Hand-Foot-and-Mouth Disease



  • Common clinical syndrome caused by several enterovirus serotypes
  • Classic appearance of oral enanthem along with exanthem of hands and feet (classically) and potentially located elsewhere
  • Exanthem (rash) may be macular, maculopapular, and/or vesicular.
  • Synonym(s): herpangina (when affecting oral mucosa and posterior pharynx)


  • Self-limiting illness resolves in 7 to 10 days.
  • Moderately contagious
  • Infection is spread by direct contact with nasal secretions, saliva, blister fluid, or stool.
  • Infected individuals are most contagious during the 1st week of the illness but may continue to spread illness for days to weeks after. Some exposed individuals (especially adults) may be asymptomatic but still contagious.
  • The viruses that cause hand-foot-and-mouth disease (HFMD) can persist for weeks after symptoms have resolved, most commonly in stool, allowing transmission following resolution of symptoms.
  • The incubation period is 3 to 7 days.


  • Children <5 years of age are most commonly affected, especially in daycare facilities.
  • Can occur as isolated cases, outbreaks, or epidemics
  • Occurs worldwide
  • Vertical transmission is possible.
  • Most large outbreaks occur in Southeast Asia.

Etiology and Pathophysiology

  • HFMD is not the same as foot (hoof) and mouth disease found in cattle, and there is no cross species infectious concern.
  • Transmission by the fecal–oral route or contact with skin lesions or oral secretions; caused by viruses that belong to the Enterovirus genus and replicated in the GI tract, most commonly coxsackievirus A16 and enterovirus 71 (previously caused outbreaks)
  • Also coxsackie viruses A5, A7, A9, A10, B2, B5
  • More severe cases are associated with enterovirus 71 (1).

General Prevention

  • Handwashing, especially around food handling or diaper changes
  • Exclusion of children from group settings during the first few days of the illness in the presence of open lesions in the mouth or on the skin may reduce the spread of infection.
  • Hand hygiene measures are effective in reducing transmission.
  • Pregnant woman should avoid contact with infected individuals.
  • Clinical trials with monovalent and polyvalent vaccines have shown promise in decreasing incidence and prevalence (2).

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