1.01.2017

Hand, Foot, and Mouth Disease (caused by coxsackie virus) in Adults: Background (Part 1)

Happy 2017!

I contracted Hand, Foot, and Mouth Disease (hereafter HFDM, caused by coxsackie virus) from my toddler niece (23 months old, hereafter referred to as "N," for niece) last week. I decided to write up my relatively mild HFMD experiences in case they are helpful to anyone else. Also, because I was sick at home for the worst part, not caring for children (having none of my own), I had some time to research all of this and now to write it up. Most adults who catch this from children are also caring for sick children, leaving them little time to write it up in (excruciating or not) detail!

There did not seem to be a lot of good information about adults' experiences with it, even though I now know that a bunch of my friends have caught it from their kids. (They shared their experiences with me privately.) One friend referred me to this helpful blog post from Sarcastically Yours.

Notes you should read:
  1. I am not a doctor or any kind of medical professional or a scientist. So nothing I write here should be taken as anything other than the perspective of a layperson.
  2. If you are sick, you should go to a doctor, not just look for advice on the Internet.
  3. This is only about coxsackievirus group A, which tends to cause unpleasant but relatively mild symptoms including Hand Foot and Mouth Disease, not coxsackievirus group B, which can cause many more serious, long-lasting problems. (See this or this for more on Group A vs. Group B.) Some of the most dire reports online are from adults who had coxsackievirus Group B strains.
Background:
So, N had a mysterious rash on her legs on Sunday, December 4, and was diagnosed with coxsackie, (a virus that causes HFMD), as well as walking pneumonia. However, her pediatrician, to whom my sister spoke the next day, said that it didn't sound like coxsackie. N took antibiotics for ten days for the walking pneumonia and it got better and the rash went away in a day or two.

On Monday, December 19, a note was sent home from daycare that a kid in N's class had HFMD, and that children with HFMD must be kept home until they got an all-clear note from a pediatrician.

On Friday, December 23, I came to my sister and brother-in-law and N's house to visit for the weekend, planning on going home on Monday morning, or maybe staying until Tuesday night to see my step-nephew, who would be visiting then. They live about two hours, give or take, from me, via public transit.

On either Friday night, December 23 or Saturday, December 24, we noticed a new rash on N's legs, starting on the back of her thighs. My sister's first thought was that it was a recurrence of the mysterious non-coxsackie rash from a couple weeks earlier. The skin there was dry, so also I thought maybe it was dry skin (I sometimes get weird stuff from dry skin in the winter), and my sister applied moisturizer.

N hadn't slept well on Friday or Saturday night, waking up and crying a few times. I was up and rubbed her back a few times on Saturday night, but she ultimately wanted her parents.

She didn't seem that hungry on Saturday, December 24.

By Sunday, December 25, it had spread to N's arms. N also didn't want to eat. She didn't sleep well that night, either, waking up a few times. (Like, she slept from 8 pm to midnight, and was up and wanting comfort/help/Tylenol at midnight and 4 am and then woke up for the day at 6:30 or 7 am. She's normally a 7:30 pm to 6:30 am solid sleeper.)

It seemed a lot more like coxsackie/HFMD and less like dry skin, even though she had no spots on her palms or the soles of her feet or inside her mouth. She didn't really have a fever or seem hot, but maybe that didn't rule out coxsackie/HFMD.

I posted this to Facebook on Sunday evening:
So, how contagious is coxsackie (hand foot and mouth) from toddlers to adults?

Answers ranged from: "I've been around kids who had it two or three times and never caught it" to "I caught it but it was mild and I heard that it's always mild when adults catch it" to "I caught it and it was awful" to "I caught it and it was awful and other adults I know who have had it have suffered a lot more than kids seem to." So...a lot of people haven't caught it when kids have had it, but those who have have caught it, either gotten very sick (more severe than their children) or not very sick (less severe than their children). In some cases, their children were pre-verbal, so it's hard to assess who had it worse, except for by comparing fevers and counting spots. One infectious disease specialist spouse of an acquaintance said that he thought 1-5% of adults-caring-for-children-who-had-it got it.

The upshot from my research and Facebook discussions seemed to be that there were two factors that work against adults catching it from children:
  1. It seems like a lot of adults have already been exposed to the virus as children, and that's why many don't catch it. They have already developed full immunity against it as a result of having had it, just like I had chickenpox when I was four and so now I can't really get it again.
  2. It also seems like many people who "catch" it don't actually get any symptoms from it. This means that many people "catch" the virus from children, when they are either children or adults, and develop immunity to that particular strain, but never get sick. So you could have "had" it as a child and never have known, or, as an adult, you could "catch" it from a child now and also never know. (Medscape says here that "More than 90% of coxsackieviruses infections are asymptomatic or cause nonspecific febrile illnesses." (Of course, there are lots of different kind of coxsackieviruses and not all of them are the same as the ones that cause HFMD. But, still. It seems that the same is true of the specific coxsackievirus that most often causes HFMD in the US, A16.)
Adults without compromised immune systems ("immunocompetent adults"), a description which fit me, are considered to so rarely get HFMD that there are medical journal articles describing cases where they do. (Open the individual journal articles at your own risk if you are easily disturbed by images of people with skin disorders. Many describe cases that were very severe and caused by enterovirus71, a strain that is common in Asia and rare/nonexistent in the US. The link itself just goes to Google Scholar and no images.)

There were also factors in favor of adults catching it from children:
  1. There are different strains of coxsackievirus, and catching one strain doesn't mean that you can't catch another one later. (Like a cold or the flu, which are also viruses.) But it might mean that you don't get as sick if you've ever had a different strain of it.
  2. So many of my friends seem to have gotten it as adults! Like, six or more people I know caught it as adults. I don't know what percentage of total-adults-I-know-who-have-been-in-contact-with-children-who-have-HFMD that is, though. (That could be 5% or less, for all I know.) No one who got it seemed too blase about it, although a few cases were self-reported to be mild.
I never had symptomatic HFMD as a child, nor did any of my siblings. Between those two options, it really seemed like I was unlikely to catch it and get sick from it, if that's what N had, and if I attentively adhered to good hygiene practices. I had been washing my hands the normal amount during my visit (i.e., after using the bathroom, before eating), but probably not for the full 20 seconds that you're supposed to soap up for and not always with hot water (sometimes with whatever temperature water came out of the faucet when I turned the hot water on).

By Monday, December 26, it had spread to more of N's body, including around the outside of her lips, but not really to palms or soles, and she didn't seem to have any sores inside her mouth or on her tongue. Back to urgent care. They said she had coxsackie. They said adults rarely contract it. They said that there was nothing to do but wait it out.

Once the diagnosis was official or maybe even before that (sometime on Sunday?), I started washing my hands more vigorously and for longer (20 seconds of soaping), with as hot water as I could stand.

Here's Part 2.

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