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Epidemic Control Toolkit
for community volunteers
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Hand, foot and mouth disease (HFMD)

Hand, foot and mouth disease (HFMD)

Last update: 2023-06-21

Key facts

Transmission: Direct contact and droplet-borne 

  • Contact with the saliva, nose mucous, blister fluid or faeces of an infected person 
  • Breathing in droplets after an infected person coughs or sneezes
  • Touching objects and surfaces that have the virus on them (toys, utensils, doorknobs)
  • Swallowing infected, improperly treated water from swimming pool (rare occurrence)

Most vulnerable to severe consequences

  • Infants and children younger than five years of age 
  • Adults with weakened immune systems

Most vulnerable to contracting the disease

  • People living, working or going to school in shared, cramped spaces


  • Fever
  • Reduced desire to eat and drink
  • Feeling tired and unwell
  • Sore throat
  • Mouth sores (usually appear a few days after other symptoms)
  • Skin rash with red spots on the palms of the hands and bottoms of the feet
    • Rash may also appear on the knees, elbows, buttocks, or genital area

What can you do to prevent and control an epidemic?

Monitoring the community and identifying sick people 

  • Identify and isolate sick people before they spread the disease to others

Treatment and management

  • Refer severely ill people (for example, those with severe dehydration) to health facilities
  • Provide psychosocial support to the sick person and their family members

Appropriate sanitation and waste management

  • Promote recommended environmental hygiene and cleaning practices 
    • Clean and disinfect surfaces that are touched frequently and dirty items, including toys
  • Promote use of appropriate sanitation facilities (sound, clean latrines)

Hand and respiratory hygiene

  • Promote handwashing with soap (by both caregivers and children) 
    • BEFORE: preparing food; eating; feeding a child; treating wounds; or caring for sick people
    • AFTER: using the toilet or cleaning a baby; touching garbage or waste; touching or feeding animals; blowing nose, coughing or sneezing; treating wounds; or caring for sick people
  • Promote respiratory hygiene and coughing etiquette (cover cough or sneeze using a sleeve or tissue, wash hands after coughing or sneezing, do not spit onto the ground or in public)

Food and water hygiene and safety

  • Ensure access to safe, clean drinking water
  • Encourage exclusive breastfeeding for the first six months of life, and complementary breastfeeding until the age of two years (especially when a child is sick) 

Social mobilization and health promotion

  • Find out the specific advice being given by health and other relevant authorities 
  • Model following this advice and inform community members of current health practice advice 
  • Offer support and encouragement to follow the advice  
    • Try to gain understanding about if and why health practice advice is not being followed  
    • With the guidance of your supervisor and health authorities, work with communities to overcome barriers to following health advice and recommended practices 


Mapping and community assessment

  • Make a map of the community.
  • Mark the following information on the map:
    • How many people have fallen sick with HFMD? Where?
    • How many people have died? Where? When?
    • Who and where are the vulnerable people?
    • Where are the local health facilities and services? (include traditional healers)
    • Where do people obtain their drinking water?
  • Record the following information on the back of the map:
    • When did people start to fall sick with HFMD? 
    • How many people live in the affected community? How many are children under five years?
    • Is breastfeeding common?
    • Is the water source safe? 
    • Do people do anything to treat their water? 
      • Do people know how to treat water? 
        • How do they do it?
    • What sanitation facilities are available? (put communal toilets/latrines on map) 
      • Do people use them? 
    • What handwashing facilities are available? (put communal handwashing stations on map) 
      • Do they have soap?
    • What are the community’s habits, practices and beliefs about caring for and feeding sick people? Consider any differences in roles and responsibilities between women and men.
      • When babies and infants are sick, do women continue to breastfeed them?
    • Where do people go for water recreation? 
      • Is that water likely to be contaminated by faeces? 
    • Is a social mobilization or health promotion programme in place?
    • What are the barriers people face in accessing water points and sanitation and hygiene facilities, of all gender identities, ages, disabilities and backgrounds? 
    • Which sources do people use/trust the most for information?
      • Are there rumours or misinformation about HFMD? What are the rumours?
    • Can people identify the signs and symptoms of dehydration?
    • Do people know how to make oral rehydration solution (ORS)?
      • Do they have resources at hand to make it?