HFM is moderately contagious; infection is spread by direct contact with nasal discharge, saliva, blister fluid, or stool of infected individuals. Infected individuals are most contagious during the first week of the illness. However, the viruses that cause HFM can persist for weeks after symptoms have resolved, most commonly in stool, allowing transmission following resolution of symptoms. Exclusion of children from group settings is appropriate during the first few days of the illness in the setting of open lesions in the mouth or on the skin. This may reduce the spread of infection but will not interrupt transmission completely