<P> The viruses that cause HFMD are spread through close personal contact, through the air from coughing, and the feces of an infected person . Contaminated objects can also spread the disease . Coxsackievirus A16 is the most common cause and Enterovirus 71 is the second-most common cause . Other strains of coxsackievirus and enterovirus can also be responsible . Some people may carry and pass on the virus despite having no symptoms of disease . Other animals are not involved . Diagnosis can often be made based on symptoms . Occasionally a throat or stool sample may be tested for the virus . </P> <P> Handwashing may prevent spread and those infected should not go to work, daycare, or school . No antiviral medication or vaccine is available, but development efforts are underway . Most cases require no specific treatment . Simple pain medication such as ibuprofen or numbing mouth gel may be used . Occasionally intravenous fluids are given to children who are unable to drink enough . Rarely viral meningitis or encephalitis may complicate the disease . </P> <P> HFMD occurs in all areas of the world . It often occurs in small outbreaks in nursery schools or kindergartens . Large outbreaks have been occurring in Asia since 1997 . It usually occurs during the spring, summer, and fall months . Typically it occurs in children less than five years old, but can occasionally occur in adults . HFMD should not be confused with foot - and - mouth disease (also known as hoof - and - mouth disease) which mostly affects livestock . </P> <P> Common constitutional signs and symptoms of the HFMD include fever, nausea, vomiting, feeling tired, generalized discomfort, loss of appetite, and irritability in infants and toddlers . Skin lesions frequently develop in the form of a rash of flat discolored spots and bumps which may be followed by vesicular sores with blisters on palms of the hands, soles of the feet, buttocks, and sometimes on the lips . The rash is rarely itchy for children, but can be extremely itchy for adults . Painful facial ulcers, blisters, or lesions may also develop in or around the nose or mouth . HFMD usually resolves on its own after 7--10 days . Most cases of the disease are relatively harmless, but complications including encephalitis, meningitis, and paralysis that mimics the neurological symptoms of polio can occur . </P>

Where is hand foot and mouth disease found in the world