- The author of this article is By Dr. Mahesh Balsekar, Sr. Consultant (Paediatric Medicine), SRCC Children’s Hospital, managed by Narayana Health
“Hand Foot Mouth Disease”- HFMD, is a common infection in young children under 5-7 years of age. HFMD occurs worldwide. Cases occur every year, and are more common in the monsoon in tropical countries. Large outbreaks and epidemics can occur in schools, day care and the community, as we are witnessing in India this year.
It is caused by enteroviruses, of which the commonest strain is Coxsackie A 16. The incubation period can range from 2-7 days, but usually 3-5 days. The virus spreads from person to person through direct contact with skin secretions and through saliva. It can also spread through nasal secretions and through stools. Spread within family is common but most adults are immune and therefore do not catch the infection.
HFMD typically presents with rashes on the skin, particularly on the hands, feet, hips and arms. Rashes can be seen on the genitals but less common on the face and trunk. It appears as rashes, which are often raised, but the classic feature is skin blisters, which are more common on the hands and feet. These are usually a few mm in diameters but may be larger. They are usually not itchy but can cause discomfort, and are occasionally be painful. New skin eruptions can erupt for 3-4 days and dry and sometimes scabs over 3-4 days. Recovery is complete in a week but can take 10 days.
Mouth blisters are typical in HFMD. They are commonly seen on the tongue and palate and inner cheeks. They initially appear like small red eruptions which can subsequently blister. Most settle in 3-4 days. Mouth blisters are sometimes severe and painful, particularly in infants. This can lead to poor intake of food, drooling and salivation, and occasionally lead to dehydration. In a variant of HFMD called Herpangina, one usually sees only mouth blisters but no skin rashes. Not all cases have classic disease with blisters on hands, feet and mouth. You may get only skin eruptions without any mouth blisters.
Fever, if present, is usually below 101 F, and settles in 2-3 days. Some children may get fussy and have diarrhea, loose motions or vomiting.
Fortunately, serious complications are rare. HFMD can occasionally be caused by other viruses like Enterovirus 71, where infections can be more severe. Rarely infection can spread to the heart, brain, pancreas and eye. Fortunately, complications during pregnancy are rare. Occasionally several weeks after the infections, there can be shedding of nails which recovers over time.
Anti-Viral medicines and antibiotics do not work in HFMD and are not prescribed. Management is supportive and directed and relief from symptoms causing discomfort. Fever if high is treated with paracetamol. Mouth ulcers can cause pain and make swallowing difficult. Severe pain is treated with paracetamol and ibuprofen. Local pain relief gels are usually ineffective. Maintaining hydration is important. Offering cool drinks and foods makes it easier for children to eat. Children who are unable to maintain hydration are on rare occasions hospitalised for rehydration. Skin rashes usually do not need treatment but soothing lotions may be applied for discomfort.
Children who are suspected to have HFMD are usually advised isolation at home for around 7 days. Unfortunately, it is often difficult to prevents spread of infection, because children often spread infection before symptoms appear and even after apparent recovery from infection.
Children should be sent to school during outbreaks. It is impractical and unnecessary to keep children away from schools to prevent infection. Occasionally however schools ae closed for 7-10 days during severe outbreaks to prevent spread of infections within schools.
Hand washing remains the most important strategy to reduce spread of infection. Children’s hands should be washed frequently, especially after using the bathroom. Cleaning of surfaces with disinfectants can reduce spread of infection.
Currently there are no vaccines available to prevent HFMD.