Hand, foot and mouth disease


Hand, foot and mouth disease was first described in a summer outbreak that occurred in Toronto, Canada in 1957 and was caused by a virus known as Coxsackievirus A16. Since then, at least 15 other enterovirus serotypes have been shown to cause HFMD, most commonly Coxsackievirus A serotypes.


Signs and symptoms

Hand, foot, and mouth disease is a common viral illness that usually affects infants and children younger than 5 years old. However, it can sometimes occur in adults. It usually starts with a fever, reduced appetite, sore throat, and a feeling of being unwell (malaise). One or two days after the fever starts, painful sores can develop in the mouth (herpangina). They begin, often in the back of the mouth, as small red spots that blister and can become ulcers. A skin rash with red spots, and sometimes with blisters, may also develop over one or two days on the palms of the hands and soles of the feet; it may also appear on the knees, elbows, buttocks or genital area.

Some people, especially young children, may get dehydrated if they are not able to swallow enough liquids because of painful mouth sores.

Not everyone will get all of these symptoms. Some people, especially adults, may show no symptoms at all, but they can still pass the virus to others.



Through ingesting contaminated food or water, close personal contact, coughing, sneezing, or contact with contaminated objects and surfaces.

For example, you might get infected by kissing someone who has hand, foot, and mouth disease or by touching a doorknob that has viruses on it then touching your eyes, mouth or nose.

It is possible to get infected with the viruses that cause hand, foot, and mouth disease if you swallow recreational water, such as water in swimming pools. However, this is not very common. This is more likely to happen if the water becomes contaminated with feces from a person who has hand, foot, and mouth disease and is not properly treated with chlorine.

Generally, a person with hand, foot, and mouth disease is most contagious during the first week of illness. People can sometimes be contagious for days or weeks after symptoms go away. Some people, especially adults, may not develop any symptoms, but they can still spread the virus to others. This is why people should always try to maintain good hygiene (e.g. handwashing) so they can minimize their chance of spreading or getting infections.

You should stay home while you are sick with hand, foot, and mouth disease. Talk with your healthcare provider if you are not sure when you should return to work or school. The same applies to children returning to daycare.

Hand, foot, and mouth disease is not transmitted to or from pets or other animals.



Health complications from hand, foot, and mouth disease are not common.

  • Viral or “aseptic” meningitis can occur but it is rare. It causes fever, headache, stiff neck, or back pain and may require the infected person to be hospitalized for a few days.
  • Encephalitis (inflammation of the brain) or polio-like paralysis can occur, but this is even rarer.
  • Fingernail and toenail loss have been reported, occurring mostly in children within a few weeks after having hand, foot, and mouth disease. At this time, it is not known whether nail loss was a result of the disease in reported cases. However, in the reports reviewed, the nail loss was temporary, and the nail grew back without medical treatment.



There is no vaccine to protect against the viruses that cause hand, foot, and mouth disease.

A person can lower their risk of being infected by

  • Washing hands often with soap and water, especially after changing diapers and using the toilet.
  • Cleaning and disinfecting frequently touched surfaces and soiled items, including toys.
  • Avoiding close contact such as kissing, hugging, or sharing eating utensils or cups with people with hand, foot, and mouth disease.

If a person has mouth sores, it might be painful to swallow. However, it is important for people with hand, foot, and mouth disease to drink enough liquids to prevent dehydration (loss of body fluids). If a person cannot swallow enough liquids, they may need to receive them through an IV in their vein.



Hydration (drinking fluids) is essential. There is no specific treatment for hand, foot, and mouth disease. However, some things can be done to relieve symptoms, such as

  • Taking over-the-counter medications to relieve pain and fever (Caution: Aspirin should not be given to children.)
  • Using mouthwashes or sprays that numb mouth pain

Antibiotics don’t help and should not be used. People who are concerned about their symptoms should contact their health care provider.

Indication for hospitalization: inability to maintain hydration and development of neurological symptoms or cardiovascular complications.






(A-C) Generalized HFMD related to CV-A16 in a 13-month-old boy;
(D) generalized HFMD related to CV-A6 in a 12-month-old boy;
(E) grouped vesicles in a 23-month-old boy with HFMD related to CV-A16; and
(F) grouped vesicles in an 18-month-old boy with HFMD related to CV-A6.

From: Hubiche T, Schuffenecker I, Boralevi F, et al. Dermatological spectrum of hand, foot and mouth disease from classical to generalized exanthema. Pediatr Infect Dis J 2014; 33:e92. DOI: 10.1097/INF.0000000000000120. Reproduced with permission from Lippincott Williams & Wilkins. Copyright © 2014 European Society for Paediatric Infectious Diseases. Unauthorized reproduction of this material is prohibited.

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