Hand, foot and mouth disease is on the rise in certain areas. A doctor explains symptoms and treatment

By Katia Hetter, CNN

(CNN) — Health officials in the mid-Atlantic region have recently reported a rise in hand, foot and mouth disease, or HFMD.

There were 197 emergency department visits related to the disease in September, primarily among children younger than 5, according to the District of Columbia Health Department. The Virginia Department of Health is also reporting significant increases in emergency department and urgent care visits for hand, foot and mouth disease. Compared with previous years, in Virginia and West Virginia, there has been a notable increase in reported outbreaks, with schools and day care centers accounting for the majority of outbreaks.

What is hand, foot and mouth disease, and what causes it? How is it spread? What are the symptoms, and how long do they last? Can adults also get it? How is it diagnosed and treated? Should parents keep children home from school or day care when they have it? What steps can families take to help prevent infection?

To help us answer these questions, I spoke with CNN wellness expert Dr. Leana Wen. Wen is an emergency physician and clinical associate professor at the George Washington University. She previously served as Baltimore’s health commissioner.

CNN: What is hand, foot and mouth disease?

Dr. Leana Wen: Hand, foot and mouth disease is a highly contagious viral illness that primarily affects infants and young children. It’s caused by a group of viruses known as enteroviruses, most commonly coxsackievirus A16. It is not the same as foot-and-mouth disease, which affects farm animals like cattle, sheep, pigs and goats and does not infect humans.

Hand, foot and mouth disease gets its name from the small blister-like sores it causes on the hands and feet and inside the mouth. While the illness can be uncomfortable, it is generally mild and resolves on its own.

CNN: How is it spread, and who is most at risk?

Wen: Hand, foot and mouth disease spreads very easily through close personal contact and contaminated surfaces. A person can become infected after being exposed to droplets released when someone with the illness coughs, sneezes or talks. It can also spread through touching an infected person, such as during hugging, kissing, or sharing cups and utensils.
The virus is present in stool as well, so changing diapers or helping a sick child in the bathroom can lead to infection if hands aren’t washed thoroughly.

It can also spread when someone touches objects or surfaces like toys or doorknobs that have the virus on them, and then touches their eyes, nose or mouth. Rarely, people can become infected by swallowing contaminated recreational water, such as from a pool that hasn’t been properly treated.

Young children are most at risk because their immune systems are still developing, and they are more likely to struggle with personal hygiene and share toys and have close contact with others.

CNN: What are the symptoms, and how long do they last?

Wen: The first sign of the disease is usually a fever, followed by a sore throat and a general feeling of being unwell. These flu-like symptoms typically start three to five days after catching the virus. A day or two later, small painful spots can develop inside the mouth, often on the tongue, gums or inner cheeks. These spots can turn into tiny blisters or ulcers, making it uncomfortable for children to eat or drink.

Around the same time, a rash can appear on the hands and feet, and sometimes on the buttocks, legs or arms. The rash may look like flat red spots or small bumps that can form blisters, but it typically doesn’t itch.
Some children have the mouth sores without the rash, while others have the rash without any sores.

Most cases are mild and clear up on their own in about a week to 10 days. During that time, it’s important to keep children well hydrated, since mouth pain can make them less willing to drink fluids.

CNN: Can adults also get it?

Wen: Yes, although it’s much more common in young children. Because most people are first exposed during childhood, adults often have some immunity. Still, anyone who hasn’t been infected before or whose immune system is weakened can catch it through close contact with someone who is sick.

When teenagers or adults do get hand, foot and mouth disease, symptoms are usually mild or may not appear at all. Some adults may have only a sore throat or mild rash without the typical mouth sores or blisters. However, they can still spread the virus to others, including young children.

CNN: How is hand, foot and mouth disease diagnosed and treated?

Wen: Health care providers usually diagnose the disease based on the characteristic symptoms and recent exposure to other sick children. A physical exam is typically enough to confirm the diagnosis. In rare cases, if the illness looks unusual or severe, the clinician may collect a throat swab or stool sample to test for the specific virus.

There is no specific medicine that cures hand, foot and mouth disease. Because it’s caused by a virus, antibiotics do not help. Treatment focuses on relieving symptoms. Over-the-counter pain relievers such as acetaminophen or ibuprofen can reduce fever and mouth pain, and cool, soft foods or cold drinks can make eating and drinking more comfortable.

Staying hydrated is the most important part of care, since mouth sores can make swallowing painful and dehydration can develop quickly in young children. Most cases clear up on their own without complications, but parents should contact a doctor if a child cannot keep fluids down, has a high fever lasting more than a few days or seems unusually drowsy or irritable.

CNN: Should parents keep children home from school or day care?

Wen: Because hand, foot and mouth disease tends to be mild, children don’t need to stay home for the entire illness. The guidance from the US Centers for Disease Control and Prevention is that they can return to school or day care once they no longer have a fever, feel well enough to take part in normal activities, and can manage any mouth sores without excessive drooling.

Parents should also check with their school or day care, since specific policies may vary. The CDC cautions that in some situations, such as during an outbreak, the local health department may ask families to keep affected children home temporarily to help limit further spread.

CNN: Are there steps families can take to help prevent infection?

Wen: Yes. Regular and thorough handwashing is one of the most effective protective measures. Wash hands with soap and water for at least 20 seconds, especially after using the toilet or changing a diaper, before preparing or eating food, and after blowing the nose or coughing.

Covering coughs and sneezes, ideally using a disposable tissue or the crook of the elbow, can help stop the spread of virus-laden droplets. Clean and disinfect frequently touched surfaces and objects. And people should also avoid close personal contact with infected individuals. This means no sharing of drinks, utensils, toothbrushes or towels, and keeping hugs or kisses to a minimum if someone is ill.

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