When is hand, foot, and mouth disease (HFMD) no longer contagious?

When is Hand, Foot, and Mouth Disease No Longer Contagious?

Hand, foot, and mouth disease (HFMD) is typically considered no longer contagious after 7 days from the onset of symptoms, though patients should be considered potentially contagious for up to 10-14 days in some cases. 1

Understanding HFMD Transmission

HFMD is a highly contagious viral illness caused by several enteroviruses, primarily:

• Coxsackievirus A16 (CV-A16)
• Enterovirus 71 (EV-A71)
• Coxsackievirus A6 (CV-A6)
• Coxsackievirus A10 (CV-A10) 2

The disease spreads through multiple routes:

• Direct contact with saliva, respiratory secretions, fluid from blisters, or stool
• Contact with infected skin lesions
• Touching contaminated surfaces or objects (fomites)
• Respiratory droplets from coughs or sneezes 2

Contagious Period Timeline

The contagious period for HFMD follows this general pattern:

1. Incubation period: 3-10 days after exposure (patient may be contagious before symptoms appear) 3
2. Symptomatic phase: Most contagious during the first week of illness, especially when fever is present 1
3. Post-symptomatic phase:
   • Recovery of virus from infected cases is difficult after 7-10 days 1
   • Some studies suggest patients should be considered potentially contagious for at least 10-14 days 1

Determining When HFMD is No Longer Contagious

The American Academy of Pediatrics recommends considering these factors to determine when a person with HFMD is no longer contagious:

1. Fever resolution: The person should be fever-free without using fever-reducing medications
2. Healing of mouth sores: Oral lesions should be healed
3. Time since symptom onset: At least 7 days should have passed since symptoms first appeared 2

Special Considerations

• Children in daycare/school settings: Should remain home until fever is gone and mouth sores have healed 2
• Healthcare workers: Should follow strict infection control protocols and consider longer exclusion periods
• Immunocompromised individuals: May shed the virus for longer periods and require extended isolation

Prevention After Recovery

Even after a person is no longer contagious, good hygiene practices should continue:

• Frequent handwashing with soap and water, especially after diaper changes, using the toilet, and before eating
• Proper cleaning and disinfection of frequently touched surfaces
• Avoiding sharing utensils, cups, and personal items 2

Clinical Course and Resolution

HFMD typically follows a self-limiting course:

• Lesions usually resolve in 7-10 days 4
• Complete recovery without complications is the norm
• In rare cases, patients may experience onychomadesis (nail shedding) 1-2 months after infection 1, 5

While most HFMD cases resolve without complications, maintaining proper hygiene and following isolation guidelines until the contagious period has passed is essential for preventing outbreaks, especially in childcare centers, schools, and households with multiple children.