School Exclusion Guidelines for Children with Coxsackievirus (Hand, Foot, and Mouth Disease)
Children with hand, foot, and mouth disease should not return to school until fever has resolved without fever-reducing medications, all blisters have dried and crusted over, and at least 7 days have passed since symptom onset. 1
Understanding Contagious Period
- Coxsackievirus begins to be contagious 1-2 days before symptoms appear and continues until all blisters have dried and crusted over 1
- The typical contagious period lasts 7-10 days from symptom onset, but viral shedding can continue in stool for several weeks 1
- Children should be considered potentially contagious for at least 10-14 days after initial symptoms 1
Return to School Criteria
- Resolution of fever without use of antipyretics 1
- All blisters must be completely dried and crusted over 1
- At least 7 days should have passed since the first symptoms appeared 1
- Premature return to school can trigger outbreaks in the classroom setting 1
Transmission Prevention
- Hand hygiene is critical - thorough handwashing with soap and water is more effective than alcohol-based sanitizers against enteroviruses 1
- Avoid close contact with others during the contagious period 1
- Properly dispose of tissues containing nasal secretions 1
- Environmental cleaning is essential as enteroviruses can remain viable on surfaces for up to 28 days 1
Common Pitfalls to Avoid
- Relying solely on fever resolution is insufficient for determining when a child can return to school 1
- Inadequate hand hygiene can lead to continued transmission 1, 2
- Overlooking environmental cleaning in childcare settings 1
- Returning to school too early, before all lesions have crusted over 1
Special Considerations
- Children with eczema may be predisposed to more severe disease 3
- Outbreaks of coxsackievirus infections occur most commonly during warm spring and summer months 4
- Toy sterilization at home and proper hand-washing habits are protective factors against coxsackievirus A6 infection 2
- Nail dystrophies (e.g., nail shedding) may occur weeks after initial symptoms resolve 5
Following these guidelines will help minimize transmission of hand, foot, and mouth disease in school settings while ensuring that affected children have adequately recovered before returning to their normal activities.