Foot-and-mouth disease

This article is about the animal disease. For the human disease, see Hand, foot, and mouth disease.

Foot-and-mouth disease
Other names	Hoof-and-mouth disease, Aphthae epizooticae
Ruptured oral blister in diseased cow.
Specialty	Veterinary medicine

Foot-and-mouth disease or hoof-and-mouth disease is an infectious and sometimes fatal viral disease that affects cloven-hoofed animals, including domestic and wild bovids.^[1][2] The virus causes a high fever for between two and six days, followed by blisters inside the mouth and on the feet that may rupture and cause lameness.

Foot-and-mouth disease (FMD) has very severe implications for animal farming, since it is highly infectious and can be spread by infected animals comparatively easily through contact with contaminated farming equipment, vehicles, clothing, feed and by domestic and wild predators.^[3] Its containment demands considerable efforts in vaccination, strict monitoring, trade restrictions, quarantines and occasionally the culling of animals.

Susceptible animals include cattle, water buffalo, sheep, goats, pigs,^[4][5]antelope, deer, and bison. It has also been known to infect hedgehogs and elephants;^[3][6]llamas and alpacas may develop mild symptoms, but are resistant to the disease and do not pass it on to others of the same species.^[3] In laboratory experiments, mice, rats, and chickens have been successfully infected by artificial means, but they are not believed to contract the disease under natural conditions.^[3] Humans are very rarely infected.

The virus responsible for the disease is a picornavirus, Foot-and-mouth disease virus. Infection occurs when the virus particle is taken into a cell of the host. The cell is then forced to manufacture thousands of copies of the virus, and eventually bursts, releasing the new particles in the blood. The virus is genetically highly variable,^[7] which limits the effectiveness of vaccination.

Contents

• 
  1 Signs and symptoms
  


• 
  2 Cause
  
  
  
  • 
    2.1 Transmission
    
  
  
  • 
    2.2 Infecting humans
    
  
  
  
  


• 
  3 Prevention
  


• 
  4 Epidemiology
  
  
  
  • 
    4.1 United States 1870–1929
    
  
  
  • 
    4.2 Mexico-U.S. border 1947
    
  
  
  • 
    4.3 United Kingdom 1967
    
  
  
  • 
    4.4 Taiwan 1997
    
  
  
  • 
    4.5 United Kingdom 2001
    
  
  
  • 
    4.6 China 2005
    
  
  
  • 
    4.7 United Kingdom 2007
    
  
  
  • 
    4.8 Japan and Korea 2010–2011
    
  
  
  
  


• 
  5 History
  


• 
  6 Society and culture
  
  
  
  • 
    6.1 Economic and ethical issues
    
  
  
  
  


• 
  7 See also
  


• 
  8 References
  


• 
  9 External links
  

Signs and symptoms

Ruptured blisters on the feet of a pig

The incubation period for foot-and-mouth disease virus has a range between one and 12 days.^[8][9] The disease is characterized by high fever that declines rapidly after two or three days, blisters inside the mouth that lead to excessive secretion of stringy or foamy saliva and to drooling, and blisters on the feet that may rupture and cause lameness.^[4][10] Adult animals may suffer weight loss from which they do not recover for several months, as well as swelling in the testicles of mature males, and in cows, milk production can decline significantly. Though most animals eventually recover from FMD, the disease can lead to myocarditis (inflammation of the heart muscle)^[11] and death, especially in newborn animals. Some infected ruminants remain asymptomatic carriers, but they nonetheless carry FMDV and may be able to transmit it to others. Pigs cannot serve as asymptomatic carriers.^[12]

Cause

Of the seven serotypes^[13] of this virus, A, C, O, Asia 1, and SAT3 appear to be distinct lineages; SAT 1 and SAT 2 are unresolved clades.^[14] The mutation rate of the protein-encoding sequences of strains isolated between 1932 and 2007 has been estimated to be 1.46 × 10⁻³ substitutions/site/year, a rate similar to that of other RNA viruses. The most recent common ancestor appears to have evolved about 481 years ago (early 16th century). This ancestor then diverged into two clades which have given rise to the extant circulating Euro-Asiatic and South African. SAT 1 diverged first 397 years ago, followed by sequential divergence of serotype SAT 2 (396 years ago), A (147 years ago), O (121 years ago), Asia 1 (89 years ago), C (86 years ago), and SAT 3 (83 years ago). Bayesian skyline plot reveals a population expansion in the early 20th century that is followed by a rapid decline in population size from the late 20th century to the present day. Within each serotype, there was no apparent periodic, geographic, or host species influence on the evolution of global FMDVs. At least seven genotypes of serotype Asia 1 are known.^[15]

Transmission

The FMD virus can be transmitted in a number of ways, including close-contact animal-to-animal spread, long-distance aerosol spread and fomites, or inanimate objects, typically fodder and motor vehicles. The clothes and skin of animal handlers such as farmers, standing water, and uncooked food scraps and feed supplements containing infected animal products can harbor the virus, as well. Cows can also catch FMD from the semen of infected bulls. Control measures include quarantine and destruction of infected livestock, and export bans for meat and other animal products to countries not infected with the disease.

Just as humans may spread the disease by carrying the virus on their clothes and bodies, animals that are not susceptible to the disease may still aid in spreading it. This was the case in Canada in 1952, when an outbreak flared up again after dogs had carried off bones from dead animals.^[3]Wolves are thought to play a similar role in the former Soviet Union.^[16]

Daniel Rossouw Kannemeyer (1843-1925) published a note in the 'Transactions of the South African Philosophical Society' volume 8 part 1 in which he links saliva-covered locusts with the spread of the disease.^[17]

Infecting humans

Humans can be infected with foot-and-mouth disease through contact with infected animals, but this is extremely rare.^[18] Some cases were caused by laboratory accidents. Because the virus that causes FMD is sensitive to stomach acid, it cannot spread to humans via consumption of infected meat, except in the mouth before the meat is swallowed. In the UK, the last confirmed human case occurred in 1966,^[19][20] and only a few other cases have been recorded in countries of continental Europe, Africa, and South America. Symptoms of FMD in humans include malaise, fever, vomiting, red ulcerative lesions (surface-eroding damaged spots) of the oral tissues, and sometimes vesicular lesions (small blisters) of the skin. According to a newspaper report, FMD killed two children in England in 1884, supposedly due to infected milk.^[21]

Another viral disease with similar symptoms, hand, foot and mouth disease, occurs more frequently in humans, especially in young children; the cause, Coxsackie A virus, is different from FMDV. Coxsackie viruses belong to the Enteroviruses within the Picornaviridae.

Because FMD rarely infects humans, but spreads rapidly among animals, it is a much greater threat to the agriculture industry than to human health. Farmers around the world can lose enormous amounts of money during a foot-and-mouth epizootic, when large numbers of animals are destroyed, and revenues from milk and meat production go down.

Prevention

Plum Island Animal Disease Center

Like other viruses, the FMD virus continually evolves and mutates, thus one of the difficulties in vaccinating against it is the huge variation between, and even within, serotypes. There is no cross-protection between serotypes (a vaccine for one serotype will not protect against any others) and in addition, two strains within a given serotype may have nucleotide sequences that differ by as much as 30% for a given gene. This means FMD vaccines must be highly specific to the strain involved. Vaccination only provides temporary immunity that lasts from months to years.

Currently, the World Organisation for Animal Health recognizes countries to be in one of three disease states with regard to FMD: FMD present with or without vaccination, FMD-free with vaccination, and FMD-free without vaccination.^[22] Countries designated FMD-free without vaccination have the greatest access to export markets, so many developed nations, including Canada, the United States, and the UK, work hard to maintain their current status. Some countries such as Brazil and Argentina which have large beef exporting industries, practise vaccination in some areas but have other vaccination-free zones.

Reasons cited for restricting export from countries using FMD vaccines include, probably most importantly, routine blood tests relying on antibodies cannot distinguish between an infected and a vaccinated animal,^[23] which severely hampers screening of animals used in export products, risking a spread of FMD to importing countries. A widespread preventive vaccination would also conceal the existence of the virus in a country. From there, it could potentially spread to countries without vaccine programs. Lastly, an animal infected shortly after being vaccinated can harbor and spread FMD without showing symptoms itself, hindering containment and culling of sick animals as a remedy.

Many early vaccines used dead samples of FMDV to inoculate animals, but those early vaccines sometimes caused real outbreaks. In the 1970s, scientists discovered that a vaccine could be made using only a single key protein from the virus. The task was to produce enough quantities of the protein to be used in the vaccination. On June 18, 1981, the US government announced the creation of a vaccine targeted against FMD, the world's first genetically engineered vaccine.

The North American FMD Vaccine Bank is housed at the United States Department of Agriculture's Foreign Animal Disease Diagnostic Laboratory at Plum Island Animal Disease Center. The Center, located 1.5 mi (2.4 km) off the coast of Long Island, NY, is the only place in the United States where scientists can conduct research and diagnostic work on highly contagious animal diseases such as FMD. Because of this limitation, US companies working on FMD usually use facilities in other countries where such diseases are endemic.

Epidemiology

Foot and Mouth notice; Monmouthshire, Wales, 1872

United States 1870–1929

The US has had nine FMD outbreaks since it was first recognized on the northeastern coast in 1870;^[24] the most devastating happened in 1914. It originated from Michigan, but its entry into the stockyards in Chicago turned it into an epizootic. About 3,500 livestock herds were infected across the US, totaling over 170,000 cattle, sheep, and swine. The eradication came at a cost of US$4.5 million, a huge sum of money in 1914.

A 1924 outbreak in California resulted not only in the slaughter of 109,000 farm animals, but also 22,000 deer.

The US had its latest FMD outbreak in Montebello, California, in 1929. This outbreak originated in hogs that had eaten infected meat scraps from a tourist steamship that had stocked meat in Argentina. Over 3,600 animals were slaughtered and the disease was contained in less than a month.^[25][26]

Mexico-U.S. border 1947

An outbreak on the U.S.-Mexico border resulted in a bilateral effort to eradicate the disease. It was a sign that U.S.-Mexico relations were improving in the post-World War II era.^[27][28]

United Kingdom 1967

Main article: 1967 United Kingdom foot-and-mouth epidemic

In October 1967, a farmer in Shropshire reported a lame sow, which was later diagnosed with FMD. The source was believed to be remains of legally imported infected lamb from Argentina and Chile. The virus spread and, in total, 442,000 animals were slaughtered and the outbreak had an estimated cost of £370 million.^{[citation needed]}

Taiwan 1997

Pork export from Taiwan during 1995 to 1998.Shows the devastating drop.^[29]

Taiwan had previous epidemics of FMD in 1913–14 and 1924–29, but had since been spared,^[30] and considered itself free of FMD as late as in the 1990s. On the 19th of March 1997, a sow at a farm in Hsinchu Prefecture, Taiwan, was diagnosed with a strain of FMD which only infects swine. Mortality was high, nearing 100% in the infected herd. The cause of the epidemic was not determined, but the farm was near a port city known for its pig-smuggling industry and illegal slaughterhouses. Smuggled swine or contaminated meat are thus likely sources of the disease.

The disease spread rapidly among swine herds in Taiwan, with 200–300 new farms being infected daily. Causes for this include the high swine density in the area, with up to 6,500 hogs per square mile, feeding of pigs with untreated garbage, and the farms' proximity to slaughterhouses. Other systemic issues, such as lack of laboratory facilities, slow response, and initial lack of a vaccination program, contributed. The farmers allegedly intentionally introduced FMD to their flocks, because the payment offered to farmers for culled swine was at the time higher than their market value.^{[citation needed]}

A complicating factor is the endemic spread of swine vesicular disease (SVD) in Taiwan. The symptoms are indistinguishable from FMD, which may have led to previous misdiagnosing of FMD as SVD. Laboratory analysis was seldom used for diagnosis, and FMD may thus have gone unnoticed for some time.

The swine depopulation was a massive undertaking, with the military contributing substantial manpower. At peak capacity, 200,000 hogs per day were disposed of, mainly by electrocution. Carcasses were disposed of by burning and burial, but burning was avoided in water resource protection areas. In April, industrial incinerators were running around the clock to dispose of the carcasses.

Initially, 40,000 combined vaccine doses for the strains O-1, A-24, and Asia-1 were available and administered to zoo animals and valuable breeding hogs. At the end of March, half a million new doses for O-1 and Asia-1 were made available. On the May 3rd, 13 million doses of O-1 vaccine arrived, and both the March and May shipments were distributed free of charge. With a danger of vaccination crews spreading the disease, only trained farmers were allowed to administer the vaccine under veterinary supervision.

Taiwan had previously been the major exporter of pork to Japan,^[31] and among the top 15 pork producers in the world in 1996.^[32] During the outbreak, over 3.8 million swine were destroyed at a cost of US$6.9 billion. The Taiwanese pig industry was devastated as a result, and the export market was in ruins.^[25][33]
In 2007, Taiwan was considered free of FMD, but was still conducting a vaccination program, which restricts the export of meat from Taiwan.

United Kingdom 2001

Main article: 2001 United Kingdom foot-and-mouth outbreak

The epidemic of foot-and-mouth disease in the United Kingdom in the spring and summer of 2001 was caused by the "Type O pan Asia" strain of the disease.^[34] This episode resulted in more than 2,000 cases of the disease in farms throughout the British countryside. Around ten million sheep and cattle were killed in an eventually successful attempt to halt the disease.^[35] The county of Cumbria was the most seriously affected area of the country, with 843 cases. By the time the disease was halted in October 2001, the crisis was estimated to have cost Britain £8 billion ($13 billion)^[36] to the agricultural and support industries, and to the outdoor industry. What made this outbreak so serious was the amount of time between infection being present at the first outbreak locus, and the time when countermeasures were put into operation against the disease, such as transport bans and detergent washing of both vehicles and personnel entering livestock areas. The epidemic was probably caused by pigs which had been fed infected rubbish that had not been properly heat-sterilized. Further, the rubbish is believed to have contained remains of infected meat that had been illegally imported to Britain.^[37]

China 2005

In April 2005, an Asia-1 strain of FMD appeared in the eastern provinces of Shandong and Jiangsu. During April and May, it spread to suburban Beijing, the northern province of Hebei, and the Xinjiang autonomous region in northwest China. On 13 May, China reported the FMD outbreak to the World Health Organization and the OIE. This was the first time China has publicly admitted to having FMD.^[38][39] China is still reporting FMD outbreaks. In 2007, reports filed with the OIE documented new or ongoing outbreaks in the provinces of Gansu, Qinghai and Xinjiang. This included reports of domestic yak showing signs of infection.^[40] FMD is endemic in pastoral regions of China from Heilongjiang Province in the northeast to Sichuan Province and the Tibetan Autonomous region in the southwest. Chinese domestic media reports often use a euphemism "Disease Number Five" (五号病 wǔhàobìng) rather than FMD in reports because of the sensitivity of the FMD issue. In March 2010, Southern Rural News (Nanfang Nongcunbao), in an article "Breaking the Hoof and Mouth Disease Taboo", noted that FMD has long been covered up in China by referring to it that way.^[41] FMD is also called canker (口疮, literally "mouth ulcers" kǒuchuāng) or hoof jaundice (蹄癀 tíhuáng) in China, so information on FMD in China can be found online using those words as search terms.^[42][43] One can find online many provincial orders and regulations on FMD control antedating China's acknowledgment that the disease existed in China, for example Guangxi Zhuang Autonomous Region 1991 regulation on preventing the spread of Disease No.5.^[44]

United Kingdom 2007

Main article: 2007 United Kingdom foot-and-mouth outbreak

An infection of foot-and-mouth disease in the United Kingdom was confirmed by the Department for Environment, Food and Rural Affairs, on 3 August 2007, on farmland located in Normandy, Surrey.^[45][46] All livestock in the vicinity were culled on 4 August. A nationwide ban on the movement of cattle and pigs was imposed, with a 3-km (1.9-mi) protection zone placed around the outbreak sites and the nearby virus research and vaccine production establishments, together with a 10-km (6.2-mi) increased surveillance zone.^[47]

On 4 August, the strain of the virus was identified as a "01 BFS67-like" virus, one linked to vaccines and not normally found in animals, and isolated in the 1967 outbreak.^[48] The same strain was used at the nearby Institute for Animal Health and Merial Animal Health Ltd at Pirbright, 2.5 miles (4.0 km) away, which is an American/French-owned research facility, and was identified as a possible source of infection.^[49]

On 12 September, a new outbreak of the disease was confirmed in Egham, Surrey, 19 km (12 mi) from the original outbreak,^[50] with a second case being confirmed on a nearby farm on 14 September.^[51]

These outbreaks caused a cull of all at-risk animals in the area surrounding Egham, including two farms near the famous four-star hotel Great Fosters. These outbreaks also caused the closure of Windsor Great Park due to the park containing deer; the park remained closed for three months. On 19 September 2007, a suspected case of FMD was found in Solihull, where a temporary control zone was set up by Defra.

Japan and Korea 2010–2011

Main articles: 2010 Japan foot-and-mouth outbreak and 2010–2011 South Korea foot-and-mouth outbreak

In April 2010, a report of three incursions of FMD in Japan and South Korea led the United Nations Food and Agriculture Organization (FAO) to issue a call for increased global surveillance. Japan veterinary authorities confirmed an outbreak of type O FMD virus, currently more common in Asian countries where FMD is endemic.

South Korea was hit by the rarer type A FMD in January, and then suffered type O infection in April.^[52] The most serious case of foot-and-mouth outbreak in South Korea's history started in November 2010 in pig farms in Andong city of Gyeongsangbuk-do, and has since spread in the country rapidly.^[53][54] More than 100 cases of the disease have been confirmed in the country so far,^[53] and in January 2011, South Korean officials started a mass cull of approximately 12%, or around three million in total, of the entire domestic pig population, and 107,000 of three million cattle of the country to halt the outbreak.^[53]
According to the report based on complete 1D gene sequences, Korean serotype A virus was linked with those from Laos. Korean serotype O viruses were divided into three clades and were closely related to isolates from Japan, Thailand, the UK, France, Ireland, South Africa, and Singapore, as well as Laos.^[55]

On 10 February 2011, North Korea reported an outbreak affecting pigs in the region around Pyongyang, by then ongoing since at least December 2010. Efforts to control the outbreak were hampered by illicit sales of infected meat.^[56]

History

The cause of FMD was first shown to be viral in 1897 by Friedrich Loeffler. He passed the blood of an infected animal through a Chamberland filter and found the collected fluid could still cause the disease in healthy animals.

FMD occurs throughout much of the world, and while some countries have been free of FMD for some time, its wide host range and rapid spread represent cause for international concern. After World War II, the disease was widely distributed throughout the world. In 1996, endemic areas included Asia, Africa, and parts of South America; as of August 2007, Chile is disease-free,^[57] and Uruguay and Argentina have not had an outbreak since 2001. In May 2014, the FAO informed that Bolivia, Colombia, Ecuador and Peru were "just one step away" from eradication;^[58]North America and Australia have been free of FMD for many years. New Zealand has never had a case of foot-and-mouth disease.^[59] Most European countries have been recognized as disease-free, and countries belonging to the European Union have stopped FMD vaccination.

However, in 2001, a serious outbreak of FMD in Britain resulted in the slaughter of many animals, the postponing of the general election for a month, and the cancellation of many sporting events and leisure activities, such as the Isle of Man TT. Due to strict government policies on sale of livestock, disinfection of all persons leaving and entering farms, and the cancellation of large events likely to be attended by farmers, a potentially economically disastrous epizootic was avoided in the Republic of Ireland,^{[citation needed]} with just one case recorded in Proleek, Co. Louth. As one result, the Animal Health Act 2002 was designed by Parliament to provide the regulators with more powers to deal with FMD.^[60][61]

In August 2007, FMD was found at two farms in Surrey, England. All livestock were culled and a quarantine erected over the area. Two other suspected outbreaks have occurred since, although these seem now not to be related to FMD. The only reported case in 2010 was a false alarm from GIS Alex Baker, as proven false by the Florida Farm and Agricultural Department, and quarantine/slaughter of cattle and pigs was confirmed from Miyazaki Prefecture in Japan in June after three cows tested positive. Some 270,000 cattle have been ordered slaughtered following the disease's outbreak.

Society and culture

Economic and ethical issues

Epidemics of FMD have resulted in the slaughter of millions of animals, despite this being a frequently nonfatal disease for adult animals (2–5% mortality), though young animals can have a high mortality.^[62] The Taiwan outbreak that affected only pigs also showed a high mortality for adults. The destruction of animals is primarily to halt further spread, as growth and milk production may be permanently affected, even in animals that have recovered. Due to international efforts to eradicate the disease, infection would also lead to trade bans being imposed on affected countries. Critics of current policies to cull infected herds argue that the financial imperative needs to be balanced against the killing of many animals,^[63] especially when a significant proportion of infected animals, most notably those producing milk, would recover from infection and live normal lives, albeit with reduced milk production. On the ethical side, one must also consider FMD is a painful disease for the affected animals.^[64] The vesicles/blisters are painful in themselves, and restrict both eating and movement. Through ruptured blisters, the animal is at risk from secondary bacterial infections^[64] and, in some cases, permanent disability.

See also

• Animal virology


• 
  Hand, foot and mouth disease (HFMD)


• 
  Swine vesicular disease (SVD)


• 
  Blain, an archaic disease of uncertain etiology

References

1. 
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External links

Classification	D ICD-10: B08.8 (ILDS B08.820) ICD-9-CM: 078.4 MeSH: D005536 DiseasesDB: 31707

Wikimedia Commons has media related to Foot-and-mouth disease.

• FMD Myocarditis in Pigs


• 
  Stenfeldt, C.; Pacheco, J. M.; Smoliga, G. R.; Bishop, E.; Pauszek, S. J.; Hartwig, E. J.; Rodriguez, L. L.; Arzt, J. (2014). "Detection of Foot-and-mouth Disease Virus RNA and Capsid Protein in Lymphoid Tissues of Convalescent Pigs Does Not Indicate Existence of a Carrier State". Transboundary and Emerging Diseases. 63 (2): 152–164. doi:10.1111/tbed.12235. PMID 24943477.
  


• 
  Foot-and-Mouth Disease 12-part comprehensive overview from the Center for Infectious Disease Research and Policy
  


• FMD portal


• 2007 Outbreak Foot and Mouth Disease Timeline


• 
  Animal Disease and Human Trauma—Emotional geographies of disaster Palgrave Macmillan
  ISBN 978-0-230-50697-8 authored by the research team of a longitudinal study into the Health and Social Consequences of FMD in North Cumbria (Lancaster University).


• 
  A Manufactured Plague: The history of Foot-and-mouth Disease in Britain. Foot and Mouth—the Management of a Pseudo-crisis (2004,
  ISBN 1-84407-080-8) by Abigail Wood, a veterinary researcher at the University of Manchester.


• 
  Armstrong R, Davie J, Hedger RS (1967). "Foot-and-mouth disease in man". Br Med J. 4 (5578): 529–30. doi:10.1136/bmj.4.5578.529. PMC 1749100. PMID 4294412.
  


• 
  Current status of Foot and Mouth Disease worldwide at OIE. WAHID Interface—OIE World Animal Health Information Database


• Disease card


• USDA Foot-and-Mouth Research Laboratory Records

v t e Infectious skin disease: Viral cutaneous conditions, including viral exanthema (B00–B09, 050–059)
DNA virus Herpesviridae Alpha .mw-parser-output .nobold{font-weight:normal} HSV Herpes simplex Herpetic whitlow Herpes gladiatorum Herpes simplex keratitis Herpetic sycosis Neonatal herpes simplex Herpes genitalis Herpes labialis Eczema herpeticum Herpetiform esophagitis Herpes B virus B virus infection VZV Chickenpox Herpes zoster Herpes zoster oticus Ophthalmic zoster Disseminated herpes zoster Zoster-associated pain Modified varicella-like syndrome Beta Human herpesvirus 6/Roseolovirus Exanthema subitum Roseola vaccinia Cytomegalic inclusion disease Gamma KSHV Kaposi's sarcoma Poxviridae Ortho Variola Smallpox Alastrim MoxV Monkeypox CPXV Cowpox VV Vaccinia Generalized vaccinia Eczema vaccinatum Progressive vaccinia Buffalopox Para Farmyard pox: Milker's nodule Bovine papular stomatitis Pseudocowpox Orf Sealpox Other Yatapoxvirus: Tanapox Yaba monkey tumor virus MCV Molluscum contagiosum Papillomaviridae HPV Wart/plantar wart Heck's disease Genital wart giant Laryngeal papillomatosis Butcher's wart Bowenoid papulosis Epidermodysplasia verruciformis Verruca plana Pigmented wart Verrucae palmares et plantares BPV Equine sarcoid Parvoviridae Parvovirus B19 Erythema infectiosum Reticulocytopenia Papular purpuric gloves and socks syndrome Polyomaviridae Merkel cell polyomavirus Merkel cell carcinoma RNA virus Paramyxoviridae MeV Measles Togaviridae Rubella virus Rubella Congenital rubella syndrome ("German measles" ) Alphavirus infection Chikungunya fever Picornaviridae CAV Hand, foot and mouth disease Herpangina FMDV Foot-and-mouth disease Boston exanthem disease
Ungrouped	Asymmetric periflexural exanthem of childhood Post-vaccination follicular eruption Lipschütz ulcer Eruptive pseudoangiomatosis Viral-associated trichodysplasia Gianotti–Crosti syndrome

• The European Commission for the Control of Foot-and-Mouth Disease (EuFMD)

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