Guidelines for the Management of Hand, Foot and Mouth Disease outbreaks in Educational Institutions

Hand, Foot, and Mouth Disease (HFMD)

Hand, foot, and mouth disease is a common childhood illness caused by different Enteroviruses such as the Coxsackie virus. The illness most often occurs between March and June and between September and December but can occur at any time. It is most frequently seen in young children, infants, and toddlers. It is characterized by fever and a blister-like rash affecting the palms of the hands and soles of the feet along with blisters inside the mouth.



Children usually become infected with the virus from other children through hugging, kissing or contact with stool. It typically occurs in small epidemics in nursery schools or kindergartens.


Symptoms and Signs

  • Fever and general malaise (poor appetite, aches and pains, for one to two days
  • The fever is usually followed by small red spots on the hands, feet, and in the mouth.
  • The spots develop into blisters.
  • The blisters may develop on the gums, inner cheeks, and tongue and patients may complain of mouth pain and a sore throat.
  • These young patients tend to drool and avoid swallowing and may refuse to drink or eat because of the discomfort.
  • Very young infants may even become dehydrated due to the refusal to drink.

Children infected with the virus causing hand, foot, and mouth disease generally have mild illness and recover within one week of developing symptoms.


When to Seek Medical Care

Any high fever in a very young infant should be evaluated by a health-care practitioner. For older infants and children, as long as the child has adequate oral intake, this particular illness can be managed comfortably at home.



There is no specific treatment for hand, foot, and mouth disease. Supportive care, including fever management, and prevention of dehydration are the primary goals.

If your child’s fever remains elevated despite appropriate fever-reducing drugs, or if he/she develops any signs or symptoms of dehydration (dry skin and mucous membranes, weight loss, persistent irritability, lethargy, or decreased urine output), you should seek immediate medical attention. When concerned or in doubt, contact your child’s health-care provider.


Methods of control:

  • Limit person to person contact such as hugging, kissing or sharing utensils
  • Promote good hygiene practices such as:
    • Hand washing with soap and water.
    • Covering nose and mouth when sneezing
  • Appropriate infection control practices are recommended to prevent the spread of hand, foot, and mouth disease. This includes:
  • Immediately separating suspected cases of HFMD from the general school population and send home.
  • Frequent disinfection of schools in order to prevent the spread of this disease.




Schools should clean all areas and items that are more likely to have frequent hand contact (for example, taps, toys, keyboards, door handles or desks) at least twice a day and also clean these areas immediately when visibly handled by ill persons. We recommend first washing items with soap and water and then disinfecting with 5% bleach (which is commonly sold commercially) diluted 1 part bleach to 10 parts water.

School officials should contact the Medical Officer at the Parish Health Department for additional guidance



All cases of Hand, Foot and Mouth disease at the institutions (day care, schools, etc.) should be reported to the Medical Officer at the Parish Health Department.