What are the risks of skin-to-skin contact with someone who has hand, foot, and mouth disease (HFMD)?

Skin-to-Skin Contact with Hand, Foot, and Mouth Disease Blisters

Hand, foot, and mouth disease (HFMD) is highly contagious through direct skin-to-skin contact with blisters and lesions, and you should avoid contact with known infected individuals and practice meticulous hand hygiene to prevent transmission. 1

Transmission Risk Through Skin Contact

Direct skin-to-skin contact with HFMD blisters poses significant transmission risk, as the virus is shed from vesicular lesions on the hands, feet, and oral cavity. 2, 3 The disease demonstrates high infectivity and has contributed to several large outbreaks, with transmission occurring readily between infected and susceptible individuals. 4

• Familial transmission from children to immunocompetent adults is well-documented, demonstrating that even healthy adults with intact immune systems can contract HFMD through direct contact with infected children's lesions. 4
• The virus remains viable on skin surfaces and can be transmitted through touching contaminated skin areas, particularly the hands, feet, and oral regions where characteristic lesions appear. 2, 5
• Contact sports and activities involving skin-to-skin contact create high-risk scenarios for transmission, similar to other skin-contact transmitted pathogens. 1

Essential Prevention Measures

Hand hygiene is the single most important method of preventing transmission of infectious agents, and must be performed before and after each contact with potentially infected individuals. 1

• Wash hands with soap and water when visibly soiled or after contact with body fluids; if hands are not visibly soiled, alcohol-based hand rub is acceptable. 1
• Perform hand hygiene immediately after removing gloves if gloves were worn during contact. 1
• Avoid contact with known infected people until lesions have completely resolved. 1

Personal Protective Equipment Recommendations

Wear medical gloves when potential exists for contacting blood, body fluids, or mucous membranes of infected individuals. 1

• Remove gloves promptly after use and wash hands immediately to avoid transfer of microorganisms. 1
• Do not wash or reuse gloves; use a new pair for each patient contact. 1
• Consider protective clothing that covers forearms if extensive contact with lesions is anticipated. 1

Clinical Context and Disease Characteristics

HFMD typically presents as a self-limited viral syndrome lasting less than one week, with fever, oral ulcers, and characteristic skin manifestations on palms, soles, and buttocks. 2 However, the disease can present with atypical features including vesiculobullous exanthema on the trunk or extremities, particularly with Coxsackievirus A6 infections. 4

• Adults can contract HFMD from children through familial transmission, with complete recovery expected in immunocompetent individuals. 4
• The oral vesicular and ulcerative lesions are usually the first clinical signs, making early recognition important for implementing isolation precautions. 5
• Enteroviruses are highly contagious with predilection for person-to-person transmission, contributing to ongoing outbreaks. 3

Critical Pitfalls to Avoid

• Do not assume adults are immune to HFMD—immunocompetent adults can contract the disease through direct contact with infected children's lesions. 4, 6
• Never rely solely on avoiding "visibly infected" individuals, as viral shedding can occur before lesions are fully apparent. 3
• Do not share towels, equipment, or personal items with infected individuals, as contaminated objects can harbor viable virus. 1
• Avoid touching your face, mouth, or eyes after potential contact with infected individuals before performing hand hygiene. 1