Monday, March 10, 2014

Can my child get recurrent episodes of Hand Foot Mouth Disease ?

Q: My 4 year old had Hand Foot Mouth Disease (HFMD) around 1 year back. Now he is having the same symptoms of rash in feet, hands and mouth ulcers again, can this disease recur?

Ans: This is certainly an unusual situation. Here is what Dr Greene has to say about this ...
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.
So the answer is that your child can get it again, but if we help keep the immunity high then the chances of recurrence are less, and the severity of the disease is likely to be lesser too.

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