Hand, foot and mouth disease

Fever is often the first sign of HFMD. Most young people who get it might also feel unwell, have a sore throat or no appetite.

A rash in the mouth appears after one to two days, particularly at the back of the mouth, on the tongue and on the gums. It consists of small red dots that can turn into blisters and then painful open sores. Children avoid swallowing as a result, which can cause them to drool a lot.

Red, sometimes slightly raised spots then appear on the skin another one or two days later, usually on the palms of the hands and the soles of the feet. But the rash can also occur on the buttocks (bottom), around the genitals, and on the knees or elbows. It usually isn’t itchy. There is a less typical kind that is very itchy, though.

Some spots turn into blisters that crust over after a couple of days, particularly around the mouth. The rash usually goes away after about one week. It doesn't leave any scars.

Hand, foot and mouth disease is caused by a type of virus called enteroviruses. The viruses are very contagious and are passed from person to person. This often happens through direct contact with bodily fluids like mucus from the nose or throat, or saliva (spit) – for instance, when sneezing or coughing. They can also be passed on through kissing and close physical contact. You may become infected if you come into contact with the stool (poo) of an infected child, like when changing their diaper. But adults are only rarely affected, probably because they already had it when they were younger. Or they do actually become infected but don’t have any symptoms and so don’t notice it.

Infectious bodily fluids can also be found on objects like toys, door handles, knives and forks. You may become infected if you touch them with your hands and then rub your eyes or touch your mouth or nose.

Hand, foot and mouth disease is very common and mainly affects children under the age of ten. It is estimated that 80,000 to 140,000 people get the disease each year in Germany. There are no exact figures, though, because a lot of people don’t even notice that they have it.

Outbreaks are more common in the summer and fall, probably because warm, damp weather increases the likelihood of infection.

It is thought that 80% of all people who become infected with HFMD viruses don't have any symptoms, so they don’t notice that they have the disease. These kinds of symptom-free infections are most common in adults.

It usually takes a few days to a week for the first symptoms to appear after infection. The disease is normally mild with no lasting effects. It takes about a week for the symptoms to go away again.

Children who have severe pain in their mouth might no longer swallow their saliva (spit) as a result. The saliva then flows out of their mouth. This can increase the risk of getting blisters and crusts around the mouth, especially if they touch their face a lot.

The pain can also cause children to hardly eat anything, particularly not hard, spicy or sour foods. If your child doesn't want to drink anything either, it's important to see a doctor to make sure they get enough fluids.

Complications are very rare: Individual nails might fall off toes or fingers, but the nails will grow back. Other possible (but very rare) complications include encephalitis and meningitis, paralysis and even life-threatening lung and circulation problems.

If a pregnant woman gets hand, foot and mouth disease, it is still usually harmless. Newborn babies can be infected by the mother during and after birth. In very rare cases, the infection can then spread through the baby’s whole body and cause complications. But the risk of this kind of "systemic" infection goes down again two weeks after birth.

Hand, foot and mouth disease can generally be spotted easily because of the symptoms and the typical rash. Parents might also notice their child drooling, hardly eating anything, or only wanting to drink cold drinks, if at all.

More detailed tests like laboratory examinations are usually not needed. In rare severe cases, the diagnosis can be confirmed quickly by testing a stool (poo) sample, a swab from the throat or the fluid in a blister, or cerebrospinal fluid (fluid in the brain and spinal cord) if necessary.

You are especially contagious while you have symptoms. The fluid in the blisters is particularly infectious. The viruses can still be found in the stool (poo) for several weeks after the symptoms have gone away. So it's still possible to pass them on, but it’s less likely. Because of this, experts recommend that children only stay at home during the acute phase, until the blisters have completely dried up.

Like with many other infectious diseases, the following is true: Good hand hygiene prevents infections. It is important to make sure you don’t touch the blisters and crusts. If you do, make sure you don’t touch your face afterwards, and immediately wash your hands thoroughly. Parents, brothers, sisters and other contacts don't need to take any other measures.

There is no vaccination against hand, foot and mouth disease.

There is no treatment that fights the HFMD virus and makes the disease go away. Antibiotics don't help. But because the infection usually goes away on its own without any lasting effects, no special treatments are needed.

Parents should make sure that their child still drinks enough despite the pain in their mouth, though. Pain-relieving and fever-reducing medication like acetaminophen (paracetamol) can help to ease the symptoms. But children with a viral infection must not take acetylsalicylic acid (the drug in medicines like “Aspirin”) because it can cause a rare but life-threatening complication called Reye’s syndrome.

Hand, foot and mouth disease can usually be left to clear up on its own at home without any problems. Complications may have to be treated in hospital, though. It is important to see a doctor soon if any of the following is true:

• The affected child is younger than six months old.
• The child isn't drinking enough and seems dehydrated. For instance, they are sleepy, slow to respond, and have a dry mouth. They might also have sunken eyes or a sunken fontanel ("soft spot" on the top of the head).
• The fever has lasted for longer than three days.
• The child has a weakened immune system.
• The symptoms are especially bad – for instance, very painful, or large sores in the mouth.
• Other symptoms develop that could be a sign of complications, such as severe headaches, seizures, a stiff neck (they can't touch their chest with their chin), drowsiness or unconsciousness.
• The symptoms still haven't got better after ten days.

It is also a good idea for adults to seek medical attention if they do develop severe symptoms or the symptoms last for a long time.

When people are ill or need medical advice, they usually go to see their family doctor or pediatrician first. In our "Health care in Germany" topic you can read about how to find the right doctor – and our list of questions can help you to prepare for your appointment.