HFMD
HAND,FOOT, AND MOUTH DISEASE
What is hand,foot and mouth disease?
Hand, foot and mouth
disease (HFMD) is a common infectious disease of infants and children. It is
characterized by fever, painful sores in the mouth, and a rash with blisters on
hands, feet and also buttocks. It is prevalent in many Asian countries.
Is it the same as
foot-and-mouth disease in animals?
No, HFMD is not to be
confused with foot-and-mouth (also called hoof-and-mouth) disease which is
caused by a different virus and affects cattle, sheep, and pigs.
Where does HFMD occur?
Individual cases and
outbreaks of HFMD occur worldwide. In tropical and subtropical countries,
outbreaks often occur year-round.
Outbreaks of HFMD occur
every few years in different parts of the world, but in recent years these have
occurred more in Asia. Countries with recent large increases in the number of
reported cases in Asia include: China, Japan, Hong Kong (China), Republic of
Korea, Malaysia, Singapore, Thailand, Taiwan (China) and Vietnam.
What causes HFMD?
Viruses from the group
called enteroviruses cause HFMD. There are many different types in the group
including polioviruses, coxsackieviruses, echoviruses and other enteroviruses.
HFMD is most commonly
caused by coxsackievirus A16 which usually results in a mild self-limiting
disease with few complications. However, HFMD is also caused by Enteroviruses,
including enterovirus 71 (EV71) which has been associated with serious
complications, and may be fatal.
How serious is HFMD?
Most people with HFMD
recover fully after the acute illness.
- HFMD is usually a mild disease, and
nearly all patients recover in 7 to 10 days without medical treatment and
complications are uncommon.
v Dehydration
is the most common complication of HFMD infection caused by coxsackieviruses;
it can occur if intake of liquids is limited due to painful sores in the mouth.
v Rarely,
patients develop "aseptic" or viral meningitis, in which the person
has fever, headache, stiff neck, or back pain, and may need to be hospitalized
for a few days.
- HFMD
caused by EV71 has been associated with meningitis and encephalitis, and
on occasion can cause severe complications, including neurological,
cardiovascular and respiratory problems. Cases of fatal EV71 encephalitis
have occurred during outbreaks.
How
soon after exposure do symptoms appear?
v The usual period from infection
to onset of symptoms is 3–7 days.
v Fever, lasting 24-48 hours, is
often the first symptom of HFMD.
What
are the symptoms?
The
disease usually begins with a fever, poor appetite, malaise, and frequently
with a sore throat.
v One or 2 days after fever onset,
painful sores develop in the mouth. They begin as small red spots that blister
and then often become ulcers. They are usually located on the tongue, gums, and
inside of the cheeks.
v A non-itchy skin rash develops
over 1–2 days with flat or raised red spots, some with blisters. The rash is
usually located on the palms of the hands and soles of the feet; it may also
appear on the buttocks and/or genitalia.
v A person with HFMD may not have
symptoms, or may have only the rash or only mouth ulcers.
v In a small number of cases,
children may experience a brief illness, present with mixed neurological and
respiratory symptoms and succumb rapidly to the disease.
How
do you get HFMD?
HFMD
virus is contagious and infection is spread from person to person by direct
contact with nose and throat discharges, saliva, fluid from blisters, or the
stool of infected persons. Infected persons are most contagious during the
first week of the illness, but the period of communicability can last for
several weeks (as the virus persists in stool).
HFMD
is not transmitted to or from pets or
other animals.
Who
is at risk for HFMD?
v Everyone who has not already been
infected is at risk of infection, but not everyone who is infected becomes ill.
v HFMD occurs mainly in children
under 10 years old, but most commonly in children younger than 5 years of age.
Younger children tend to have worse symptoms.
v Children are more likely to be
susceptible to infection and illness from these viruses, because they are less
likely than adults to have antibodies and be immune from previous exposures to
them. Most adults are immune, but cases in adolescents and adults are not
unusual.
Can
you be infected with HFMD more than once?
Yes,
infection only results in immunity to one specific virus, other episodes may
occur following infection with a different virus type.
What about pregnant
women?
Ideally
pregnant women should avoid close contact with anyone with HFMD and pay
particular attention to measures that prevent transmission.
Enterovirus
infections, including HFMD are common and pregnant women are frequently exposed
to them. They may cause mild or no illness in the pregnant woman and currently
there is no clear evidence that maternal enterovirus infection, including HFMD,
is associated with any particular adverse outcomes of pregnancy (such as
abortion, stillbirth or congenital defects). However, pregnant women may pass
the virus to the baby if they are infected shortly before delivery or have
symptoms at the time of delivery.
Most
newborns infected with an enterovirus have mild illness, but rarely may develop
an overwhelming infection of many organs, including liver and heart, and die
from the infection. The risk of this severe illness is higher for newborns
infected during the first two weeks of life.
How
is HFMD treated?
Presently,
there is no specific treatment available for HFMD. Patients should drink plenty
of water and may require symptomatic treatment to reduce fever and pain from
ulcers.
Can
HFMD be prevented?
There
are no specific antiviral drugs or vaccines available against non-polio
enteroviruses causing HFMD. The risk of infection can be lowered by good,
hygiene practices and prompt medical attention for children showing severe
symptoms.
Preventive
measures include:
v frequent handwashing with soap
and water especially after touching any blister or sore, before preparing food
and eating, before feeding young infants, after using the toilet and after
changing diapers;
v cleaning contaminated surfaces
and soiled items (including toys) first with soap and water, and then
disinfecting them using a dilute solution of chlorine-containing bleach;
v avoiding close contact (kissing,
hugging, sharing utensils, etc.) with children with HFMD may also help to
reduce of the risk of infection;
v keeping infants and sick children
away from kindergarten, nursery, school or gatherings until they are well;
v monitoring the sick child's
condition closely and seeking prompt medical attention if persistent high
fever, decrease in alertness or deterioration in general condition occurs;
v covering mouth and nose when
sneezing and coughing;
v disposing properly of used
tissues and nappies into waste bins that close properly;
maintaining
cleanliness of home, child care centre, kindergartens or schools.REFERENCE: HFMD
SYMPTOMS |
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