Health and Medical Concerns

Hand, Foot & Mouth Disease

What is hand, foot, and mouth disease?

Hand, foot, and mouth disease (HFMD) is a common illness of infants and children. It is characterized by fever, sores in the mouth, and a rash with blisters. HFMD 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. A person with HFMD may have only the rash or the mouth ulcers.

Is HFMD the same as foot-and-mouth disease?

No. HFMD is a different disease to the foot-and-mouth disease of cattle, sheep, and swine, which have been talked about in the press in the last months. Although the names are similar, the two diseases are not related at all and are caused by different viruses. There are no serious human health implications from foot and mouth disease, although humans in contact with infected animals very occasionally get mild respiratory symptoms. Humans do not become infected by eating meat originating from infected animals.

What causes HFMD?

Several different viruses cause HFMD. The most common cause is coxsackievirus A16; sometimes, enterovirus 71 or other strains of enteroviruses cause the syndrome. The enterovirus group includes polioviruses, coxsackieviruses, and echoviruses.

Is it contagious?

Yes, HFMD 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. HFMD is not transmitted to or from pets or other animals.

How soon will someone become ill after getting infected?

The usual period from infection to onset of symptoms is 3 to 7 days. Fever is often the first symptom of HFMD.

Who is at risk for HFMD?

HFMD occurs mainly in children under 10 years old, but adults may also be at risk. 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.

When and where does HFMD occur?

Individual cases and outbreaks of HFMD occur worldwide, more frequently in summer and early autumn. In the recent past, major outbreaks of HFMD attributable to enterovirus 71 have been reported in some South East Asian countries.

How is HFMD diagnosed?

HFMD is one of many infections that result in mouth sores. Another common cause is oral herpesvirus infection, which produces an inflammation of the mouth and gums (sometimes called stomatitis). Usually, the physician can distinguish between HFMD and other causes of mouth sores based on the age of the patient, the pattern of symptoms reported by the patient or parent, and the appearance of the rash and sores on examination. A throat swab or stool specimen may be sent to a laboratory to determine which enterovirus caused the illness. Since the testing often takes 2 to 4 weeks to obtain a final answer, the tests are usually not done.

How is HFMD treated?

No specific treatment is available for this or other enterovirus infections.

There are 2 troublesome things about this viral illness. One is the fever. This should be managed by an appropriate dose of anti-pyretic given every 4 hours. Many times, anti-pyretic is only able to bring the fever down some, but not all the way to normal.

The other troublesome feature of this illness is that the sores in the mouth often make children not want to eat or drink. If this happens, try these ideas. Numbing ointments used for teething can be applied in small doses to the mouth sores using your finger. Offer only cold, bland liquids to drink. Milk is a good choice. Sodas with carbonation or citrus juices will sting and your child won't drink them.

As for solid food, be prepared for a child who simply won't eat very well for a few days. The foods you offer will need to be bland, soft, not spicy, and not hot in temperature. Warm noodles with a little butter and salt may be tolerated. Try bread or soft rolls. If you are worried that your child won't eat anything, try an ice lolly or Jelly. Foods like toast, spicy and tomato based foods, potato chips, and crunchy cereal are usually refused by children with this illness.

Many parents can diagnose this illness themselves and a visit to the doctor is usually not required. Antibiotics simply do not help this condition at all. The disease is about as contagious as the common cold and probably passed the same way - contact with an infected person.

Can HFMD be prevented?

There is nothing that can be done to prevent you from getting the illness if you have been exposed, but only a fraction of the people who are exposed will get this disease. Preventitive measures include frequent hand washing, especially after nappy 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 childcare programmes, schools, or other group settings during the first few days of the illness. These measures may reduce the spread of infection, but they will not completely interrupt it. As for the small blisters that may form on the feet and hands, leave them alone. They will heal much better if not popped.

Is HFMD serious?

Usually not. HFMD caused by coxsackievirus A16 infection is a mild disease and nearly all patients recover without medical treatment in 7 to 10 days. There are no common complications. 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. Another cause of HFMD, EV71 may also cause viral meningitis and, rarely, more serious diseases, such as encephalitis, or a poliomyelitis-like paralysis. EV71 encephalitis may be fatal. Cases of fatal encephalitis occurred during outbreaks of HFMD in Malaysia in 1997, Taiwan in 1998 and Malaysia/Singapore in 2000.

We trust this information will assist you to make correct choices for your health and welfare. However it is not, and is not intended to be, a substitute for personalized advice from your medical advisor.

Our appreciation to Dr. Paul Vandewalle of International SOS, An AEA Company who has contributed this article to assist expatriate families in Indonesia.

If you have medical-related questions about living in Indonesia to ask of medical professionals, see Ask the Experts.

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