Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is a common, highly contagious viral illness caused primarily by enteroviruses, most frequently Coxsackievirus A16 (the most common cause in North America and Europe) and Enterovirus 71 (EV-A71, more commonly associated with severe neurological complications in the Asia-Pacific region). Other causative agents include Coxsackievirus A6 (associated with more extensive and atypical rash presentations), Coxsackievirus A10, and other enterovirus serotypes. HFMD predominantly affects children under 5 years of age, with peak incidence between 1 and 3 years, though older children, adolescents, and adults can also be infected. The disease occurs most commonly in summer and early fall in temperate climates but may occur year-round in tropical regions. Transmission occurs through multiple routes: fecal-oral route (the primary mode, through contact with stool from infected individuals), direct contact with vesicular fluid from skin lesions, respiratory droplet spread from oropharyngeal secretions, and contact with contaminated surfaces (fomites). The virus can be shed in stool for weeks to months after clinical recovery, which has important implications for infection control in daycare and household settings. The pathophysiology of HFMD begins...