Can you catch Hand-Foot-And-Mouth Disease twice?

Can you catch Hand-Foot-And-Mouth Disease twice?
Q:
Can you catch Hand-Foot-And-Mouth Disease twice?

My fourteen-month-old son recently had hand-foot-and-mouth virus. Is this something he can catch again, or will he be immune from future recurrences? It’s nice to have a place to ask non-urgent questions about the little ones, and as I know you — you have seen my son in the office — I trust your answers and advice.
Nancy Stone – Post-Doctoral Fellow – Stanford Medical School – Palo Alto, California

A:

Dr. Greene’s Answer:

The incredible human body is equipped with an immune system that staggers the imagination. In ages past, explorers charted thrilling new lands. Today, one of the most exciting frontiers of discovery is the wondrous, intricate, complex immune system silently protecting us day and night.

Two types of defense against viruses predominate in the bloodstream: humoral immunity and cellular immunity. The humoral (or one might say ‘liquid’) immune system attacks viruses when they are loose in the body, either in the bloodstream or in bodily secretions. The cellular immune system attempts to destroy viruses once they have taken up residence inside the body’s cells.

The humoral response consists of antibodies made to specific viruses. These antibodies remain present in the circulation and secretions, hopefully eliminating the virus and protecting against future infections. The more water soluble a particular virus is, the more effective the humoral response. A good example of this is the poliovirus. Polio vaccines (and other vaccines) work precisely because they so effectively stimulate specific antibody formation. When a person is re-exposed to polio, the virus is destroyed by antibodies before infection sets in.

The cellular response consists of certain white blood cells, such as cytotoxic lymphocytes or natural killer cells, which attack and destroy our own cells that have been invaded and altered by viruses. Some viruses, such as herpes, are ‘sneaky’ enough to hide in our cells without changing the way they look to the cellular immune system. These viruses can remain dormant within cells for years, only to re-emerge periodically when our humoral defenses are weak and allow the viruses to get loose in the circulation once again.

Hand-foot-and-mouth syndrome is a distinct viral illness. It produces blisters in the mouth in 90% of infected children and a characteristic rash primarily on the hands, feet, or buttocks in 64% of these children. Most children are cranky, with a sore throat, decreased appetite, and/or fever. The illness typically clears within a week.

Hand-foot-and-mouth syndrome was first reported in 1956, in Australia. As far as we know, it never occurred before that time. For the next 7 years it was reported, only occasionally, in pockets dotting the globe. By 1963, however, it became a common feature of childhood worldwide.

Hand-foot-and-mouth syndrome is caused by several different viruses, including coxsackieviruses A5, A9, A10, A16, B1, B3, enterovirus 71, foot-and-mouth disease virus, and herpes simplex. The vast majority of cases, however, are caused by coxsackievirus A16.

A child with a healthy immune system will form antibodies to whichever virus caused the infection. If your son is re-exposed to the same virus, he will probably not be re-infected. He is still susceptible, in varying degrees, to the other viruses. Since 1963, most children have had one case of hand-foot-and-mouth syndrome, caused by coxsackievirus A16.

There is one other snag. While most children clear their bodies of the virus within one week, coxsackievirus A16 occasionally succeeds in hiding inside children’s own cells, like herpes. By eluding the cellular immune system, coxsackievirus A16 can cause chronic or recurring skin lesions. Healthy humoral immunity is able to keep these recurrences from being as severe as the initial episode.

Will your son catch hand-foot-and-mouth syndrome again? Probably not, but there are no guarantees. Who knows? In the next century, enterovirus 71 might become the major cause of hand-foot-and-mouth syndrome. Even so, the human immune system has a remarkable history of adapting to the ever-changing microscopic world around us.

Reviewed by: Khanh-Van Le-Bucklin, Rebecca Hicks
Last reviewed: May 25, 2009
Dr. Alan Greene

Article written by

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

 

Comments

  • Rita Robelin Huron

    My granddaughter is 3 months old and she was diagnosed with HF&MD in early July. Well it is now August and she still has it or has got it again. She has lesions all over her hands which she puts in her mouth all the time. She has been to the doctors twice and they just say it will go away. She also has the blisters all over her body. I know it is rare to get it twice, should we take her to the doctors again and ask for blood work to see if there is anything else going on? Do these lesions hurt or itch? She is only 3 months old and can’t tell us how she feels. Please advise.

    • Alan Greene

      Rita, when a rash isn’t getting better when expected, going back to re-evaluate is a great idea. Putting the hands in the mouth all the time might be a normal behavior at her age, might be a sign her gums feel strange with teething — or might because her hands itch or hurt.

      There are other things that could cause her symptoms as well, including scabies – which cause a rash that can be a great mimicker (http://www.drgreene.com/articles/scabies/)

      • Rita Robelin Huron

        If it was scabies we would all have it since we hold her all the time and it is highly contagious. No one we know has HF&MD. Should we have blood work done? Could a low immune system prevent her from fighting off this disease? Please advise.

        • Alan Greene

          Rita, when it’s not clear what’s going on, taking a baby back to the doctor to ask for a re-evaluation and whether blood work would be appropriate seems wise.

          Most people with the virus that causes HFM disease don’t have symptoms, so it’s impossible to know if she’s been exposed. And many people with scabies don’t react to them, and don’t get the itching or the rash – so comfortable family members don’t rule it out.

          A careful re-examination and perhaps blood work, depending on the findings, seems prudent. Blood work could also evaluate the immune system, though there are plenty of other possible reasons for the prolonged rash.

        • http://batman-news.com MiMi

          Dr. Greene, my granddaughter(age 2 and a half years) has also has this virus at least 3-4 times in the past year alone. She nor her brother have been vaccinated(he’s 5 years old). Is it possible that their immune systems are compromised because of this?

    • Heather White Parker

      Use baby wipes and wash them down with it pretty regular it will help make the rash go away my aunt told me this and it really works been using them on my 5 year old for two days and the rash is almost gone.

      • http://DrGreene.com/ Cheryl Greene

        Hi Heather and Rita,

        Not all wipes are created equal. Some have chemicals that may irritate. Three brands I like a lot are Episencial, Honest, and 7th Generation. All are very gentle.

  • -AJ

    What about a teenager age 18 with a HFMD can he be caught again??

  • Melissa

    Hello, im 30 and have it for the second time. I had it when I was 22 the first time. My mom doesnt remember me having it when I was a child. Does this mean I have a weak immune system?? Or just a run of bad luck with this virus!? I work in health care and am wondering how long I should be off before going back. Thank-you, Melissa D

  • Dari

    Hi, I caught HFMD from my toddler back at the end of the summer. I had a mild case, red marks on the palms of my hands and some sores/blisters in the mouth. My daughter had it worse. Ever since this episode, anytime I have a cold or am not feeling well, I notice that I get a few on my hands and in my mouth again. Am I going to keep having outbreaks of this from now on whenever I catch a cold, etc.? Also, am I contagious when I have these recurrences? I’ve been teaching preschool for over 12 years so I think I have a pretty strong immune system. I’m all set with blisters in my mouth! Thanks for any feedback:-)

  • Saoirsephoto

    I’ve noticed from time to time spots and bumps on my toddler’s feet very similar (but not as bad) to when she had HFMD and occasionally on my hands as well (the entire family got it). Does this mean that the virus has embedded like herpes simplex does? Will it pop like this for the rest of her life and like with the herpes virus, is she contagious every time the spots reappear?

  • Kate

    I have the same question as Dari. I got HFMD from my 6-month old daughter nine months ago and every once in a while I get a lesion or two on my hands. I’m assuming that means that for me the virus has made it into my cells (you said it was like Herpes?!). Am I condemned to have this for the rest of my life now? Does this mean there’s something wrong with my immune system?

  • Linda Wolski Gonzales

    My grandson has HFMD on the soles of his feet. Yesterday, I noticed about a dozen “pimple-like” blisters near my left elbow. I can’t wear long sleeves because it is too darn hot here, but if it is HFMD, I am terrified of getting it on my face because I would lose income as my work would require me to stay home.;

    • http://DrGreene.com/ Cheryl Greene

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  • John Annis

    My son had hand, foot and mouth syndrome in 1982 when he was less than a year old. He’s 33 now and apparently caught it again from his kids. It must be a different virus causing it, I guess. The blisters look the same, and are on his hands, feet and mouth just like they were 31 years ago.

  • Patricia Columbo

    My neighbor’s child has had HF&M 3 times within the past 4 1/2 months. He is 2 yrs old. It has been said the parents both have an STD called Herpes Simplex. He gets very high fevers & needs to be hospitalized when he gets these bouts. Am I correct in understanding what you’ve written – states HF&M can be caused by the Herpes Simplex virus? If so, what needs to be done where he can be free of this disease and not have anymore relapses.