Coxsackievirus infection: hand, foot and mouth disease and related illness

Coxsackieviruses are a group of viruses within the enterovirus genus. A UKHSA research summary notes that human enteroviruses are ubiquitous, and that they are important causes of aseptic meningitis, myocarditis, hand, foot and mouth disease, acute haemorrhagic conjunctivitis, herpangina and Bornholm disease (a painful chest and abdominal muscle illness), as well as non-specific fevers, respiratory illnesses and rash.

In everyday life, most people meet a coxsackievirus as hand, foot and mouth disease. The NHS describes this as a common childhood illness that can also affect adults, and stresses that it is not the same as foot and mouth disease in farm animals.

Because many different viruses can cause it, one attack does not give lasting protection against all of them. That is why NHS inform advises that people can get hand, foot and mouth disease more than once.

The NHS describes two stages. The first symptoms can be a sore throat, a high temperature and not wanting to eat. The second stage usually starts a few days later.

• Mouth ulcers, which can be painful; NHS inform says they may be yellow-grey with red edges and make eating, drinking and swallowing difficult, and that they should pass within a week.

• A raised rash of spots on the hands and feet, and sometimes the groin area and bottom. The NHS says the spots can look pink, red, or darker than the surrounding skin depending on skin tone.

• Spots that can turn into blisters, which might be grey or lighter than the surrounding skin and can be painful.

• Symptoms that are usually mild and the same in adults and children, according to the NHS.

UKHSA says hand, foot and mouth disease is spread by being around an infected person who is coughing or sneezing, and by direct contact with that person's poo or body fluids. People are infectious until a few weeks after symptoms stop, and most infectious in the first week of illness. The incubation period is 3 to 5 days.

The NHS adds that you can start spreading it from a few days before you have symptoms. Younger children are more at risk because, as UKHSA puts it, they often play close together, and anyone changing nappies or helping with toileting should wash hands frequently with soap and water.

A clinical reference from Patient says it typically affects children under 10, especially under 4, that outbreaks are frequent in nurseries and schools, and that most adults are immune after earlier exposure. It notes that adult cases may occur, particularly with coxsackievirus A6. It also notes that infected people can continue to shed virus in the stools for some weeks.

The NHS advises that there is no medicine to cure it, so care is about comfort. It suggests cool drinks to soothe the mouth and prevent dehydration, avoiding acidic drinks such as fruit juice, eating soft foods like yoghurt, avoiding hot, salty and spicy foods, and taking paracetamol or ibuprofen for a sore mouth or throat.

A pharmacist can suggest mouth ulcer gels, sprays and mouthwashes and say which are suitable for children. To reduce spread, the NHS suggests washing hands often with soap and water, using tissues, binning them quickly, not sharing towels or cups and washing soiled bedding on a hot wash.

On school, the NHS says to keep a child off nursery or school while they feel too unwell to go, and that they can go back as soon as they feel better, with no need to wait until the blisters have healed.

The NHS says to see a GP if symptoms do not improve after 7 to 10 days, or if you are pregnant and get hand, foot and mouth disease. Because the illness spreads easily, call the surgery first, as they may suggest a phone consultation.

It advises asking for an urgent GP appointment or help from NHS 111 if you or your child has a very high temperature or feels hot, cold or shivery, if you are worried about symptoms, or if a child is peeing less than usual, which may mean dehydration.

UKHSA says people should get medical advice quickly if they have complications, including a high temperature, headache, stiff neck or back pain. A clinical reference from Patient adds neurological signs such as persistent or severe headache or myoclonic jerks to the reasons clinicians consider referral. Anyone who becomes drowsy, confused or very unwell needs urgent assessment through NHS 111, A&E or 999.

According to the clinical reference, diagnosis is usually clinical, based on the typical mouth and skin lesions, and investigations are not usually necessary. The virus can be identified from throat, blister or rectal swabs or from stool, and PCR testing allows subtyping, but this is mainly used in specialist centres and is rarely needed in routine care.

The UKHSA research summary adds that laboratory diagnosis of enterovirus infection has improved by replacing viral culture and serology with PCR, which is now part of routine cerebrospinal fluid investigation when meningitis is suspected. It notes that although specific antiviral therapy remains elusive, laboratory diagnosis helps by excluding other treatable infections.

The NHS says there is usually no risk to the pregnancy or baby, but it is best to avoid close contact with anyone who has hand, foot and mouth disease, because getting it shortly before giving birth can mean the baby is born with a mild version. It suggests speaking to a GP or midwife if you have been in contact with a case.

UKHSA gives similar advice, saying pregnant women should avoid close contact with anyone who has the illness and get advice from their doctor or midwife if they have been in contact. NHS inform adds that anyone who becomes infected within a few weeks of their due date should speak to their GP practice. The UKHSA research summary says that neonatal enterovirus infection can be particularly severe, which is the reason these conversations matter.

Most cases are managed at home with advice from a pharmacist or the NHS website. GP, NHS 111 and urgent care services are the NHS routes if symptoms are worrying, and suspected complications such as meningitis or heart involvement are managed in hospital.

Private GP or paediatric consultations may be quicker to access, but the care is the same: supportive treatment and monitoring for complications. UKHSA says there is no need to contact the health protection team about a single case.