This spring and summer has already brought Lancaster County many cases of hand, foot and mouth disease. This viral illness is usually not serious, but certainly can make a child — and her parents — quite miserable.

HFMD and its cousin disease, herpangina, are characterized by oral ulcers and rash on the hands and feet. It occurs most often in children younger than 5 to 7 years, but can affect teens and adults as well. Cases tend to spike in summer and early autumn.

Interesting facts to know about this illness:

— The usual cause of HFMD is coxsackievirus, a serotype, or strain, of the enterovirus family. The virus is named after the village in New York state where it was first discovered. Dr. Gilbert Dallendorf identified it while looking for a cure for polio.

— The virus is spread through oral ingestion of virus shed in stool or respiratory secretions. The virus is quite hardy and can live in the mouth for up to four weeks and in the stool for several months.

— Coxsackievirus is quite contagious; outbreaks in daycare centers and schools are not uncommon. The incubation period is typically around three days from time of exposure.

— Clinical symptoms consist mainly of fever and mouth pain. There can be accompanying symptoms such as diarrhea, vomiting or abdominal pain.

— The hallmark of this disease is the rash. It typically consists of flat red patches that develop a small vesicle filled with clear fluid. The vesicles typically rupture, leaving an ulcer in their place. The rash does not itch and usually appears on the palms, soles, buttocks, legs and arms. The torso and face are less commonly involved.

— Oral lesions appear on the tongue and cheeks, but also can be seen on the palate, lips, tonsils and uvula.

— It is not uncommon for fingernails and toenails to peel or even fall off. This can occur several weeks after infection

— A strain of the virus labeled enterovirus A71 recently has been linked with more severe symptoms, including meningitis and paralysis. Fortunately this strain is rare, and these complications are very unusual.

— Typical infection causes symptoms for five to seven days and resolves on its own. Parents may choose to give ibuprofen or acetaminophen if the child is uncomfortable. It is advised to avoid spicy, salty or sour foods, which may irritate the mouth even more.

— Children do not need to be excluded from child care or school unless they have fever, excessive drooling or open blisters on the skin.

— An immunity develops to the HFMD virus after infection, however, because there are several strains, it is possible to have this infection more than once.

— This virus is not related to or affected by foot and mouth disease, a viral illness that affects cows, goats, pigs and other livestock.

— Vaccines for these virus types, especially ones targeted toward the more serious but rare A71 strain, currently are in experimental trials.

Be on the lookout for this annual enemy of children and pediatricians alike this summer. Rest assured it is usually quite harmless but is certainly a nuisance.

  • Dr. Pia Fenimore, of Lancaster Pediatric Associates, answers questions about children's health. You can submit questions at