Recent progress and challenges in drug development to fight hand, foot and mouth disease

Introduction: Hand, foot and mouth disease (HFMD) is a serious public health concern in the Asia-Pacific region with recurrent cyclical outbreaks. Enterovirus 71 (EV-A71) and coxsackievirus type A are the main causative agents of HFMD. While majority of HFMD cases are mild and self-limiting, neurological complications have been reported for EV-A71 associated HFMD. There is currently no effective treatment against HFMD and monovalent vaccines against EV-A71 are currently limited to the Chinese market.Areas covered: As of today, HFMD antiviral development has focused on EV-A71 and involves conventional screening of drug libraries. In recent years, attention has shifted toward identifying druggable host factors to avoid drug resistance and identify drug candidates with broader antiviral activity across EV-A71 genogroups and other HFMD causative agents.Expert opinion: The effective development of HFMD interventions requires us to address the gaps in our understanding of its pathogenesis at the molecular level. The limited resources devoted to the development of HFMD treatment strategies worldwide also contribute to the slow progress of promising drug and vaccine candidates along the clinical pipeline.