Hand, foot and mouth disease

Fact sheet

Key facts

• Hand, foot and mouth disease (HFMD) is a common viral infectious disease of infants and children caused by a group of enteroviruses, including Coxsackie A16 and Enterovirus 71 (EV71).
• It is characterized by fever, painful sores in the mouth, and a rash with blisters on hands, feet and also buttocks. However, not everyone who is infected has symptoms, and at times mouth sores or skin rash may be the only symptoms.
• HFMD occurs mainly in children under 10 years old, and can occur in adults but it is most commonly seen in children aged 5 years or less. Younger children tend to have worse symptoms.
• HFMD is usually a mild disease, and nearly all patients recover fully in 7 - 10 days without medical treatment. Although complications are uncommon, HFMD caused by Enterovirus 71 (EV71) can cause severe disease in children and has been associated with meningitis and encephalitis, and sometimes death.
• Enteroviruses causing HFMD are spread by direct contact with saliva, mucus, fluid from blisters and stool of infected people. Some people infected with HFMD usually adults, may shed the virus and have no symptoms.
• HFMD may also be spread when infected persons touch objects and surfaces which are then touched by others.
• There are no specific antiviral drugs or vaccine available against enteroviruses causing HFMD. The risk of infection can be lowered by good hygiene practices and prompt medical attention for children showing severe symptoms.
• Preventive measures include: frequent hand-washing with soap and water; cleaning contaminated surfaces and soiled items including toys first with soap and water and then disinfecting them with a dilute solution of chlorine-containing bleach; and avoiding close contact with persons with HFMD.
• Keeping children with symptoms at home may not prevent more cases since the virus may be present in stool for several weeks after the symptoms have disappeared.
• It may be helpful to keep children at home until fever and blisters in their mouths, or on their skin clear up.

The situation

• In Viet Nam HFMD circulates year-round in most provinces with two associated peaks, from March to May and from September to December. The southern region is the most affected area and accounted for over 60% of cases for the whole country.
• In 2011 Viet Nam experienced a significant increase in HFMD activity with 112370 cases and 169 deaths reported from 63/63 provinces.
• The response of the Viet Nam Ministry of Health has included: (1) strengthened surveillance, early detection and treatment; (2) enhanced communication on HFMD preventive measures, including a national campaign to prevent and control HFMD; (3) improved clinical management of cases and hospital infection control practices through training of hospital staff; and (4) training of epidemiological, clinical, laboratory and public health staff to raise awareness and reduce morbidity and mortality.

WHO's response

• WHO has developed and disseminated WPRO guidelines on clinical management and public health reponse to HFMD.
• WHO has provided techical support to the Ministry of Health to:
• establish sentinel surveillance;
• improve clinical case management, particularly for severe cases requiring intensitive care;
• improve laboratory diagnosis;
• identify risk factors for severe cases and deaths
• evaluate control and prevention measures;
• support the conduct of research studies.