Text_Files/Hand_Foot_and_Mouth_Disease.txt

Division of Public Health Services  Disease Handbook for Childcare Providers 
Bureau of Infectious Disease Control   REVISED –January 2018 
HAND, FOOT & MOUTH DISEASE 
 
Hand, foot and mouth disease is a self -limited 
infection caused by the Coxsackie A16 virus and 
enterovirus 71.  Vesicular lesions (i.e., blisters) 
may appear in the mouth, on the sides of the 
tongue, inside the cheek and on the gums.  
Lesions may also occur on the palms, fingers, 
soles and buttocks.  Most lesions persist for 7- 10 
days.  A low -grade fever may accompany the 
illness for one to two days.  The infection usually 
goes away without any serious complications. 
 
Who gets this disease? 
The infection is seen primarily in children under 
10 years old but may also occur in adults.  
Outbreaks of hand, foot and mouth disease among 
groups of children in nursery schools and 
childcare centers during the summer and early fall 
are common. 
 
How is it spread? 
Having direct contact with nose and throat 
secretions of an infected person may spread the 
infection.  It may also be spread by the aerosol 
droplet route (e.g., sneezing, coughing). 
 
Additionally, the virus may also be spread by 
having contact with infected persons who may not 
seem sick (aka carriers) but are able to spread the 
infection since the virus may persist in the stool 
for several weeks after the acute illness is over. 
 
What are the symptoms? 
Vesicular lesions may occur in t he mouth, on the 
sides of the tongue, inside the cheek and on the 
gums.  Lesions also occur on the palms, fingers, 
soles and buttocks.  Most lesions persist for 7- 10 
days.  A low -grade fever may accompany the 
illness for one to two days. 
 
How soon do symptoms appear? 
People who are going to contract the infection 
usually do so three to six days after exposure. 
 
Can a person have this disease without 
knowing it? 
Yes.  Infected persons who may not seem sick are 
able to spread infection.  The virus may persist  in 
the stool for several weeks after the acute illness 
is over. 
 
How is it diagnosed and treated? 
A healthcare provider may diagnose hand, foot 
and mouth disease based on clinical signs and 
symptoms.  There is no specific treatment. 
 
How can the spread of  this disease be 
prevented? 
1. Wash your hands thoroughly after using 
the toilet and diapering a child. 
2. Wash hands thoroughly after handling 
respiratory discharges, stool and soiled 
articles of infected persons. 
3. Discourage children from putting toys and 
other objects in their mouths. 
4. Clean and disinfect toys and contaminated 
areas (e.g., diapering area, potty chairs, 
toilets) daily and when soiled. 
5. Do not allow children to share drinking 
cups or eating utensils. 
6. Teach children to sneeze and cough into a 
tissue, or into their elbow and away from 
other people. 
7. Dispose of tissues and diapers properly; 
wash hands after sneezing, coughing, 
changing diapers and using the toilets. 
8. Children may attend childcare if they feel 
well enough even if lesions are still 
present.  In this situation, childcare staff 
should be especially careful to adhere to 
steps 1-7 above. 
9. Grouping of symptomatic individuals, 
where practical, might be considered. 


HAND, FOOT & MOUTH DISEASE (cont.) 
Division of Public Health Services  Disease Handbook for Childcare Providers 
Bureau of Infectious Disease Control   REVISED –January 2018 
Who should be excluded? 
Exclusion from a childcare facility or school is 
not recomm ended.  Special attention to hand 
washing after toileting is required. 
 
Reportable? 
No.  Hand, foot and mouth disease are not 
reportable by New Hampshire law to the Division 
of Public Health Services, Bureau of Infectious 
Disease Control .  However, Public Health 
Professionals are available for consultation at 
(603) 271-4496.