When can a person with Hand, Foot, and Mouth Disease (HFM) return to school, work, or daycare?

Return to School, Work, or Daycare After Hand, Foot, and Mouth Disease

Individuals with Hand, Foot, and Mouth Disease (HFMD) can return to school, work, or daycare when they no longer have active, moist, or draining lesions, typically after all lesions have completely healed. 1

Understanding HFMD Transmission and Contagiousness

• HFMD is a contagious viral illness caused by enteroviruses, primarily affecting children under 5 years of age, characterized by fever, oral ulcerations, and rashes on hands, feet, and sometimes buttocks 2, 3
• The disease is transmitted through fecal-oral, oral-oral, and respiratory droplet contact, making proper hygiene crucial for prevention 2
• HFMD lesions typically resolve within 7-10 days without complications in most cases 2
• The incubation period varies by age: approximately 4.4 days for kindergarteners, 4.7 days for primary school children, and 5.7 days for secondary school students 4

Return-to-School/Work Guidelines

• The primary criterion for return is the absence of active infection as indicated by completely healed lesions with no signs of moist or draining areas 1
• While specific HFMD guidelines are not extensively documented in the evidence provided, general principles for infectious skin conditions apply:
  • Individuals should not return until they are no longer contagious 1
  • For healthcare workers, food handlers, and childcare workers, restriction from direct care/food preparation is necessary until the condition resolves 1

Infection Control Measures

• Hand hygiene is the most important preventive measure for reducing HFMD transmission 5
  • Regular handwashing with soap and water is essential, especially after using the toilet, changing diapers, and before handling food
• Environmental disinfection of potentially contaminated surfaces and fomites helps prevent spread 2
• In childcare settings, enhanced infection control practices should be implemented during outbreaks 5
• Children should be encouraged to spend time outdoors when possible, as this reduces transmission risk 5

Special Considerations for Different Settings

Daycare and School Settings

• Children in daycare and school settings should be excluded until lesions have healed to prevent outbreaks 5
• Given that some children may have incubation periods longer than 10 days (8.8% in kindergartens and 23.2% in secondary schools), extended periods of enhanced hygiene may be needed during outbreaks 4

Healthcare and Food Service Workers

• Healthcare workers and food handlers should be restricted from direct patient care or food preparation until all lesions are completely healed 1
• These workers may need to provide documentation of resolution before returning to work 5

Patient Education

• Educate patients and families about:
  • The importance of hand hygiene in preventing transmission 5
  • Avoiding close contact with others while lesions are present
  • Proper cleaning and disinfection of shared items and surfaces 2
  • Recognition of potential complications, which are rare but can include neurological issues 3

Common Pitfalls to Avoid

• Returning too early while lesions are still healing can lead to continued transmission and potential outbreaks 1
• Failing to implement proper hand hygiene and environmental disinfection measures can contribute to spread 2
• Not recognizing that older children may have longer incubation periods, potentially affecting containment strategies 4

By following these guidelines, the spread of HFMD can be minimized while allowing individuals to return to their normal activities as soon as it is safe to do so.