Hand, Foot, and Mouth Disease (HFMD) is a common viral illness. It typically manifests with fever, mouth sores, and a skin rash. While generally mild, preventing its spread is important. This article provides practical, actionable information on limiting the transmission of HFMD.
How Hand, Foot, Mouth Spreads
Hand, Foot, and Mouth Disease spreads through person-to-person contact. HFMD viruses, like Coxsackievirus A16 and Enterovirus 71, are in respiratory secretions (saliva, mucus, phlegm) expelled by coughing or sneezing. Direct contact with the fluid from blisters on the skin or mouth sores also facilitates transmission.
The virus is also present in the stool of an infected person, spreading via fecal-oral routes, like diaper changes. Contaminated surfaces and objects (fomites) also spread the virus. Touching items like toys or doorknobs that have been in contact with an infected person’s secretions can transfer the virus to hands, leading to infection when hands touch the eyes, nose, or mouth. Notably, individuals can spread the virus even if they do not show any symptoms or if their symptoms are mild.
Contagiousness is highest during the first week of illness. However, the virus can continue to be shed from the respiratory tract for about a week and in stool for up to four weeks after symptoms begin. The viruses that cause HFMD may also survive on surfaces for long periods, contributing to potential indirect transmission.
Essential Prevention Practices
Frequent and thorough handwashing is a primary defense against HFMD spread. Hands should be washed with soap and running water for at least 20 seconds, ensuring all surfaces are scrubbed effectively. This practice is especially important after changing diapers, assisting a child with toileting, and before preparing or eating food. Alcohol-based hand sanitizers containing at least 60% alcohol can be used when soap and water are unavailable, though they may not be as effective against all types of viruses.
Disinfecting frequently touched surfaces and shared objects eliminates viral particles. Toys, doorknobs, countertops, and other common surfaces should be cleaned and disinfected, particularly in childcare settings or homes with an infected individual. A solution of one tablespoon of bleach mixed with four cups of water can be an effective disinfectant, or a household disinfectant registered with the Environmental Protection Agency (EPA) can be used according to product instructions. It is important to wear gloves during cleaning and to rinse toys or surfaces that children might put in their mouths.
Avoiding close personal contact with individuals who are infected reduces transmission risk. This includes refraining from hugging, kissing, or sharing eating utensils and drinking cups. These actions directly transfer oral secretions that contain the virus. During an outbreak, maintaining a greater physical distance from others can also be a helpful measure.
Keeping infected individuals home from school, daycare, or work prevents wider outbreaks. Children should remain home until their fever has subsided and their mouth sores have healed, as the highest contagiousness typically occurs during the first week of illness. While the virus can still be shed in stool for several weeks, returning to group settings after acute symptoms resolve generally poses a lower risk. Covering coughs and sneezes with a tissue, or into the elbow if a tissue is not available, also prevents the airborne spread of respiratory droplets.
When to Consult a Doctor
Though HFMD is often mild, some symptoms warrant medical consultation. A healthcare provider should be contacted if a child experiences a high fever that persists for more than a few days, or if the fever is accompanied by unusual lethargy. Similarly, if symptoms worsen significantly or do not show improvement after several days, typically 7 to 10 days, medical advice is recommended.
Signs of dehydration, such as reduced urination, dry mouth, or a lack of tears, indicate a need for prompt medical evaluation. In rare instances, more severe neurological symptoms like a stiff neck, severe headache, or back pain may occur, which require immediate medical attention. Parents of very young infants, especially those under six months old, should seek medical guidance if their child contracts HFMD due to their developing immune systems. Any concerns about the severity of the illness or the appearance of unusual symptoms should prompt a call to a healthcare professional.