Hand-foot-and-mouth disease
Hand-foot-and-mouth disease (HFMD) is an enteroviral illness primarily affecting children, particularly those aged one to five years. It is commonly caused by coxsackievirus A16 and occasionally by enterovirus 71, with outbreaks typically occurring in the summer and early fall. The disease is characterized by low-grade fever, sore mouth, and painful vesicular lesions that develop on the hands, feet, and inside the mouth. Symptoms can appear about three to six days after exposure, with the illness generally resolving within seven to ten days without specific treatment.
While HFMD is usually mild, it can occasionally lead to more severe complications like meningoencephalitis. Currently, there are no antiviral treatments specifically for HFMD; however, symptomatic relief can be provided through topical anesthetics, pain relievers, and soothing foods. Although a vaccine against enterovirus 71 was developed in China in 2020, it is not yet available in the United States. Research is ongoing into the development of vaccines that might protect against multiple strains of the virus. Understanding HFMD is essential for parents and caregivers, especially during peak outbreak seasons, to recognize symptoms and manage the illness effectively.
Hand-foot-and-mouth disease
ANATOMY OR SYSTEM AFFECTED: Gastrointestinal system, mouth, skin
DEFINITION: An enteroviral disease that usually affects children, causing vesicular eruptions on the hands, feet, oral mucosa, and tongue
CAUSES: Viral infection
SYMPTOMS: Low-grade fever, sore mouth, oral lesions that rupture into painful ulcers, skin lesions on hands and feet
DURATION: Seven to ten days
TREATMENTS: None (self-resolving); topical anesthetic agents for mouth lesions
Causes and Symptoms
Hand-foot-and-mouth disease is usually caused by coxsackievirus A16, but it may also be associated with a number of other coxsackieviruses and enterovirus 71. Outbreaks of the disease are most common in the summer and early fall. Infants and young children ages one to five years are most commonly infected because they have not had previous exposure to the virus and, therefore, have less immunity than adults. They often become infected through contact with the nasal and oral secretions of infected children, and nursery school outbreaks may occur. Skin lesions and fecal material may also contribute to the spread of the virus. The incubation period is three to six days.
The illness commences with a low-grade fever (100 to 101 degrees Fahrenheit) and a sore mouth. Oral lesions begin as small, red macules and evolve rapidly into fragile vesicles that rupture, leaving painful ulcers. Any part of the mouth may be involved, but the hard palate buccal mucosa and tongue are mainly affected with an average of five to ten lesions. Similar lesions develop on the skin over the next one to two days; they usually number twenty to thirty, but there may be as many as one hundred. Discrete macular lesions, about 4 millimeters in diameter, appear on the hands and feet and sometimes the buttocks. These lesions often occur along skin lines and progress to become papules and white or gray flaccid vesicles containing infective virus. The lesions may be painful or tender. The fever occurs during the first one to two days of the illness, which resolves in seven to ten days. Rarely, the viral infection is complicated by meningoencephalitis, carditis, or pneumonia.
Treatment and Therapy
There is no specific treatment for hand-foot-and-mouth disease. The infection usually resolves without complications in about one week. Topical anesthetic agents, such as viscous lidocaine, may be used to soothe the discomfort of the mouth lesions. Popsicles and cool sherbets may be given to young children to help soothe a sore mouth. Acetaminophen given at an appropriate dosage for the body weight of the child may also help to relieve the pain of this condition. Some pediatricians recommend a blend of Benadryl (diphenhydramine) and liquid antacid to relieve the stinging sensation of the mouth lesions.
Perspective and Prospects
The first described outbreak of this disease occurred in Toronto, Canada, in 1957. British authors first coined the term “hand-foot-and-mouth disease” when they reported an outbreak in Birmingham, England, in 1959. While there currently are no medications available for treating enteroviral infections, a number of antiviral agents are being studied and might be useful for complicated forms of this disease, such as meningoencephalitis.
A monovalent vaccination, or a vaccine against one virus, was developed in China in 2020. This vaccine protects against enterovirus-71, but it was not available in the United States as of 2024. Bivalent vaccines protecting against hand-foot-and-mouth disease caused by two viruses are in development.
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