Epidemiological, virological, and clinical features of an epidemic of hand, foot, and mouth disease in England and Wales.

We describe the epidemiological, virological, and clinical features of an epidemic of hand, foot, and mouth disease, attributed to coxsackie A virus serotype 16, that occurred throughout England and Wales in the last quarter of 1994. Nine hundred and fifty-two cases were reported by spotter practices that make weekly returns to the Royal College of General Practitioners, which made this the largest epidemic of hand, foot, and mouth disease in England and Wales reported to date. Most patients were aged 1 to 4 years and lived in central or southern regions. Clinical features were unavailable from the weekly returns but were described in detail for 39 patients, mostly by means of a questionnaire to general practitioners near the PHLS Coxsackie Reference Laboratory. All cases had a rash on their hands and 23 also had rashes on their feet and in their mouths. Most cases were mild. Severity was associated with the degree of mouth involvement. Secondary cases in family members were rare. Data from the Royal College of General Practitioners since 1963 reveal a period between epidemics of two to three years. The epidemics in 1988 and 1990 also occurred in the last quarters of these years and cases were concentrated in the central and southern regions.