Can you Catch Hand-Foot-and-Mouth Disease Twice?

Hand Foot and Mouth syndrome is caused by several different viruses, including coxsackieviruses A5, A9, A10, A16, B1, B3, enterovirus 7, herpes simplex...

Question

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

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.

Several Different Viruses Can Cause Hand-Foot-and-Mouth Syndrome

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.

Last medical review on: October 29, 2014
About the Author
Photo of Alan Greene MD
Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
Get Dr. Greene's Wellness RecommendationsSignup now to get Dr. Greene's healing philosophy, insight into medical trends, parenting tips, seasonal highlights, and health news delivered to your inbox every month.
Showing
10
comments (141 total)
Add your comment

Recent Comments

I am an adult female. I had a severe case of HFMD in July of 2017. My mouth was so full of lesions and so painful, I lost 9 lbs in 10 days because I could not eat. It took about a month to recover. Since that time, every 3 or 4 months I get a recurrence of the blisters in my mouth. Nowhere near as bad as the first time, but still very painful. I mentioned it to my Doc and he said it is impossible that it would come back. However, I know it is the same thing and wonder if this is something that will last for the rest of my life.

I am a 74 year old male. I have experienced hand foot and mouth three times in the last four years. Your comments about the possibility of the virus being dormant and possible re-emerging was very interesting.
Each of my episodes were similar, Hands, feet and mouth and very uncomfortable.
Recent full blood count indicated possible CLL with elevated white blood cell count though low enough to not require treatment at this stage.
Now wondering if dormant H,F&M virus could be a factor.
Intend to discuss with hemotologist at next visit.
Thanks for your article, very difficult to get information as my docs to date have very little experience of this condition.
Fred Meaney. Ireland

This was a really wonderful post. Thank you for your provided information.

Posting here to see if anyone has received any updated information to share on this virus. Has anyone who has had numerous outbreaks had them completely stop?

I don’t need a response by Dr Greene that it can be caused by various strains of the virus. Clearly numerous posters here are saying that is NOT what is happening. For example, I’ve had 15 plus outbreaks over the past year and my child isn’t even in daycare or school. Are there even 15 strains of the virus??

My first outbreak was when my son got HFM at school. I caught it about 2 weeks after him (funny how they say it isn’t contagious after the sores have healed..riiiiight).

My outbreaks seem to be following a stressful time or after a lot of exercise. I don’t have the spots on my hands but just a low grade fever and the mouth sores.

I would like to have another baby and I’m concerned about having outbreaks while pregnant.

I don’t believe it is different strains of the virus. There are numerous studies that point to coxsackievirus persistence in the body. My daughter had HFMD almost constantly for a year (I posted about it below) and while Acyclovir got rid of the rash on her hands and feet, her gastrointestinal distress, chest pain, and headaches are still constant. Doctors are not able to keep up with the changes in the virus.

I have been expecting very similar symptoms since 2015. There seems to be no rhyme or reason. I’m on my second outbreak in 6 weeks right now. I see my doctor in the morning. I’m hoping and praying for some relief. 😭

Leigha,

Wow, that sounds painful.

Dr. Greene points out two important facts that answer your question:

  1. 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.
  2. Several Different Viruses Can Cause Hand-Foot-and-Mouth Syndrome: 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.

Likely, your daughter is succumbing to different viruses that all product that same group of symptoms. Again, OUCH!

I hope that helps.
Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

My daughter seems to keep catching HF&M over and over. She’s 15 now, and has had it in the past but just this year Summer 2018 to Spring 2019 she’s had it 6X’s. She is a healthy girl otherwise. What could be causing her to get this over and over?

I don’t believe it is different strains of the virus. There are numerous studies that point to coxsackievirus persistence in the body. My daughter had HFMD almost constantly for a year (I posted about it below) and while Acyclovir got rid of the rash on her hands and feet, her gastrointestinal distress, chest pain, and headaches are still constant. Doctors are not able to keep up with the changes in the virus.

Leigha,

Wow, that sounds painful.

Dr. Greene points out two important facts that answer your question:

  1. 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.
  2. Several Different Viruses Can Cause Hand-Foot-and-Mouth Syndrome: 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.

Likely, your daughter is succumbing to different viruses that all product that same group of symptoms. Again, OUCH!

I hope that helps.
Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

Emma,
I haven’t had a full blown outbreak in a couple of years now fortunately, and have found that when I feel as though it’s coming on, I take valtrex. That seems to help suppress it to a certain extent. It’s an absolutely awful virus, I’ve had maybe a dozen outbreaks in my adult life and it usually takes me out of work and social life for at least two weeks, at worst, a month. I hope your baby girl leaves it behind in childhood, which I hear most kiddos do.

🌈

Hi Holly,

Did your bouts of HFM eventually stop? My daughter is going through a similar cycle of symptoms after contracting coxsackie last year. Thanks!

Emma

Emma,
I haven’t had a full blown outbreak in a couple of years now fortunately, and have found that when I feel as though it’s coming on, I take valtrex. That seems to help suppress it to a certain extent. It’s an absolutely awful virus, I’ve had maybe a dozen outbreaks in my adult life and it usually takes me out of work and social life for at least two weeks, at worst, a month. I hope your baby girl leaves it behind in childhood, which I hear most kiddos do.

🌈