Hand, foot and mouth disease (HFMD)

Hand, foot and mouth disease is an infectious disease. It most often affects children under the age of 10 (childhood illness) and usually goes away without any complications. It is typically an illness of the late summer and fall seasons. Major outbreaks occur mainly in Southeast Asia.

At a glance

  • Hand, foot and mouth disease is an infection with viruses known as enteroviruses, usually group A enteroviruses, EV-A. 
  • It is usually transmitted through direct contact (smear infection). 
  • It primarily affects infants and young children. 
  • The illness is normally mild and goes away without treatment. 
  • The main symptoms are a high temperature and rashes in the mouth and on hands and feet. 
  • There is no causative treatment against the virus and no vaccination.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Hand, foot and mouth disease: blister-type wounds on a child’s hands.

What is hand, foot and mouth disease?

Hand, foot and mouth disease is an infectious disease caused by group A enteroviruses. The sores and blisters on hands, feet and mouth are so typical that they have given the disease its name.  

It most often affects children under the age of 10 and is usually harmless. The infection may rarely affect adults. 

Important: Hand, foot and mouth disease is popularly often confused with foot and mouth disease found in cows, sheep and pigs. But these are two different diseases. 

What are the symptoms of hand, foot and mouth disease?

The illness usually starts with a high temperature and a sore throat. People also lose their appetite. One to two days after the onset of the fever, a painful rash with small red spots, blisters and often ulcers develops in the mouth, mainly affecting the tongue, gums and the lining of the mouth.

Die Symptome zeigen sich anfänglich mit Fieber und Halsschmerzen und darauf folgt ein schmerzhafter Ausschlag im Mund mit kleinen roten Flecken und Bläschen. An den Handflächen und Fußsohlen bildet sich ein typischer Ausschlag, der nicht juckt.

A typical, non-itchy rash appears on the skin around the mouth, on the surfaces of the hand and soles of the feet. It consists of flat or raised red spots, sometimes blisters also form.  

But in rare cases the illness can also appear in non-typical areas. The rash appears on the buttocks, genitals, on the knees or the elbows and can cause intense itching.

What causes hand, foot and mouth disease?

Hand, foot and mouth disease is caused by enteroviruses. The human enteroviruses that are relevant for humans are divided into groups A to D. Hand, foot and mouth disease is mainly caused by group A enteroviruses.

Enteroviral infections are very common. They can generally trigger various diseases. An infection is often without symptoms, meaning that people can also be infected by those who are healthy.

People are infected through direct contact with body fluids.

These include:

  • nose and throat secretions 
  • saliva 
  • fluid from the blisters of the rash 
  • stool
The incubation period is 3 to 5 days, up to a maximum of 10 days.

As well as kissing, the hands also play a role in spreading the virus. They pass the viruses directly to other people (smear infection). The infection can also be transmitted through contaminated objects such as door handles or pacifiers.

At the onset of the disease, droplets from people speaking can also be infectious.

Important: It takes 3 to 5 days, 10 at most, from infection to the outbreak of the disease (incubation period). The risk of contact persons being infected is particularly high in the first few days. But viruses can also be excreted through the stool when the symptoms have already disappeared. This can last up to 6 weeks after the onset of the illness. 

Is there a risk for pregnant women and new-born babies?

Pregnant women usually have enterovirus infections with mild symptoms, or no symptoms at all. In extremely rare cases, mothers who show symptoms of an enterovirus infection around the birth date and have not yet been able to form antibodies for defense can transmit the virus to the new-born baby. The disease is usually mild. Very rarely, the infection can spread throughout the new-born baby’s body. If organs such as the liver or heart are affected, the disease is life-threatening.

How many people are affected in Germany?

Since in Germany the disease does not have to be reported to the local health authorities, the prevalence can only be estimated. It is assumed that there are 80,000 to 140,000 people per year who develop the disease.

The peak of the disease is typically in late summer and fall.

How does hand, foot and mouth disease go on to develop?

The illness is usually mild. People with hand, foot and mouth disease recover within 7 to 10 days with no specific treatment. It is rare for people who have recovered from the disease to get infected a second time. 

Complications such as inflammation of the brain, meninges, motor nerve cells and heart are serious, but they are very rare.

How can people protect themselves from the disease?

The generally recommended hygiene measures such as regular handwashing or sneezing into the elbow (instead of the hand) protect against infection. Those with hand, foot and mouth disease should stay at home to prevent others from being infected. In particular, the aim here is to avoid spreading the pathogen in community facilities such as kindergartens.

There are no specific vaccines against the viruses that cause hand, foot and mouth disease. Vaccinations against individual viral strains are conceivable but it is unlikely that a universal enterovirus vaccine will be developed due to the diversity in the enterovirus family.

How is the diagnosis made?

Experienced doctors make the diagnosis by looking for the typical symptoms. If the illness is benign, no further examinations are required.

Severe cases require the virus to be detected in stool samples, throat swabs or the content of the blisters. Molecular genetic techniques are considered to be particularly fast and conclusive when it comes to the diagnosis.

How is hand, foot and mouth disease treated?

There is no specific therapy, i.e. one directly attacking the pathogen. But the symptoms can be treated, if necessary.

Anti-inflammatory medication can be used for particularly painful ulcers and blisters in the mouth and also with fever. These are intended to help people with hand, foot and mouth disease to drink enough despite painful mouth ulcers.

How can people protect themselves from getting infected?

Simply practicing good hygiene can make a big difference, especially frequent handwashing. Because close contact with a person with the disease should be avoided, special recommendations apply in community facilities such as kindergartens or schools. 

Measures at home 

All general hygiene measures are suitable.

These include:

  • regularly and carefully washing hands with soap, especially after changing diapers and going to the bathroom.
  • cleaning dirty surfaces and objects (including toys and door handles) thoroughly. 
  • avoiding close contact with people with the disease, for example kissing and hugging.
  • not sharing cutlery or crockery with people with the disease. 
  • using a personal towel.
Thorough handwashing, cleaning contaminated objects, avoiding physical contact with those affected, not sharing cutlery or crockery with those affected and using a personal towel are very important for preventing infection.

Measures in community facilities (kindergartens, schools)

  • The above hygiene measures apply here, too. 
  • Acutely ill people should stay at home to reduce the risk of infection. 
  • Children who no longer have any symptoms and whose rash blisters have healed up can go back to the childcare facility without a letter from their doctor.

Reviewed by the German Society for Pediatric Infectiology (Deutsche Gesellschaft für Pädiatrische Infektiologie e.V.).

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