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Living Well

Is Your Child at Risk for Coxsackie Virus?

Last updated: Sep 22, 2016

Reviewed by David Abrutyn, MD, sports medicine specialist; David Levine, MD, pediatrician; Eric Mirsky, MD, Orthopedic and Sports Medicine Service Line Chief at Summit Medical Group; and Daniel Hermann, MD, Pediatric and Adolescent Medicine Service Line Chief at Summit Medical Group.

Parents and high schools across New Jersey have been coping with the rapid fire spread of an illness rarely seen in adolescents: a strain of the coxsackie virus that causes hand, foot and mouth disease (HFMD), so called because ulcers and blisters break out on those parts of the body.  The virus has particularly affected high school sports teams and disrupted the playing season in the towns where it has hit the hardest.

What is Coxsackie?

Coxsackie is a type of enterovirus. Coxsackie itself isn’t uncommon, but it’s usually seen in children younger than ten, not teenagers, which is why the outbreak among adolescents is unusual. To date, the virus has struck students at Kinnelon High School, Pequannock Township High School and Wallkill Valley High School, but it could spread farther.

 “Coxsackie virus is very contagious and it can spread quickly in a group setting like a team,” said David Abrutyn, MD, an orthopedist and specialist in Summit Medical Group’s sports medicine program. “Sometimes students share towels and even water bottles, or they touch each other without washing their hands. That makes it easy to spread.”

He added, “It can be transmitted by saliva and coughing or sneezing—but the most common form of transmission is by hand.  Sometimes hands can be contaminated with fecal matter, so it’s very, very important to wash your hands.”

Signs of Coxsackie

According to the Centers for Disease Control and Prevention (CDC), initial symptoms of HFMD include:

  • Fever
  • Reduced appetite
  • Sore throat
  • Fatigue

After the fever starts, the virus progresses and then the telltale symptoms of coxsackie appear.  These may include:

  • Painful sores develop in the mouth, called “herpangina,” often beginning in the back of the mouth, as small red spots that blister and can become ulcers.
  • A skin rash with red spots.
  • Blisters, which may develop on the palms of the hands and soles of the feet, as well as knees, elbows, buttocks, and the genitals. (1)

“We started seeing outbreaks of coxsackie virus this summer,” says David Levine, MD, a specialist in Summit Medical Group’s pediatrics and adolescent medicine program.

 “Many parents think that their child has strep because they have a fever and sore throat,” he said, “but when I look in the mouth and see ulcers that seals the diagnosis.”

Best Treatment

Dr. Levine stresses that coxsackie cannot be treated with antibiotics because it is a virus.  He advises pain relief with over-the-counter medication such as ibuprofen, and tells parents to give children adequate fluids. Drinking can be difficult because of the ulcers, but it’s important to stay hydrated even if it is uncomfortable to swallow.

“There are several types of coxsackie,” Dr. Levine says.  “The one we’re seeing now is common, but there are some other types of the virus that, in very rare cases, can harm the central nervous system, so it is very important to have an accurate diagnosis.”

He cautions that parents need to monitor their child to see if symptoms develop other than what a doctor has described.  

“In those rare cases, a child needs to be reevaluated by a doctor,” he said.

Keep sick kids at home

It’s important to community health for sick children and teens to stay at home if they’re not feeling well so they do not spread the virus.  Unfortunately, many do not, according to Dr. Abrutyn.

“Sometimes students really want to practice or play, so they won’t tell an adult that they’re not feeling well, and they can spread the virus that way,” he said.

Dr. Abrutyn says that there is now a heightened awareness about illness—sparked by greater awareness of concussion risks—that students should be kept out of practice when they are not feeling well.   

“Players, nurses, coaches, parents and trainers are all increasingly aware that students need to stay off the playing field and take some time off if they’re not healthy,” Dr. Abrutyn says.  “But we can’t know if a child or adolescent is sick unless they tell us they don’t feel well.”

If your child is ill on a weekend or after office hours during the week, you can still get SMG’s expert medical care by visiting one of four conveniently located Urgent Care Centers.


1. Centers for Disease Control and Prevention. "About Hand, Foot, and Mouth Disease (HFMD)." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 18 Aug. 2015. Web. 22 Sept. 2016.

2. Interviews with David Abrutyn, MD, and David Levine, MD.  September 22, 2016