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Hand, Foot, and Mouth Disease

Incubation period for HFMD is typically 3 to 6 days.

Signs and Symptoms

HFMD more often then not, begins by presenting with a fever, malaise, reduced appetite, and a sore throat. Within 24 to 48 hours, sores are likely to appear in the back of the mouth, tongue, and cheeks that are small and red in appearance and may blister and become ulcers. This time period may also present the signature skin rashes around the mouth, hands, feet, elbows, knees, buttocks or genital region. Some individuals, especially the younger children, may become dehydrated due to the mouth sores making it difficult and painful to swallow enough liquids. These signs and symptoms are not always present and in some rare cases, primarily with adults, no signs and symptoms ever present.

 Causes

The coxsackievirus viruses that cause the disease are of the Picornaviridae family. The most common strain that causes HMFD is the A16 strain, but other coxsackievirus strains may be implicated. Outbreaks of HMFD are common in late summer and early autumn seasons. HMFD is the most contagious during the first week and can remain in the body without signs or symptoms for several weeks. Not all who have HMFD show signs and symptoms, adults in particular can pass the virus with out knowing. Hand, foot and mouth disease can be acquired multiple times in a lifetime. Separate strains of the enterovirus or Coxsackievirus A16 can infect an individual and present with similar signs and symptoms.

Transmission

Oral ingestion is the main cause of transmission, with nasal secretion/throat discharge, saliva, fluid from blisters, stool, and respiratory droplets coming from a cough or sneeze all being possible methods of transmission.

Prevention

Preventative measures include disinfecting high traffic areas and surfaces around children on a strict schedule with soap and water, then a diluted chlorine bleach and water solution as well as washing hand frequently, teaching proper hygiene, and isolating any people who may be contagious.

Complications

Pregnant women should avoid exposure to hand, foot and mouth disease. Pregnant women are generally exposed to more risk factors and increases the risk for infections. There have not yet been connections to birth defects or congenital deformities, but cases have been seen when the mother acquires the virus shortly before delivery and passes the virus to the newborn. Because hand, foot and mouth disease can be more serious for infants and children, complications post-birth could be present. Most serious cases of the disease in newborns occur within the first 2 weeks of birth.

Epidemiology

Hand, foot and mouth disease is more prevalent when there are increases in heat and humidity, not necessarily during the spring, summer and autumn. Although temperature usually follows seasonal patterns, it is not uncommon for outbreaks to occur in early winter months. Poor hygiene is a risk factor for HFMD which makes it difficult to keep children safe, with children under the age of 10 being the most common to be diagnosed with HFMD. However, protective habits such as hand washing and use of soap and clean water, and disinfecting surfaces in play areas reduce the occurrence of cases. Breast-feeding has also shown to decrease prevalence of severe HFMD, though does not reduce the risk for the infection of the disease. Child care settings are the most common places for HMFD to be contracted because of the bathroom training, diaper changes, and that children often put their hands into their mouths. Children that do not attend a preschool or kindergarten were found to be more susceptible to the disease. HFMD is contracted through nose and throat secretions such as saliva, sputum, and nasal mucus as well as fluid in blisters, and stool.

The most recent locations of large increases in prevalence include: China, Japan, Hong Kong (China), the Republic of Korea, Malaysia, Singapore, Thailand, Taiwan, and Vietnam. Observations of the virus showed more sustainability in moist environments compared to dry, suggesting the types of climates HFMD will likely impact. HFMD most commonly affects young children under the age of 10 and more often under the age of 5, but can also affect adults with varying symptoms. The Coxsackievirus A16 is the most common cause of the HFMD, however other types of nonpolio enteroviruses can may cause HFMD.

Since 1997 there have been large enterovirus 71 outbreaks reported, mostly in East and South East Asia, primarily affecting children.

History

HFMD cases were first described in New Zealand and Canada in 1957.