Can a deadly form of hand, foot, and mouth disease hit the US?

A deadly form of a common childhood illness has been linked to dozens of child deaths in Cambodia . (AP Photo/Heng Sinith)

Sept 20, 2012
By Deborah Kotz, Globe Staff

Public health experts think they’ve solved the mystery behind the illness that’s linked to more than 50 deaths of children across Cambodia since April: a virus that causes a common illness in children called hand, foot, and mouth disease. The particular strain of the virus -- Enterovirus Type 71 or EV-71 -- that destroyed the lungs and led to brain swelling in the children who died, has posed problems in other Asian countries, but it isn’t seen often in the US and tends to be less dangerous when it does infect children here.

“We’re not sure why that is,” said Dr. Al DeMaria, state epidemiologist at the Massachusetts Department of Public Health. “It may be a slightly different strain that comes here or have something to do with a difference in hygiene practices or overall health of our population.”

While parents shouldn’t panic that the deadly EV-71 might cause an outbreak at, say, summer camp, DeMaria said public health officials have it on their radar screen. “I think it is a concern. It’s one of the emerging infections we look out for,” he said. “We need to keep an eye on it since infections can travel quickly around the world.”

More commonly, though, the strains of virus that cause hand, foot, and mouth disease in this country are relatively benign only leading to meningitis or lung problems in extremely rare cases. The viruses usually infect children under age five and often spread in nursery school or daycare settings causing fever, crankiness, and blister-like growths on the tongue, palate, and inside of the cheeks, making it painful to eat or swallow liquids. The infection can also cause an uncomfortable rash on the hands, feet, and buttocks.

“Most of the time, it’s pretty self limited and resolves on its own within a week,” said Dr. Thomas Sandora, an infectious disease physician at Boston Children’s Hospital. “We don’t have specific treatments for it. It’s really just supportive care” like over-the-counter pain relievers like ibuprofen or acetaminophen and plenty of rest and fluids.

Dehydration is the biggest concern, so parents need to make sure infected children drink enough, even if they have to sip tiny amounts of fluid throughout the day. Those who find it too painful to swallow may need to be admitted to the hospital to get IV fluids, said Sandora, but that’s uncommon.

The enteroviruses that cause hand, foot, and mouth disease usually peak during the summer months, though this past spring the state experienced clusters of coxsackievirus A6, according to DeMaria, a more severe form of enterovirus that caused more hospitalizations of children.

Adults can get hand, foot, and mouth disease too, but they often have milder symptoms such as a low-grade fever without a rash.

The virus is, though, very contagious spreading through saliva as well as fecal matter. “One of the most important things people can do for prevention is to wash their hands frequently and thoroughly, particularly after diaper changes,” said Sandora.