Hand, Foot, and Mouth Disease
A common illness of infants and children under 10 years of age characterized by fever, sores in the mouth, and a rash with blisters. It is due to infection, most commonly with coxsackievirus A16 or less often enterovirus 71 or another enterovirus. The disease begins with a mild fever, poor appetite, malaise (“feeling sick”), and frequently a sore throat. One or 2 days after the fever begins, sores develop in the mouth. They begin as small red spots that blister and then often become ulcers. They are usually located on the tongue, gums, and inside of the cheeks. The skin rash develops over 1 to 2 days with flat or raised red spots, some with blisters. The rash does not itch, and it is usually located on the palms of the hands and soles of the feet. It may also appear on the buttocks. One may have only the rash or the mouth ulcers. The infection is a mild disease and children usually recover with no medical treatment in 7 to 10 days. Rarely, this illness may be associated with “aseptic” or viral meningitis, in which the person has fever, headache, stiff neck, or back pain, and may need to be hospitalized for a few days. If caused by enterovirus 71 viral meningitis may occur and, rarely, more serious diseases, such as encephalitis, or a poliomyelitis-like paralysis. Enterovirus 71 encephalitis may be fatal. The disease is moderately contagious. Infection is spread from person to person by direct contact with nose and throat discharges or the stool of infected persons. A person is most contagious during the first week of the illness. The incubation period (from infection to onset of symptoms) is 3 to 7 days. Everyone is susceptible to infection. Infection results in immunity to the specific virus, but a second episode may occur following infection with a different member of the enterovirus group. Symptomatic treatment is given to provide relief from fever, aches, or pain from the mouth ulcers. Preventive measures include frequent handwashing, especially after diaper changes; disinfection of contaminated surfaces by household cleaners (such as diluted bleach solution made by mixing 1 capful of household bleach containing chlorine with 1 gallon water), and washing soiled articles of clothing. Children are often excluded from child care programs, schools, or other group settings during the first few days of the illness.