What you need to know about hand, foot and mouth disease: ‘It starts with one dot’

Shari Rudavsky | IndyStar

Show Caption Hide Caption What is hand, foot and mouth disease Cases of hand, foot and mouth disease are common during the spring, summer and fall according to the CDC. @Finnerty_Meghan MEFinnerty@gannett.com

Hand, foot, and mouth disease didn't come to mind the first time Kailee Petro saw the red marks on her toddler’s skin.

She figured it was eczema and took her daughter to daycare. The worried teacher urged her to take the girl to a doctor who confirmed it was hand, foot and mouth.

Over the next five months, Brynlee would get hand, foot, and mouth two more times. When she got it the second time in May, her father also came down with blisters on his hands and tongue that he described as feeling like needle pricks.

“I really hope this is the last of it. I’m sick and tired of it,” said Petro, a nurse who lives on the Southside and just got through disinfecting her house once more after Brynlee’s latest bout. “We just keep getting this hand, foot and mouth, over and over…. It starts with one dot.”

The syndrome recently made headlines when New York Met Noah Syndergaard was placed on the disabled list after contracting hand, foot, and mouth most likely after volunteering at a camp for youth.

What is hand, food and mouth?

More common in the summer, hand, foot, and mouth syndrome — named for where on the body the signature blisters typically form – is caused by any of a number of enteroviruses, a large group that includes the virus that causes polio.

These microbes hang out in the gastrointestinal tract and can also lead to stomach distress, experts say. Or, they may go undetected.

“Most common is they don’t manifest at all,” said Dr. John Christenson, a professor of clinical pediatrics at the Ryan White Center for Pediatric Infectious Disease and Global Health at Riley Hospital for Children.

It’s not clear why these viruses circulate more in the warmer months. One reason might be that other viruses such as influenza and respiratory viruses are more dominant in colder months, crowding these viruses out, Christenson said.

Although this summer may seem worse than others, Christenson said, it has not struck him as unusual for hand, foot, and mouth cases.

“It comes and goes. Some summers are more active than others,” he said.

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Daycares take precautions, but 'everyone seems to get it'

Most years Alexis Yoo, a pediatric nurse practitioner with Community Health Network, doesn’t see an influx of cases until right after school begins around the middle of August. But Yoo, who works at an Eastside MedCheck, added she has seen a few cases recently.

And those on the front lines of daycare, say they’re seeing more cases.

Last week several of the younger children who attend Greenwood Christian School were out with symptoms, said Carah Cruse, director of childcare ministries.

“This isn’t the first time that we have seen it, but we have seen it a lot in the last month or so,” she said. “It seems when it goes through the infant and toddler rooms, everyone seems to get it.”

For that reason, Cruse and her colleagues take even a single case seriously, checking the other children for symptoms, alerting parents that there’s been a suspected case, doing a thorough cleaning, and asking parents to keep their ill children at home while symptoms persist.

'You freak out with every little bump'

Because Brynlee’s daycare follows similar precautions, each time she had hand, foot, and mouth she was out for at least a week.

Now, Petro said, every spot she sees on her child’s body strikes fear. One day this week Brynlee woke up and had a red dot on her cheek. Petro feared the worst but in a few hours the mark had disappeared.

“You freak out with every little bump that comes upon her body because you just don’t know,” she said.

About a month ago, both of Brandi Pahl’s twin five-year-old sons came home with the virus, one after the other. Both developed fever, one had itchy spots on his hands and feet and the other complained of a sore throat, another common symptom.

Pahl and her husband each missed work a few days until the boys were cleared to return to daycare.

“It was just very inconvenient,” she said.

Symptoms and how to treat it

There’s not much parents can offer children who are suffering. Yoo recommends popsicles to soothe the blisters in their throat, cold wash rags for those on their body, fever-reducers to bring down their temperature.

In most cases the virus just needs to run its course, Christenson said. But occasionally the virus can cause a child to develop meningeal encephalitis in which case a child might require hospitalization.

The best way to prevent hand, foot and mouth is hygiene and isolation, hence the letters from daycare asking that infected children stay home until their symptoms resolve. But children can pass the virus even before symptoms appear and some people may pass on the virus without having symptoms themselves.

Enteroviruses can also spread through pools, Christenson warned, and often begin when an infected toddler enters the water.

There is no protection

While the polio vaccine protects against the virus that causes that disease, children in the United States receive no protection against viruses that cause hand, foot, and mouth disease.

China does have a vaccine against enterovirus 71, which is more common there and can lead to severe and even fatal cases of hand, foot, and mouth. While there’s a current outbreak in Beijing, EV71 is responsible for only a small of minority of the cases.

In the United States, Coxsackie virus causes most of the cases of hand, foot and mouth, according to the Centers for Disease Control and Prevention. Earlier this summer, however, health officials sent out an alert, telling providers to watch for cases caused by EV71, Christenson said.

With multiple viruses that can cause hand, foot, and mouth, however, here’s no surefire way to prevent hand, foot, and mouth.

Your best shot, said Christenson: “You would have to hide your children in the closet and leave them there all year. That’s very difficult to do.”

Call IndyStar staff reporter Shari Rudavsky at (317) 444-6354. Follow her on Twitter: @srudavsky.