How do you transmit hand foot and mouth disease

Hand, foot and mouth disease (HFMD) is a viral infection that causes a rash or blisters on the hands and feet, as well as in or around the mouth. There are two types of viruses that cause HFMD, and the symptoms vary depending on the virus.

HFMD mainly affects children under the age of 10, but can also affect adolescents. It spreads easily from one person to another. It is possible to contract the virus more than once, but the symptoms will be less severe.

HFMD is not related to the foot and mouth disease that is found in animals.

Signs and symptoms of HFMD

Symptoms usually start three to seven days after becoming infected, and can last from seven to 10 days. If your child has HFMD, they may feel tired, have a fever, and have a rash. Depending on which virus your child has, the skin rash can look like:

• Small, oval, white blisters on the palms, soles of the feet, as well as in the mouth. Your child may have a sore mouth and throat, leading to poor appetite or risk of dehydration (drinking and eating can be painful because of the mouth blisters).
• A red skin rash with a brown scale on it. The rash appears on the outer arms, hands, legs, feet, around the mouth and upper buttocks. The trunk is usually relatively clear. Sometimes there are blisters present, but they are not usually in the mouth and your child can eat and drink as usual.

The blisters should not be itchy like chickenpox blisters. If your child has eczema, the HFMD can cause the eczema to worsen and potentially become infected with bacteria.

How is HFMD spread?

HFMD is most commonly caused by the coxsackie virus. The main way HFMD spreads is through contact with the fluid from inside the blisters, or with the droplets spread from sneezing and coughing. The virus can also be present in bowel movements (poo) for up to several weeks after the person has recovered.

To prevent the spread of HFMD:

• Wash your hands thoroughly after touching your child’s bodily fluids. This includes touching their blisters, helping them blow their nose, and changing nappies or helping with toileting.
• Make sure your child doesn’t share items such as cutlery, drinking cups, towels, toothbrushes and clothing.
• Keep your child home from school, kindergarten or child care until all the fluid in their blisters has dried.

Care at home

HFMD is a viral infection that rarely causes further complications. Antibiotics do not work on viruses and are not given to children with HFMD. HFMD will get better on its own, but there are ways you can care for your child at home:

• If your child is in pain or is uncomfortable, give them pain relief, such as paracetamol or ibuprofen. Do not give aspirin. See our fact sheet Pain relief for children.
• Give your child frequent sips of water or an oral rehydration solution to stop them becoming dehydrated.
• Leave blisters to dry naturally. Do not pierce or squeeze them.
• If your child is unwell with a fever and a skin rash (small bright red spots or purple spots or unexplained bruises) that does not turn to skin-colour (blanch) when you press on it, this may be a sign of meningococcal infection (see our fact sheet Meningococcal infection).

Key points to remember

• HFMD is a mild illness that will get better on its own.
• Two types of viruses cause HFMD, and the rash depends on which virus your child has.
• HFMD is spread easily from one person to another.

For more information

• Kids Health Info fact sheet: Pain relief for children
• Kids Health Info fact sheet: Dehydration
• Kids Health Info fact sheet: Eczema
• Kids Health Info fact sheet: Fever in children
• Kids Health Info fact sheet:  Stopping the spread of germs
  
• See your GP or Maternal and Child Health Nurse.
• Hand, foot and mouth disease (HFMD)
• NSW Health: Hand, foot and mouth disease fact sheet
• Better Health Channel: Hand, foot and mouth disease

Common questions our doctors are asked

Is HFMD dangerous for pregnant women?

HFMD is not known to pose a risk to pregnant women or their unborn babies.

My child still has blisters. Can she return to school?

If the fluid in the blisters has dried, then it is safe for your child to go back to school.

Developed by The Royal Children's Hospital Emergency and Infection Control departments. We acknowledge the input of RCH consumers and carers.

Reviewed February 2018.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.

Overview

What is hand, foot, and mouth disease?

Hand, foot and mouth disease gets its name from the blister-like rash that forms on the hands, feet and mouth. The rash can actually appear anywhere on the body, including the trunk, extremities, genitals and buttocks. A virus causes this very infectious disease. It tends to spread quickly among children in day care and schools.

Who might get hand, foot, and mouth disease?

Infants and children younger than five are most likely to get hand, foot and mouth disease. Still, older children and even grownups can get it. It’s possible to catch the virus multiple times.

How long is hand, foot and mouth disease contagious?

You’re most contagious during the first few days of the illness, often before the rash appears. The blisters usually dry up in about 10 days. You’re less likely to spread it to others once the blisters dry up. However, the virus can live in stool for weeks after the rash goes away.

Is hand, foot, and mouth disease the same as foot-and-mouth disease?

No. Foot-and-mouth disease is also known as hoof-and-mouth disease because it only affects livestock. Cows, sheep, goats and pigs can get it — but humans can’t. Different viruses cause the two diseases.

Symptoms and Causes

What causes hand, foot and mouth disease? How does it spread?

Viruses belonging to the enterovirus family cause hand, foot and mouth disease. Most often, a strain of the coxsackie virus is to blame. The disease is highly contagious and spreads through:

• Airborne droplets when an infected person sneezes or coughs.
• Contact with an infected person’s stool (poop) and then touching your mouth, eyes or nose.
• Direct contact with an infected person’s blisters.
• Kissing or hugging someone who has the virus.
• Sharing eating utensils, cups, towels or clothing.
• Touching contaminated toys, surfaces, doorknobs or other items and then touching your eyes, nose or mouth.

What are the symptoms of hand, foot and mouth disease?

Symptoms of hand, foot and mouth disease typically appear within three to seven days after exposure. When the illness starts, you or your child might have a mild fever, sore throat, runny nose and little appetite. After a couple of days, these flu-like symptoms go away and these new symptoms develop:

• Itchy rash on the palms of the hand, soles of the feet, knees, elbows, genitals or butt cheeks.
• Painful mouth sores.
• Swollen lymph nodes in the neck.

Diagnosis and Tests

How is hand, foot and mouth disease diagnosed?

Your doctor can diagnose the illness by looking at the blisters. Occasionally, a doctor tests for the virus by sending throat swab samples, or samples taken from blisters or stool, to a lab.

If you know you or your child has been exposed to the virus, alert your doctor before scheduling an exam. To protect the health of other patients, your doctor may want to conduct a "virtual," telemedicine visit and make treatment suggestions over the phone/computer.

Management and Treatment

How is hand, foot and mouth disease managed or treated?

Symptoms from hand, foot and mouth disease are typically mild. Most people improve in a week or two with minimal at-home care. Your healthcare provider may recommend:

• Over-the-counter pain relievers for fever and pain, such as acetaminophen (Tylenol®) and ibuprofen (Advil®, Motrin®).
• For people old enough to gargle, “Magic mouthwash,” a prescription combination of an antacid (Maalox®), a liquid antihistamine (Benadryl®) and a painkiller such as lidocaine.

What are the complications of hand, foot and mouth disease?

Complications from hand, foot and mouth disease are rare. Occasionally, these problems occur:

• Dehydration: Mouth sores can make drinking and eating painful. It’s important to drink enough fluids to prevent dehydration.
• Nail loss: Some people lose a few fingernails or toenails after having the virus. The nails grow back.
• Viral meningitis and encephalitis: A very small number of people with hand, foot and mouth disease develop meningitis and encephalitis. These rare conditions cause dangerous swelling of the brain (encephalitis), and brain and spinal cord membrane swelling (meningitis).

How does hand, foot and mouth disease affect pregnancy?

The virus rarely causes issues for pregnant women. Still, you should notify your doctor if you’re expecting and are exposed to the virus.

Prevention

How can I prevent hand, foot and mouth disease?

The virus that causes hand, foot and mouth disease is highly contagious. The infection often spreads before a person realizes they’re sick. You can slow or stop the spread of the illness through these good hygiene steps:

• Cover sneezes and coughs with the crook of your elbow.
• Disinfect high-touch items, such as toys, countertops and doorknobs.
• Don’t share eating utensils, cups, towels, blankets or clothing.
• Keep infected children away from healthy children.
• Wash your child's clothing, bedding and any other soiled items.
• Wash hands often with soap and water for at least 20 seconds.

Outlook / Prognosis

What should I expect if I or my child gets hand, foot and mouth disease?

While hand, foot and mouth disease is uncomfortable, it rarely causes long-term problems. Most children and adults recover in less than two weeks with minimal treatment. It’s possible to have hand, foot and mouth disease multiple times.

Living With

When should I call the doctor?

You should call your doctor if you or your child:

• Isn’t drinking enough liquids to prevent dehydration.
• Has a fever that lasts more than three days.
• Doesn’t seem to be improving after 10 days.
• Has severe itching or blistering.
• Has a weakened immune system.

What questions should I ask my doctor?

If you or your child has hand, foot and mouth disease, you may want to ask your doctor:

• How long are we contagious?
• How long should my child stay home from school?
• How long should I stay home from work?
• Should I notify my child’s school (or my work) about the infection?
• What steps can I take to ensure other family members don’t get infected?
• What can I do to make myself or my child more comfortable?
• What can I do to alleviate symptoms like an itchy rash or mouth pain?
• How long will the rash last?
• Can the infection come back?
• What steps can I take to prevent getting hand, foot and mouth disease again?
• Should I look out for any signs of complications?

Summary

Symptoms of hand, foot and mouth disease tend to be mild and go away with minimal treatment in less than two weeks. Because the virus is highly contagious, it’s important to practice good hygiene and take steps to keep it from infecting others. Your doctor can provide suggestions for symptom relief and offer tips for keeping other people healthy and virus-free.

Can you be around someone with hand foot and mouth?

At what point is hand foot and mouth not contagious?

How long does it take to transmit hand foot and mouth?

Can you spread hand foot and mouth by touching?