Credit - Washoe County Health Department
# 6498
HFMD (Hand Foot & Mouth Disease) is a very common – generally mild - viral infection, that usually peaks in late summer or early fall, and is mainly seen among children under the age of 10 (although adults may be vulnerable as well).
HFMD may be caused by a number of the non-polio enteroviruses.
While this virus classification may be unfamiliar to a lot of people, the 60+ viruses that fall into this category are among the most prevalent viral infections in the world, probably only second to the myriad and ubiquitous variants of Rhinovirus (`common cold’) that circulate every year.
The two most common causes of HFMD have been the Coxsackie A16 virus, and (particularly in Asia) Enterovirus-71 (EV-71), and rarely, the Coxsackie A10 virus.
Late last year, however, coxsackievirus A6 was reported in the United States (Alabama, California, Connecticut & Nevada (see MMWR: Coxsackievirus A6 Notes From The Field). First detected in Finland in 2008, this virus has since been seen popping up around the world, including in Taiwan and Japan.
Unlike Coxsackievirus A16, A6 produces a more robust infection, and and can occasionally lead to serious illness. According to the MMWR report mentioned above, 20% of the cases in the United States last year required hospitalization. The good news is no deaths were reported.
Barely a week before the start of the fall school session, the Washoe County, Nevada Health Department has issued a warning to parents of an ongoing outbreak of this atypical A6 HFMD strain in their community.
The local school district has asked parents to keep kids home if they are contagious (see media report).
Excerpts from the Health Department Release follow:
A rare strain of hand, foot, and mouth disease (HFMD) has made its way to the Truckee Meadows. Over four hundred self-reported cases of HFMD have been received by WCHD in 2012. Typical HFMD, most commonly caused by either Coxsackievirus A16 (CVA16) or Enterovirus 71 (EV 71) is a common illness of infants and children ≤ 5 yrs.
What is Atypical HFMD caused by Coxsackie A6 (CVA6)?
This specific virus (CVA6) has been identified as, an
emerging disease (new to the U.S. in 2012), causing
outbreaks of HFMD. The disease presentation associated with CVA6 differs from the more commonly seen forms of HFMD (e.g. CVA16 and EV 71) in that:
- Transmission from children to adults is more common with CVA6,
- The sores associated with CVA6 can be impressive and painful, appearing not only on the hands, feet and mouth but also on the buttocks, groin, face and extremities
- Some cases report nail shedding or peeling
(onychomadesis) weeks after initial onset, and- This strain is not confined to just the summer months as with other viruses causing HFMD
The local health department is offering the following advice to parents to help control the spread of this virus:
How is HFMD caused by CVA6 prevented and controlled?
Interrupting person-to-person and surface-to-person
transmission controls the spread of HFMD. If people
practice good personal hygiene after going to the
bathroom and before eating it may limit the spread of the disease.
Protect Yourself and Prevent the Spread of HFMD.
• Wash hands with soap and water carefully and frequently, especially after going to the bathroom, after changing diapers, and before preparing and/or consuming foods or beverages.
• Disinfect surfaces and items, including toys. First wash the items with soap and water; then disinfect them with a solution of 2 tablespoons of bleach to 4 cups of water.
• Avoid close contact such as kissing, hugging, or sharing eating utensils or cups with infected people.
• Remain at home until all three following criteria are met:
- fever free for 24 hours without the use of a fever reducer
- all lesions have dried or are scabbed over
- no new lesions have appeared for two days.
For many years HFMD has been a mild childhood disease in this country, rarely producing serious illness. For that reason, many parents may not be aware of this more serious, atypical form of the disease.
The CDC maintains a large website on HFMD, where you’ll find audio podcasts by a CDC pediatrician on the illness, and links to other resources.
The good news is that most cases of HFMD in this country are apt to be due to the milder Coxsackie A16 virus, and serious complications are rare.
Like all emerging viruses, we’ll simply have to watch to see how well this upstart coxsackievirus A6 manages to adapt and spread in the human population.
Stay tuned.
