Until when is hand, foot, and mouth disease (HFMD) contagious?

Hand, Foot, and Mouth Disease Contagiousness Period

Patients with hand, foot, and mouth disease (HFMD) should be considered contagious for at least 10-14 days from symptom onset, though viral shedding can persist much longer in stool. 1

Duration of Contagiousness

The contagious period for HFMD extends well beyond the resolution of visible symptoms:

• Active viral shedding occurs throughout the acute illness phase (typically 7-10 days when lesions are present) 1
• Patients remain potentially contagious for 10-14 days minimum from symptom onset, even as clinical manifestations resolve 1
• Fecal viral shedding can persist for several weeks after symptoms disappear, making transmission possible long after clinical recovery 1

Transmission Routes During Contagious Period

HFMD spreads through multiple routes during the infectious period:

• Fecal-oral transmission is the primary route and can occur for weeks after symptom resolution 1
• Oral-oral contact and respiratory droplet spread occur during the acute symptomatic phase 1
• Contact with vesicular fluid from skin lesions transmits virus while rashes are present 1

Clinical Course and Timing

Understanding the disease timeline helps determine contagiousness:

• Incubation period: 3-10 days after exposure before symptoms appear 2
• Initial symptoms (fever, sore throat) emerge first, followed by characteristic rashes within days 2
• Lesions typically resolve in 7-10 days, but this does not mark the end of contagiousness 1

Practical Isolation Recommendations

Children should be excluded from childcare and school for a minimum of 10-14 days from symptom onset, with particular attention to hand hygiene given prolonged fecal shedding 1. This is especially critical for healthcare workers and childcare providers who have high potential for transmission 3.

The best prevention methods include frequent handwashing with soap and water (not just sanitizer), disinfecting contaminated surfaces and fomites, and avoiding close contact during the contagious period 1.

Important Caveats

• Asymptomatic viral shedding can occur, meaning infected individuals may transmit disease without obvious symptoms 4
• The 10-14 day guideline represents a minimum; fecal shedding may continue for weeks, requiring ongoing hand hygiene vigilance 1
• Unlike some viral illnesses where contagiousness correlates closely with symptoms, HFMD's prolonged fecal shedding makes it particularly challenging to control 1