected and 40 died from the disease. By June, the peak season for the disease, 537 had died.
- In Vietnam, by 04.09 the disease was reported to have claimed 98 lives, 75% of whom were children under 3 years old. Although there was no official declaration of an outbreak, over 42,000 cases were reported. Over 10,000 new cases were recorded in the second half of August alone.
- The World Health Organization reporting between January to October 2011 (1,340,259) states the number of cases in China had dropped by approx 300,000 from 2010 (1,654, 866) cases, with new cases peaking in June. 437 deaths, down from 2010 (537 deaths) 
- In December, the California Department of Public Health identified a strong form of the virus, coxsackievirus A6 (CVA6), where nail loss in children is common.
- In Alabama, United States there was an outbreak of an unusual type of the disease. It occurred in a season it is not usually seen and affected teenagers and older adults. There were some hospitalizations due to the disease but no reported deaths.
- In Cambodia, 52 of 59 reviewed cases of children reportedly dead (as of 9 July 2012) due to a mysterious disease was diagnosed to be caused by a virulent form of HFMD. Although a significant degree of uncertainty exists with reference to the diagnosis, WHO report states, "Based on the latest laboratory results, a significant proportion of the samples tested positive for enterovirus 71 (EV-71), which causes hand foot and mouth disease (HFMD). The EV-71 virus has been known to generally cause severe complications amongst some patients." 
- Hand, foot and mouth disease infected 1 520 274 people with 431 deaths reported up to end of July in 2012 in China.
- Suhaimi, Nur Dianah (April 20, 2008). "HFMD: 1,000 cases a week is unusual, says doc". Singapore: The Sunday Times (Straits Times). pp. 1–2.
- "Hand, Foot and Mouth Disease: Signs & Symptoms". mayoclinic.com. The Mayo Clinic. Retrieved May 5, 2008.
- "HAND". babymd.net. Baby MD. Retrieved April 7, 2012.
- See also reports from Sarawak Health Department http://www.sarawak.health.gov.my/hfmd.htm#INFO13
- Centers for Disease Control and Prevention (CDC) (1998). "Deaths among children during an outbreak of hand, foot, and mouth disease--Taiwan, Republic of China, April–July 1998". MMWR Morb. Mortal. Wkly. Rep. 47 (30): 629–32. PMID 9704628.
- Ho M, Chen ER, Hsu KH, et al. (1999). "An epidemic of enterovirus 71 infection in Taiwan. Taiwan Enterovirus Epidemic Working Group". N. Engl. J. Med. 341 (13): 929–35. doi:10.1056/NEJM199909233411301. PMID 10498487.
- Viral epidemic maintains grip in China, with three more deaths (accessed May 15, 2008)
- Mass intestinal virus infection kills 19 children – XinHuaNet.com (Retrieved on May 2, 2008.)
- Mass intestinal virus infection in east China up to 2,477, kills 21 – XinHuaNet.com (Retrieved on May 2, 2008.)
- China on alert as virus spreads
- Spreading virus kills 28 children (Retrieved on May 7, 2008.)
- "China virus toll continues rise". BBC News. May 5, 2008. Retrieved May 4, 2010.
- China on alert over deadly child virus (Retrieved on May 3, 2008.)
- Viet Nam News: HFMD cases prompt tighter health screening at airport (accessed May 15, 2008)
- EV-71 Virus Continues Dramatic Rise (accessed May 23, 2008)
- "Hand-foot-mouth disease death toll rises to 17 in East China's Shandong Province". China View. April 9, 2009. Retrieved September 29, 2009.
- "Health Ministry: Hand-foot-mouth disease claims 50 lives this year". China View. April 10, 2009. Retrieved September 29, 2009.
- "Childhood Virus Kills 70 In Vietnam". NPR. July 29, 2011. Retrieved September 11, 2011.
- Hannah Wolfson (13 February 2012). "Outbreak of hand, foot and mouth disease severe in Alabama". The Birmingham News. Retrieved 11 May 2012.
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