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Six states report severe cases of hand, foot and mouth disease

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SAN DIEGO — Unusually severe cases of hand, foot and mouth disease have been reported in six states since November 2011, according to study data presented here at ID Week.

Hand, foot and mouth disease (HFMD) is a common viral illness that typically affects children aged older than 5 years during the spring and autumn.

Symptoms generally include mild febrile illness with vesicular lesions on the palms of the hands, soles of the feet and mouth, according to background information in the study.

In mid-January, the CDC was contacted for diagnostic assistance for patients with signs of HFMD, rash and severe fever.

“This year, we saw much more impressive and severe rashes,” M. Steven Oberste, PhD, of the CDC, said.

Health care providers or the US Department of Health and Human Services identified cases.

Researchers collected clinical specimens from patients and tested for enteroviruses by reverse transcriptase-polymerase chain reaction. Researchers at the CDC or the California Department of Public Health also tested for a partial-sequencing of the VP1 gene, according to the study.

Researchers identified 81 cases of HFMD in Alabama (n=38), California (n=7), Connecticut (n=3), Nevada (n=17), New York (n=7) and Massachusetts (n=9). Researchers collected clinical specimens from 52 patients. They identified coxsackievirus A6 (CVA6) in 41 of 52 patients (79%).

Researchers did not identify additional enteroviruses.

Of the 63 patients investigated to date, 40 (63%) were aged younger than 2 years and 15 (24%) were aged older than 18 years. Of the 63 patients investigated, 44 (70%) had exposure to a childcare facility or school.

Researchers found that more severe cases of rash and fever and hospitalization were more common than typical HFMD cases in the United States, according to Oberste.

The signs of HFMD in this patient population included fever (76%), rash on the hands or feet or in the mouth (67%), rash on the arms or legs (46%), face (41%) or buttocks (35%), according to the study. Of the 63 patients, 51 (81%) sought care from a clinician and 12 (19%) were hospitalized for dehydration or pain management.

Researchers reported no deaths.

HFMD is transferred from person to person. Good hygiene and disinfection can prevent the illness from spreading.

“Overall, this was a very unusual outbreak,” Oberste said. “The age of patients, the severity of illness and rash, seasonality and the identification of CVA6 made this unusual.”

Oberste and colleagues have seen a continuation of these cases in the past 8 to 10 months.

“At the CDC, since the beginning of the year, we have received a total of 143 specimens from over 100 patients, spanning 15 states — from the East Coast to the West Coast,” Oberste said.

For more information:

Stockman LJ. Abstract #118. Presented at: ID Week; Oct. 17-21, 2012; San Diego.

Disclosure: Oberste reported no relevant financial disclosures.