Hand, Foot, and Mouth Disease Guidelines

Understanding HFMD Transmission

• Enterovirus 71 (EV-A71) is a primary cause of hand, foot, and mouth disease (HFMD) 1
• The virus spreads through direct contact with respiratory secretions, saliva, or fluid from blisters 2

Contagious Period

• The contagious period for HFMD begins 1-2 days before symptoms appear and continues until all blisters have dried and crusted over, generally lasting 7-10 days from symptom onset 2
• Viral shedding can continue in stool for several weeks after symptoms resolve 1
• Patients should be considered potentially contagious for at least 10-14 days 3

When to Return to School

• Children with HFMD should not return to school until fever has resolved without fever-reducing medications, all blisters have dried and crusted over, and at least 7 days have passed since symptom onset 3

Preventing Transmission

• Practice thorough handwashing with soap and water to prevent spreading HFMD to others 3
• Avoid close contact with others during the contagious period 3
• Properly dispose of tissues containing nasal secretions 6

Special Considerations

• Healthcare workers should follow strict infection control protocols to prevent transmission 3
• Childcare providers should be particularly vigilant about handwashing and disinfection 3

Common Pitfalls to Avoid

• Children who return to school before the contagious period ends can trigger outbreaks 3
• Relying only on fever resolution is insufficient, as the child remains contagious until all lesions have crusted 3
• Inadequate hand hygiene, such as using only alcohol-based sanitizers, is insufficient against enteroviruses 3
• Overlooking environmental cleaning can lead to transmission, as enteroviruses can remain viable on surfaces for up to 28 days 3