Hand, foot and mouth disease
Introduction
Hand, foot and mouth disease is a common, mild illness caused by a type of virus called an enterovirus.
It is usually caused by the Coxsackie A virus but , in some cases can be caused by the coxsackie B or the enterovirus 71 virus.
Hand, foot and mouth disease gets its name from the non-itchy rash that develops on the palms of your hands and soles of your feet. It can also cause ulcers in your mouth and make you feel generally unwell, although some people have no symptoms (see Symptoms for more information).
Who is affected?
Hand, foot and mouth disease is very contagious (easily spread) and it is common in children under 10 years of age. However, adolescents and adults can also be affected.
Most adults are immune to the coxsackie A and B virus as they have been previously exposed to it during their childhood. Adults who develop the disease usually experience milder symptoms than children.
It is possible to catch hand, foot and mouth disease more than once, but children are unlikely to catch it again during the same outbreak.
Outlook
Generally, hand, foot and mouth disease is a mild and short-lasting illness. Treatment is usually not needed as the body's immune system clears the virus and symptoms go away after about 7 to 10 days.
Is it the same as foot and mouth disease?
Hand, foot and mouth disease is not the same as foot and mouth disease, which affects cattle, sheep and pigs. The two infections are completely unrelated, and you cannot contract hand, foot and mouth disease from animals.
^^ Back to top
Symptoms
Symptoms of hand, foot and mouth disease usually appear 3-5 days after infection with the virus. They last for 7 to 10 days before disappearing on their own.
Some people with hand, foot and mouth disease do not develop any symptoms.
If an adult develops the disease, their symptoms will usually be much milder than those of a child.
Early symptoms
The first symptoms of hand, foot and mouth disease include:
- fever and feeling unwell,
- loss of appetite,
- sore throat, and
- small red spots in the mouth, throat and skin.
Later symptoms
Mouth lesions
After one or two days red spots in the mouth will develop into painful ulcers, particularly around the tongue, gums and inside of the cheeks. It may be difficult to eat, drink and swallow.
Skin rash
Any red spots on the skin will turn into a non-itchy rash over the following one to two days. The spots are flat or raised, sometimes with blisters, and smaller than chickenpox sores.
The rash develops on the palms of the hands, the soles of the feet and between the fingers and toes. In some cases, spots also develop on the buttocks and genitals.
^^ Back to top
Causes
Hand, foot and mouth disease is usually caused by the coxsackie A virus, but it is sometimes caused by the coxsackie B or the enterovirus 71.
These viruses remain in the body for weeks after symptoms have gone away, so infected people can pass the disease to others even when they appear well.
Airborne spread
The viruses that cause hand, foot and mouth disease are contained in the millions of tiny droplets that come out of the nose and mouth when someone with the disease coughs or sneezes. These droplets hang suspended in the air for a while, then land on surfaces. Anyone who touches these surfaces can spread the virus by touching something else.
People usually become infected by picking up the virus on their hands from contaminated objects and then placing their hands near their mouth or nose. It is possible to breathe in the virus if it is suspended in airborne droplets.
Other ways of catching it
You can also become infected with hand, foot and mouth disease if you have contact with fluid from the sores, saliva or faeces of someone who is infected.
The virus stays in the faeces for about four weeks after the person has recovered. It is, therefore, vital that adults and children wash their hands thoroughly after going to the toilet or handling nappies.
^^ Back to top
Diagnosis
Several different viruses can cause sores and ulcers in the mouth. However, a GP will normally be able to distinguish hand, foot and mouth disease from other viral infections by:
- The age of the affected person. Hand, foot and mouth disease is most common in children under the age of 10.
- The pattern of symptoms. Symptoms begin with fever and a sore throat; spots then develop in your mouth and later on the palms of your hands and soles of your feet.
- The appearance of sores. The sores are smaller than chickenpox sores.
A throat swab or stool sample may be taken and sent to a laboratory to determine which enterovirus has caused hand, foot and mouth disease. The result usually takes a few days.
^^ Back to top
Treatment
There is no specific treatment for hand, foot and mouth disease. The condition usually clears up by itself after about 7 to 10 days. As it is caused by a viral infection, it cannot be treated with antibiotics.
You can ease the symptoms of hand, foot and mouth disease by:
- resting,
- taking plenty of fluids (water or weak squash are ideal) and
- taking medication to relieve symptoms.
Medication
Fever
If you or your child has a fever or sore throat, paracetamol should relieve pain and bring down a temperature. Children's paracetamol can be used to treat your child. Aspirin must not be given to children under 16 years of age.
Mouth sores
The pain of mouth ulcers can be numbed with anaesthetic mouthwashes or sprays, such as benzydamine hydrochloride (Difflam). Choline salicylate gel can be used in adults and children aged 16 and over.
^^ Back to top
Complications
Hand, foot and mouth disease is usually a mild disease that clears up on its own. Complications are uncommon, but could include the following.
Dehydration
The sores that develop in your throat and mouth may make it difficult for you to drink and swallow. As a result, dehydration can occur. Therefore, if you have the disease, it is important to drink plenty of fluids. If your child is affected, you should make sure that they drink plenty.
If dehydration becomes severe, you may have to go to hospital so that fluid can be given through a drip in your arm (intravenously).
Infection
Another possible complication of hand, foot and mouth disease is infection of the sores. If the sores are scratched, they may become infected. If this happens, your GP may prescribe antibiotics to treat the infection.
Viral meningitis
In rare cases, hand, foot and mouth disease can lead to viral meningitis. Viral meningitis is an infection of the meninges (membranes that cover the brain and spinal cord).
Viral meningitis is less severe than bacterial meningitis and most people will make a full recovery within two weeks. Symptoms include fever, drowsiness, headache, neck stiffness, vomiting, and dislike of bright lights. There is no specific treatment.
For more information see Encyclopaedia topic: Meningitis
Encephalitis
In very rare cases, hand, foot and mouth disease can lead to encephalitis. Encephalitis is an infection that causes the brain tissue to swell and become inflamed. It can cause brain damage and is potentially life threatening.
Early signs of encephalitis are flu-like symptoms, which can develop in a few hours or over a few days. Other symptoms include:
- vomiting,
- drowsiness or confusion,
- seizures (fits), and
- dislike of bright lights.
If you develop encephalitis you will have to be admitted to hospital. Many people make a full recovery.
For more information, see Encyclopaedia topic: encephalitis.
Pregnancy risk
Pregnant women who catch hand, foot and mouth disease just before giving birth may pass it to their baby. However, babies born with the disease will usually only experience mild symptoms.
In very rare cases, catching hand, foot and mouth disease during your pregnancy may result in miscarriage.
^^ Back to top
Prevention
Hand, foot and mouth disease is very contagious. The best way to avoid catching and spreading it is to avoid close contact with people who have the disease and to practise good hygiene.
- Always wash your hands after going to the toilet and handling nappies, and before preparing food. If your child has hand, foot and mouth disease, encourage them to wash their hands regularly as well.
- Avoid sharing utensils with people who are infected with hand, foot and mouth disease.
- Make sure that shared work surfaces are clean.
Keeping your child off school
If your child has hand, foot and mouth disease, keep them out of school or playschool while they are feeling unwell. They can go back to school when their symptoms get better.
^^ Back to top
Q&A
What are the risks of hand, foot and mouth disease during pregnancy?
Hand, foot and mouth disease is rare in healthy adults, so the risk of infection during pregnancy is very low.
If a pregnant woman gets hand, foot and mouth disease, the risk of complications is also very low.
Complications are rare
There is some limited evidence that catching hand, foot and mouth disease during pregnancy may result in miscarriage in very rare cases.
There’s normally no risk to your unborn baby if you catch hand, foot and mouth disease. However, if you catch the virus shortly before you give birth, the infection can be passed on to your baby. Most babies born with hand, foot and mouth disease have only mild symptoms. On rare occasions, complications can affect the baby’s organs. Occasionally, these complications are severe.
When to get advice
If you develop any type of rash when you’re pregnant, contact your GP or midwife. If you think you've got hand, foot and mouth disease, seek their advice.
What is hand, foot and mouth disease?
Hand, foot and mouth disease is a viral infection, usually caused by coxsackievirus A. It’s highly contagious and spreads through:
- coughs and sneezes, and
- contact with infected stools (faeces).
Hand, foot and mouth disease is common in children but rare in healthy adults. Most adults are immune to the virus because they had contact with it as a child.
Early symptoms of hand, foot and mouth disease include a fever and sore throat, followed by sores or blisters in your mouth and on your hands and feet. The incubation period (the time between catching the disease and showing symptoms) is three to six days. During this time, the virus can be passed on.
There’s no specific treatment for hand, foot and mouth disease, but there are steps that you can take to ease your symptoms. For more details, see the Treatment section (above).
Reducing the risk of infection
Always wash your hands thoroughly with soap and hot water after going to the toilet or handling nappies, and make sure that the toilet is clean.
Avoiding children who have the virus may help to reduce the risk of catching the disease. However, a child with the virus will be infectious before they show any symptoms.
Is it related to foot and mouth disease?
No. Foot and mouth disease is a different condition, and usually only affects animals.
^^ Back to top