Is Hand, Foot, and Mouth Disease (HFMD) Contagious?

Multiple, discrete, small, vesicular lesions on the fingers and palms; similar lesions were also present on the feet.

Hand, foot, and mouth disease are caused by viruses called enteroviruses. Many different types of these viruses can cause the disease, but in the U.S., the most common cause is Coxsackievirus A16.

• The disease is called hand, foot, and mouth disease because a few days after the individual develops symptoms of a fever, reduced appetite, sore throat, and feeling weak, painful sores can develop on the palms of the hands, on the soles of the feet, and in the mouth.
• Some individuals may also develop sores on the knees, elbows, buttocks, and genital area.
• The sores can blister and ulcerate.
• HFMD is highly contagious.
• The disease is common and usually affects infants and children under 5 years of age (although it is possible for adults to get the disease).

Hand, foot, and mouth disease is highly contagious. It is easily spread by nose and throat secretions (nasal mucus, saliva, kissing, for example). For children, it is common to transmit the disease by the fecal-oral route. In addition, these viruses can be transmitted in contaminated droplets developed during sneezing or coughing. If the droplets land on objects, uninfected people can be contaminated if they pick up the object and then put their hands in their mouths or touch their faces. A person may be contagious before symptoms develop and are most contagious during the first week of illness. However, some individuals can be contagious for weeks after symptoms and signs remit. Some people, especially adults, develop no symptoms but still can be contagious.

The incubation period (time from initial exposure to development of symptoms) for HFMD ranges from about three to six days. Fever is usually the first or early symptom.

• Individuals with HFMD can be contagious during the incubation period (about three to six days) before symptoms develop and may remain contagious for days or weeks after the symptoms and signs abate.
• Even people with mild or no symptoms and signs during infection can be contagious.
• People are most contagious during the first week after symptoms and signs develop.

In general, HFMD is diagnosed by the characteristic symptoms and signs of sores on the hands, feet, and mouth, along with the patient's history, age, and probability of association with a child or other person with the disease.

If the patient has a severe HFMD, throat and stool samples for viral cultures can be used to identify the viral strain causing the disease. This test may diagnose the disease definitively and provide physicians with evidence of an outbreak in their area.

HFMD is spread by nose and throat secretions, blisters or ulcers, and feces. In addition, kissing, mucosal contact, and touching objects like toys or other items that have had contact with infected body fluids may spread HFMD. Occasionally, some individuals may get the disease from droplets that are spread in the air.

Child care businesses often have outbreaks of this disease. In small wading pools that are inadequately chlorinated, children may transmit the disease to others (both children and adults) usually by fecal contamination of the pool water.

After symptoms develop for HFMD, it takes about five to seven days for the symptoms to resolve. Although the individual is cured of HFMD when symptoms and signs stop, the individual may still shed viruses for a week or so.

There are many viruses that cause HFMD. Resolution of one infection may not protect against subsequent different viral types that can cause HFMD; consequently, a person can get the disease again. However, as children get older, they are less likely to get HFMD.

For most children and adults, HFMD is a self-limiting disease that resolves with no therapy and does not require treatment by a medical caregiver. However, if symptoms and signs become severe and especially if the individual becomes dehydrated (poor fluid intake, dry mucous membranes, and little or no urination) and/or is not acting normally, a medical caregiver should be contacted urgently or the individual should be seen at an emergency department.

Although there is no evidence that HFMD in a pregnant woman affects the fetus, the disease may be transferred to the neonate if the woman has HFMD at delivery. Pregnant women should contact their OB/GYN physician if they suspect they have HFMD during pregnancy.