Does your under-5 child have a runny nose accompanied by a general tendency toward being absolutely and uncharacteristically miserable? Do they want nothing other than to whine and drink cold milk around the clock?
Coxsackie! No, that’s not a swear; it’s the name of a family of viruses, and it might be the reason for your misery. Coxsackievirus are another of the many causes of the common cold. They also cause hand-foot-and-mouth disease (aka HFMD), which is very common among young children in group care settings like daycare.
The typical symptoms of HFMD start with crankiness and decreased appetite. This is followed by a mild fever and runny nose, sore throat, more crankiness, and finally–7 to 10 days after symptoms begin–a characteristic, painful blistering rash on the feet, hands, and inside the mouth. After the rash resolves, some unfortunate kids may lose their fingernails or toenails.
Usually, HFMD means a couple of weeks of torment for young children and their parents. However, rarely, coxsackie infection can also produce acute myocarditis (dangerous swelling of the heart), or a serious brain infection (viral meningitis). Adults can get it too, though symptoms are often less severe and rarely include the rash. Adults are thought to be less susceptible because by the time we are adults, we’ve been exposed to many of this family of viruses and have some immunity.
Coxsackieviruses are part of a family of viruses called enteroviruses. The most notorious member of this family is poliovirus, but there are many others. These viruses are often spread by what we politely call “fecal-to-oral route.” It means poop in your mouth. Yep. That’s why handwashing is important, people. In some cases, these viruses can also be transmitted by respiratory droplets or by touching an infected person’s blisters and then putting your hands in your mouth.
Coxsackieviruses, and other non-polio enteroviruses, are very common in young children. Small outbreaks are frequently reported in childcare settings like daycares, especially in summer and fall.
If you’re a grandparent reading this and thinking “did I miss a memo? My kid never had this one…” you’re right. HFMD was much less common 40 years ago than it is today. They are getting worse over time. We don’t know why the outbreaks tend to be in summer and fall; and like flu, it’s hard to predict which subtype will dominate each season.
Coxsackieviruses come in two flavors, called groups A and B. Group A includes the virus that most often causes hand, foot, mouth disease in the United States–called A16. However, some other strains (especially A6, and the closely related enterovirus 71) are dominant elsewhere in the world, especially Asia. These strains also cause HFMD, but are more likely to cause severe symptoms, including life-threatening heart and neurological problems.
Coxsackie type B viruses, called CVB, are less common and more mysterious. CVB infection is the most frequent cause of viral meningitis. CVB infection is also associated with type 1 diabetes and celiac disease. Though no one seems to understand why that is, epidemiological evidence points to a link, and experiments in mice have shown a causal association too. Outbreaks of CVB often co-occur with another enterovirus in the family, called echovirus.
No vaccine is available for coxsackieviruses, but there is at least one vaccine in human trials targeting several strains of type B coxsackieviruses.
Until a vaccine is available, our best protection against coxsackie is clean hands. Wash your hands for 20 seconds with soap and water, especially after changing diapers, using the bathroom, coughing/sneezing, and before eating. Encourage children to wash hands often too.
For the curious, Coxsackieviruses were named for the eponymous town where they were first isolated in 1947: Coxsackie, New York, USA. They were isolated by a researcher named Gilbert Dalldorf. Dalldorf was searching for the cause of polio when he isolated this other enterovirus. He was among the first to discover how useful mice can be in isolating and studying a virus.
CDC References & Resources for Hand, Foot, and Mouth Disease
On prospects and challenges for a vaccine, from 2015
Phase 1 clinical trial of a CVB vaccine in progress now