Editing Hand, foot, and mouth disease

{{Short description|Common human disease caused by a group of viruses}}
{{about|viral disease|the chemotherapy-induced condition|Chemotherapy-induced acral erythema|the animal disease|Foot-and-mouth disease|the card game|Canasta#Hand and Foot Canasta}}
{{Distinguish}}
{{Use mdy dates|date=September 2022}}
{{Infobox medical condition (new)
| name            = Hand, foot, and mouth disease
| synonyms        = Enteroviral vesicular stomatitis with exanthem
| image           =Hand Foot Mouth Disease.png
| caption         = Small reddish [[macule|spots]] and [[papule|bumps]] around mouth in HFMD
| field           = [[Infectious disease (medical specialty)|Infectious disease]]
| symptoms        = [[Fever]], [[maculopapular rash|flat discolored spots or bumps]] that may blister<ref name=Kam2013/><ref name=Lancet2010/>
| complications   = Temporary loss of nails, [[viral meningitis]]<ref name=CDC2015Comp/>
| onset           = 3–6 days post exposure<ref name=Hoy2012/>
| duration        = 1 week<ref name="Harrison's"/>
| causes          = [[Coxsackievirus]] A16, [[Enterovirus 71]]<ref name=Repass2014/>
| risks           =
| diagnosis       = Based on symptoms, viral culture<ref name=CDC2015Diag/>
| differential    =
| prevention      = [[Handwashing]]<ref name=CDC2015Cau/>
| treatment       = [[Supportive care]]<ref name="Harrison's"/>
| medication      = [[Pain medication]] such as [[ibuprofen]]<ref name=CDC2015Tx/>
| prognosis       =
| frequency       = As outbreaks<ref name=Kam2013/>
| deaths          =
}}
<!-- Definition and symptoms -->
'''Hand, foot, and mouth disease''' ('''HFMD''') is a common infection caused by a group of [[enterovirus]]es.<ref name=CDC2015Sym/> It typically begins with a [[fever]] and [[Malaise|feeling generally unwell]].<ref name=CDC2015Sym/> This is followed a day or two later by [[maculopapular rash|flat discolored spots or bumps]] that may blister, on the hands, feet and mouth and occasionally buttocks and groin.<ref name=Kam2013>{{cite journal |last1=Kaminska |first1=K |last2=Martinetti|first2=G |last3=Lucchini |first3=R|last4=Kaya|first4=G|last5=Mainetti|first5=C|title=Coxsackievirus A6 and Hand, Foot, and Mouth Disease: Three Case Reports of Familial Child-to-Immunocompetent Adult Transmission and a Literature Review|journal=Case Reports in Dermatology|volume=5 |issue=2 |pages=203–209 |year=2013|pmid=24019771|doi=10.1159/000354533 |pmc=3764954}}</ref><ref name=Lancet2010>{{cite journal |last1=Ooi |first1=MH |last2=Wong |first2=SC |last3=Lewthwaite |first3=P|last4=Cardosa|first4=MJ|last5=Solomon|first5=T|title=Clinical features, diagnosis, and management of enterovirus 71|journal=Lancet Neurology|volume=9 |issue=11 |pages=1097–1105 |year=2010|pmid=20965438|doi=10.1016/S1474-4422(10)70209-X|s2cid=17505751 |url=http://ir.unimas.my/id/eprint/7019/2/Clinical%20features.pdf }}</ref><ref name=Fry2003>{{cite journal|last1=Frydenberg|first1=A|last2=Starr|first2=M|title=Hand, foot and mouth disease.|journal=Australian Family Physician|date=August 2003|volume=32|issue=8|pages=594–5|pmid=12973865}}</ref> Signs and symptoms normally appear 3–6 days [[incubation period|after exposure to the virus]].<ref name=Hoy2012>{{cite journal |last1=Hoy |first1=NY |last2=Leung |first2=AK |last3=Metelitsa |first3=AI|last4=Adams|first4=S|title=New concepts in median nail dystrophy, onychomycosis, and hand, foot and mouth disease nail pathology|journal=ISRN Dermatology|volume=2012 |issue=680163 |pages= 680163|year=2012|pmid=22462009|doi=10.5402/2012/680163 |pmc=3302018 |doi-access=free }}</ref> The rash generally resolves on its own in about a week.<ref name="Harrison's"/> 

<!-- Cause and diagnosis -->
The viruses that cause HFMD are spread through close personal contact, through the air from coughing, and via the feces of an infected person.<ref name=CDC2015Cau/> Contaminated objects can also spread the disease.<ref name=CDC2015Cau>{{cite web|title=Causes & Transmission|url=https://www.cdc.gov/hand-foot-mouth/about/transmission.html|website=CDC|access-date=May 15, 2016|date=August 18, 2015|url-status=live|archive-url=https://web.archive.org/web/20160514150205/http://www.cdc.gov/hand-foot-mouth/about/transmission.html|archive-date=May 14, 2016}}</ref> [[Coxsackievirus]] A16 is the most common cause, and [[enterovirus 71]] is the second-most common cause.<ref name=Repass2014/> Other strains of coxsackievirus and [[enterovirus]] can also be responsible.<ref name=Repass2014>{{Cite journal|vauthors=Repass GL, Palmer WC, Stancampiano FF |title=Hand, foot, and mouth disease: Identifying and managing an acute viral syndrome |journal=Cleve Clin J Med |volume=81 |issue=9 |pages=537–43|date=September 2014|pmid=25183845|url=http://www.ccjm.org/content/81/9/537.long |doi=10.3949/ccjm.81a.13132|doi-access=free }}</ref><ref name=PLOS2012>{{cite journal |last1=Li |first1=Y |last2=Zhu |first2=R |last3=Qian |first3=Y|last4=Deng|first4=J|title=The characteristics of blood glucose and WBC counts in peripheral blood of cases of hand foot and mouth disease in China: a systematic review|journal=PLOS ONE|volume=7 |issue=1 |pages=e29003 |year=2012|pmid=22235257|doi=10.1371/journal.pone.0029003 |pmc=3250408|bibcode=2012PLoSO...729003L |doi-access=free }}</ref> Some people may carry and pass on the virus despite having no symptoms of disease.<ref name=CDC2015Sym/> Other animals are not involved.<ref name=CDC2015Cau/> Diagnosis can often be made based on symptoms.<ref name=CDC2015Diag/> Occasionally, a throat or stool sample may be tested for the virus.<ref name=CDC2015Diag>{{cite web|title=Diagnosis|url=https://www.cdc.gov/hand-foot-mouth/about/diagnosis.html|website=CDC|access-date=May 15, 2016|date=August 18, 2015|url-status=live|archive-url=https://web.archive.org/web/20160514142722/http://www.cdc.gov/hand-foot-mouth/about/diagnosis.html|archive-date=May 14, 2016}}</ref>

<!-- Treatment and prognosis-->
Most people with hand, foot, and mouth disease get better on their own in 7 to 10 days.<ref name=CDC2015Cau/> Most cases require no specific treatment.<ref name="Harrison's">{{cite book|last1=Longo|first1=Dan L.|title=Harrison's Principles of Internal Medicine.|date=2012|publisher=McGraw-Hill|location=New York|isbn=978-0-07174889-6|edition=18th}}</ref> No [[antiviral drug|antiviral medication]] or [[vaccine]] is available, but development efforts are underway.<ref name=Pour2014>{{cite journal|vauthors=Pourianfar HR, Grollo L |title=Development of antiviral agents toward enterovirus 71 infection|journal=J Microbiol Immunol Infect|volume=48 |issue=1|pages=1–8|date=February 2014|pmid=24560700|doi=10.1016/j.jmii.2013.11.011|doi-access=}}</ref><ref>{{Cite journal|last1=Fang|first1=Chih-Yeu|last2=Liu|first2=Chia-Chyi|date=2018|title=Recent development of enterovirus A vaccine candidates for the prevention of hand, foot, and mouth disease|journal=Expert Review of Vaccines|volume=17|issue=9|pages=819–831|doi=10.1080/14760584.2018.1510326|issn=1744-8395|pmid=30095317|s2cid=51952220}}</ref> For fever and for painful mouth sores, over-the-counter [[pain medication]]s such as [[ibuprofen]] may be used, though aspirin should be avoided in children.<ref name="CDC2015Tx">{{cite web|date=February 2, 2021|title=Treat Hand, Foot, and Mouth Disease|url=https://www.cdc.gov/hand-foot-mouth/about/treatment.html|access-date=October 9, 2021|website=CDC}}</ref> The illness is usually not serious. Occasionally, intravenous fluids are given to children who are dehydrated.<ref>{{Cite web|title=Hand-foot-and-mouth disease – Symptoms and causes|url=https://www.mayoclinic.org/diseases-conditions/hand-foot-and-mouth-disease/symptoms-causes/syc-20353035|access-date=October 9, 2021|website=Mayo Clinic|language=en}}</ref> Very rarely, [[viral meningitis]] or [[encephalitis]] may complicate the disease.<ref name="CDC2015Comp">{{cite web |date=May 7, 2024 |title=HFMD Symptoms and Complications |url=https://www.cdc.gov/hand-foot-mouth/signs-symptoms/?CDC_AAref_Val=https://www.cdc.gov/hand-foot-mouth/about/complications.html |archive-url= |archive-date= |access-date=July 7, 2024 |website=CDC}}</ref> Because HFMD is normally mild, some jurisdictions allow children to continue to go to child care and schools as long as they have no fever or uncontrolled drooling with mouth sores, and as long as they feel well enough to participate in classroom activities.<ref name="CDC2015Cau" />

<!-- Epidemiology -->
HFMD occurs in all areas of the world.<ref name=CDC2015Epi/> It often occurs in small [[epidemic|outbreaks]] in nursery schools or kindergartens.<ref name=Kam2013/> Large outbreaks have been occurring in Asia since 1997.<ref name=CDC2015Epi/> It usually occurs during the spring, summer, and fall months.<ref name=CDC2015Epi>{{cite web|title=Outbreaks|url=https://www.cdc.gov/hand-foot-mouth/outbreaks.html|website=CDC|access-date=May 15, 2016|date=August 18, 2015|url-status=live|archive-url=https://web.archive.org/web/20160517180547/http://www.cdc.gov/hand-foot-mouth/outbreaks.html|archive-date=May 17, 2016}}</ref> Typically it occurs in children less than five years old but can occasionally occur in adults.<ref name=Kam2013/><ref name=CDC2015Sym>{{cite web|title=Hand Foot and Mouth Disease|url=https://www.cdc.gov/hand-foot-mouth/about/signs-symptoms.html|website=CDC|access-date=May 14, 2016|date=August 18, 2015|url-status=live|archive-url=https://web.archive.org/web/20160516032600/http://www.cdc.gov/hand-foot-mouth/about/signs-symptoms.html|archive-date=May 16, 2016}}</ref> HFMD should not be confused with [[foot-and-mouth disease]] (also known as hoof-and-mouth disease), which mostly affects livestock.<ref>{{cite web|url=http://www.defra.gov.uk/news/2007/070814c.htm|title=Foot and Mouth Disease update: further temporary control zone established in Surrey |publisher=[[Department for Environment, Food and Rural Affairs|Defra]]|date=August 14, 2007|access-date=August 14, 2007 |archive-url=https://web.archive.org/web/20070927000836/http://www.defra.gov.uk/news/2007/070814c.htm|archive-date=September 27, 2007}}</ref>

== Signs and symptoms ==

Common constitutional signs and symptoms of HFMD include fever, nausea, vomiting, [[fatigue|feeling tired]], [[malaise|generalized discomfort]], [[Anorexia (symptom)|loss of appetite]], and irritability in infants and toddlers. Skin lesions frequently develop in the form of a [[maculopapular|rash of flat discolored spots and bumps]] which may be followed by [[vesicle (dermatology)|vesicular sores]] with [[blister]]s on palms of the hands, soles of the feet, buttocks, and sometimes on the lips.<ref name="Huang1999">{{cite journal|last1=Huang|first1=CC|last2=Liu|first2=CC|last3=Chang|first3=YC|last4=Chen|first4=CY|last5=Wang|first5=ST|last6=Yeh|first6=TF|title=Neurologic complications in children with enterovirus 71 infection.|journal=The New England Journal of Medicine|date=September 23, 1999|volume=341|issue=13|pages=936–42|pmid=10498488|doi=10.1056/nejm199909233411302|doi-access=free}}</ref> The rash is rarely itchy for children,<ref name=Hoy2012/> but can be extremely itchy for adults. [[Pain]]ful facial [[ulcer]]s, [[blister]]s, or lesions may also develop in or around the nose or [[Human mouth|mouth]].<ref name=Kam2013/><ref name=Sar2013/><ref name='HFMD Symptoms'>{{Cite web |url=http://www.mayoclinic.com/health/hand-foot-and-mouth-disease/DS00599/DSECTION=2 |title=Hand, Foot and Mouth Disease: Signs & Symptoms |access-date=May 5, 2008 |work=mayoclinic.com |publisher=The Mayo Clinic |url-status=live |archive-url=https://web.archive.org/web/20080501111320/http://www.mayoclinic.com/health/hand-foot-and-mouth-disease/DS00599/DSECTION%3D2 |archive-date=May 1, 2008  }}</ref> HFMD usually resolves on its own after 7–10 days.<ref name=Sar2013/> Most cases of the disease are relatively harmless, but complications including encephalitis, meningitis, and paralysis that mimics the neurological symptoms of polio can occur.<ref>{{Cite web|url=http://www.wpro.who.int/topics/hand_foot_mouth/en/|archive-url=https://web.archive.org/web/20120423165020/http://www.wpro.who.int/topics/hand_foot_mouth/en/|url-status=dead|archive-date=April 23, 2012|title=Hand, Foot and Mouth Disease (HFMD)|website=WHO Western Pacific Region|language=en-GB|access-date=November 6, 2017}}</ref>

<gallery widths="220" heights="220">
Image:Characteristic rash of hand, foot, and mouth disease, on human hands.jpg|Rash on palms of the hands
File:Hand Foot Mouth Disease Adult 36Years.jpg|Rash on hands and feet of a 36-year-old man
File:Hand foot and mouth disease on child feet.jpg|Rash on the soles of a child's feet
</gallery>

==Cause==
The viruses that cause the disease are of the [[Picornavirus|''Picornaviridae'']] [[family (biology)|family]]. [[Coxsackievirus]] A16 is the most common cause of HFMD.<ref name=Repass2014/> [[Enterovirus 71|Enterovirus 71 (EV-71)]] is the second-most common cause.<ref name="Repass2014"/> Many other strains of coxsackievirus and [[enterovirus]] can also be responsible.<ref name="Repass2014"/><ref name=PLOS2012/>

===Transmission===
HFMD is highly contagious and is transmitted by [[Oropharynx|nasopharyngeal secretions]] such as saliva or nasal mucus, by direct contact, or by [[Fecal–oral route|fecal–oral transmission]]. It is possible to be infectious for days to weeks after the symptoms have resolved.<ref name=CDC2015Cau/>

Childcare settings are the most common places for HFMD to be contracted because of toilet training, diaper changes, and children's propensity to put their hands into their mouths.<ref name="HFMD Symptoms" /> HFMD is contracted through nose and throat secretions such as saliva, sputum, and nasal mucus as well as fluid in blisters, and stool.<ref name=Koh2016 />

==Diagnosis==
A diagnosis usually can be made by the presenting signs and symptoms alone.<ref name=Sar2013/> If the diagnosis is unclear, a throat swab or stool specimen may be taken to identify the virus by culture.<ref name=Sar2013/> The common [[incubation period]] (the time between infection and onset of symptoms) ranges from three to six days.<ref name=Hoy2012/> Early detection of HFMD is important in preventing an outbreak in the pediatric population.<ref>{{Cite journal|last1=Omaña-Cepeda|first1=Carlos|last2=Martínez-Valverde|first2=Andrea|last3=del Mar Sabater- Recolons|first3=María|last4=Jané-Salas|first4=Enric|last5=Marí-Roig|first5=Antonio|last6=López-López|first6=José|date=March 15, 2016|title=A literature review and case report of hand, foot and mouth disease in an immunocompetent adult|journal=BMC Research Notes|volume=9|pages=165|doi=10.1186/s13104-016-1973-y|pmid=26975350|pmc=4791924|issn=1756-0500 |doi-access=free }}</ref>

==Prevention==
Preventive measures include avoiding direct contact with infected individuals (including keeping infected children home from school), proper cleaning of shared utensils, disinfecting [[Fomite|contaminated surfaces]], and proper hand hygiene. These measures are effective in decreasing the transmission of the viruses responsible for HFMD.<ref name=Sar2013/><ref name="CDC">{{cite web |url=https://www.cdc.gov/hand-foot-mouth/about/prevention-treatment.html |title=Hand, Foot and Mouth Disease |year=2013 |work=Prevention and Treatment |publisher=Centers for Disease Control and Prevention |access-date=October 18, 2013 |url-status=live |archive-url=https://web.archive.org/web/20131017175928/http://www.cdc.gov/hand-foot-mouth/about/prevention-treatment.html |archive-date=October 17, 2013  }}</ref>

Protective habits include hand washing and disinfecting surfaces in play areas.<ref name=Koh2016 /> Breastfeeding has also been shown to decrease rates of severe HFMD, though does not reduce the risk of the infection of the disease.<ref name=Koh2016 />

===Vaccine===
A vaccine known as the [[Enterovirus 71|EV71]] vaccine is available to prevent HFMD in China {{as of|2015|December|lc=y}}.<ref>{{cite journal|last1=Mao|first1=QY|last2=Wang|first2=Y|last3=Bian|first3=L|last4=Xu|first4=M|last5=Liang|first5=Z|title=EV71 vaccine, a new tool to control outbreaks of hand, foot and mouth disease (HFMD).|journal=Expert Review of Vaccines|date=May 2016|volume=15|issue=5|pages=599–606|pmid=26732723|doi=10.1586/14760584.2016.1138862|s2cid=45722352}}</ref>  No vaccine is currently available in the United States.<ref name="CDC"/>

==Treatment==
Medications are usually not needed as hand, foot, and mouth disease is a viral disease that typically resolves on its own. Currently, there is no specific curative treatment for hand, foot, and mouth disease.<ref name=Sar2013/> Disease management typically focuses on achieving symptomatic relief. Pain from the sores may be eased with the use of [[analgesic|analgesic medications]]. Infection in older children, adolescents, and adults is typically mild and lasts approximately 1 week, but may occasionally run a longer course. [[Antipyretic|Fever reducers]] can help decrease body temperature.{{cn|date=May 2021}}

A minority of individuals with hand, foot, and mouth disease may require hospital admission due to complications such as [[encephalitis|inflammation of the brain]], [[meningitis|inflammation of the meninges]], or [[acute flaccid paralysis]].<ref name="PLOS2012" /> Non-neurologic complications such as [[myocarditis|inflammation of the heart]], [[pulmonary edema|fluid in the lungs]], or [[pulmonary hemorrhage|bleeding into the lungs]] may also occur.<ref name="PLOS2012" />

==Complications==
Complications from the viral infections that cause HFMD are rare but require immediate medical treatment if present. HFMD infections caused by [[Enterovirus 71]] tend to be more severe and are more likely to have neurologic or cardiac complications including death than infections caused by Coxsackievirus A16.<ref name=Sar2013/> Viral or [[aseptic meningitis]] can occur with HFMD in rare cases and is characterized by fever, [[headache]], [[neck stiffness|stiff neck]], or back pain.<ref name=PLOS2012/><ref name=Sar2013/>  The condition is usually mild and clears without treatment; however, hospitalization for a short time may be needed. Other serious complications of HFMD include [[encephalitis]] (inflammation of the brain), or [[flaccid paralysis]] in rare circumstances.<ref name="Huang1999"/><ref name=Sar2013/>

[[Onychomadesis|Fingernail and toenail loss]] have been reported in children 4–8 weeks after having HFMD.<ref name=Hoy2012/> The relationship between HFMD and the reported nail loss is unclear; however, it is temporary and nail growth resumes without treatment.<ref name=Hoy2012/><ref>{{cite web |url=https://www.cdc.gov/hand-foot-mouth/about/complications.html |title=Hand, Foot and Mouth Disease |year=2011 |work=Complications |publisher=Centers for Disease Control and Prevention |access-date=October 14, 2013 |url-status=live |archive-url=https://web.archive.org/web/20131017093341/http://www.cdc.gov/hand-foot-mouth/about/complications.html |archive-date=October 17, 2013  }}</ref>

Minor complications due to symptoms can occur such as dehydration, due to mouth sores causing discomfort with intake of foods and fluid.<ref name=":0">{{Cite web|url=http://www.wpro.who.int/mediacentre/factsheets/fs_10072012_HFMD/en/|archive-url=https://web.archive.org/web/20140424065042/http://www.wpro.who.int/mediacentre/factsheets/fs_10072012_HFMD/en/|url-status=dead|archive-date=April 24, 2014|title=Hand, Foot and Mouth Disease|website=WHO Western Pacific Region|language=en-GB|access-date=November 6, 2017}}</ref>

==Epidemiology==
Hand, foot and mouth disease most commonly occurs in children under the age of 10<ref name=Hoy2012/><ref name=Sar2013/> and more often under the age of 5, but it can also affect adults with varying symptoms.<ref name="HFMD Symptoms" /> It tends to occur in outbreaks during the spring, summer, and autumn seasons.<ref name="Repass2014"/> This is believed to be due to heat and humidity improving spread.<ref name=Koh2016>{{Cite journal|last1=Koh|first1=Wee Ming|last2=Bogich|first2=Tiffany|last3=Siegel|first3=Karen|last4=Jin|first4=Jing|last5=Chong|first5=Elizabeth Y.|last6=Tan|first6=Chong Yew|last7=Chen|first7=Mark Ic|last8=Horby|first8=Peter|last9=Cook|first9=Alex R.|date=October 2016|title=The Epidemiology of Hand, Foot and Mouth Disease in Asia: A Systematic Review and Analysis|journal=The Pediatric Infectious Disease Journal|volume=35|issue=10|pages=e285–300|doi=10.1097/INF.0000000000001242|issn=1532-0987|pmc=5130063|pmid=27273688}}</ref> HFMD is more common in rural areas than urban areas; however, socioeconomic status and hygiene levels need to be considered.<ref>{{Cite journal|last1=Koh|first1=Wee Ming|last2=Bogich|first2=Tiffany|last3=Siegel|first3=Karen|last4=Jin|first4=Jing|last5=Chong|first5=Elizabeth Y.|last6=Tan|first6=Chong Yew|last7=Chen|first7=Mark IC|last8=Horby|first8=Peter|last9=Cook|first9=Alex R.|date=October 2016|title=The Epidemiology of Hand, Foot and Mouth Disease in Asia: A Systematic Review and Analysis|journal=The Pediatric Infectious Disease Journal|volume=35|issue=10|pages=e285–e300|doi=10.1097/INF.0000000000001242|pmid=27273688|issn=0891-3668|pmc=5130063}}</ref> Poor hygiene is a risk factor for HFMD.<ref>{{Cite news|url=https://www.webmd.com/children/guide/hand-foot-mouth-disease#1|title=Hand-Foot-and-Mouth Disease|work=WebMD|access-date=November 28, 2017|language=en-US}}</ref>{{better source needed|date=November 2018}}

===Outbreaks===
* In 1997, an [[1997 Sarawak HFMD outbreak|outbreak]] occurred in [[Sarawak]], Malaysia with 600 cases and over 30 children died.<ref>{{cite journal|title=Deaths of Children during an Outbreak of Hand, Foot, and Mouth Disease in Sarawak, Malaysia: Clinical and Pathological Characteristics of the Disease|author1=L. G. Chan|author2=Umesh D. Parashar|author3=M. S. Lye|author4=F. G. L. Ong|author5=Sherif R. Zaki|author6=James P. Alexander|author7=K. K. Ho|author8=Linda L. Han|author9=Mark A. Pallansch|author10=Abu Bakar Suleiman|author11=M. Jegathesan|author12=Larry J. Anderson|journal=Clinical Infectious Diseases|volume=31|issue=3|pages=678–683|via=[[Oxford Academic]]|year=2000|doi=10.1086/314032|pmid=11017815|doi-access=free}}</ref><ref>{{cite book|author=Academy of Medicine (Singapore)|title=Annals of the Academy of Medicine, Singapore|url=https://books.google.com/books?id=dPlNAQAAIAAJ|year=2003|publisher=Academy of Medicine.|page=385|quote=In April 1997, in Sarawak, Malaysia, 600 cases of HFMD were admitted and over 30 children died.}}</ref><ref>{{cite journal|url=http://eprints.um.edu.my/7327/1/Enterovirus_71_in_Malaysia-_A_decade_later.pdf|title=Enterovirus 71 in Malaysia: A decade later|author1=Yoke Fun-Chan|author2=I-Ching Sam|author3=Kai-Li Wee|author4=Sazaly Abu Bakar|journal=Neurology Asia|via=[[University of Malaya]]|year=2011|access-date=August 29, 2019|volume=16|number=1|archive-url=https://web.archive.org/web/20190829040819/http://eprints.um.edu.my/7327/1/Enterovirus_71_in_Malaysia-_A_decade_later.pdf|archive-date=August 29, 2019|url-status=live}}</ref><ref>{{cite journal|url=http://eprints.utm.my/id/eprint/78873/1/NurNajihahHasanMFGHT2017.pdf|title=Assessing the Prevalence of Hand, Foot and Mouth Disease (HFMD) Using Geospatial Density and Distribution Techniques|author=Nur Najihah Hasan|journal=Faculty of Geoinformation and Real Estate|via=[[Universiti Teknologi Malaysia]]|year=2017|access-date=August 29, 2019|pages=2–3 [18–35]|archive-url=https://web.archive.org/web/20190829025807/http://eprints.utm.my/id/eprint/78873/1/NurNajihahHasanMFGHT2017.pdf|archive-date=August 29, 2019|url-status=live}}</ref>
* In 1998, there was an outbreak in [[Taiwan]], affecting mainly children.<ref>{{Cite journal |author=Centers for Disease Control and Prevention (CDC) |title=Deaths among children during an outbreak of hand, foot, and mouth disease—Taiwan, Republic of China, April–July 1998 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=47 |issue=30 |pages=629–32 |year=1998 |pmid=9704628 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/00054640.htm |url-status=live |archive-url=https://web.archive.org/web/20080726222228/http://www.cdc.gov/mmwr/preview/mmwrhtml/00054640.htm |archive-date=July 26, 2008  }}</ref> There were 405 severe complications, and 78 children died.<ref name=Ho>{{Cite journal |vauthors=Ho M, Chen ER, Hsu KH, etal |title=An epidemic of enterovirus 71 infection in Taiwan. Taiwan Enterovirus Epidemic Working Group |journal=N. Engl. J. Med. |volume=341 |issue=13|pages=929–35 |year=1999 |pmid=10498487 |doi= 10.1056/NEJM199909233411301|doi-access=free }}</ref> The total number of cases in that epidemic is estimated to have been 1.5&nbsp;million.<ref name="Repass2014"/>
* In 2008 an outbreak in China, beginning in March in [[Fuyang, Anhui]], led to 25,000 infections, and 42 deaths, by May 13.<ref name="Repass2014"/> Similar outbreaks were reported in Singapore (more than 2,600 cases as of April 20, 2008),<ref name="Nur">{{Cite news|last=Suhaimi|first=Nur Dianah|title=HFMD: 1,000 cases a week is unusual, says doc|location=Singapore|publisher=The Sunday Times (Straits Times)|date=April 20, 2008|pages=1–2}}</ref> Vietnam (2,300 cases, 11 deaths),<ref>[http://vietnamnews.vnagency.com.vn/showarticle.php?num=01HEA150508 Viet Nam News: HFMD cases prompt tighter health screening at airport] {{webarchive|url=https://web.archive.org/web/20090213070442/http://vietnamnews.vnagency.com.vn/showarticle.php?num=01HEA150508 |date=February 13, 2009 }}(accessed May 15, 2008)</ref> Mongolia (1,600 cases),<ref>[http://ubpost.mongolnews.mn/index.php?option=com_content&task=view&id=1847&Itemid=1 EV-71 Virus Continues Dramatic Rise] {{webarchive|url=https://web.archive.org/web/20081021100614/http://ubpost.mongolnews.mn/index.php?option=com_content&task=view&id=1847&Itemid=1 |date=October 21, 2008 }} (accessed May 23, 2008)</ref> and Brunei (1,053 cases from June–August 2008).<ref>{{cite news |url=http://www.bt.com.bn/home_news/2008/11/07/1_053_hfmd_cases_recorded |title=1,053 HFD cases recorded |author=Bandar Seri Begawan |date=November 7, 2008 |newspaper=The Birmingham News |access-date=May 11, 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120722220853/http://www.bt.com.bn/home_news/2008/11/07/1_053_hfmd_cases_recorded |archive-date=July 22, 2012  }}</ref>
* In 2009 17 children died in an outbreak during March and April 2009 in China's eastern [[Shandong Province]], and 18 children died in the neighboring [[Henan Province]].<ref>{{Cite news | title=Hand-foot-mouth disease death toll rises to 17 in East China's Shandong Province | date=April 9, 2009 | work=China View | url=http://news.xinhuanet.com/english/2009-04/09/content_11159556.htm | access-date=September 29, 2009 | url-status=dead | archive-url=https://web.archive.org/web/20090413063806/http://news.xinhuanet.com/english/2009-04/09/content_11159556.htm | archive-date=April 13, 2009 | df=mdy-all }}</ref> Out of 115,000 reported cases in China from January to April, 773 were severe and 50 were fatal.<ref>{{Cite news | title=Health Ministry: Hand-foot-mouth disease claims 50 lives this year | date=April 10, 2009 | work=China View | url=http://news.xinhuanet.com/english/2009-04/10/content_11165126.htm | access-date=September 29, 2009 | url-status=dead | archive-url=https://web.archive.org/web/20090415093929/http://news.xinhuanet.com/english/2009-04/10/content_11165126.htm | archive-date=April 15, 2009 | df=mdy-all }}</ref>
* In 2010 in China, an outbreak occurred in southern China's Guangxi Autonomous Region as well as Guangdong, Henan, Hebei, and Shandong provinces. Until March, 70,756 children were infected and 40 died from the disease. By June, the peak season for the disease, 537 had died.<ref>{{cite web |url=http://news.xinhuanet.com/english2010/china/2010-06/24/c_13367598.htm |title=China reports 537 deaths from hand-foot-mouth disease this year |access-date=December 2, 2011 |url-status=dead |archive-url=https://web.archive.org/web/20110501194633/http://news.xinhuanet.com/english2010/china/2010-06/24/c_13367598.htm |archive-date=May 1, 2011  }}</ref>
* The [[World Health Organization]] reporting between January and October 2011 (1,340,259) states the number of cases in China had dropped by approx 300,000 from 2010 (1,654,866) cases, with new cases peaking in June. There were 437 deaths, down from 2010 (537 deaths).<ref>{{cite web |url=http://english.peopledaily.com.cn/90001/90782/90880/7039439.html |title=China reports 537 deaths from hand-foot-mouth disease this year |year=2010 |publisher=People's Daily Online |access-date=October 16, 2013 |url-status=live |archive-url=https://web.archive.org/web/20131017081837/http://english.peopledaily.com.cn/90001/90782/90880/7039439.html |archive-date=October 17, 2013  }}</ref>
* In December 2011, the [[California Department of Public Health]] identified a strong form of the virus, coxsackievirus A6 (CVA6), where nail loss in children is common.<ref>{{cite web|url=http://www.cdph.ca.gov/programs/cder/Pages/CVA6.aspx|title=Coxsackievirus A6 (CVA6)|year=2013|publisher=California Department of Public Health|access-date=October 16, 2013|url-status=dead|archive-url=https://web.archive.org/web/20131017090918/http://www.cdph.ca.gov/programs/cder/Pages/CVA6.aspx|archive-date=October 17, 2013}}</ref>
* In 2012 in [[Alabama]], United States there was an outbreak of an unusual type of the disease. It occurred in a season when it is not usually seen and affected teenagers and older adults.  There were some hospitalizations due to the disease but no reported deaths.<ref>{{cite news|url=http://blog.al.com/spotnews/2012/02/outbreak_of_hand_foot_and_mout.html|title=Outbreak of hand, foot and mouth disease severe in Alabama|author=Hannah Wolfson|date=February 13, 2012|newspaper=The Birmingham News|access-date=May 11, 2012|url-status=live|archive-url=https://web.archive.org/web/20120304001524/http://blog.al.com/spotnews/2012/02/outbreak_of_hand_foot_and_mout.html|archive-date=March 4, 2012}}</ref>
* In 2012 in [[Cambodia]], 52 of 59 reviewed cases of children reportedly<ref>{{cite web|url=http://www.wpro.who.int/cambodiaPRdisease.pdf|title=Joint Press Release Between The Ministry of Health Kingdom of Cambodia and the World Health Organization|author=CBS News Staff|year=2012|publisher=CBS News|access-date=October 16, 2013|url-status=live|archive-url=https://web.archive.org/web/20131017073643/http://www.wpro.who.int/cambodiaPRdisease.pdf|archive-date=October 17, 2013}}</ref> dead ({{as of|2012|July|9|lc=y|df=US}}) due to a mysterious disease were diagnosed to be caused by a virulent form of HFMD.<ref>{{cite web|url=https://www.cbsnews.com/news/mysterious-deadly-illness-in-cambodian-children-tied-to-hand-foot-and-mouth-disease/|title=Mysterious deadly illness in Cambodian children tied to hand, foot and mouth disease|year=2012|work=Hand, Foot and Mouth Disease|publisher=World Health Organization|access-date=June 7, 2022|url-status=live|archive-url=https://web.archive.org/web/20130603011518/http://www.cbsnews.com/8301-504763_162-57468483-10391704/mysterious-deadly-illness-in-cambodian-children-tied-to-hand-foot-and-mouth-disease/|archive-date=June 3, 2013}}</ref> Although a significant degree of uncertainty exists with reference to the diagnosis, the WHO report states, "Based on the latest laboratory results, a significant proportion of the samples tested positive for enterovirus 71 (EV-71), which causes hand foot and mouth disease (HFMD). The EV-71 virus has been known to generally cause severe complications amongst some patients."<ref>{{cite web|url=https://www.who.int/csr/don/2012_07_09/en/index.html|title=Global Alert and Response (GAR)|year=2012|work=Undiagnosed illness in Cambodia-update|publisher=World Health Organization|access-date=October 16, 2013|url-status=dead|archive-url=https://web.archive.org/web/20131017073810/http://www.who.int/csr/don/2012_07_09/en/index.html|archive-date=October 17, 2013}}</ref>
* HFMD infected 1,520,274 people with up to 431 deaths reported at the end of July in 2012 in China.<ref>{{cite web |url=http://www.wpro.who.int/emerging_diseases/HFMD/en/index.html |title=Emerging disease surveillance and response |year=2013 |work=Hand, Foot and Mouth Disease |publisher=World Health Organization |access-date=October 16, 2013 |url-status=dead |archive-url=https://web.archive.org/web/20131017073800/http://www.wpro.who.int/emerging_diseases/HFMD/en/index.html |archive-date=October 17, 2013  }}</ref>
* In 2018, more than 50,000 cases occurred through a [[2018 Malaysia HFMD outbreak|nationwide outbreak]] in Malaysia with two deaths also reported.<ref>{{cite web|url=https://www.thestar.com.my/news/nation/2018/08/16/over-50000-cases-of-hfmd-recorded-virus-strain-relatively-benign|title=Over 50,000 cases of HFMD recorded, virus strain relatively benign|author1=Martin Carvalho|author2=Hemananthani Sivanandam|author3=Rahimy Rahim|author4=Loshana K Shagar|work=The Star|date=August 16, 2018|access-date=August 29, 2019|quote=Over 50,000 cases of hand, foot and mouth disease (HFMD) stemming from the Coxsackie virus have been reported since the outbreak of the disease.}}</ref><ref>{{cite web|url=https://says.com/my/news/hfmd-claimed-its-first-victim-as-two-year-old-died-from-the-virus|title=A 2-Year-Old Boy In Sarawak Suffering From HFMD Has Died|author=Katrina Khairul Azman|publisher=Says.com|date=July 29, 2018|access-date=August 29, 2019|archive-url=https://web.archive.org/web/20190829030802/https://says.com/my/news/hfmd-claimed-its-first-victim-as-two-year-old-died-from-the-virus|archive-date=August 29, 2019|url-status=live}}</ref><ref>{{cite web|url=https://www.thestar.com.my/news/nation/2018/07/30/17monthold-boys-death-in-penang-due-to-hfmd|title=17-month-old boy's death in Penang due to HFMD|work=The Star|date=July 30, 2018|access-date=August 29, 2019}}</ref>

=== India 2022 <span class="anchor" id="Tomato fever"></span>===
<!-- 
Please do not remove anchor, used for redirect from [[Tomato fever]]
-->An outbreak of an illness referred to as ''tomato fever'' or ''tomato flu'' was identified in the [[Kollam district]] on May 6, 2022.<ref name=Chavda2022>{{cite journal |vauthors=Chavda VP, Patel K, Apostolopoulos V |title=Tomato flu outbreak in India |journal=Lancet Respir Med  |date=August 2022 |volume=11 |issue=1 |pages=e1–e2 |pmid=35987204 |doi=10.1016/S2213-2600(22)00300-9 |pmc=9385198 }}</ref> The illness is endemic to [[Kerala]], India and gets its name because of the red and round [[blister]]s it causes, which look like [[tomato]]es.<ref name=Chavda2022/> The disease may be a new variant of the viral HFMD or an effect of [[chikungunya]] or [[dengue fever]].<ref name=Chavda2022/><ref name=NIE>{{Cite web |title=It's not tomato flu, fever caused by HFMD virus variant: Health Secy Radhakrishnan |url=https://www.newindianexpress.com/states/tamil-nadu/2022/may/14/its-not-tomato-flu-fever-caused-by-hfmd-virus-variant-health-secy-radhakrishnan-2453387.html |access-date=June 16, 2022 |website=[[The New Indian Express]]|date = May 14, 2022}}</ref><ref>{{Cite web |date=May 11, 2022 |title=Tomato flu in Kerala: No need to panic, authorities instructed to be vigilant |url=https://www.livemint.com/news/india/tomato-flu-in-kerala-no-need-to-panic-authorities-instructed-to-be-vigilant-minister-says-11652286503501.html |access-date=June 30, 2022 |website=livemint.com}}</ref> ''Flu'' may be a misnomer.<ref name= NIE/><ref>{{Cite web |title=Tomato fever or HFMD virus in Kerala? Know causes, and symptoms of HFMD |url=https://zeenews.india.com/india/tomato-fever-or-hfmd-virus-in-kerala-know-causes-and-symptoms-of-head-foot-and-mouth-disease-2463642.html |access-date=June 16, 2022 |website=Zee News |date= May 15, 2022}}</ref>

The condition mainly affects children under the age of five.<ref name=Chavda2022/><ref>{{cite journal |vauthors=Thiagarajan K |title=Reports of "tomato flu" outbreak in India are not due to new virus, say doctors |journal=BMJ |volume=378 |pages=o2101 |date=August 2022 |pmid=36028244 |doi=10.1136/bmj.o2101 |s2cid=251814659 |url=https://www.bmj.com/content/378/bmj.o2101.long}}</ref> An article in ''[[The Lancet]]'' states that the appearance of the blisters is similar to that seen in [[Mpox]], and the illness is not thought to be related to [[SARS-CoV-2]].<ref name= Chavda2022/> Symptoms, treatment and prevention are similar to HFMD.<ref name= Chavda2022/>

==History==
HFMD cases were first described clinically in Canada and New Zealand in 1957.<ref name="Sar2013">{{cite journal|last1=Wang|first1=Jing|date=August 21, 2017|title=Epidemiological characteristics of hand, foot, and mouth disease in Shandong, China, 2009–2016|journal=Scientific Reports|volume=7|issue=8900|pages=8900|doi=10.1038/s41598-017-09196-z|pmid=28827733|pmc=5567189|bibcode=2017NatSR...7.8900W}}</ref> The disease was termed "Hand Foot and Mouth Disease", by [[Thomas Henry Flewett]], after a similar outbreak in 1960.<ref name="pmid13682692">{{cite journal |vauthors=Alsop J, Flewett TH, Foster JR |title="Hand-foot-and-mouth disease" in Birmingham in 1959 |journal=British Medical Journal |volume=2 |issue=5214 |pages=1708–11 |date=December 1960 |pmid=13682692 |pmc=2098292 |doi= 10.1136/bmj.2.5214.1708}}</ref><ref name="pmid13945538">{{cite journal |vauthors=Flewett TH, Warin RP, Clarke SK |title='Hand, foot, and mouth disease' associated with Coxsackie A5 virus |journal=Journal of Clinical Pathology |volume=16 |pages=53–5 |date=January 1963 |issue=1 |pmid=13945538 |pmc=480485 |doi= 10.1136/jcp.16.1.53}}</ref>

==Research==
Novel antiviral agents to prevent and treat infection with the viruses responsible for HFMD are currently under development. Preliminary studies have shown inhibitors of the EV-71 [[viral capsid]] to have potent antiviral activity.<ref name=Pour2014/>

== References ==
{{Reflist}}

== External links ==
{{Medical condition classification and resources
|  DiseasesDB     = 5622
|  ICD10          = {{ICD10|B|08|4|b|00}}
|  ICD9           = {{ICD9|074.3}}
|  ICDO           =
|  OMIM           =
|  MedlinePlus    = 000965
|  eMedicineSubj  = derm
|  eMedicineTopic = 175
|  MeshID         = D006232
}}
* {{commons category-inline|Hand, foot and mouth disease}}
* {{Wikinews-inline|Highly contagious Hand, foot and mouth disease killing China's children}}

{{Viral cutaneous conditions}}
{{Oral pathology}}

{{Authority control}}

{{DEFAULTSORT:Hand, Foot And Mouth Disease}}
[[Category:Enterovirus-associated diseases]]
[[Category:Oral mucosal pathology]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Wikipedia emergency medicine articles ready to translate]]
[[Category:Virus-related cutaneous conditions]]