Hand, Foot, and
What is hand,
foot, and mouth disease?
Hand, foot, and mouth disease (HFMD) is a common illness of
infants and children. It is characterized by fever, sores in
the mouth, and a rash with blisters. HFMD begins with a mild
fever, poor appetite, malaise ("feeling sick"), and frequently
a sore throat.
One or two days after the fever begins, sores develop in the
mouth. They begin as small red spots that blister and then
often become ulcers. They are usually located on the tongue,
gums, and inside of the cheeks. The skin rash develops over 1
to 2 days with flat or raised red spots, some with blisters.
The rash does not itch, and it is usually located on the palms
of the hands and soles of the feet. It may also appear on the
buttocks. A person with HFMD may have only the rash or the
Is HFMD the same
as foot-and-mouth disease?
No. HFMD is a different disease than foot-and-mouth disease of
cattle, sheep, and swine. Although the names are similar, the
two diseases are not related at all and are caused by
Is HFMD serious?
Usually not. Nearly all people with HFMD recover without
medical treatment. HFMD usually resolves in 7 to 10 days.
There are no common complications. Rarely, this illness may be
associated with aseptic or viral meningitis, in which the
person has fever, headache, stiff neck, or back pain, and may
need to be hospitalized for a few days.
What causes HFMD?
Several different viruses cause HFMD. The most common cause is
coxsackievirus A16; occasionally, other strains of
coxsackievirus A or enterovirus 71 cause HFMD. The
coxsackieviruses are members of a group of viruses called the
enteroviruses. The enterovirus group includes polioviruses,
coxsackieviruses, and echoviruses.
Is it contagious?
Yes, HFMD is moderately contagious. Infection is spread from
person to person by direct contact with nose and throat
discharges or the stool of infected persons. A person is most
contagious during the first week of the illness. HFMD is not
transmitted to or from pets or other animals.
How soon will
someone become ill after getting infected?
The usual period from infection to onset of symptoms is 3 to 6
days. Fever is often the first symptom of HFMD.
Who is at risk for
HFMD occurs mainly in children under 10 years old, but adults
may also be at risk. Everyone is susceptible to infection.
Infection results in immunity to the specific virus, but a
second episode may occur following infection with a different
member of the enterovirus group.
When and where
does HFMD occur?
Individual cases and outbreaks of HFMD occur worldwide, more
frequently in summer and early autumn.
How is HFMD
HFMD is one of many infections that result in mouth sores.
Another common cause is oral herpesvirus infection, which
produces an inflammation of the mouth and gums (sometimes
called stomatitis). Usually, the physician can distinguish
between HFMD and other causes of mouth sores based on the age
of the patient, the pattern of symptoms reported by the
patient or parent, and the appearance of the rash and sores on
examination. A throat swab or stool specimen may be sent to a
laboratory to determine which enterovirus caused the illness.
Since the testing often takes 2 to 4 weeks to obtain a final
answer, the physician usually does not order these tests.
How is HFMD
treated? Can it be prevented?
No specific treatment is available for this infection.
Symptomatic treatment is given to provide relief from fever,
aches, or pain from the mouth ulcers. Preventive measures
include frequent handwashing, especially after diaper changes;
disinfection of contaminated surfaces by household cleaners;
and washing soiled articles of clothing. Children are often
excluded from child care programs, schools, or other group
settings during the first few days of the illness. These
measures may reduce the spread of infection, but they will not
completely interrupt it.