Q&A: Hand-foot-and-mouth disease on the rise

Nadia Qureshi

Cases of viral hand-foot-and-mouth disease have spiked in recent months, and with the school year quickly approaching, there is a higher risk of transmission — especially among children aged 0 to 5 years.

According to the CDC, there is no vaccine available that protects against hand-foot-and-mouth disease, and there are no specific treatment options. Symptoms usually begin with a fever, reduced appetite, sore throat and malaise. After 1 or 2 days, small red dots typically appear in the back of the mouth and eventually develop into painful sores. A skin rash may also be present. Adults, however, tend to be asymptomatic, the CDC said.

Prevention is critical, and the CDC recommends practicing good hand hygiene and being mindful of keeping frequently used surfaces clean and disinfected. Close contact, including kissing, hugging or sharing of eating utensils or cups, should be avoided with people who have contracted hand-foot-and-mouth disease.

Infectious Diseases in Children spoke with Nadia Qureshi, MD, FAAP, assistant professor at Loyola University Medical Center, about the recent uptick in cases and the increasingly common occurrence of adults contracting the viral illness. – by Marley Ghizzone

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This summer, doctors in South Carolina, Tennessee, Virginia , Indiana and now Illinois have reported a spike in hand-foot-and-mouth disease among children. What is causing the increases in cases?

It’s every summer that hand-foot-and-mouth disease peaks. It’s usually June through October in the Northern Hemisphere. The reason behind the increase in cases is several-fold. One, there is better recognition of the disease. There is also more spread of the pathogen — with climate change, the spring is ending earlier, fall is coming later and summer has extended. Finally, there are more strains. It used to be only enterovirus strain 71 and A16 that affected mainly children aged younger than 5 years, but adults were rarely infected and mainly asymptomatic. Now, in the last decade, the A6 strain has emerged as a cause of atypical hand-foot-and-mouth disease, and it affects both adults and children, which is why with every year the number of people infected keeps increasing.

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Two major league baseball players — Noah Syndergaard, pitcher for the New York Mets, and J. A. Happ, pitcher for the New York Yankees — also contracted the disease. How common is the infection in adults , and how concerning are the rates of adult cases?

Since 2008, the A6 strain has emerged as a worldwide cause of atypical hand-foot-and-mouth disease. Since 2014, enterovirus D68 has been reported as well. This particular strain causes more respiratory symptoms and neurological complications. Also, the atypical hand-foot-and-mouth disease that affects adults can mimic many other diseases, such as Rocky Mountain spotted fever, chicken pox or Henoch-Schönlein purpura, parvovirus B19, among others. Because of the atypical appearance of vesicles, purpurae and distribution, the diagnosis in adults can be delayed and confused with other things.

What should physicians be aware of as the school years begins, and how can they council their patients — both children and adults — to avoid the disease?

It spreads more commonly in day-care settings because babies are putting things in mouth drooling and touching things that expedites the spread. Hand hygiene, especially after diaper changing, and respiratory hygiene are important in decreasing the spread of enteroviruses within families and institutions. Other measures include avoidance of contaminated utensils and fomites and disinfection of surfaces. Recommended chlorination treatment of drinking water and swimming pools may also help prevent transmission.

References:

Bland DT. The State. Outbreak of contagious disease affecting SC children. Adults are vulnerable too. https://www.thestate.com/living/health-fitness/article216106900.html. Accessed August 27, 2018.

CDC. Hand, Foot, and Mouth Disease (HFMD): Prevention & Treatment. https://www.cdc.gov/hand-foot-mouth/about/prevention-treatment.html. Accessed August 28, 2018.

CDC. Hand, Foot, and Mouth Disease (HFMD): Signs & Symptoms. https://www.cdc.gov/hand-foot-mouth/about/signs-symptoms.html. Accessed August 28, 2018.

Harvey C. ESPN. Yankees' J.A. Happ diagnosed with hand, foot and mouth disease. http://www.espn.com/mlb/story/_/id/24247119/ja-happ-new-york-yankees-diagnosed-hand-foot-mouth-disease. Accessed August 27, 2018.

Kekatos M, Thompson A. Daily Mail. Hand, foot and mouth disease is spreading across the US: Outbreaks are occurring in four states. http://www.dailymail.co.uk/health/article-6018367/Hand-foot-mouth-disease-spreading-Outbreaks-occurring-four-states.html. Accessed August 27, 2018.

Disclosure: Qureshi reports no relevant financial disclosures.