Hand, foot, and mouth disease

Template:Short description Template:About Template:Distinguish Template:Use mdy dates Template:Infobox medical condition (new) Hand, foot, and mouth disease (HFMD) is a common infection caused by a group of enteroviruses.<ref name=CDC2015Sym/> It typically begins with a fever and feeling generally unwell.<ref name=CDC2015Sym/> This is followed a day or two later by flat discolored spots or bumps that may blister, on the hands, feet and mouth and occasionally buttocks and groin.<ref name=Kam2013>Template:Cite journal</ref><ref name=Lancet2010>Template:Cite journal</ref><ref name=Fry2003>Template:Cite journal</ref> Signs and symptoms normally appear 3–6 days after exposure to the virus.<ref name=Hoy2012>Template:Cite journal</ref> The rash generally resolves on its own in about a week.<ref name="Harrison's"/>

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>Template:Cite web</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>Template:Cite journal</ref><ref name=PLOS2012>Template:Cite journal</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>Template:Cite web</ref>

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">Template:Cite book</ref> No antiviral medication or vaccine is available, but development efforts are underway.<ref name=Pour2014>Template:Cite journal</ref><ref>Template:Cite journal</ref> For fever and for painful mouth sores, over-the-counter pain medications such as ibuprofen may be used, though aspirin should be avoided in children.<ref name="CDC2015Tx">Template:Cite web</ref> The illness is usually not serious. Occasionally, intravenous fluids are given to children who are dehydrated.<ref>Template:Cite web</ref> Very rarely, viral meningitis or encephalitis may complicate the disease.<ref name="CDC2015Comp">Template:Cite web</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" />

HFMD occurs in all areas of the world.<ref name=CDC2015Epi/> It often occurs in small 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>Template:Cite web</ref> Typically it occurs in children less than five years old but can occasionally occur in adults.<ref name=Kam2013/><ref name=CDC2015Sym>Template:Cite web</ref> HFMD should not be confused with foot-and-mouth disease (also known as hoof-and-mouth disease), which mostly affects livestock.<ref>Template:Cite web</ref>

Signs and symptoms

Common constitutional signs and symptoms of HFMD include fever, nausea, vomiting, feeling tired, generalized discomfort, loss of appetite, and irritability in infants and toddlers. Skin lesions frequently develop in the form of a rash of flat discolored spots and bumps which may be followed by vesicular sores with blisters on palms of the hands, soles of the feet, buttocks, and sometimes on the lips.<ref name="Huang1999">Template:Cite journal</ref> The rash is rarely itchy for children,<ref name=Hoy2012/> but can be extremely itchy for adults. Painful facial ulcers, blisters, or lesions may also develop in or around the nose or mouth.<ref name=Kam2013/><ref name=Sar2013/><ref name='HFMD Symptoms'>Template:Cite web</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>Template:Cite web</ref>

• Rash on palms of the hands
  Rash on palms of the hands
• Rash on hands and feet of a 36-year-old man
  Rash on hands and feet of a 36-year-old man
• Rash on the soles of a child's feet
  Rash on the soles of a child's feet

Cause

The viruses that cause the disease are of the Picornaviridae family. Coxsackievirus A16 is the most common cause of HFMD.<ref name=Repass2014/> 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 nasopharyngeal secretions such as saliva or nasal mucus, by direct contact, or by 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>Template:Cite journal</ref>

Prevention

Preventive measures include avoiding direct contact with infected individuals (including keeping infected children home from school), proper cleaning of shared utensils, disinfecting 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">Template:Cite web</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 EV71 vaccine is available to prevent HFMD in China Template:As of.<ref>Template:Cite journal</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 medications. Infection in older children, adolescents, and adults is typically mild and lasts approximately 1 week, but may occasionally run a longer course. Fever reducers can help decrease body temperature.Template:Cn

A minority of individuals with hand, foot, and mouth disease may require hospital admission due to complications such as inflammation of the brain, inflammation of the meninges, or acute flaccid paralysis.<ref name="PLOS2012" /> Non-neurologic complications such as inflammation of the heart, fluid in the lungs, or 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, 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/>

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>Template:Cite web</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">Template:Cite web</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>Template:Cite journal</ref> HFMD is more common in rural areas than urban areas; however, socioeconomic status and hygiene levels need to be considered.<ref>Template:Cite journal</ref> Poor hygiene is a risk factor for HFMD.<ref>Template:Cite news</ref>Template:Better source needed

Outbreaks

• In 1997, an outbreak occurred in Sarawak, Malaysia with 600 cases and over 30 children died.<ref>Template:Cite journal</ref><ref>Template:Cite book</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>
• In 1998, there was an outbreak in Taiwan, affecting mainly children.<ref>Template:Cite journal</ref> There were 405 severe complications, and 78 children died.<ref name=Ho>Template:Cite journal</ref> The total number of cases in that epidemic is estimated to have been 1.5 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">Template:Cite news</ref> Vietnam (2,300 cases, 11 deaths),<ref>Viet Nam News: HFMD cases prompt tighter health screening at airport Template:Webarchive(accessed May 15, 2008)</ref> Mongolia (1,600 cases),<ref>EV-71 Virus Continues Dramatic Rise Template:Webarchive (accessed May 23, 2008)</ref> and Brunei (1,053 cases from June–August 2008).<ref>Template:Cite news</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>Template:Cite news</ref> Out of 115,000 reported cases in China from January to April, 773 were severe and 50 were fatal.<ref>Template:Cite news</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>Template:Cite web</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>Template:Cite web</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>Template:Cite web</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>Template:Cite news</ref>
• In 2012 in Cambodia, 52 of 59 reviewed cases of children reportedly<ref>Template:Cite web</ref> dead (Template:As of) due to a mysterious disease were diagnosed to be caused by a virulent form of HFMD.<ref>Template:Cite web</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>Template:Cite web</ref>
• HFMD infected 1,520,274 people with up to 431 deaths reported at the end of July in 2012 in China.<ref>Template:Cite web</ref>
• In 2018, more than 50,000 cases occurred through a nationwide outbreak in Malaysia with two deaths also reported.<ref>Template:Cite web</ref><ref>Template:Cite web</ref><ref>Template:Cite web</ref>

India 2022

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>Template:Cite journal</ref> The illness is endemic to Kerala, India and gets its name because of the red and round blisters it causes, which look like tomatoes.<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>Template:Cite web</ref><ref>Template:Cite web</ref> Flu may be a misnomer.<ref name= NIE/><ref>Template:Cite web</ref>

The condition mainly affects children under the age of five.<ref name=Chavda2022/><ref>Template:Cite journal</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">Template:Cite journal</ref> The disease was termed "Hand Foot and Mouth Disease", by Thomas Henry Flewett, after a similar outbreak in 1960.<ref name="pmid13682692">Template:Cite journal</ref><ref name="pmid13945538">Template:Cite journal</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/>

External links

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