Spring is here and so is Hand, Foot and Mouth Disease

By Dr. Francisco R. Velázquez and Jenni Horecny

Spring is in the air, and summer is not far behind. The summer season gives us a break from the flu and many other viruses prevalent during the winter months, but there is one contagious virus that children are at risk of contracting during the summer. First described in 1948, “hand, foot and mouth disease” is a common illness in the summer months, predominantly found in infants and children under the age of 5, but one that can also affect teens and adults.

HFMD is spread from person to person by direct contact with the viruses that cause this disease. These viruses are found in the nose and throat secretions (such as saliva or drool, sputum, or mucus from the nose), fluid in blisters, and stool (poop) of infected persons. The viruses can also be spread when infected people touch or use objects (such as personal items, utensils, cups, toys) and surfaces that are then touched or used by others. HFMD is not transmitted to or from pets or other animals.

The incubation period of HFMD is usually two to 10 days, with an average of three to five days. HFMD usually starts with a fever, poor appetite, a general feeling of being unwell (malaise) and a sore throat. One or two days after the fever starts, painful sores that blister usually develop in the mouth and a skin rash might appear. The rash is usually on the palms of the hands and soles of the feet, but might also appear on the knees, elbows, buttocks or genital area. Most people get better on their own in about seven to 10 days. Some may show no symptoms but will still pass the infection to others. HFMD is most contagious during the first week of illness but a person can spread the virus for days or weeks after symptoms appear.

Complications from HFMD are rare. There is no specific treatment for HFMD. Over-the-counter medications might be given to relieve fever or pain, and ill people should drink plenty of fluids. People who are concerned about their symptoms should contact their health care provider. Diagnosis is typically based on clinical criteria, individual risk, and a history of potential exposure. Providers determine whether the mouth sores are caused by HFMD by considering the age of the patient, what other symptoms are reported, and what the mouth sores look like. Depending on how severe the symptoms are, samples from the throat or stool might be collected and sent to a laboratory for testing. Blood tests may also be taken to rule out other causes.

HFMD can cause outbreaks in settings that involve a lot of close contact, such as child care settings. To prevent spreading to others, children with HFMD should not go to school or child care for at least 24 hours after fever is gone without the use of a fever-reducing medicine. They should also feel well enough to participate in normal activities. If the rash is still present and there are blisters, they should be covered before returning. Younger children who still have blisters in the mouth should return after the blisters have healed due to uncontrolled drooling or tendency to put items in their mouths. Talk to the child’s health care provider about how long to wait before it is OK to go back to school or child care. A child with sores that are draining fluids and does not feel well enough to participate in classroom activities should not go to school or child care.

Although highly contagious, the risk of infection can be decreased by following some simple rules such as the following:

• Washing hands often with soap and water, especially after changing diapers, using the toilet, blowing your nose, coughing or sneezing, and before or after caring for someone who is sick.

• Cleaning and disinfecting frequently touched surfaces, shared items, dirty surfaces and soiled items, including toys. First, wash the items and surfaces with soap and water. Then, disinfect with a bleach solution (one part bleach to 10 parts water).

• Avoid close contact such as kissing, hugging or sharing eating utensils and cups with people who have HFMD.

• Cover your nose and mouth when you cough or sneeze. Throw used tissues in the trash. If you don’t have a tissue, cough or sneeze into your elbow, not your hands.

Although not a reportable disease, SRHD is aware of several cases in the region, thus the need to be aware and informed. For more information, visit srhd.org and search, “hand, foot and mouth.”

Francisco R. Velázquez, M.D., S.M., FCAP, is the health officer for the Spokane Regional Health District. Jenni Horecny, MPH, RN, is an epidemiologist for the health district.