Coxsackie viruses belong to a family of viruses called enteroviruses. These viruses live in the gastrointestinal tract, and are therefore present in feces. They can be spread easily from one person to another when poor hygiene allows the virus within the feces to be passed from person to person. After exposure to the virus, development of symptoms takes only four to six days. Hand-foot-and-mouth disease can occur year-round, although the largest number of cases are in summer and fall months.
An outbreak of hand-foot-and-mouth disease occurred in Singapore in 2000, with more than 1,000 diagnosed cases, all in children, resulting in four deaths. A smaller outbreak occurred in Malaysia in 2000. In 1998, a serious outbreak of enterovirus 71 in Taiwan resulted in more than one million cases of hand-footand-mouth disease. Of these, there were 405 severe cases and 78 deaths, 71 of which were children younger than five years of age.
Hand-foot-and-mouth should not be confused with foot and mouth disease, which infects cattle but is extremely rare in humans. An outbreak of foot and mouth disease swept through Great Britain and into other parts of Europe and South America in 2001.
Causes and symptoms
Hand-foot-and-mouth disease is very common among young children, and often occurs in clusters of children who are in daycare together. It is spread when poor hand-washing after a diaper change or contact with saliva (drool) allows the virus to be passed from one child to another.
Within about four to six days of acquiring the virus, an infected child may develop a relatively low-grade fever, ranging from 99–102°F (37.2–38.9°C). Other symptoms include fatigue, loss of energy, decreased appetite, and a sore sensation in the mouth that may interfere with feeding. After one to two days, fluid-filled bumps (vesicles) appear on the inside of the mouth, along the surface of the tongue, on the roof of the mouth, and on the insides of the cheeks. These are tiny blisters, about 3–7 mm in diameter. Eventually, they may appear on the palms of the hands and on the soles of the feet. Occasionally, these vesicles may occur in the diaper region.
The vesicles in the mouth cause the majority of discomfort, and the child may refuse to eat or drink due to pain. This phase usually lasts for an average of a week. As long as the bumps have clear fluid within them, the disease is at its most contagious. The fluid within the vesicles contains large quantities of the causative viruses. Extra care should be taken to avoid contact with this fluid.
Diagnosis is made by most practitioners solely on the basis of the unique appearance of blisters of the mouth, hands, and feet, in a child not appearing very ill.
There are no treatments available to cure or decrease the duration of the disease. Medications like aceta-
There are no effective alternative treatments for hand-foot-and-mouth disease.
The prognosis for a child with hand-foot-and-mouth disease is excellent. The child is usually completely better within about a week of the start of the illness.
Prevention involves careful attention to hygiene. Thorough, consistent hand-washing practices, and discouraging the sharing of clothes, towels, and stuffed toys are all helpful. Virus continues to be passed in the feces for several weeks after infection, so good hygiene should be practiced long after all signs of infection have passed.
Morag, Abraham, and Pearay L. Ogra. "Viral Infections." In Nelson Textbook of Pediatrics, 16th Edition, edited by Richard Behrman. Philadelphia: W.B. Saunders Co.,2000.
Ray, C. George. "Enteroviruses." In Sherris Medical Microbiology: An Introduction to Infectious Diseases, edited by Kenneth J. Ryan. Norwalk, CT: Appleton and Lange, 1994.
Stoffman, Phyllis. The Family Guide to Preventing and Treating 100 Infectious Diseases. New York: John Wiley and Sons, Inc., 1995.
Huerter, Christopher, et al. "Helpful Clues to Common Rashes." Patient Care 31, 8 (April 30, 1997): 9+.
No author. "New Tricks for an Old Enterovirus." Infectious Disease Alert (Dec. 15, 1999): 45.
Slavin, Kevin A. and Ilona J. Frieden. "Hand-Foot-And-Mouth Disease." Archives of Pediatrics & Adolescent Medicine (May 1998): 505-507.
Ken R. Wells
Rosalyn S. Carson-DeWitt, MD
Enteroviruses—Viruses which live in the gastrointestinal tract. Coxsackie viruses, viruses that cause hand-foot-mouth disease, are an enterovirus.
Vesicle—A bump on the skin filled with fluid.
minophen or ibuprofen may be helpful for decreasing pain, and allowing the child to eat and drink. It is important to try to encourage the child to take in adequate amounts of fluids, in the form of ice chips or popsicles if other foods or liquids are too uncomfortable.