Herpangina is a highly contagious viral illness characterized by an abrupt onset of fever and painful lesions at the back of the throat. This common infection often affects young children, particularly those under the age of ten. Cases are most frequently seen during the warmer summer and early autumn months, often leading to outbreaks in group settings like daycares and schools. The hallmark of the infection is the development of small, blister-like sores that form on the soft palate and tonsils, causing discomfort and difficulty swallowing.
The Viral Cause and Primary Routes of Transmission
The highly contagious nature of herpangina stems from its viral origin, primarily caused by various types of enteroviruses. The most common agents are the Coxsackievirus A strains, though Coxsackievirus B, Echovirus, and Enterovirus 71 can also be responsible. These viruses are shed by an infected person and can remain stable in the environment, making transmission efficient.
The most common way the virus spreads is through the fecal-oral route, which is prevalent among young children who may not practice consistent hand hygiene. Viral particles are passed through the stool of an infected person and can contaminate hands, food, water, or objects. Ingestion of these contaminated items allows the virus to enter a new host.
Transmission also occurs via respiratory droplets, expelled when an infected individual coughs, sneezes, or speaks. If these droplets are inhaled or land on the mucous membranes of another person, infection can follow. Contact with contaminated surfaces, known as fomites, presents a third route of spread. Toys, doorknobs, and shared utensils can harbor the virus, which is then transferred when a non-infected person touches their mouth, nose, or eyes.
Duration of Contagiousness
A person exposed to the virus typically enters an incubation period lasting three to five days before any symptoms appear. The infected individual is often contagious during this silent period before the fever begins. The period of highest contagiousness occurs during the acute phase of the illness, generally spanning the first week or two after symptoms manifest.
Even after the mouth sores have healed and the fever has resolved, the virus continues to be shed from the body. Respiratory shedding can persist for up to three weeks. More significantly, the virus can continue to be shed in the feces for several weeks, sometimes for as long as eight weeks following the initial infection. Individuals are typically cleared to return to group settings once their fever has subsided and they feel well enough to participate.
Strategies for Limiting the Spread
Controlling the spread of herpangina focuses on interrupting the primary transmission routes through strict hygiene and cleaning protocols. Frequent and thorough handwashing with soap and water is the single most effective action, especially after using the restroom, changing diapers, or before preparing food. Hands should be scrubbed for at least twenty seconds to properly dislodge viral particles.
Regular disinfection of high-touch surfaces and shared objects is necessary to eliminate the virus that can linger on fomites. This includes cleaning toys, countertops, light switches, and doorknobs with an appropriate germicidal agent. Symptomatic individuals should be kept home from school or work until the fever has broken and they are without symptoms, which helps reduce the spread of respiratory droplets. Covering the mouth and nose when coughing or sneezing, and immediately disposing of used tissues, further contains the virus.