Hand, Foot, and Mouth Disease Outbreaks Continue to Appear Across East Coast Schools

The recent spate of hand, foot, and mouth disease (HFMD) outbreaks continue to vex East Coast schools and universities, as health officials are reporting new and continuing clusters of the virus.

An outbreak of HFMD that began on September 12, 2016, at Florida State University in Tallahassee, has now seen 56 cases of the illness on campus, marring the new semester excitement. These infections are caused by strains of polioviruses, coxsackieviruses, echoviruses, and enteroviruses.

According to the Centers for Disease Control and Prevention, coxsackieviruses are most often the culprit behind HFMD, which often begins with a fever, reduced appetite, sore throat, and malaise. Typically, individuals suffering from this virus develop painful sores in the back of the mouth one or two days after the onset of symptoms and a rash can form on the palms of hands and the bottom of feet. Spots may also appear on the knees, elbows, buttocks, or genital area. The spots caused by HFMD can blister and feel tender to the touch. Complications of the infection are rare. While the disease most often occurs in children younger than 5 years of age, it at times infect adults as well.

At the University of North Florida in Jacksonville, school health officials say that at least eight students have confirmed cases of HFMD. Such outbreaks at universities highlight the contagiousness of the illness, which can spread quickly and easily through nose and throat secretions, blister fluid, and feces. A healthy individual can catch HFMD from close personal contact with an infected individual. Those infected are most contagious in the first week of infection, although they can continue to be contagious even after symptoms go away. For colleges and universities, the challenge is preventing the spread of HFMD outbreaks in dorms, classrooms, and other shared facilities. At both Florida universities, school officials are ramping up sanitation efforts while encouraging students to keep shared spaces clean using bleach-based products.

Another string of HFMD cases, also timed with the start of the school year, has continued in New Jersey. Since two high schools in the state reported small outbreaks in early September— hitting members of school sports teams– nearly a dozen schools altogether have reported students with the virus. At Hightstown High School, eight students, including six of the school’s football team members, have contracted HFMD. In addition, school officials are reporting that student athletes at Holmdel High, Mendham High, and North Warren High have also come down with the disease.

Nicole Mulvaney Kirgan, of the New Jersey Department of Health, notes that while state health officials expect HFMD this time of year, as the virus tends to spike in late summer and fall, the number of cases varies from year to year. “Last year, six outbreaks were reported in the five months ending in October, and in 2014, there were 23 outbreaks during that period,” says Kirgan. “Although some of the cases reported are due to coxsackie virus— the virus that causes hand, foot, and mouth disease–it is not clear if all of the reported illnesses are HFMD or if other viruses are involved.”

Kirgan explains that in the case of such outbreaks, the state’s recommendations for scholastic sports participation are that if children are sick, they should not be playing sports. If they are not sick, there is no reason they should not play, unless there are so many ill team-members that they cannot field a team. “The state follows guidelines for sports hygiene and communicable diseases from the National Collegiate Athletic Association and the National Federation of State High School Associations,” says Kirgan. “Those guidelines call for a health professional to evaluate any skin lesion before a player returns to competition. In the event of a team outbreak, especially in a contact sport, all team members should be evaluated.”

In Connecticut, seven students attending schools in the Waterbury Public School district have confirmed cases of HFMD. The district has 19,000 students, and a notice went out to parents informing them of the outbreak. Hartford Public Schools have reported an additional five cases of students with HFMD. To prevent further spread of the virus, officials at the district have asked students to stay home from school for an additional 24 hours after symptoms cease.