Hand-Foot-Mouth Disease

Hand-foot-mouth disease is a frequent infection caused by a group of enteroviruses, most commonly coxsackievirus A16 and secondarily enterovirus 71 ^[1]. It is a viral illness transmitted among humans without animal involvement ^[1].

The illness usually starts with fever and general malaise, followed one to two days later by flat discolored spots or blisters on the hands, feet, mouth, and occasionally buttocks or groin ^[1]. Symptom onset typically occurs three to six days after viral exposure, and the rash resolves spontaneously within about a week ^[1]. Atypical forms may show polymorphic lesions such as vesicles, papules, or bullae extending to arms, legs, face, or trunk, with resolution in roughly ten days ^[2].

HFMD is found in all regions of the world and shows seasonal outbreaks in spring, summer, and autumn, with heat and humidity thought to favor spread ^[1]. Children younger than ten, particularly under five, are most affected, and rural settings report higher occurrence than urban areas after accounting for hygiene and socioeconomic factors ^[1]. A review of atypical pediatric cases found a mean age of 2.4 years and male predominance among 1,359 reported children ^[2].

The causative viruses pass through close personal contact, airborne droplets from coughing, and fecal-oral routes, as well as via contaminated objects ^[1]. Nasopharyngeal secretions, blister fluid, and stool from infected persons are infectious, and asymptomatic carriers can transmit the virus ^[1]. Childcare environments are frequent contraction sites due to diapering and toilet training, and individuals may remain infectious for days to weeks after symptoms fade ^[1].

No licensed vaccine or antiviral exists, though development is ongoing, so control relies on hygiene and limiting exposure ^[1]. Poor hand hygiene and inadequate sanitation raise infection risk, making handwashing and clean-contact practices central to prevention ^[1]. Early diagnosis and prompt care at higher-level facilities have been associated with reduced severity in pediatric populations ^[3].

1. 1 Wikipedia contributors. Hand, foot, and mouth disease - Wikipedia [Internet]. Wikipedia. cited 23 Oct 2026. Available from: https://en.wikipedia.org/wiki/Hand%2C_foot%2C_and_mouth_disease
2. 2 Starkey SY et al. Atypical cutaneous findings of hand-foot-mouth disease in children: A systematic review. Pediatr Dermatol. 2024 Jan-Feb. PMID: 37877202. doi: 10.1111/pde.15461. PubMed: https://pubmed.ncbi.nlm.nih.gov/37877202/
3. 3 Li P et al. Risk Factors for Severe Hand-Foot-Mouth Disease in China: A Systematic Review and Meta-Analysis. Front Pediatr. 2021. PMID: 34858899. doi: 10.3389/fped.2021.716039. PubMed: https://pubmed.ncbi.nlm.nih.gov/34858899/