Hand, Foot, and Mouth Disease (HFM)
What is Hand, Foot, and Mouth Disease?
Hand, foot, and mouth disease (HFM) is a common set of symptoms associated with viral infections that are most frequently seen in the summer and early fall. HFM is mild and common in children. Several different types of viruses can cause the disease. Sometimes people can develop the disease more than once if exposed to a different virus. HFM is most common in children aged 5 years and younger, but can sometimes occur in adults.
Signs and symptoms
- Tiny blisters in the mouth, fingers, palms of the hands, buttocks, and/or soles of the feet
- Poor appetite due to mouth blisters/pain
- Common cold signs or symptoms with fever
- Vomiting and diarrhea are uncommon
- May cause neurologic symptoms, such as balance issues or muscle jerking
Incubation period
Usually 3-6 days
Contagious period and spread
Virus may shed for weeks to months in the stool after the infection starts; respiratory shedding of the virus is usually limited to 1-3 weeks.
Spread through:
- Respiratory (droplet) route: Contact with large droplets that form when a child talks, coughs, or sneezes. These droplets can land on or be rubbed into the eyes, nose, or mouth. Most of these droplets do not stay in the air. Usually, they travel no more than three feet and fall onto the ground.
- Contact with respiratory secretions, or objects contaminated by children that carry these viruses.
- Fecal→oral route: Contact with feces of children who are infected. This generally involves an infected child contaminating their fingers and then touching an object that another child touches. The child who touched the contaminated surface then puts their fingers into their mouth or another person’s mouth.
Public health reporting requirements
- Report the infection to the facility director, school nurse, or child care health consultant. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms.
- Individual cases do not need to be reported to public health.
- Contact the local or state public health agency for guidance if notification of families via letter is planned.
Control of spread
- Teach children and teachers/caregivers to cover their mouths and noses when sneezing or coughing with disposable facial tissues, if possible, or with an upper arm sleeve or elbow if no facial tissue is available in time.
- Teach everyone to practice hand hygiene right after using facial tissues or having contact with mucus. Change or cover contaminated clothing.
- Dispose of facial tissues that contain nasal secretions after each use.
- Use good hand-hygiene techniques at all times, especially after diaper changing.
- Promptly disinfect contaminated surfaces (like diaper-changing areas) and other commonly touched surfaces (like toys).
- Consult with local or state public health with implementation of control measures if the spread is ongoing among children/students.
Treatment
There is no specific treatment. Over-the-counter medications can help relieve symptoms. Children with mouth sores should be encouraged to stay hydrated.
Exclusion
None, unless the child meets other exclusion criteria, is drooling uncontrollably and has mouth sores, or is unable to participate and staff determine they cannot care for the child without compromising the health and safety of others.
Note: Exclusion may not reduce disease transmission because some children may shed the virus without becoming recognizably ill and other children who do become ill may shed virus in their stool for several weeks.
Role of teachers, caregivers, and family
- Seek medical advice if the child is uncomfortable with signs of illness from the infection, such as an inability to drink or eat, or if the child seems very ill.
- Practice good hand hygiene, and cover mouths and noses when sneezing or coughing.
- Clean and disinfect contaminated surfaces.