How is hand, foot, and mouth disease (HFMD) contracted?

How Hand, Foot, and Mouth Disease (HFMD) is Contracted

Hand, foot, and mouth disease is primarily transmitted through direct contact with infected bodily fluids, respiratory droplets, and contaminated surfaces, with the highest infectivity during the first week of illness. 1

Transmission Routes

• HFMD spreads through direct contact with fluid from blisters or vesicles of infected individuals 1
• Fecal-oral transmission is a common route, particularly in childcare settings 2
• Oral-oral contact (such as sharing utensils, cups, or food) can spread the virus 3
• Respiratory droplet transmission occurs through coughing and sneezing of infected individuals 1, 2
• Indirect contact via contaminated surfaces and objects (fomites) that have been touched by infected individuals 1

Infectious Period

• The disease is most contagious during the first week of illness, particularly when fever and skin lesions are present 1
• Infected adults can continue to shed the virus for up to five days after symptom onset 1
• Infected children can shed the virus for up to seven days after symptoms begin 1
• The amount of virus shed decreases steadily over this period, reducing infection risk 1
• Pre-symptomatic transmission (before symptoms develop) has only rarely been documented 1

Risk Factors and High-Risk Settings

• Children under 10 years of age are most commonly affected 2
• Outbreaks typically occur during spring to fall seasons in North America 2
• Daycare and school settings present high transmission risk due to close contact among children 3
• Swimming pools should be avoided by infected individuals during the acute illness phase 1

Prevention Measures

• Hand hygiene is the most important preventive measure, with thorough handwashing with soap and water being more effective than alcohol-based hand sanitizers 3
• Environmental cleaning of potentially contaminated surfaces and objects is crucial, particularly toys that may be placed in children's mouths 3
• Avoiding close contact with infected individuals until fever resolves and mouth sores heal 3
• Following standard precautions in healthcare settings, including appropriate use of personal protective equipment when examining patients 1
• Avoiding sharing utensils, cups, or food to prevent oral-oral transmission 3

When to Return to Normal Activities

• Children can generally return to daycare or school once fever has resolved and mouth sores have healed 3
• The American Academy of Pediatrics notes that exclusion based solely on healing skin lesions is not necessary 3
• Special attention should be paid to hand hygiene even after returning to normal activities, as some viral shedding may continue 1

Common Misconceptions

• HFMD is not the same as foot-and-mouth disease that affects livestock (despite similar names) 4
• By the time HFMD is diagnosed, the child has likely had the infection for some time, posing limited additional risk to others 3

Understanding these transmission routes and implementing appropriate preventive measures can significantly reduce the spread of hand, foot, and mouth disease, particularly in settings with young children.