Hand, Foot and Mouth Understanding this common viral infection in kids and adults

Hand, foot and mouth disease is one of those illnesses that we’ve probably heard, but may not be sure what it really is. We just know we do NOT want it brought into our homes. In recent months, it became more widely talked about, partly due to news coverage of a fall semester outbreak of the illness on the Johns Hopkins University campus in Baltimore. So what is hand, foot and mouth?

Here, Dr. Julie King, from Pavilion Pediatrics at Green Spring Station, and Dr. Roanna Kessler, director of the Student Health and Wellness Center at Johns Hopkins University, help give us the lowdown on HFMD.

What Is It? Well, for one thing, it’s not just one thing.

“A misconception is that it is a single entity, but it is actually lots of different strains of viruses,” King says. It is an infection caused by an enterovirus, coxsackievirus being the most common. “Hand, foot and mouth sounds like an old-fashioned ailment that we wouldn’t have to deal with in modern days, but it really is just referring to the symptoms,” King explains. “And it sounds contagious, what with all the body parts in the very name.”

It is usually a relatively tame condition, but different strains and different folks’ responses can create different woes.  A test for the virus does exist, but most often healthcare providers diagnose the illness by simply doing an exam and hearing about the symptoms.

What Are The Symptoms?

“Not all symptoms strike all people who contract the virus,” King says. Symptoms may include a non-itchy rash of red bumps or blisters on the skin, commonly but not exclusively on the palms of hands and soles of feet; sore throat; sores on the tongue, gums, inside of cheeks, and in the back of the mouth; irritability and loss of appetite; and fever. “Sometimes, children and adults will also present with other viral symptoms, such as a runny nose and cough. For some, it is primarily an upper respiratory virus, while others have the rash and ulcers. Those ulcers can make it very uncomfortable to eat and drink,” King says.

How Does It Spread?

The viruses that cause HFMD can be transmitted in mucus, saliva, fluid from sores and stool. It is usually caught through close contact or sharing of contaminated items. “The virus is most contagious during the incubation period of typically three to six days,” King says. “It’s hard to know exactly, since the symptoms are caused by a variety of different viruses, but as in most cases of illness, we use fever within the last 24-hour period as our best proxy for determining contagiousness.” It may look worse than it is for a while longer. “There is a misconception that the rash is contagious,” King adds. “Day cares may say a child cannot attend while they have the rash, because of fear of spreading. But the rash itself is a just sign of the virus, and sometimes lingers a few weeks as it crusts over and disappears.”

How Is It Treated?

Since HFMD is caused by viruses, antibiotics are of no use in treating it. The infection itself usually goes away on its own within several days. During that time, however, you can help treat the specific symptoms that cause discomfort. Over-the-counter medications such as Tylenol and ibuprofen may be used for pain or fever, and oral rinses or numbing sprays may be effective for treating mouth pain.

“The key to weathering most any virus is staying well hydrated. Because there are often ulcers in the back of the mouth, this is usually the trickiest part,” King says. “We recommend encouraging fluids and soft, soothing foods such as yogurt, pudding and popsicles.” Because it is critical to maintain hydration to ride out the infection, in extreme cases in which the patient really cannot tolerate swallowing liquids, they could require IV fluids.

Who Is At Risk?

HFMD is more typically seen in young children, because most adults have been exposed to so many viruses over time that they aren’t affected. But then, a new strain comes along and anyone, of any age, can be vulnerable.

Parents should stay alert. “Just because your son or daughter had hand, foot and mouth as a child, they may not be protected from getting it again, since there are multiple strains of viruses,” Kessler says. “Best advice is to practice good hand hygiene and avoid sharing personal items.”

It most often strikes in late summer into the fall, but as with any virus, it can pop up any time, according to King.

“Winter vacations and family visits can bring new bugs into play,” she says. “Travel to and from new areas also brings an increase in viruses. Moves that suddenly expose people to whatever virus strain happened to be going around a new location means that exposed person is more likely to be susceptible.”

Novel Strains Bring New Twists

HFMD is often a tame ailment, but different versions may add risk. At JHU in the fall, students were likely affected by coxsackievirus A6, a strain that often results in more serious symptoms, which could include higher fever, wider distribution of rash or blisters on the body, peeling skin on hands and feet, nail damage and longer duration of illness.

The JHU Student Health Center treated 145 affected students. “The actual number of students could have been much larger (since they may not have sought medical attention, or gone elsewhere). It was the first time we saw that many cases in such a short span of time,” Kessler says. “We started to notice more students with HFMD than usual at the end of August. Many freshmen were affected. There was no particular pattern in terms of dorms or clubs.” In all, it took about two months for the outbreak to pass.

How Can It Be Prevented?

Hand washing is the number one answer. The most important thing you can do to prevent the spread of this infection is to clean your hands, often, with soap and water, especially after using the toilet. Keep living spaces sanitary; disinfect items and surfaces that are frequently touched and may harbor germs; use caution in close company — avoid kissing, hugging or sharing food or drinks with people who have the infection. And if you have a fever or open sores, stay home!

There is no vaccine, so it’s up to you to practice and promote good hygiene habits. Stay vigilant. HFMD doesn’t have to be a virus that keeps on giving.

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