Herpangina

Herpangina is a painful mouth infection of childhood caused by enteroviruses, most commonly Coxsackievirus A (the strain historically termed "herpangina virus"), and occasionally Coxsackievirus B, Enterovirus A (including EV-A71), or echoviruses ^[1][2][3]. The entity was first characterized in 1920 ^[2].

The clinical picture typically begins with sudden fever, sore throat, headache, loss of appetite, and often neck pain ^[2]. Within about two days of onset, a small number (often two to six, occasionally up to twenty) of 1–2 mm grayish lesions develop, progressing from macules to vesicles and then to shallow ulcers up to 2–5 mm in diameter that heal within one to seven days ^[2]. Lesions characteristically localize to the posterior oropharynx, most often the tonsillar pillars and soft palate, and may also involve the tonsils, uvula, or tongue, distinguishing herpangina from herpetic gingivostomatitis in which lesions favor the anterior oropharynx ^[2][3]. The overall course is generally 4–6 days with a good prognosis, although severe cases may develop complications such as febrile seizures or myocarditis ^[1][3].

Herpangina is a common infectious disease in childhood caused by enteroviruses, with the main pathogenic serotypes including Coxsackievirus-A, Enterovirus-A, and Echovirus ^[1]. The disease is part of a broader spectrum of enterovirus-associated illness that represents a significant global public health issue, particularly affecting children five years of age or younger ^[4]. Among causative agents, Enterovirus A71 (EV-A71) is recognized as one of the main etiological agents of herpangina worldwide, although the morbidity rate of EV-A71 infection differs between countries, and the pathogen's genetic lineages are undergoing rapid evolutionary changes ^[5]. Diagnosis of herpangina is rendered on the basis of a history of epidemiology, typical symptoms, characteristic pharyngeal damage, and virological tests ^[1]. The overall impact of enterovirus-associated disease is increasing globally, underscoring the need for vigilant surveillance systems for enterovirus infections worldwide ^[4]. ^[1][5][4]

Herpangina spreads from person to person primarily via the fecal–oral route and via respiratory droplets ^[2].

Prevention and control of herpangina are pursued in the broader context of enterovirus infection control, with expert consensus efforts aimed at standardizing prevention and clinical diagnosis in children ^[1]. Because EV-A71 is a principal causative agent and a life-threatening pathogen globally, there is an urgent need for vaccine development to prevent EV-A71–associated herpangina (alongside HFMD) ^[5]. At the population level, enterovirus-associated HFMD/HFMD-like illness, including herpangina, has highlighted the need for vigilant surveillance and efficacious vaccines, as specific antiviral treatment options remain limited ^[4].

1. 1Yu H et al. Diagnosis and treatment of herpangina: Chinese expert consensus. World J Pediatr. 2020 Apr. PMID: 31347021. doi: 10.1007/s12519-019-00277-9.PubMed: https://pubmed.ncbi.nlm.nih.gov/31347021/
2. 2Wikipedia contributors. Herpangina - Wikipedia [Internet]. Wikipedia. cited 3 Sept 2026.Available from: https://en.wikipedia.org/wiki/Herpangina
3. 3Wang Y et al. Oral Chinese patent medicines for herpangina in children: A network meta-analysis. Medicine (Baltimore). 2025 Dec 26. PMID: 41465969. doi: 10.1097/MD.0000000000046672.PubMed: https://pubmed.ncbi.nlm.nih.gov/41465969/
4. 4Huang CY et al. A review of enterovirus-associated hand-foot and mouth disease: preventive strategies and the need for a global enterovirus surveillance network. Pathog Glob Health. 2024 Oct-Dec. PMID: 39229797. doi: 10.1080/20477724.2024.2400424.PubMed: https://pubmed.ncbi.nlm.nih.gov/39229797/
5. 5Chang YK et al. Hand, foot and mouth disease and herpangina caused by enterovirus A71 infections: a review of enterovirus A71 molecular epidemiology, pathogenesis, and current vaccine development. Rev Inst Med Trop Sao Paulo. 2018 Nov 8. PMID: 30427405. doi: 10.1590/S1678-9946201860070.PubMed: https://pubmed.ncbi.nlm.nih.gov/30427405/