What is Hand-Foot-Mouth Disease (HFMD)?
Hand-foot-mouth disease (HFMD) is a common infectious disease caused by a variety of enteroviruses, mainly in infants and children. Most patients have mild symptoms, with fever and a rash or herpes on the hands, feet and mouth. A small number of patients can be complicated by aseptic meningitis, encephalitis, acute flaccid paralysis, respiratory tract infection and myocarditis, etc. Individual children with severe disease progress rapidly and even die. Adolescent children and adults do not develop disease after infection, but are able to transmit the virus. There are more than 20 types of enteroviruses that cause HFMD, including enterovirus 71 (EV71) and certain serotypes of group A coxsackieviruses (CoxA) and echoviruses (Echo). Among them, EV71 infection causes a larger proportion of severe cases. Xu Yi, Department of Infection, Guangzhou Women’s and Children’s Medical Center
Is hand, foot and mouth disease contagious?
HFMD is a global infectious disease, with epidemics reported in most parts of the world. In China, the disease was first reported in Shanghai in 1981. Since then, the disease has been reported in more than 10 provinces, including Beijing, Hebei, Tianjin, Fujian, Jilin, Shandong, Hubei, Qinghai, and Guangdong and Guangxi. The enterovirus is highly infectious, has a large proportion of latent infections, complex transmission routes, and rapid spread, and can cause a large epidemic in a short period of time, making epidemic control difficult. During epidemics, collective infections in kindergartens and nurseries and family clusters of illnesses can occur. Since May 2, 2008, China has included hand, foot and mouth disease into the management of category C infectious diseases. Medical institutions of all levels and types are required to report cases of HFMD in accordance with the relevant provisions of the Law of the People’s Republic of China on the Prevention and Control of Statutory Infectious Diseases and the Code of Practice for the Management of Infectious Disease Information Reporting.
How does HFMD occur and spread?
Both patients with HFMD and those with latent infection are the infectious source of the disease. The disease is transmitted mainly through close contact between people. The enterovirus is transmitted mainly by fecal-oral and/or respiratory droplets, and can also be contracted by contact with the skin and mucosal vesicles of patients. It is not known whether it can be transmitted through water or food. The virus can be detected in the pharynx and stool of infected patients several days before the onset of the disease, and is usually most contagious within a week after the onset of the disease. The disease can be spread by the patient’s feces, herpes fluid and respiratory secretions, as well as by their contaminated hands, towels, handkerchiefs, dental cups, toys, eating utensils, milk utensils, bedding, underwear, and medical instruments. HFMD especially favors infants and children younger than 3 years old, while children and adults who are infected mostly do not develop the disease, which we call recessive infected persons, but become carriers of the virus and spread it.
Why are infants and young children susceptible to the disease?
The susceptibility of infants and young children is related to the epidemiological characteristics of HFMD. HFMD generally has small outbreaks every year and large epidemics every four to five years. Babies come into the world having never been exposed to viruses, the organism has not developed antibodies against these viruses, and they belong to a susceptible population, especially children before the age of five. Small epidemics each year are not enough to cover all children, so every four to five years a group of susceptible people accumulates to form an epidemic outbreak.
How can HFMD be identified?
In general, at the beginning of HFMD infection, children often have symptoms such as fever, cough, runny nose and drooling. At the same time, blisters appear in the mouth, which break down very easily to form a vesicular surface and reveal a small red papule on the skin, which is also prone to blistering on top. The rash has the following characteristics.
four sites: the small papules generally appear on four major sites: hands, feet, mouth and buttocks.
four unlike: unlike mosquito bites, unlike drug rashes, unlike herpes of the mouth, lips and gums, and unlike chicken pox.
Four not: the rash is not painful, not itchy, not crusty, not scarred. However, the child’s eating will be affected when there are more oral ulcers.
What are the signs of HFMD in children?
The incubation period for typical cases is usually 2-7 days, and most children have a sudden onset of illness. About half of the children have a fever 1-2 days before the onset of the disease, mostly around 38°C, lasting 2-3 days, with a few children having it for more than 3-4 days. Some children have early symptoms of mild upper sensation, such as cough, runny nose, nausea, vomiting, etc. Due to painful oral mucosal ulcers, the child has salivation and refusal to eat. Oral mucosal rash appears early, mainly on the tongue and cheeks, and often on the side of the lips and teeth. A maculopapular or herpetic rash appears on the distal parts of the hands and feet. The maculopapular rash turns from red to dark in about 5 days and then fades; the herpes is round or oval with flattened projections and cloudy fluid inside, with the same length and diameter as the skin lines, such as the size of a soybean. The papules and herpes on the distal parts of the hands and feet are usually painless and itchy, and do not leave traces after healing. Note that in the same patient hand, foot and mouth rashes may not all appear.
In atypical, disseminated children, the rash only appears on one part of the patient’s body, and the maculopapular or herpetic rash is sparse and atypical. It is often difficult to distinguish from rash febrile illnesses, and pathogenic and serologic tests must be performed at the hospital to determine this.
Is HFMD serious?
It is usually not serious and most children usually recover from the disease within 7-10 days and complications are uncommon. A small number of patients may have complications such as aseptic meningitis, encephalitis, acute flaccid paralysis, respiratory infections and myocarditis. Only individual children with severe disease progress rapidly and death can occur. With prompt medical attention, most children will recover.
Which children are at risk of developing severe HFMD?
Children with the following characteristics are likely to develop into severe cases within a short period of time and should be seen in a timely manner, with close observation of changes in their condition, necessary ancillary tests and targeted treatment.
1, persistent high fever that does not subside.
2, chills and fluttering of the hands and feet.
3, accelerated respiration, nasal flapping, altered respiratory rhythm, and significantly increased heart rate.
4. the presence of irritability, frequent startled jumping, shaking of the limbs and even convulsions
5. increased or decreased peripheral blood leukocyte count.
6, high blood glucose.
7, high or low blood pressure.
Which children with HFMD need to be kept in hospital for observation?
Infants and children under 3 years old with one of the following conditions need to be kept in the hospital for observation. If a township health center finds a patient who meets the indications for stay for observation, they should be immediately transferred to a medical institution at or above the county level.
1. fever with hand, foot, oral, or perianal rash of less than 4 days duration.
2, herpetic pharyngitis with increased peripheral blood leukocyte count.
3, fever and poor mental health.
Which children with HFMD need to be hospitalized?
Those with one of the following conditions need to be hospitalized and should be transferred to a designated medical institution immediately
1. poor mental health/lethargy, easily startled, irritable
2.Shaking or weakness of limbs, paralysis.
3, pallor, increased heart rate, poor peripheral circulation.
4. shallow breathing or chest X-ray suggesting pulmonary edema, pneumonia.
How can individuals prevent hand, foot and mouth disease?
HFMD is transmitted in many ways, and infants and children are generally susceptible. Good hygiene for children, families and childcare institutions is the key to preventing infection.
1. Wash children’s hands with soap or hand sanitizer before and after meals and after going out, do not allow children to drink raw water or eat cold food, and avoid contact with sick children.
2. Caregivers should wash their hands before touching children, changing diapers for young children, and after handling feces, and dispose of the dirt properly.
3.Bottles and pacifiers used by infants and children should be washed before and after use.
4. During the epidemic period, children should not be taken to public places with poor air circulation, and attention should be paid to maintaining family hygiene, frequent ventilation of the living room, and regular drying of clothes and blankets.
5. Children should go to medical institutions promptly when symptoms appear. For children treated at home, do not contact other children, parents should dry or disinfect the affected children’s clothes, and disinfect the affected children’s feces in a timely manner; children with minor illnesses do not need to be hospitalized, but should be treated and rested at home to reduce cross-infection.
How to prevent hand, foot and mouth disease in collective units such as child care institutions and elementary school?
1. During the epidemic season, classrooms and dormitories should be well ventilated.
2. daily cleaning and disinfection of toys, personal hygiene utensils, tableware and other items
3.When cleaning or disinfecting (especially cleaning toilets), staff should wear gloves. Wash hands immediately after cleaning work.
4.Daily wipe and disinfect door handles, stair handrails, table tops and other object surfaces.
5.Educate and guide children to develop the habit of proper hand washing.
6.Daily morning checkups, and when suspicious children are found, the children should be sent to the clinic and rest at home in time; the objects used by the children should be disinfected immediately.
7. To report to the health and education departments in a timely manner when the number of affected children increases. Depending on the need for epidemic control when the education and health departments may decide to take measures to close child care institutions or elementary school.
How can medical institutions prevent hand, foot and mouth disease?
1, during the disease epidemic, hospitals should implement pre-screening and triage, and set up consultation rooms (desks) to receive suspected HFMD patients, direct children with fever and rash to special consultation rooms (desks), increase the frequency of cleaning and disinfection in areas such as waiting and consultation, and use wet cleaning when cleaning indoors.
2. Medical personnel should wash their hands or disinfect them carefully after treating and caring for each patient.
3. Non-disposable instruments and articles used in the process of treatment and care of patients should be wiped and disinfected.
4. No other non-enterovirus infected children should be admitted in the same ward. Seriously ill children should be treated in separate isolation.
5. Facilities and items such as beds and tables and chairs used by hospitalized children must be disinfected before continued use.
6. respiratory secretions and feces of the child and its contaminated items should be disinfected
7. Medical institutions should immediately report to the local health administrative department and the CDC when they find an increase in the number of patients with hand, foot and mouth or deaths related to enterovirus infection.