Hand, foot and mouth disease (HFMD)

Key facts

  • Hand, foot and mouth disease (HFMD) is a common infectious disease of infants and children. It is characterized by fever, painful sores in the mouth, and a rash with blisters on the hands, feet and buttocks.
  • Viruses from the enteroviruses group cause HFMD. There are many different types in the group, including polioviruses, coxsackieviruses, echoviruses and other enteroviruses.
  • HFMD is most commonly caused by coxsackievirus A16, which usually results in a mild self-limiting disease with few complications. However, HFMD is also caused by enteroviruses, including enterovirus 71 (EV71), which has been associated with serious complications and may be fatal.
  • HFMD virus is contagious and infection is spread from person to person by direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons. Infected persons are most contagious during the first week of the illness, but the period of communicability can last for several weeks (as the virus persists in stool). HFMD is not transmitted to or from pets or other animals.
  • HFMD occurs mainly in children under 10 years of age. Children under 5 years of age are at greatest risk, and symptoms in younger children tend to be more severe than in other age groups. Adolescents and adults can also contract HFMD.
  • Presently, there is no specific treatment for HFMD. Patients should drink plenty of water and may require symptomatic treatment to reduce fever and pain from ulcers.
  • There are no specific antiviral drugs or vaccines available against non-polio enteroviruses causing HFMD. The risk of infection can be lowered by good, hygiene practices and prompt medical attention for children showing severe symptoms.

The situation

  • HFMD was listed as a Class C notifiable disease in the national surveillance system on May 2, 2008. It requires information on every case be submitted to the National Notifiable Disease Reporting System (NNDRS) within 24 hours from diagnosis.
  • Emerging epidemics of HFMD associated with enterovirus 71 (EV71) have become a serious concern.
  • In 2010, approximately 1.75 million cases were reported, including 905 deaths. In 2011, 1.6 million cases, including 509 deaths, were reported..
  • Prefectural laboratories conduct tests using real-time PCR (RT-PCR) on clinical samples to identify EV71, CA16, and other enteroviruses.
  • Provincial laboratories perform virus isolation and serotyping on positive samples from prefectural laboratories. The identified EV71 and CA16 isolates are forwarded to the national laboratory for sequencing and molecular analysis.
  • The most predominant subgenotype is C4, thought to have caused emerging HFMD outbreaks in China since 1998.

WHO's response

  • WHO has developed and disseminated: "A Guide to Clinical Management and Public Health Response for Hand, Foot and Mouth Disease (HFMD)”
  • WHO has provided technical support to the Ministry of Health to:
    • improve clinical case management, particularly for severe cases requiring intensive care;
    • identify risk factors for severe cases and deaths;
    • evaluate control and prevention measures;
    • support research.