How long should individuals with hand, foot, and mouth disease (HFMD) be isolated?

Hand, Foot, and Mouth Disease Isolation Duration

Individuals with hand, foot, and mouth disease (HFMD) should be isolated until symptoms resolve, typically for at least 7-10 days from symptom onset.

Understanding HFMD

• HFMD is a highly contagious viral illness primarily affecting children under 5 years of age, caused by enteroviruses (most commonly coxsackieviruses A6, A10, A16, and enterovirus 71) 1
• The disease has an incubation period of 3-10 days, with initial symptoms including fever, sore throat, malaise, and irritability 1, 2
• Characteristic vesicular lesions appear on the palms, soles, and in the oral cavity a few days after initial symptoms 1, 2

Isolation Guidelines

Duration of Isolation

• Infected individuals should avoid close contact with others during the period of contagion, which is typically considered to be 7 days from the onset of symptoms 3
• Some studies suggest patients should be considered potentially contagious for 10-14 days 3
• Children are particularly infectious until the blisters have disappeared 4

School and Childcare Exclusion

• Children with HFMD should be excluded from childcare facilities and schools during the acute phase of illness 5
• Timely notification (within 24 hours) of clustered outbreaks to local health authorities is crucial for effective control 5
• Complete exclusion from school or childcare until the virus is completely cleared may not be practical as the virus may be present in the feces for several weeks 4

Infection Control Measures

Personal Hygiene

• Infected individuals should be counseled to wash hands frequently with soap and water (rather than just using hand sanitizer) 3
• Use separate towels and pillows to prevent household transmission 3
• Proper hand hygiene is especially important after contact with respiratory secretions or blister fluid 3

Environmental Considerations

• Proper cleaning of surfaces is important as enteroviruses can remain infectious in a desiccated state on surfaces for extended periods 3
• Multiple-use items that come into contact with infected individuals should be properly disinfected 3

Special Considerations

High-Risk Settings

• Healthcare workers and childcare providers with HFMD should be especially cautious about avoiding contact with others due to high potential for transmission 3
• In healthcare settings, patients diagnosed with HFMD should be placed in isolation with appropriate precautions 3

Severe Cases

• While most cases are mild and self-limiting, some outbreaks (particularly those caused by enterovirus 71) have been associated with severe neurological complications 1, 6
• In severe cases with complications, isolation may need to be extended and determined on a case-by-case basis 6

Common Pitfalls to Avoid

• Failing to recognize that HFMD can affect adults as well, especially in outbreaks caused by coxsackievirus A6 1
• Underestimating the contagious period, which begins before symptoms appear and continues during the illness 5
• Inadequate hand hygiene, which is crucial for preventing transmission 3

When to End Isolation

• Isolation can generally end when fever has resolved and blisters have dried 4
• Return to school or work should occur only after the acute phase has resolved, typically 7-10 days after symptom onset 3, 5