Hand, foot, and mouth disease (HFMD) was first formally identified in 1957, during a summer outbreak in Toronto, Canada. That makes it a recognized disease for nearly 70 years. But the viruses that cause it almost certainly circulated in humans long before anyone gave the illness a name. The 1957 outbreak was simply the first time doctors documented the distinct pattern of mouth sores and skin blisters and linked it to a specific virus.
The 1957 Toronto Outbreak
The story of HFMD as a named disease begins with a cluster of cases among children in Toronto during the summer of 1957. Doctors identified a pattern: painful blisters in the mouth along with a rash on the hands and feet. Laboratory work traced the cause to coxsackievirus A16, a member of the enterovirus family. This was the first clinical description of the disease, and the name “hand, foot, and mouth disease” came directly from where the blisters appeared.
Coxsackievirus A16 had actually been isolated a few years earlier, in South Africa in 1951, but it wasn’t connected to this specific illness until the Toronto outbreak. The virus was already circulating globally; it just took a concentrated outbreak for researchers to connect the dots between the virus and the distinctive rash pattern.
A Second Virus Enters the Picture
In 1969, researchers in California isolated a different virus, enterovirus 71 (EV-A71), that could also cause HFMD. This discovery mattered because EV-A71 turned out to be far more dangerous than coxsackievirus A16. While most HFMD cases cause mild symptoms that clear up on their own, EV-A71 was linked to neurological complications and, in rare cases, death. The identification of this second major cause of HFMD expanded the medical understanding of the disease from a mild childhood nuisance to something that could occasionally become serious.
The Virus Before the Diagnosis
The fact that HFMD was first described in 1957 doesn’t mean it appeared out of nowhere that year. Enteroviruses, the family of viruses responsible for HFMD, have been infecting humans for centuries. Children have always gotten fevers and mouth sores, and mild cases of HFMD were likely lumped in with other childhood rashes for generations before modern virology could distinguish them. What changed in the 1950s was the technology to isolate and identify specific viruses, not the virus itself.
Phylogenetic studies, which trace viral evolution by comparing genetic sequences, show that coxsackievirus A16 has been diversifying into different genetic lineages for decades. The dominant strain shifted at least twice since the 1950s. One major genetic lineage dominated from 1981 to the late 1990s before being gradually replaced by a newer lineage after 1997. These ongoing shifts confirm that the virus has a long evolutionary history with humans, constantly adapting and changing.
Major Outbreaks Since the 1990s
HFMD remained a relatively quiet, routine childhood illness for most of the late 20th century. That changed dramatically in the late 1990s when EV-A71 activity surged across the Western Pacific. In 1997, a large outbreak in Malaysia caused 41 deaths. The following year, Taiwan reported roughly 100,000 cases, including 400 severe cases and 78 deaths. These outbreaks marked a turning point, pushing HFMD onto the radar of global public health agencies for the first time.
Since then, large outbreaks have continued to occur, particularly in China and Southeast Asia, where HFMD remains one of the most common infectious diseases in young children. The scale of these outbreaks, sometimes reaching millions of reported cases per year in China alone, is far larger than anything documented before the 1990s.
Not the Same as Animal Foot-and-Mouth Disease
One common source of confusion is the similarity in name between human HFMD and foot-and-mouth disease in cattle and sheep. The two diseases share a name, both produce blisters in the mouth and on the feet, and both are caused by viruses in the same broad family (picornaviruses). But they are caused by completely different viruses and are not related in any meaningful way. The animal disease is caused by a virus in the genus Aphthovirus, while human HFMD is caused by enteroviruses. Human HFMD cannot be transmitted to animals, and the animal version poses essentially no risk to people. The last reported human case of animal foot-and-mouth disease in Great Britain occurred in 1966, and it was extremely rare even then.
Animal foot-and-mouth disease has been recognized for much longer than human HFMD and has a history stretching back centuries. This sometimes leads people to assume human HFMD is equally ancient as a recognized condition, but the human disease has only been formally known since 1957.