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

When Hand, Foot, and Mouth Disease Is 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

Contagious Period Timeline

The contagiousness of HFMD follows a predictable pattern:

• Most contagious period: During the first week of illness, especially when fever is present 1
• Standard non-contagious threshold: 7 days after symptom onset 1, 2
• Extended precautionary period: Up to 10-14 days in some cases 1
• Virus recovery difficulty: After 7-10 days, virus recovery from infected cases becomes difficult 1

Determining When HFMD Is No Longer Contagious

To determine when a person with HFMD is no longer contagious, consider these key factors:

1. Time since symptom onset: At least 7 days should have passed 1
2. Fever resolution: Patient should be fever-free 1
3. Healing of lesions: Mouth sores and skin lesions should be healed 1, 2

Transmission Methods

Understanding transmission helps prevent spread during the contagious period:

• Direct contact: Person-to-person contact with saliva, respiratory secretions, fluid from blisters, or stool of infected persons 1
• Indirect contact: Touching contaminated surfaces or objects (fomites) 1
• Respiratory droplets: Close-range exposure to respiratory secretions from coughs or sneezes 1

Prevention During Contagious Period

To prevent transmission while contagious:

• Hand hygiene: Frequent handwashing with soap and water, especially after diaper changes, using the toilet, and before eating 1
• Environmental cleaning: Disinfect frequently touched surfaces and shared toys 1
• Isolation: Keep infected individuals home from school, daycare, or work until fever is gone and mouth sores have healed 1
• Avoid sharing: Don't share utensils, cups, towels, and personal items 1

Special Considerations

• Immunocompromised individuals: May shed virus for longer periods
• Daycare settings: Extra precautions may be needed due to close contact among children 1
• Onychomadesis (nail shedding): Can occur 1-2 months after infection but is not associated with continued contagiousness 1, 3, 4

Common Pitfalls to Avoid

1. Returning to school/daycare too soon: Ensure both fever resolution AND healing of mouth sores before allowing return 1
2. Focusing only on visible symptoms: Remember that virus shedding can continue even as symptoms improve
3. Neglecting hand hygiene: This remains the most important preventive measure even as contagiousness decreases 1

HFMD is typically a self-limiting disease that resolves within 7-10 days in most cases 2, but appropriate precautions during the contagious period are essential to prevent outbreaks, particularly in childcare settings.