Hand, Foot and Mouth Disease Highlights Need for Hygiene in Child Care Settings

Hand, foot and mouth diseaseⁱ is a viral illness caused by coxsackievirus. Afflicting mostly children, coxsackievirus normally causes mild fever and rash or sores on the palms of the hands and soles of the feet, and sores or blisters in the mouth. Recently, the US Centers for Disease Control and Prevention (CDC) reported coxsackievirus A6 in four states. Previously seen only in some European and Asian countries, the “A6” strain causes more severe symptoms and more hospitalizations. An April 20 article in USA Today states the virus “can hit kids and adults hard, causing fingernails and toenails to fall off two to three weeks after the illness has passed.”

The Reno Gazette-Journal cited 30 cases of hand, foot and mouth disease in Nevada’s Washoe County in a March 30 article. According to the article, in addition to the Nevada cases, 46 other cases had been reported in California, Connecticut and Alabama. The April 20 USA Today article indicates the virus is spreading around the country and that, according to one physician, about 25 percent of cases are in adults.

According to CDC, the cases were identified as unusual by healthcare providers or by health departments that contacted CDC for diagnostic assistance. Coxsackievirus A6 was identified in clinical specimens collected from 25 of 34 patients. The majority of those infected, 70 percent, had exposure to a child care facility or school. Hand, foot and mouth disease is not a “reportable” illness in the United States, meaning that physicians are not obliged to report diagnoses of the illness to government agencies. However, as healthcare providers and health departments contacted CDC with questions, and the significance of clinical results became clear, attention was focused on this uncommon strain of coxsackievirus.

Coxsackievirus is spread by person to person contact, especially during summer and autumn months. According to WebMD, there is no treatment for hand, foot and mouth disease other than pain relievers, such as acetaminophen. Infection usually lasts about one week. CDC notes that transmission of the virus can be reduced by maintaining good hygiene, including frequent hand-washing and disinfecting surfaces in child care settings.

Advice for Preventing Hand, Foot and Mouth Diseaseⁱⁱ

• WASH YOUR HANDS often and carefully, especially after using the bathroom, preparing food or drinks and changing diapers.
• DISINFECT ITEMS AND HARD SURFACES by washing them with hot, soapy water, then applying a solution of two tablespoons of bleach and four cups of water; rinse with clear water and dry.
• LIMIT CONTACT WITH INFECTED PERSONS by avoiding hugging, kissing or sharing cups or utensils.

Finally, CDC recommends contacting your health provider if you suspect a severe case of hand, foot and mouth disease.

Fred Reiff, P.E., is retired from the Pan American Health Organization, and lives in the Reno, Nevada area.

ⁱVesicular pharyngitis and vesicular stomatitis with exanthema
ⁱⁱBased on recommendations from the Washoe County, Nevada Health District