Hand, foot and mouth disease is not nearly as scary it seems

by Ruth Nichol / 23 October, 2017

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It sounds alarmingly like foot and mouth disease, but all they have in common is they are viral.

Five days after developing a fever – followed by a rash on his bottom and blisters on his palms, the soles of his feet and in his mouth – Arthur Clayton was well enough to go away on a family ski trip. But the Wellington toddler had a few miserable days in-between: general malaise, long daytime sleeps and difficulties eating thanks to the blisters in his mouth.

“He definitely wasn’t eating as much and it affected the kinds of things he could eat – no apples or oranges, which he quite likes,” says his mother, Ruth Hendry.

For Arthur’s GP, the mouth blisters made diagnosis easy. They’re one of the classic symptoms of hand, foot and mouth disease, a common viral illness that affects thousands of children – mostly preschoolers – every year.

It’s highly contagious, which meant Arthur had to stay away from his childcare centre for a few days. But apart from that minor inconvenience, it was all over in less than a week.

“We were lucky because the illness lasted only four to five days, and I know it can be more serious and last longer,” says Hendry.

Hand, foot and mouth disease sounds alarmingly like foot and mouth disease, the highly contagious animal malady that has the potential to devastate the farming industry. However, all they have in common is they are both viral.

In the case of hand, foot and mouth disease, the virus responsible for most cases is called coxsackievirus A16. It’s one of more than 60 enteroviruses – viruses that replicate in the gut – that cause a wide range of illnesses in humans, including diarrhoea, colds and viral meningitis. The most well-known enterovirus is the poliovirus, which is now almost completely eradicated.

The effects of coxsackievirus A16 are much milder and very easy to recognise. “Clinically, hand, foot and mouth disease is usually quite obvious – blisters on the hands and soles of the feet and often in the mouth; you can often see they have a sore throat with blisters,” says Auckland paediatrician Emma Best. “Sometimes they get a more generalised rash.”

Mostly, the only treatment needed is the judicious use of paracetamol if a child is feeling miserable or is in pain. “The majority of cases are managed in a general practice or at home, because it’s not a serious illness,” says Best.

Some children have so many blisters in their mouth that they stop eating and drinking, and a few become so seriously dehydrated they end up in hospital.

Affected children should be kept away from childcare or school until their blisters have dried up. Frequent handwashing helps stop the disease spreading.

Adults rarely develop the disease, as most have immunity from having previously been exposed to coxsackievirus A16 or a similar enterovirus – even if they don’t remember having it.

However, in late 2012, Best and her colleagues noticed an increase in the number of children being hospitalised for hand, foot and mouth disease, most of whom had atypical symptoms, such as a much more widespread rash and peeling nails a fortnight afterwards. Unusually, adults were also affected.

Laboratory tests identified the virus responsible – coxsackievirus A6, which had already been reported in a number of other countries. Best says there have been no similar outbreaks since then, though it’s likely that coxsackievirus A6 is still circulating.

Fortunately, New Zealand is free of enterovirus 71, which causes the most serious form of hand, foot and mouth disease. Affected children develop the typical symptoms of the disease, but some go on to develop complications such as meningitis, encephalitis and paralysis, which can be fatal.

Several outbreaks of hand, foot and mouth disease caused by enterovirus 71 have been reported in the Asia-Pacific region in the past 15 years, and the virus is now well established in countries such as Malaysia, Borneo, Singapore and Thailand.

“In these countries, they are very proactive about managing hand, foot and mouth disease,” says Best. “They shut down childcare centres when they have a case, because they know it will become a rampant outbreak and may cause serious complications.”

This article was first published in the September 16, 2017 issue of the New Zealand Listener.

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