How is hand foot mouth disease (HFMD) transmitted and what are the prevention and treatment methods?

Hand, Foot, and Mouth Disease Transmission, Prevention, and Treatment

Hand, foot, and mouth disease (HFMD) is primarily transmitted through direct contact with saliva, respiratory secretions, fluid from blisters, stool of infected persons, contaminated surfaces, and respiratory droplets, with prevention focusing on proper hand hygiene, environmental cleaning, and isolation of infected individuals. 1

Transmission Routes

HFMD spreads through multiple routes:

1. Direct contact transmission:

   • Person-to-person contact with infected bodily fluids (saliva, respiratory secretions)
   • Contact with fluid from skin lesions/blisters
   • Fecal-oral transmission 1, 2

2. Indirect contact transmission:

   • Touching contaminated surfaces or objects (fomites)
   • Contact with toys, doorknobs, or other items exposed to the virus 1

3. Respiratory droplet transmission:

   • Close-range exposure to respiratory secretions from coughs or sneezes 1

HFMD is highly contagious and spreads particularly easily in:

• Childcare centers
• Kindergartens
• Schools
• Households with multiple children
• Areas with close community contact 1

Contagious Period

• Most contagious during the first week of illness, especially when fever is present
• Typically no longer contagious after 7 days from symptom onset
• May remain potentially contagious for up to 10-14 days in some cases 1
• Incubation period ranges from 3 to 10 days 3

Prevention Methods

The American Academy of Pediatrics recommends the following prevention measures:

1. Hand hygiene:

   • Frequent handwashing with soap and water, especially after diaper changes, using the toilet, and before eating
   • Using alcohol-based hand sanitizers when soap and water aren't available 1, 2

2. Environmental cleaning:

   • Disinfecting frequently touched surfaces and shared toys
   • Avoiding sharing utensils, cups, towels, and personal items 1

3. Respiratory etiquette:

   • Covering coughs and sneezes
   • Proper disposal of tissues 1

4. Isolation precautions:

   • Keeping infected individuals home from school, daycare, or work until:
     • Fever is gone
     • Mouth sores have healed
   • Avoiding close contact with infected persons 1

Treatment Approaches

Treatment is primarily supportive as there is no specific antiviral therapy approved for routine HFMD cases:

1. Symptomatic management:

   • Hydration maintenance
   • Pain relief with acetaminophen or ibuprofen as needed 2
   • Note: Oral lidocaine is not recommended 2

2. For severe cases (rare but possible with EV-A71):

   • May require hospitalization for neurological or cardiopulmonary complications
   • Mechanical ventilation may be necessary in severe cases 3, 4

Causative Agents

HFMD is caused by several enteroviruses:

• Coxsackievirus A16 (CV-A16) - traditionally common
• Enterovirus 71 (EV-A71) - associated with more severe cases
• Coxsackievirus A6 (CV-A6) - increasingly common
• Coxsackievirus A10 (CV-A10) 1, 5, 6

Clinical Course and Complications

• Most cases resolve within 7-10 days without complications 2
• Typical symptoms include low-grade fever, maculopapular or papulovesicular rash on hands and feet, and painful oral ulcerations 2
• Rare complications may include:
  • Neurologic complications (encephalitis, meningitis)
  • Cardiopulmonary complications
  • Onychomadesis (nail shedding) 1-2 months after infection 1, 3, 4

By implementing proper prevention measures and providing appropriate supportive care, the spread and impact of HFMD can be significantly reduced.