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Hand, Foot, And Mouth Disease: Contagious To Children And Adults

Families and daycares can spread HFMD

Medically reviewed by Daniel Combs, MD

Hand, foot, and mouth disease (HFMD) is a contagious illness common in children ages 5 and younger but can also impact adults. It's caused by a group of viruses and is transmitted through close contact.

Signs of HFMD include a fever and a painful rash of small blisters that appear on the hands, feet, and inside of the mouth, among other potential areas on the body.

This article discusses the symptoms of hand, foot, and mouth disease, how it spreads, and its treatment options.

Do You or Your Child Have Hand, Foot, and Mouth Disease?

Visible symptoms of hand, foot, and mouth disease usually show up within three to six days after contracting the virus, so you might not always know immediately if you have it.

The most common telltale signs of HFMD to watch for include:

Painful sores inside of the mouth: Usually on the tongue but sometimes on the roof of the mouth. These can start as red or discolored bumps that eventually become blisters.

An itchy, blistery, or bumpy rash that develops on the palms of the hands and/or soles of the feet: This itchy, blistery, or bumpy rash can also develop on other body parts, like the knees, elbows, or buttocks.

Other symptoms can include:

Here's a typical timeline of how HFMD can develop:

Days one and two after contracting the virus, you might notice a mild fever and sore throat. Sometimes, children also complain of stomach pain and might have a loss of appetite.

Starting on day three after contracting the virus, those initial viral symptoms should start to go away. Around this time, you'll notice the mouth sores, rash on the hands and feet, and swollen neck lymph nodes. This can last until day seven or longer.

Keep in mind that all HFMD signs may not be present, even if you've contracted it. Some people only develop a couple of symptoms, while other people may experience each one.

Definition

Hand, foot, and mouth disease is completely different from foot-and-mouth disease (FMD), which is a contagious viral illness in certain animals.

How Hand, Foot, and Mouth Disease Spreads

Hand, foot, and mouth disease is highly contagious, particularly in kids ages 5 and younger. Once the HFMD virus is contracted, it lives in the following bodily substances:

As with other viruses, HFMD spreads quickly in the following ways:

Close contact with another person who has HFMD, such as hugging, kissing, or sharing silverware

Exposure to droplets from sneezing, coughing, or talking

Touching a contaminated surface or object, then touching your mouth, eyes, or nose

In rare cases, it may also be possible to contract an HFMD virus from swallowing pool water that's been contaminated with infected feces and hasn't been adequately treated with chlorine.

Studies show that symptoms typically take four to six days to become noticeable after being infected with HFMD. And while HFMD is usually most contagious during the first week of the illness, it's still possible to transmit the virus days after the symptoms have disappeared or if there weren't any noticeable symptoms.

Takeaway

In the United States, the peak seasons for transmitting HFMD viruses are spring, summer, and fall. Around the world, research has also shown that warmer temperatures and higher humidity levels are linked to a higher incidence of HFMD.

Quarantine With Hand, Foot, and Mouth Disease

The key to avoiding transmitting HFMD to other people is staying home from school, work, and other activities until symptoms are completely cleared.

With HFMD, experts recommend that children and adults quarantine and avoid contact with others outside the household for seven to 10 days. Before you venture out, make sure that:

You or your child is fever-free for at least a day.

HFMD blisters are healed.

You or your child feels well enough to go back to a regular routine.

Remember that HFMD transmits quickly in part because children often have closer contact with one another than adults do, sharing toys, playing games, and touching common surfaces. If you or your child has contracted HFMD, let the school or daycare know if they need to control an outbreak.

Treatment for Hand, Foot, and Mouth Disease in Children

There are not any specific treatment options for HFMD. Many cases of HFMD are mild and go away on their own within a week to 10 days.

For painful or bothersome symptoms, experts recommend over-the-counter (OTC) treatments and at-home remedies to make your child feel more comfortable. These include:

Tylenol (acetaminophen) for fever

Advil or Motrin (ibuprofen) for headaches

Topical medications or oral antihistamines to relieve itching

Liquid mouth-soothing remedies

Drinking plenty of fluids

Getting plenty of rest

Eating soft foods

Be sure to thoroughly wash and sanitize toys (in addition to other surfaces in your home).

Explainer

While most HFMD cases will go away on their own without any issue, see a healthcare provider right away if you notice the following in your child:

You should also seek medical treatment if your child is younger than 6 months or has a weakened immune system.

Treatment for Hand, Foot, and Mouth Disease in Adults

For adults, recovering from HFMD will also focus on treating uncomfortable symptoms. In addition to OTC remedies for a headache, sore throat, or an itchy rash, you might also consider:

Trying throat lozenges to help relieve a sore throat

Avoiding acidic and spicy foods

Drinking cold water

Sucking on ice

Gargling with warm salt water

In addition, adults will want to consider other prevention tactics as they recover, such as:

Keeping hands washed as often as possible

Avoiding kissing, hugging, or touching others

Keeping hands away from the mouth, nose, and eyes

Keeping household surfaces disinfected

Summary

Hand, foot, and mouth disease (HFMD) is a highly contagious viral infection common in children younger than 5, though adults can contract it, too. It's transmitted through bodily contact with saliva, feces, and contaminated surfaces.

Suppose you have any telltale signs of HFMD (including a painful, bumpy rash on the hands, feet, and mouth). In that case, staying home and avoiding contact with others until symptoms are gone (usually seven to 10 days) is essential to avoid transmitting the virus. In the meantime, treatment options focus on relieving symptoms with OTC therapies.

What Is Hand, Foot, And Mouth Disease? West Virginia University Postpones Fan Day

West Virginia University had to postpone its Fan Appreciation Day when 5 unnamed West Virginia... [+] Mountaineer football players came down with hand, foot- and mouth disease. (Photo by Ronald Martinez/Getty Images)

There's the foot in mouth problem, which means accidentally saying something stupid or offensive. This can affect children and adults who behave like children. There is foot-and-mouth disease (also called hoof-and-mouth disease), which only affects those with hooves, like cattle, sheep, and swine. Then there's hand, foot, and mouth disease, which is something completely different. This is much more common in young children, especially those under 5 years old, but can affect adults.

Cattle, sheep, and swine can't get hand, foot, and mouth disease (HFMD). It is unclear whether they can have foot in mouth problem because anything they say would come out as "mooo," "baaaa," or "oink." Humans can get the first and the third conditions.

The third condition seems to be on the rise this year. There have been reports of HFMD outbreaks in Indiana, South Carolina, Tennessee, and Virginia. HFMD has sidelined 2 major league baseball players: the New York Mets' Noah Syndergaard and the New York Yankees' J.A. Happ. Now 5 unnamed West Virginia University football players getting the disease led to the University postponing Fan Appreciation Day. Yes, before the University could give fans a hand, they had to make sure that they didn't give more people hand, foot, and mouth disease.

Toronto Blue Jays pitcher J.A. Happ who is now with the New York Yankees, battled hand, foot and... [+] mouth disease. (John Sleezer/Kansas City Star/TNS via Getty Images)

That's because HFMD is quite contagious, caused by various enteroviruses. Coxsackievirus (CV) A16 and enterovirus (EV) 71 are the most common culprits. CV A6 is an emerging cause. Transmission of the virus occurs via the saliva, sputum, nasal mucus, blister fluid, and poop of infected people. Yet, another reason to wash your hands frequently and not play with poop. You also may catch the virus by swallowing pool water contaminated with infectious poop. So don't drink from swimming pools after someone has pooped in it. Besides washing your hands often and thoroughly, especially after changing diapers, you should also not kiss, hug, or share anything that went into the mouths, on the hands, on the feet, or in the butts of people who have or may have HFMD.

The disease tends to develop 4 to 6 days after infection and most commonly occurs in kids younger than 5 years old who haven't yet developed immunity against these viruses. The disease usually isn't severe, causing first fatigue and possibly fever, followed by potentially painful vesicular (fluid-filled and blister-like) lesions, on the, you guessed it, hands and feet and in the mouth. These last for about 7 to 10 days.

Here are hand, foot, and mouth disease lesions. (Photo: Shutterstock)

Occasionally, the disease is more severe. Those with the disease can lose their fingernails or toenails, which can be quite disconcerting but is usually temporary as the nails can grow back. In rare cases, infection of the brain (encephalitis) or the wrapping around the brain (meningitis) can occur and result in paralysis or even be life-threatening. 

The list of treatments is like the list of treatments for people who constantly put their foot in their mouths. There is no available pill, elixir, or vaccine that will significantly alter the course of the disease. You should keep well hydrated. You may try to reduce the fever and pain with acetaminophen or ibuprofen. You can eat soft and cold stuff like ice cream and avoid acidic (like orange juice), salty, spicy, or rough stuff that may further irritate the mouth. Warm water mouth rinses may help.

If you suspect that you or your child has HFMD call your doctor. Even though HFMD is not officially a reportable disease, it helps to know when and where outbreaks are occurring so that families and schools can take appropriate precautions such as extra disinfecting of surfaces and doorknobs. If you have foot in mouth problem, you may want to stop talking. If you have foot and mouth disease caused by the picornavirus and have hooves then you have a different set of problems.

What's Going Around: COVID, Hand, Foot And Mouth

This week, the providers of UPMC Children's Community Pediatrics in York and Spring Grove are seeing hand, foot, and mouth disease, a stomach bug and pink eye.

The CVS MinuteClinic in York reports COVID, viral upper respiratory infections and poison ivy rashes this week.

Penn Medicine Lancaster General Health Physicians Roseville Pediatrics reports sporadic COVID cases this week. They also diagnosed hand, foot and mouth, swimmer's ear, inner ear infections and viral colds with fevers. They also treated bug bites and bee stings.

Dr. Joan Thode offered the following advice about inner ear infections:

"The inner ears produce fluid as part of their function of hearing. This fluid moves down the inner ear, then drains out tubes at the bottom of the inner ear area into the throat. When a virus causes throat inflammation, the tube swells shut and the fluid builds up in the inner ear cavity, known as an ear effusion. While bacteria can't grow on the moving fluid within the inner ear, the bacteria can grow on this stagnant fluid. Now we have an ear infection.

The immune system does not tolerate these types of bacterial overgrowths. The pain from an ear infection comes from the combination of extra fluid, extra bacteria, and lots of immune cells taking up a lot of extra space and thus pushing against the eardrum from the inside. The eardrum will bulge as a result of this pressure, and it's this bulging that stretches the nerve that runs across the surface of the ear, causing it to register pain.

The good news is that the immune system can totally handle the infection and kill off the overgrowth of bacteria. Additionally, as soon as the virus clears, the outflow tubes reopen and drain all of that bacteria-laden fluid from the inner ear. Antibiotics are not needed to clear an ear infection in most cases. They are indicated only in babies younger than 12 months old or in cases where the infection is not clearing in the expected amount of time. The antibiotics do not immediately cure the infection but rather help the immune system clear it a day or two faster than it otherwise would. Our goal as clinicians is to relieve the pain, which is best accomplished with ibuprofen. Please note that ibuprofen can only safely be given to babies over six months of age."

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