What is hand, foot and mouth disease?

Hand, foot and mouth disease is a common, mild illness caused by a type of virus called an enterovirus.

The disease gets its name from the non-itchy rash that develops on the palms of the hands and soles of the feet. It can also cause ulcers in the mouth and overall make you feel generally unwell.

Hand, foot and mouth disease is highly contagious so spreads easily.

Who is affected?

It is quite common in children under the age of 10, however adolescents and adults can also be affected.

Most adults are immune to the virus type that causes the disease as they have been previously exposed to it during their childhood.

It is possible to catch hand, foot and mouth disease more than once, however, children are unlikely to catch it again during the same outbreak.

Outlook

Generally, hand, foot and mouth disease is a mild and short-lasting illness. Treatment is usually not needed as the body’s immune system clears the virus and symptoms go away after about 7 to 10 days.

Is it the same as foot and mouth disease?

No.

Foot and mouth disease affects cattle, sheep and pigs. The two infections are unrelated and you cannot catch hand, foot and mouth disease from animals.

Symptoms of hand, foot and mouth disease

Symptoms tend to appear 3 to 5 days after becoming infected with the virus and last for 7 to 10 days before disappearing on their own.

Some people with hand, foot and mouth disease do not develop any symptoms.

Adults who develop hand, foot and mouth disease tend to experience milder symptoms than children.

Early symptoms

The first symptoms of hand, foot and mouth disease:

• Fever & feeling unwell
• Loss of appetite
• Sore throat
• Small red spots in the mouth, throat and on the skin

Later symptoms

Mouth lesions

After one or two days, red spots in the mouth will develop into painful ulcers, particularly around the tongue, gums and inside of the cheeks. It may be difficult to eat, drink and swallow.

Skin rash

Any red spots on the skin will turn into a non-itchy rash over the following one to two days. The spots are flat or raised, sometimes with blisters, and smaller than chickenpox sores.

The rash develops on the palms of the hands, the soles of the feet and between the fingers and toes. In some cases, spots also develop on the buttocks and genitals.

Causes & how it spreads

Hand, foot and mouth disease is usually caused by the coxsackie A virus, but it is sometimes caused by the coxsackie B virus or the enterovirus 71.

These viruses remain in the body for weeks after symptoms have gone away, so infected people can pass the disease to others even when they appear well.

Airborne

The viruses that cause hand, foot and mouth disease are contained in the millions of tiny droplets that come out of the nose and mouth when someone with the disease coughs or sneezes.

These droplets hang suspended in the air for a while, then land on surfaces. Anyone who touches these surfaces can spread the virus by touching something else.

People usually become infected by picking up the virus on their hands from contaminated objects and then placing their hands near their mouth or nose. It is also possible to breathe in the virus if it is suspended in airborne droplets.

Other ways of catching it

You can also become infected with hand, foot and mouth disease if you have contact with fluid from the sores, saliva or faeces of someone who is infected.

The virus stays in the faeces for approximately 4 weeks after the person has recovered. It is, therefore, vital that adults and children wash their hands thoroughly after going to the toilet or handling nappies.

Diagnosis

Several different viruses can cause sores and ulcers in the mouth. A GP will normally be able to distinguish hand, foot and mouth disease from other viral infections by:

• The age of the affected person. Hand, foot and mouth disease is most common in children under the age of 10
• The pattern of symptoms. Symptoms begin with fever and a sore throat; spots then develop in your mouth and later on the palms of your hands and soles of your feet
• The appearance of sores. The sores are smaller than chickenpox sores

A throat swab or stool sample may be taken and sent to a laboratory to determine which enterovirus has caused hand, foot and mouth disease. The result usually takes a few days.

Treatment

There is no specific treatment for hand, foot and mouth disease. The condition usually clears up by itself after 7 to 10 days. As it is viral, it cannot be treated with antibiotics.

You can ease symptoms by:

• Getting plenty of rest
• Drinking plenty of fluids (water or weak squash are best)
• Taking medication to relieve symptoms

Medication

Fever

If you or your child has a fever or sore throat, paracetamol should relieve pain and bring down a temperature. Children's paracetamol can be used to treat your child.

Aspirin must not be given to children under 16 years of age.

Mouth sores

The pain of mouth ulcers can be numbed with anaesthetic mouthwashes or sprays, such as benzydamine hydrochloride (ask your CarePlus Pharmacist for Difflam). Choline salicylate gel can be used in adults and children aged 16 and over.

Complications

Complications of hand, foot and mouth disease are uncommon, but can include:

Dehydration

The sores that develop in your throat and mouth may make it difficult for you to drink and swallow. As a result, dehydration can occur. Therefore, it is important to drink plenty of fluids as often as you can. If your child has the disease, ensure that they do the same.

Infection of sores

If the sores are scratched, they may become infected. If this happens, your GP may prescribe antibiotics to treat the infection.

Viral meningitis

In rare cases, hand, foot and mouth disease can lead to viral meningitis. Viral meningitis is an infection of the meninges (membranes that cover the brain and spinal cord).

Viral meningitis is less severe than bacterial meningitis and most people will make a full recovery within two weeks. Symptoms include fever, drowsiness, headache, neck stiffness, vomiting and difficulty looking at bright lights. There is no specific treatment.

Encephalitis

In very rare cases, hand, foot and mouth disease can lead to encephalitis. Encephalitis is an infection that causes the brain tissue to swell and become inflamed. It can cause brain damage and is potentially life threatening.

Early signs of encephalitis are flu-like symptoms, which can develop in a few hours or over a few days. Other symptoms include:

• Vomiting
• Drowsiness or confusion
• Seizures (fits)
• Dislike of bright lights

If you develop encephalitis, you will need to be admitted to hospital. Often those affected make a full recovery.

Pregnancy risk

Pregnant women who catch hand, foot and mouth disease just before giving birth may pass it to their baby. However, babies born with the disease will usually only experience mild symptoms.

In extremely rare cases, catching hand, foot and mouth disease during your pregnancy may result in miscarriage.

Prevention

Hand, foot and mouth disease is highly contagious. The best way to avoid catching and spreading the disease is to avoid close contact with people who have the disease and to practise good hygiene:

• Always wash your hands after going to the toilet and handling nappies, and before preparing food. If your child has hand, foot and mouth disease, encourage them to wash their hands regularly as well
• Avoid sharing utensils with people who are infected with the disease
• Make sure that shared work surfaces are clean

Keeping your child off school

If you child has hand, foot and mouth disease, keep them out of school or playschool while they are feeling unwell. They can go back to school when their symptoms get better.