Over the past week, Florida State University Health Services has identified more than a dozen cases of hand, foot and mouth disease, an illness commonly seen in children. No new cases of the contagious viral illness were reported Wednesday.
“We’ve seen less than 16 cases on-site,” Director of University Health Services Lesley Sacher said, adding that she was aware of more students who either called without coming in or were seen by a health care provider elsewhere in the community.
The outbreak began as “a trickle” on Monday, Sacher said, noting that the infection is more common in day care centers than on college campuses. However, cases occur with regularity on college campuses, according to the American College Health Association.
“Anybody who has had a child has generally seen their child come home with blisters in their mouth,” she said.
Along with painful mouth sores, hand, foot and mouth disease causes fever and a skin rash on both the hands and the feet.
Hand, foot and mouth is “due to a virus that lives in the intestines, and it is very contagious,” said William Schaffner, an infectious diseases specialist at Vanderbilt University. He noted that late summer and early fall are when enteroviruses — those related to the intestines — seem to spread readily.
That said, Dr. Christopher Houts of Powell Pediatric Care in Ohio said he’s seen more cases this year than anytime in his 21 years as a pediatrician. While patients usually begin to come in during the summer, this year, they’ve arrived at his community practice early, beginning in the spring.
“You are contagious before you are ill and during the illness, but undoubtedly people have the virus in their intestinal tract who never get ill,” Schaffner said. He explained that there are also people who become infected but don’t have symptoms, though they can spread the illness.
“The week before, we had the hurricane,” Sacher said, “so we’re thinking days without electricity, hot, humid conditions make germs very happy.”
How it’s treated
Hand, foot and mouth disease can be confused with hoof-and-mouth disease, which affects cattle, sheep and swine. “Humans do not get the animal disease, and animals do not get the human disease,” the Centers for Disease Control and Prevention notes.
“Treatment is comfort measures [pain relief] and hydration,” said Dr. Jennifer Shu, an Atlanta pediatrician who sees the disease often in her practice.
“Luckily, most people recover within a week without problems besides some discomfort/pain in the mouth,” she said, adding that the disease is “most contagious before the rash appears, so it can be difficult to avoid catching it.”
There are many strains of hand, foot and mouth, and some strains cause distinct illnesses, according to Dr. Mark Pasternack of MassGeneral Hospital for Children.
Outbreaks can easily occur in confined places, so “home, day care, college, the military would all be plausible situations,” Pasternack said.
It can be most severe in newborns, Pasternack said. Complications are rare, but if the virus spreads from the intestines to the central nervous system, a patient can get viral meningitis or viral encephalitis, with confusion and seizures and coma. If the spinal cord is affected, there could be motor weakness and difficulty walking, he said.
At Florida State, patients have seen just the usual symptoms.
Cleaning up after an outbreak
After Monday’s trickle, FSU Health Services — a large medical care facility, with 72,000 patient visits last year — started seeing more cases the next day.
At that point, Sacher notified others at the university and called an emergency management meeting.
“Not because it was an emergency,” she said. “We wanted to do a full sanitation effort.”
Some of the sickened students were fraternity members, so the university took the precaution of canceling a few events, including Rush Week activities on Tuesday night. Scheduled activities resumed the following evening.
Sacher instructed “people to be vigilant about cleaning bathrooms, kitchens, any shared spaces, common areas both in the residence halls and in the fraternities and sororities.” Workers wiped down classrooms and went through every exam room, giving them a second cleaning with bleach-based products.
Meanwhile, Sacher soldiers on, continuing with measures to communicate, educate and prevent: “We’re thinking there might be one more spike, because there’s an incubation period of three to five days, so we’re going to be very cautious, very watchful.
“This isn’t my first time at the rodeo, my dear,” Sacher said. “This year we had Zika, a hurricane and now this.”