Hand, Foot, and Mouth Disease (HFMD) is a highly contagious viral illness that primarily affects infants and children younger than five years old. It is caused by enteroviruses, most often Coxsackievirus A16 and Enterovirus 71. HFMD is recognized by its characteristic rash and sores, and while generally mild, it spreads easily in environments like daycares and schools.
How Hand, Foot, and Mouth Disease Spreads
Hand, Foot, and Mouth Disease spreads through person-to-person contact and is not considered a truly airborne illness. HFMD typically spreads through respiratory droplets expelled when an infected person talks, coughs, or sneezes. These droplets are large and heavy, causing them to fall quickly onto nearby surfaces or people, usually within a short distance of about three feet.
The most common routes of transmission involve direct contact with an infected person’s body fluids. This includes contact with saliva, nasal secretions, and fluid from the blisters. A significant method of spread is the fecal-oral route, where the virus is transmitted through contact with contaminated stool, such as during diaper changes, followed by touching the mouth.
The virus is also easily transmitted indirectly through contaminated objects. Since the virus can survive on surfaces for hours or even days, shared items like toys, doorknobs, and countertops become a source of infection. This indirect spread is common among young children who frequently put their hands in their mouths after touching objects.
Recognizing the Signs of Infection
The initial presentation of HFMD often mimics the common cold or flu, beginning with an incubation period of three to six days after exposure. Early symptoms include a mild fever and a sore throat. Children may also exhibit irritability and a reduced appetite due to the discomfort.
Within one or two days of the fever starting, the more specific signs of the illness appear. Painful, blister-like sores form in the mouth, frequently appearing on the tongue, gums, and the inside of the cheeks. These oral lesions can make eating and drinking difficult, which may lead to dehydration.
The characteristic rash typically follows the mouth sores, appearing as flat spots or small blisters. This rash is most commonly found on the palms of the hands and the soles of the feet, but it can also appear on the buttocks and groin. The lesions are usually non-itchy and resolve on their own within seven to ten days. Some individuals, particularly adults, may have the infection and shed the virus without ever developing visible symptoms.
Controlling Contagion and Preventing Spread
Preventing the spread of HFMD relies on strict hygiene practices, especially since the virus is most contagious during the first week of illness. Frequent and thorough handwashing is the most effective preventative measure. Hands should be washed with soap and water for at least 20 seconds, particularly after using the restroom, changing diapers, or handling respiratory secretions.
Alcohol-based hand sanitizers are generally less effective against the enteroviruses that cause HFMD than traditional soap and water. Environmental cleaning is also necessary to break the chain of transmission from contaminated surfaces. High-touch surfaces, shared toys, and countertops should be regularly cleaned and disinfected using a solution effective against enteroviruses, such as a diluted bleach solution.
Infected individuals should take steps to avoid close personal contact with others. This includes refraining from hugging, kissing, or sharing eating utensils and cups while symptomatic. Children should be kept home from school or daycare until their fever has resolved and the blisters have dried up or crusted over.
Contagiousness can persist even after visible symptoms disappear. The virus may shed in respiratory secretions for up to three weeks and can be found in stool for weeks or even months after the infection has cleared. This extended shedding period emphasizes the ongoing need for diligent hand hygiene, especially after using the toilet, to limit transmission.