TUANGPORN TURONGSOMBOON, M.D.
Pediatric Pediatric Infectious Disease
Hand, Foot, and Mouth Disease (HFMD) is caused primarily by two types of viruses: Coxsackievirus A6 & A16 and Enterovirus A71 (EV-A71). This disease primarily affects young children and can sometimes lead to severe complications. Symptoms typically appear 2–3 days after incubation, starting with fever. HFMD is most common in children aged 6 months to 5 years. However, both children and caregivers can take preventive measures to reduce the risk of infection.
The initial symptoms of HFMD include high fever, decreased appetite, and excessive drooling. Upon physical examination, ulcers can be found inside the cheeks and on the soft palate. Red spots or fluid-filled blisters may appear on the palms, soles of the feet, buttocks, genitals, arms, and legs. These symptoms generally improve within 2–3 days. Most children over the age of 5 develop immunity to the virus and are less likely to contract the disease.
Although rare, adults who have never been infected and have not developed immunity may also contract HFMD, as can older children who lack prior exposure to the virus.
HFMD spreads through direct contact with nasal secretions, saliva, or feces of an infected person. The virus is especially concentrated in stool, making it highly contagious. Infected children may also transmit the virus through contact with fluid from blisters. The virus can persist in the body for weeks or even months after recovery, meaning that individuals can continue to spread the infection even after symptoms subside.
Indirect transmission is also possible through contaminated objects. For example, if an infected child touches toys, other children who play with the same toys can contract the virus. Additionally, HFMD can spread through contaminated food or water, making young children particularly vulnerable.
Childcare facilities, especially nurseries where caregivers frequently change diapers, pose a high risk for HFMD transmission. If proper hygiene practices are not followed, the virus can easily spread through contaminated hands or surfaces. Play areas, such as ball pits, are also potential hotspots due to inadequate cleaning.
Most children recover from HFMD without complications. However, infections caused by Enterovirus A71 can lead to severe complications.
Severe complications from HFMD include brainstem encephalitis, meningitis, heart failure, and acute paralysis, all of which can be life-threatening. Warning signs of serious complications include lethargy, muscle weakness, seizures, tremors, difficulty walking, rapid breathing, and vomiting. If any of these symptoms appear, immediate medical attention is required.
Currently, no antiviral medication specifically targets HFMD. Treatment focuses on managing symptoms. Fever-reducing medications can be used to control fever. If a child has difficulty eating, intravenous fluids may be administered. Soft, easily digestible, and cold foods that do not irritate the mouth are recommended, along with adequate hydration to support recovery.
Caregivers can help prevent HFMD by avoiding contact with contaminated surfaces and maintaining proper hygiene. Since this virus is resistant to alcohol-based hand sanitizers, proper handwashing with soap and water is crucial.
A vaccine is available to protect against HFMD caused by Enterovirus A71. Children aged 6 months to under 6 years can receive two doses, administered one month apart. This vaccine is safe and helps reduce the risk of severe complications from HFMD.
Further Reading: HFMD: A Common Childhood Illness During the Rainy Season
Last updated:
September 20, 2022
Pediatric Pediatric Infectious Disease
