Conditions Hand, foot and mouth disease

Hand, foot and mouth disease is a highly contagious infectious disease caused by different viruses.

Typical indicators of the viral infection are a skin rash consisting of red spots, as well as blisters on the hands, feet and mouth.

Hand, foot and mouth disease mainly affects children under the age of 10. Adults are rarely affected. The infection is usually harmless.

Hand, foot and mouth disease is not to be confused with foot and mouth disease found in animals. They are two different, entirely unrelated diseases.

Most people who become infected do not have any symptoms. This is the case with adults in particular.

If symptoms occur, the first signs of the disease are usually:

• fever
• sore throat
• low appetite

Typical symptoms

One to two days after the onset of the fever, a painful rash with small red spots and blisters develops in the mouth. These appear on the tongue, gums, and lining of the mouth and can also form small ulcers.

Around the same time, a non-itchy rash develops on the skin around the mouth, the surfaces of the hand and the soles of the feet. The rash consists of small red spots, which may be flat or raised. Blisters sometimes develop.

The rash remains for approximately 10 days. The blisters may burst. They then crust over and heal without leaving scars.

Other symptoms

In rare cases, a rash develops on the bottom, around the genitals, on the knees or on the elbows. In some cases, the rash can be very itchy.

Hand, foot and mouth disease is mainly caused by an infection with group A enteroviruses. The viruses are highly contagious and spread easily from person to person. It usually takes 3 to 10 days from infection to the onset of symptoms (incubation period).

How do people get infected with the viruses?

People are infected through direct contact with body fluids. These include:

• nose and throat secretions
• saliva
• fluid from the blisters of the rash
• stool

How are the viruses transmitted?

The main way in which the disease is spread is by people touching bodily fluids containing the virus with their hands and then touching their mouths with their hands. This type of infection by touch is known as “smear infection” and can also occur when people touch objects that are contaminated with viruses, such as door handles or baby’s pacifiers.

Transmission via saliva occurs, for example, when kissing. Transmission via stool (feces) can occur, for example, when changing a diaper.

At the beginning of the illness, it is also possible to become infected via small droplets that contain the virus and are produced when speaking, coughing, or sneezing (droplet transmission).

Hand, foot and mouth disease is not a notifiable disease in Germany. As a result, it is only possible to estimate its prevalence.

Typically, young children become ill. A health insurance fund survey conducted between 2005 and 2021 shows that in some years more than one in ten children aged 2 years old were diagnosed with hand, foot and mouth disease.

Most cases occur in late summer and autumn.

Hand, foot and mouth disease is usually mild.

Most people infected recover within a few days to a week without requiring medical treatment. The blisters usually disappear after about 10 days without scarring.

In very rare cases, the virus can spread to the brain and spinal cord. If this happens, it can cause complications such as encephalitis, meningitis or paralysis.

In rare cases, the nails on the fingers and toes can fall out a few weeks after the illness. However, these grow back again later.

After recovering from the illness, it is possible to become infected again. This is because different types of virus can trigger the illness.

How does an enterovirus progress in pregnant women and newborn babies?

Pregnant women usually experience enterovirus infections with mild symptoms or no symptoms at all.

Very rarely, mothers who contract hand, foot and mouth disease around the time of birth and have not yet formed any protective antibodies may pass the virus on to the newborn.

Most infections in newborns are mild. In very rare cases, the virus spreads throughout the entire body. However, if organs such as the liver or heart are affected, the disease can be life-threatening.

Observing certain hygiene and other precautionary measures on a daily basis goes a long way towards preventing hand, foot and mouth disease.

A preventive vaccine is not yet available in Germany.

Measures at home

The most important measures include:

• washing hands regularly and thoroughly with soap, especially after changing diapers and using the toilet
• thoroughly cleaning contaminated surfaces and objects, including toys and door handles
• avoiding close contact with the infected person; avoiding kissing or hugging during the illness if possible.
• not sharing cutlery or crockery with infected individuals
• using a personal towel

What is the advice on attending community facilities?

Since the disease is usually mild, children may continue to attend community facilities such as daycare centers and schools as long as they have no fever and feel well.

If a child has a fever or the illness is severe, the pediatrician will usually issue a sick note for a few days.

In certain situations, the public health department can decide that a child is temporarily not allowed to attend the facility – for example, to contain an outbreak.

Children who no longer have any symptoms and whose rash blisters have healed can return to preschool or school without a letter from their doctor.

Doctors usually diagnose hand, foot and mouth disease on the basis of its typical symptoms.

In severe cases, doctors may also examine stool samples, throat swabs or the fluid from inside the blisters using a PCR test to detect the virus’s genetic material.

If there are neurological symptoms such as paralysis, doctors may consider testing the cerebrospinal fluid (liquor) to detect the pathogen.

There is no specific therapy, i.e. one that targets the virus directly. As the illness generally runs a mild course, special treatment is usually not necessary.

As with other febrile illnesses, it is essential for children to drink sufficient fluids – even if they have painful ulcers and blisters in the mouth.

Medication such as ibuprofen or paracetamol can relieve the pain. Specific mouthwashes can also be used for gargling.

A doctor should be consulted if the child still resists drinking any or sufficient fluids or if the symptoms become more severe. A doctor should also be consulted if a child under 6 months old becomes ill. Immediate medical attention is also important in the event of rare symptoms such as neck stiffness, seizures, lightheadedness, or loss of consciousness – as these symptoms indicate complications.