Hand, Foot, and Mouth Disease Quarantine Guidelines
Children with hand, foot, and mouth disease should be excluded from childcare or school until fever resolves and oral lesions have healed sufficiently to allow normal eating and drinking, typically 7-10 days from symptom onset, though viral shedding can persist for weeks in stool.
Exclusion from School and Childcare
Exclude symptomatic children from childcare, school, and group settings until fever has resolved for at least 24 hours without antipyretics AND oral ulcerations have improved enough to allow adequate oral intake 1, 2.
Children may return to school once they can participate comfortably in normal activities, even if mild rash persists, as the rash itself is not highly contagious 1.
The typical duration of symptoms is 7-10 days, which serves as a practical timeframe for most exclusions 1, 2, 3.
Critical Caveat About Viral Shedding
Viral shedding continues in stool for 3-4 weeks after symptom resolution, making complete prevention of transmission impossible through exclusion alone 1, 4.
Respiratory droplet shedding typically ceases within 1-2 weeks of illness onset 1.
Because asymptomatic shedding is common and prolonged, exclusion policies focus on symptomatic individuals rather than attempting to eliminate all transmission risk 4.
Infection Control Measures
Hand Hygiene (Primary Prevention Strategy)
Perform hand hygiene with antimicrobial soap and water when hands are visibly soiled, or use alcohol-based hand rub when hands are not visibly dirty 5.
Hand hygiene is mandatory after contact with body fluids, after using the restroom, after diaper changes, before food preparation, and before eating 5.
Handwashing is the single most effective method to prevent HFMD spread, superior to exclusion policies alone 1.
Environmental Disinfection
Disinfect frequently touched surfaces and fomites (toys, doorknobs, changing tables) with appropriate disinfectants, as the virus can survive on surfaces 1.
Pay particular attention to bathroom surfaces and diaper-changing areas where fecal-oral transmission risk is highest 1.
Household and Close Contact Management
Close contacts do not require quarantine or exclusion if asymptomatic, as the incubation period is 3-7 days and exclusion of asymptomatic contacts is not practical given widespread asymptomatic shedding 4.
Household members should practice meticulous hand hygiene, especially after diaper changes and before food preparation 5, 1.
Monitor close contacts for fever, oral lesions, or rash for 7 days after last exposure 2.
Adult Considerations
Adults with HFMD should avoid work in healthcare, food service, or childcare settings until fever resolves and they can perform job duties without risk of contaminating food or transmitting to vulnerable populations 6.
For other occupations, adults may return to work once fever resolves and they feel well enough to work, typically 3-5 days 6.
Common Pitfalls to Avoid
Do not exclude children solely based on the presence of a rash on hands and feet, as this is not the primary mode of transmission and the child may be past the most infectious period 1.
Do not rely on negative symptoms in contacts to assume they are not infectious, as asymptomatic viral shedding is common 4.
Recognize that HFMD caused by enterovirus A71 may have more severe complications requiring hospitalization, though this does not change basic quarantine recommendations 2.