How long is Hand, Foot, and Mouth Disease (HFMD) contagious?

Hand, Foot, and Mouth Disease Contagious Period

Hand, foot, and mouth disease (HFMD) is contagious for approximately 7-10 days from symptom onset, with the highest viral shedding occurring during the first week of illness, though viral shedding can continue for weeks after symptoms resolve.

Transmission and Contagious Period

HFMD is a highly contagious viral illness primarily affecting children under 5 years of age, though it can affect individuals of any age. The disease is caused by enteroviruses, most commonly coxsackieviruses A6, A10, A16, and enterovirus 71 1.

The contagious period follows this timeline:

• Incubation period: 3-10 days after exposure 1
• Most contagious period: First 7 days of illness 2
• Extended contagiousness: Virus can continue to be shed in stool and oral secretions for weeks after symptoms resolve

Transmission Routes

HFMD spreads through multiple routes:

• Fecal-oral contact
• Oral-oral contact (saliva)
• Respiratory droplets
• Contact with fluid from blisters
• Contaminated surfaces and objects (fomites) 3

Disease Course and Symptoms

The typical progression of HFMD includes:

1. Initial symptoms: Fever and sore throat
2. Rash development: Maculopapular or vesicular eruptions on hands, feet, and in the oral cavity appearing a few days after fever onset 1
3. Resolution: Symptoms typically resolve within 7-10 days 3

Prevention of Transmission

To prevent spreading HFMD to others:

• Hand hygiene: Frequent handwashing with soap and water (alcohol-based sanitizers are less effective against enteroviruses)
• Isolation: Avoid close contact with others during the period of highest contagiousness (first week of illness)
• Environmental cleaning: Disinfect potentially contaminated surfaces and objects
• Avoid sharing: Don't share utensils, cups, towels, or other personal items 2, 3

Special Considerations

• Childcare and schools: Children should be kept home from childcare or school during the first week of illness
• High-risk professions: Healthcare workers and childcare providers should consider temporary work restrictions during the acute phase 2
• Nail shedding: Some patients may experience nail dystrophies or shedding weeks after initial infection, particularly with coxsackievirus A6 infections 4

When to Return to School/Work

A person with HFMD can generally return to school or work when:

1. Fever has resolved
2. The person feels well enough to participate in normal activities
3. At least 7 days have passed since symptom onset

Complications

While HFMD is usually self-limiting, rare complications can occur:

• Neurological complications (encephalitis, meningitis)
• Cardiopulmonary complications
• Severe neurological sequelae 5

These complications are more commonly associated with enterovirus 71 and, more recently, with coxsackievirus A6 infections 1, 6.

Remember that HFMD can remain contagious even after symptoms improve, so maintaining good hygiene practices is essential even during recovery.