Causative agent

Hand, foot and mouth disease (HFMD) is a common disease in children caused by enteroviruses such as coxsackieviruses and enterovirus 71 (EV71). The EV71 infection is of particular concern as it more likely associates with severe outcomes (like viral meningitis, encephalitis, poliomyelitis-like paralysis) and even death. The usual peak season for HFMD is from early summer to autumn, with a smaller peak in winter.

Clinical features

The disease is mostly self-limiting and resolves in 1 week. It usually begins with fever, poor appetite, tiredness and sore throat. One to two days later, painful ulcers will develop inside the mouth, and non-itchy skin rash with vesicles will appear mainly on the hands and feet. The disease is most contagious during the first week of the illness and the viruses can be found in stool for weeks.

Infection will result in immunity to (protection against) the specific virus that has caused HFMD. However, a second attack of HFMD may occur following infection with a different member of the enterovirus group.

Mode of transmission

The disease mainly spreads by contact with nose and throat discharges, saliva, fluid from vesicles or patients' stool, or after touching contaminated objects.

Incubation period

About 3-7 days.

Management

• There is no specific drug treatment for HFMD. Patients should drink plenty of water and take adequate rest, and may receive symptomatic treatment to reduce fever and pain from oral ulcers.
• Sick children should stay away from school or gatherings till all vesicles have dried up to avoid spreading the disease. If infection is caused by enterovirus 71, the patient should stay at home for 2 more weeks after all vesicles have dried up.
• Parents should monitor the child’s condition closely and seek prompt medical attention if persistent high fever, decrease in alertness or deterioration in general condition develop.

Prevention

There is no effective vaccine. Good hygiene practices are the mainstay of prevention:

• Always keep hands clean by frequent hand washing, especially after using toilet or changing diaper
• Cover mouth and nose when sneezing and coughing
• Disinfect toys, objects and the environment which are contaminated by secretions or excreta with diluted household bleach (1 part of household bleach containing 5.25% sodium hypochlorite in 49 parts of water)
• Avoid close contact (such as kissing, hugging, sharing eating utensils or cups, etc.) with infected persons

For detailed information about Enterovirus 71, please refer to http://www.chp.gov.hk/content.asp?lang=en&info_id=12431&id=24&pid=9