HAND, FOOT, AND MOUTH DISEASE

CHILDHOOD HAND, FOOT, AND MOUTH DISEASE

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

Hand, foot, and mouth disease (HFMD) is a very common and highly contagious viral infection that mostly affects infants and children under 10 years old. It is so named because it causes a rash on the hands, feet, and in the mouth.

HFMD can affect adults, although it’s far more common in children. Adults are often less likely to experience symptoms or may have milder symptoms. Even if they don’t show symptoms, adults can still spread the virus to others, especially children.

HFMD is caused by a group of viruses known as enteroviruses, which infect millions each year around the world. It is spread through direct contact with an infected person’s saliva, mucus, or stool, or by touching contaminated surfaces. Unfortunately, getting the disease does not give you immunity and you can get it more than once.

HFMD is usually a mild illness that gets better on its own in 7 to 10 days. It is not in any way related to foot-and-mouth disease (also called hoof-and-mouth disease), which affects animals like sheep and cattle.

The best way to protect you and your child from HFMD is through frequent hand washing. The Centers for Disease Control and Prevention (CDC) calls hand washing a “do-it-yourself vaccine.”

HAND, FOOT, AND MOUTH DISEASE (HFMD) IN SOUTH AFRICA

HFMD is common in South Africa, particularly in children under 5 years old. While it can occur anywhere in the country, outbreaks are more frequent in institutions like crèches and daycare centers, especially during the summer and autumn months.

CAUSES OF HFMD

The most common cause of HFMD is infection from coxsackievirus 16. This coxsackievirus belongs to a group of viruses called nonpolio enteroviruses. Other types of enteroviruses also may cause hand-foot-and-mouth disease.

SYMPTOMS OF HFMD

Symptoms usually start 3 to 7 days after infection and last 7 to 10 days.

The first symptoms of HFMD can be:

a sore throat
a high temperature
not wanting to eat
generally feeling tired and unwell

The second stage usually starts a few days later and symptoms can include:

mouth ulcers, which can be painful and make eating and drinking difficult
a rash of spots develop in the mouth, on the hands, and feet, and sometimes on the buttocks and legs. In infants, the spots can sometimes be seen in the nappy area.

The spots can look pink, red, or darker than the surrounding skin, depending on your skin tone. The spots can turn into blisters, which might be grey or lighter than surrounding skin and can be painful.

Hand, foot and mouth disease can be confused with:

chickenpox (but the chickenpox rash is all over the body)
cold sores in your child’s mouth

The blisters should not be itchy like chickenpox blisters. However, if your child has eczema, the HFMD can cause the eczema to worsen and potentially become infected with bacteria.

HOW HFMD IS SPREAD

Hand, foot and mouth disease is easily spread person-to-person by contaminated hands but can also be spread through sneezing and coughing.

You can start spreading it from a few days before you have any symptoms, but you’re most likely to spread it to others in the first 5 days after symptoms start. An infected person can still transmit viruses for 1 to 2 weeks after they no longer have symptoms

Direct contact – touching an infected person’s saliva, nasal secretions, or blisters
Droplets – coughing or sneezing spreads the virus in the air
Contaminated surfaces and objects – shared toys, stationery, and utensils
Contact with faeces – poor hand hygiene after using the toilet or changing nappies. The viruses can remain in faeces for several weeks.

WHO IS AT RISK?

Young children: as the viruses that cause HFMD are common, particularly affect children, and largely spread through direct contact, outbreaks tend to occur in child-care settings like crèches, daycare centers, and primary schools.
Households: HFMD can also spread easily and quickly within households, particularly among children.
Adults: many adults, including pregnant women, are often exposed to them without symptoms. There is no clear evidence of risk to unborn babies from HFMD, but infected mothers (and siblings) can pass the infection onto newborn babies. Newborns rarely have severe disease.

PROTECTING YOUR CHILD FROM HFMD

Hand hygiene: frequent handwashing with soap and water is crucial.
Avoid close contact: children should avoid direct contact with individuals who are ill. Stay home from school or work if you or your child has symptoms.
Clean and disinfect: regularly clean and disinfect frequently touched surfaces and other shared items, such as toys and stationery.
Parents, teachers and care givers should encourage good hygiene habits like regular handwashing and not sharing eating utensils (e.g. cutlery, cups, toothbrushes).

PROTECTING YOURSELF FROM HFMD

Prioritise good hygiene:

Frequent handwashing: wash hands thoroughly with soap and water for at least 20 seconds, especially after using the toilet, changing nappies, before and after eating, and after blowing your nose or coughing.
Disinfect surfaces: regularly clean and disinfect frequently touched surfaces and objects, such as toys, doorknobs, and shared items.
Avoid close contact: minimise close contact with anyone who has HFMD, such as hugging, kissing, or sharing eating utensils. Do not share personal hygiene items like towels, toothbrushes, or clothing,

If you are pregnant:

The risk of infection during pregnancy is very low. If you are pregnant and do get HFMD, the risk of complications is also very low. If you catch the virus shortly before you give birth, the infection can be passed on to your baby. Most babies born with HFMD have only mild symptoms.

In very rare cases it is possible that HFMD infection during pregnancy may result in miscarriage or could affect how your baby develops. If you have contact with HFMD while you are pregnant, or if you develop any kind of rash, see your doctor or midwife.

TREATMENTS FOR HFMD

There is no specific vaccine or treatment for HFMD. Symptom relief, like pain relievers for fever and sores, is recommended. A healthcare professional like a pharmacist can provide you with advice about treatments, such as mouth ulcer gels, sprays and mouthwashes, to relieve pain. They can also tell you which ones are suitable for children.
Drink cool fluids to soothe the mouth and avoid acidic drinks, such as fruit juice.
Eat soft foods like yoghurt and avoid hot, salty and spicy foods.
Infected individuals should rest, stay hydrated, keep their blisters clean, and avoid touching them. Allow blisters to dry out naturally. The blisters should not be deliberately burst because the fluid within them is infectious.

WHEN TO SEEK MEDICAL ASSISTANCE

In rare cases, the virus enters the brain and causes serious complications such as viral meningitis, encephalitis and polio-like paralysis.

Viral meningitis: this is a rare infection and inflammation of the membranes (meninges) and cerebrospinal fluid surrounding the brain and spinal cord.
Encephalitis: this severe and potentially life-threatening disease involves brain inflammation. Encephalitis is rare.

You should see urgent medical care if:

Your child is not drinking
Your child is passing less urine than usual
Your child has a fever over 38°C (or for longer than 72 hours), or feels hot and shivery, or any fever in babies younger than 3 months old
Your child exhibits any abnormal / jerking movements, or rapid breathing
Your child is excessively tired and drowsy
Your child has trouble walking
You’re worried about your child’s hand, foot and mouth disease symptoms
If you are pregnant and develop a rash.