Herpangina

What is herpangina?

Herpangina is a viral infection that quickly spreads among children who are close to each other, especially if they attend daycare or school. The infection causes a high fever and mouth sores that can be painful. Herpangina is closely related to hand, foot and mouth disease.

Who does herpangina affect?

Herpangina most often affects toddlers and children younger than 10 years old, especially children who attend daycare or schools where they interact with other children. Adolescents and adults can also get the condition, but it’s less frequent. Newborns, people with compromised immune systems and those who are pregnant are at a higher risk of getting a severe form of herpangina that could be dangerous or life-threatening.

How common is herpangina?

Herpangina is a common viral infection that quickly spreads in daycare centers and schools due to children being in close contact with each other. It’s most common in the summer and fall months.

How does herpangina affect my child’s body?

Herpangina causes blister-like sores inside of your child’s mouth and throat. This will make eating and drinking painful and swallowing difficult if their diagnosis is severe. Even though your child will want to avoid eating or drinking, it’s important that they don’t miss meals and are drinking plenty of fluids to avoid dehydration.

What are the symptoms of herpangina?

Symptoms vary for each person diagnosed with herpangina and range in severity. Symptoms of herpangina include:

• Fever.
• Headache.
• Loss of appetite.
• Sore throat.
• Sores or blisters (ulcers) in the mouth and throat.

What causes herpangina?

Highly contagious coxsackieviruses and enteroviruses cause herpangina. These viruses include:

• Coxsackieviruses A and B.
• Echovirus.
• Enterovirus 71.

Is herpangina contagious?

Yes. The viruses that cause herpangina are extremely contagious and survive in environments outside of the body for long periods of time. The virus easily spreads through:

• Close contact with someone who has the virus.
• Exhaling small, wet particles (respiratory droplets).
• Direct contact with bodily fluids (saliva or mucus) or fecal matter (poop or pee).

The incubation period (the time between being exposed to the virus and developing symptoms) for herpangina is three to five days. You can spread the virus during this time, even if you don’t show symptoms (viral shedding) and you will likely be contagious for three to eight weeks after the incubation period. You are the most contagious during the first two weeks of the virus. The virus can still be spread even after your symptoms go away.

Proper handwashing and good hygiene help stop the spread of viruses that cause herpangina.

How is herpangina diagnosed?

Your child’s healthcare provider will ask questions about their symptoms and medical history, followed by a physical examination to verify the diagnosis. Tests are not usually necessary, since the sores that form as a result of the virus are unique to those with herpangina and a physical exam is sufficient.

How is herpangina treated?

Treatment alleviates symptoms of the condition since antibiotics or antiviral medicine is ineffective at treating herpangina. The condition usually goes away after one week. Treatment for herpangina includes:

• Acetaminophen or ibuprofen for fever.
• Drink plenty of fluids to avoid dehydration.
• Avoid foods or beverages that can irritate sores in the mouth or throat like hot drinks, acidic, spicy or salty foods.
• Use topical anesthetics for sores in the mouth and throat.
• Rinse your child's mouth out after meals with saltwater.

While your child is ill, make sure they rest in a well-ventilated room to reduce the number of contagious virus particles from sticking to surfaces, objects and transferring to other members of your family.

What should my child eat if they have herpangina?

Your child’s mouth will be sore because of the sores and blisters in their mouth and throat. This can make them lose their appetite from the pain. It's important to provide plenty of fluids for your child to avoid dehydration. Food and beverages your child could have after a herpangina diagnosis include:

• Cold dairy products (milk).
• Electrolyte beverages.
• Ice cream or popsicles.
• Soft, bland foods.
• Water.

Avoid foods that are salty, spicy, fried, hot or acidic like orange juice and potato chips.

How long does herpangina last?

Herpangina normally clears up after a week to 10 days. If your child is not getting better after 10 days, visit your healthcare provider.

Although your child might not show symptoms, they could still be contagious for three to eight weeks after getting the virus.

If your child gets and recovers from herpangina, they will build a natural immunity to the virus. This will reduce their risk of getting the virus again, but it doesn’t mean that they won’t get it ever again. Your child is still able to get other strains of the virus that exist.

How can I prevent the spread of herpangina?

You can prevent the spread of viruses like herpangina by:

• Practicing good hygiene by regularly washing your hands with soap and water. The virus can be shed in stool.
• Sanitizing and disinfecting highly touched surfaces and objects.
• Covering your mouth and nose when coughing or sneezing, immediately followed by washing your hands.
• Staying home if your child feels ill.

What can I expect if my child has herpangina?

Most children with herpangina will feel better within a week to 10 days. During their illness, your child will likely experience symptoms that will cause discomfort and pain, like a fever, sore throat and difficulty eating and drinking. Even though your child might not feel up to eating or drinking, stay regular with meals that are soft and bland and have them drink plenty of fluids to avoid dehydration.

Your child is contagious and they could spread herpangina to other children or adults. Make sure you wash your hands and your child’s hands often and disinfect frequently touched surfaces, especially after caring for your child, using the toilet and before preparing meals. Children can usually return to school when their fever goes away. They can participate in normal activities if they don’t have numerous open blisters in their mouth.

Herpangina can be dangerous and life-threatening in newborns, young children and people with compromised immune systems. If you believe your child received the virus and has a compromised immune system, visit your healthcare provider immediately.

How do I take care of my child with herpangina?

Your child could be fussy because of their symptoms. Make sure you treat your child’s fever with acetaminophen or ibuprofen as directed by your healthcare provider.

Keep meals on schedule and avoid acidic, spicy, hot or salty foods and choose meals that are soft and bland, which won’t irritate the sores in your child’s mouth or throat.

Your child can become dehydrated if they're not drinking because of the sores in their mouth. Keep track of how much fluid your child drinks and provide electrolyte beverages if your child isn’t drinking enough.

When should I see my healthcare provider?

Symptoms could cause your child to feel discomfort and pain. Reach out to your healthcare provider if your child:

• Has a high fever.
• Can’t eat or drink.
• Has sores in their mouth that don’t go away after one week.
• Vomits or has diarrhea for more than 24 hours.
• Shows signs of dehydration (urine is dark, feels tired or dizzy, less frequent urination, dry mouth).

If your child has a compromised immune system or is younger than three years old and they come in contact with someone who has herpangina, visit your healthcare provider immediately because symptoms could be dangerous or life-threatening.

What questions should I ask my doctor?

• When can my child return to school or daycare?
• How do I help my child if they refuse to eat or drink?
• How do I protect other members of my family from getting the virus as well?

What is the difference between herpangina and hand, foot and mouth disease?

Herpangina and hand, foot and mouth disease are both caused by the coxsackievirus. The difference between the two conditions is that herpangina causes sores or blisters to form in the mouth and throat only and sores from hand, foot and mouth disease can form on the hands, feet and/or inside of the mouth. Both conditions are very contagious and often spread in daycare centers and schools among children.

What is the ICD code for herpangina?

The International Classification of Diseases (ICD) is a diagnostic tool for healthcare providers to classify conditions for clinical settings. The ICD-10-CM code for herpangina is B08.5.

A note from Cleveland Clinic

Herpangina can take a toll on your family if your child gets the virus because it may spread in your household. Your child will be uncomfortable due to their symptoms and it can be difficult to soothe. Reach out to your healthcare provider if your child’s symptoms get worse or if they are unable to eat or drink. Protect yourself and your child by washing your hands frequently, disinfecting high-touch surface areas and keeping your child away from other kids (especially if they are in school or daycare) who might get the virus.