What is Hand, Foot, and Mouth (HFM) disease?

From the Guidelines

Hand, foot, and mouth disease (HFM) is a common viral illness primarily affecting infants and children under 5 years old, caused by enteroviruses, and its treatment should focus on supportive care, including symptom management with acetaminophen or ibuprofen, and prevention of dehydration, as the disease is typically self-limiting and resolves within 7-10 days. The disease is caused by enteroviruses, most commonly coxsackievirus A16, and can occasionally be caused by other types such as EV-A71 and EV-D68, which have been associated with more severe presentations and outbreaks 1.

Key Considerations

• The disease spreads through direct contact with saliva, respiratory droplets, fluid from blisters, and feces, so practice good hygiene including frequent handwashing, avoid close contact like kissing or hugging infected individuals, and disinfect commonly touched surfaces.
• Children should stay home from school or daycare until fever subsides and mouth sores heal.
• While uncomfortable, HFM disease rarely causes serious complications, though in rare cases it can lead to viral meningitis or encephalitis, as noted in studies on enterovirus infections 1.
• For symptom management, use acetaminophen or ibuprofen for fever and pain (follow age-appropriate dosing), avoid aspirin in children, and provide cold liquids and soft foods to soothe mouth sores.
• Saltwater rinses (1/2 teaspoon salt in 1 cup warm water) can help with mouth discomfort.

Prevention and Hygiene

• Frequent handwashing with soap and water is essential to prevent the spread of the disease.
• Avoid close contact with infected individuals, and disinfect commonly touched surfaces to reduce the risk of transmission.
• Keep the affected person hydrated and watch for signs of dehydration, as this can lead to more severe complications.

Monitoring for Complications

• Although rare, it is essential to monitor for signs of serious complications such as viral meningitis or encephalitis, which can be associated with certain enterovirus types 1.

From the Research

HFM Disease Overview

• Hand-foot-and-mouth disease (HFM) is a common viral disease in childhood, caused by human enteroviruses and coxsackieviruses 2, 3, 4.
• The disease is characterized by a painful oral enanthem and asymptomatic exanthem on the palms and soles, with symptoms usually lasting less than 1 week 2, 3, 5.

Transmission and Prevention

• HFM is transmitted by fecal-oral, oral-oral, and respiratory droplet contact 2.
• The best methods to prevent the spread of HFM are handwashing and disinfecting potentially contaminated surfaces and fomites 2.
• Vaccination of susceptible individuals in high-risk areas and good personal hygiene are also important preventative measures 3, 4, 6.

Clinical Manifestations and Complications

• Patients with HFM present with a low-grade fever, a maculopapular or papulovesicular rash on the hands and soles of the feet, and painful oral ulcerations 2.
• Lesions usually resolve in seven to 10 days; however, in rare cases, patients may have neurologic or cardiopulmonary complications 2, 3, 4.
• Severe complications such as meningitis, encephalitis, acute flaccid paralysis, and neurorespiratory syndrome can occur, especially in cases caused by enterovirus A71 3, 4.

Treatment and Management

• Treatment is mainly symptomatic and supportive, with a focus on hydration and pain relief as needed with acetaminophen or ibuprofen 2, 3.
• Intravenous immunoglobulin should be considered for the treatment of severe/complicated HFM 3.
• There are no specific antiviral agents approved for the treatment of HFM, but several potential candidates are being researched 3.