Outbreak of Hand, Foot, and Mouth Disease Among University Residential Students

To the Editor: Between mid-September and mid-October, 2023 our university student health clinic encountered 60 cases of hand, foot, and mouth disease that occurred primarily among freshman residential students. Diagnoses were made clinically. None of the students became seriously ill and there were likely additional infected students who did not present to our clinic. Diagnosed students were instructed on hygiene measures and to isolate in place until they were fever-free and the lesions had healed.

As was the case in the students we saw, typical symptoms of hand, foot, and mouth disease include a low-grade fever with a maculopapular rash or papulovesicular rash on the hands and soles of the feet as well as painful oral ulcerations that resolve in 7 to 10 days.^1,2 Fingernail and toenail changes can include Beau’s lines, yellow-orange discoloration, and separation of the nail plate from the nail matrix that occur 4 to 8 weeks after disease onset and resolve within 1 to 2 months.³

Rare serious complications from hand, foot, and mouth disease include aseptic meningitis, encephalomyelitis, pulmonary edema, pulmonary hemorrhage, and viral myocarditis, and cardiorespiratory failure.^1,2 Erythema multiforme-like lesions with atypical presentation on the torso have been reported in adult immunocompetent patients which can delay the diagnosis of hand, foot, and mouth disease and institution of mitigation measures.^4,5

Most cases of hand, foot, and mouth disease occur in patients under 10 years old.¹ Outbreaks on college campuses have occurred but are infrequent.⁶ Our experience demonstrates the need for vigilance in the immediate post-COVID-19 pandemic era for outbreaks of infectious diseases that may follow an atypical epidemiologic pattern as a result of prior social distancing measures, particularly in adolescent and young adult populations.