Hand, Foot, & Mouth Disease

Infectious Agent

In the United States, coxsackievirus A16 is most commonly detected, but other enteroviruses (such as coxsackievirus A10) can cause hand, foot, and mouth disease. In the past few years, coxsackievirus A6 has been detected in outbreaks. Internationally, enterovirus 71 is a common etiologic agent.


Person-to-person, through contact with saliva, nose and throat secretions, fluid in blisters, or stool of an infected person.


A common illness in young children, with worldwide distribution. Recent large outbreaks have been reported in Cambodia, China, Japan, Korea, Malaysia, Singapore, Thailand, Taiwan, and Vietnam.

Clinical Presentation

Incubation period is 4–6 days. Patients usually present with fever and malaise, followed by sore throat and the development of vesicles in the mouth and a rash, often vesicular, on the hands (palms) and feet (soles). In some cases, the rash may be more widespread. Lesions usually resolve in 1 week, but rare complications can include aseptic meningitis and encephalitis.


Diagnosis is most often made clinically. Laboratory testing (such as PCR) is available and is usually performed on atypical or severe cases.


Supportive care.


Avoiding close contact with infected people, maintaining good hand hygiene, and disinfecting potentially contaminated surfaces, including toys.

CDC website: www.cdc.gov/hand-foot-mouth


  1. CDC. Notes from the field: severe hand, foot, and mouth disease associated with coxsackievirus A6—Alabama, Connecticut, California, and Nevada, November 2011–February 2012. MMWR Morb Mortal Wkly Rep. 2012 Mar 30;61(12):213–4.  [PMID:22456122]
  2. Ooi MH, Wong SC, Lewthwaite P, Cardosa MJ, Solomon T. Clinical features, diagnosis, and management of enterovirus 71. Lancet Neurol. 2010 Nov;9(11):1097–105.  [PMID:20965438]
  3. World Health Organization. A guide to clinical management and public health response for hand, foot and mouth disease (HFMD). Geneva: World Health Organization; 2011 [cited 2016 Sep. 23]. Available from: http://www.wpro.who.int/publications/docs/Guidancefortheclinicalmanagement....


Eileen Schneider