Can you get Hand, Foot, and Mouth Disease (HFMD) more than once?

Can You Get Hand, Foot, and Mouth Disease More Than Once?

Yes, you can definitely get Hand, Foot, and Mouth Disease (HFMD) more than once because multiple different enteroviruses can cause the infection, and immunity to one type does not protect against others.

Understanding HFMD Recurrence

HFMD is a contagious viral illness primarily affecting young children under 5 years of age, though it can occur at any age. The disease is characterized by:

• Fever
• Vesicular rashes on hands, feet, and buttocks
• Ulcers in the oral mucosa

Why Recurrence Happens

1. Multiple Causative Agents:

   • Traditionally caused by Coxsackievirus A16 (CV-A16) and Enterovirus A71 (EV-A71) 1
   • Recent shifts show increasing cases from Coxsackievirus A6 (CV-A6) and Coxsackievirus A10 (CV-A10) 2
   • Immunity to one enterovirus type does not confer protection against other types

2. Viral Evolution and Recombination:

   • Extensive recombination events occur among enterovirus strains 2
   • This leads to faster evolution and extinction of dominant enterovirus serotypes
   • New strains can evade previously developed immunity

3. Changing Epidemiology:

   • The molecular epidemiology of HFMD-causing pathogens shifts over time 2
   • Different geographic regions may have different predominant strains
   • Outbreaks can be caused by strains significantly different from those previously circulating 3

Clinical Implications of Recurrent HFMD

Most cases of HFMD are self-limiting with symptoms resolving within a few days without complications. However:

• A small proportion of children may experience severe complications including:

  • Meningitis
  • Encephalitis
  • Acute flaccid paralysis
  • Neurorespiratory syndrome 1

• Recent evidence shows increased frequency of neurological complications and mortality, particularly with newer strains 1, 2

• Nail dystrophies (e.g., Beau's lines or nail shedding) may occur weeks after initial symptom onset 4

Prevention of Recurrent HFMD

Currently, there is no specific pharmaceutical intervention available for HFMD in most countries. Prevention measures include:

• Good hand hygiene
• Avoiding close contact with infected individuals
• Disinfection of contaminated surfaces and objects

A formalin-inactivated EV-A71 vaccine has been approved in China and provides high protection against EV-A71-related HFMD 5. However, this vaccine cannot protect against other major emerging etiologies of HFMD such as CV-A16, CV-A6, and CV-A10 1.

Diagnosis of Recurrent Episodes

For accurate diagnosis of recurrent episodes:

• Reverse transcriptase PCR (RT-PCR) targeting the 5′non-coding regions is recommended for initial diagnosis 6
• Sequencing of the VP1 capsid protein gene is recommended for enterovirus typing 6
• Appropriate samples include vesicle fluid, respiratory samples, and stool samples 6

Conclusion

Given the multiple causative agents and their evolving nature, individuals can experience HFMD multiple times throughout their lives, with each episode potentially caused by a different enterovirus strain. The development of multivalent vaccines targeting multiple HFMD-causing enteroviruses may be the best strategy for preventing recurrent infections in the future 1.