- The Washington Times - Sunday, August 13, 2000

When Emily O'Brien, age 4, was feeling fatigued and had red blisters in her mouth, her mother was concerned.

"The blisters were in the back of her throat," says Emily's mother, Diana O'Brien, of Reston. "She had a fever and blisters for four days."

Her doctor determined that Emily had hand, foot and mouth disease.

It may sound serious, but hand, foot and mouth disease actually is a mild but contagious virus that runs rampant in the summertime. After a few days, Emily was back to her old self with no medical treatment.

Hand, foot and mouth disease is caused by the coxsackievirus, a group of viruses in the enterovirus family, says Dr. Michael Gerber, a National Institutes of Health physician and member of the American Academy of Pediatrics' Infectious Disease Committee. The virus gets its name from an old belief that infants spread it by putting their hands and feet in their mouths, Dr. Gerber says.

It should not be confused with the foot-and-mouth disease of cattle, sheep and swine.

"Hand, foot and mouth disease is highly contagious but very innocuous," Dr. Gerber says. "For just about everyone, it is a mild infection. It is characterized by tiny red blisters in the mouth, which can be painful. Children may not eat as well. They might be irritable or may have a fever."

The typical infection begins with a mild fever, poor appetite, fatigue and a sore throat. One or two days after the fever begins, sores develop in the mouth. The sores begin as small red spots but eventually may ulcer. They usually are located on the tongue, gums and inside of the cheeks.

The child also may develop a skin rash with flat or raised red spots. The rash, which does not itch, usually is located on the palms of the hands and soles of the feet. Some children also develop the rash on their bottoms. Other children may have only the rash or the mouth ulcers.

Though hand, foot and mouth disease is common, the Centers for Disease Control and Prevention has no estimate of how many cases develop annually because many people do not seek medical treatment or do not even know they have it.

"Most people are completely asymptomatic," Dr. Gerber says. "People often take the step of isolation [such as keeping children home from school or day care], but by the time they have the lesions, they are less infectious than before. Besides, the virus is everywhere, like cold germs."

Still, there are measures to take to avoid spreading the virus. Preventive measures, according to CDC guidelines, include washing hands frequently (especially after diaper changes), disinfecting contaminated surfaces and washing soiled clothes.

Hand, foot and mouth disease is most common in children younger than 10, Dr. Gerber says. Adults generally do not get it but can get a different strain of the cox-sackievirus that causes mild flulike symptoms. Infection results in immunity to the specific strain of the virus, but a second episode may occur with a different member of the enterovirus group.

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