Hand, foot and mouth disease (HFMD) is an infectious disease caused by enterovirus, which mostly occurs in children under 5 years old and can cause hand, foot and mouth herpes. A few children can cause complications such as myocarditis, pulmonary edema and aseptic meningoencephalitis. Individual critically ill children develop rapidly, leading to death.
There are more than 20 kinds of enteroviruses that cause hand, foot and mouth disease. Coxsackievirus A (16, 4, 5, 9 and 10), Coxsackievirus B (2 and 5) and enterovirus 7 1 are the common pathogens of hand, foot and mouth disease, among which Coxsackievirus A (16) is the most common.
[Edit this paragraph] 2 communication channels
1. Contact with patient's skin.
2. Contaminate hands, towels, handkerchiefs and other items through viruses.
3. The patient's throat secretions (droplets) spread.
4. Drink polluted water.
[Edit this paragraph] III Prevention
Hand, foot and mouth disease is generally easy to infect babies. Most cases have mild symptoms, mainly manifested as fever, rash or herpes on hands, feet or mouth, and most patients can heal themselves. Disease control experts advise everyone to develop good hygiene habits, wash their hands before and after meals, do not drink raw water, do not eat cold food, dry clothes and quilts frequently, and have more ventilation. Kindergartens and parents who find suspicious children should go to medical institutions for treatment in time, report to health and education departments in time, and take control measures in time. Mild children do not need to be hospitalized, but can be treated and rested at home to avoid cross-infection. As long as these aspects are well controlled.
[Edit this paragraph] Four clinical features
Acute onset, fever; Oral mucosa appears scattered herpes, the size of rice grain, and the pain is obvious; Herpes the size of a grain of rice appears on the palm or sole, and occasionally the buttocks or knees may be tired by clinical features. There is an inflammatory blush around the herpes, and there is less liquid in the blister. Some children may be accompanied by cough, runny nose, loss of appetite, nausea, vomiting and headache. Doctors can usually distinguish hand, foot and mouth disease from oral ulcers caused by other reasons according to the age of patients, symptoms complained by patients or parents, rashes and ulcers. Swallow swabs or stool samples can be sent to the laboratory for virus testing, but it takes 2-4 weeks for virus testing to produce results, so doctors usually don't recommend this kind of testing. Basis: Epidemiological data, clinical manifestations, laboratory examination and diagnosis must be based on pathogenic examination.
Hand, foot and mouth disease is an infectious disease caused by several enteroviruses, which mainly affects infants under 5 years old. Hand, foot and mouth disease is often manifested as: children's cheeks, tongue, soft palate, hard palate, inner lip, hands, feet, elbows, knees, buttocks, and anterior vulva appear around the size of rice grains or mung beans, red gray-white herpes or red papules.
Rash "four unlike": unlike mosquito bites, unlike drug rash, unlike lip and gum herpes, unlike chickenpox.
After the herpes in the oral cavity is broken, there will be ulcers, frequent drooling and inability to eat.
Clinically, it does not itch, hurt, scab or leave scars.
The child's urine is yellow.
Children with severe rash may be accompanied by fever, runny nose, cough and other symptoms.
Hand, foot and mouth disease can usually be cured within a week, but if herpes attacks before, it is very easy to be infected. Hand, foot and mouth disease has the characteristics of high epidemic intensity, strong infectivity and complicated transmission route. The virus can be transmitted to healthy children through saliva drops or food bitten by flies with the virus, through the nose and mouth or direct contact.
[Edit this paragraph] Five identifications
According to the above clinical features, it is not difficult to diagnose in a large-scale epidemic. But when it happens, it must be differentiated from foot-and-mouth disease, herpetic pharyngitis and rubella:
(1) foot-and-mouth disease is caused by foot-and-mouth disease virus. There are currently 7 serotypes and 65 subtypes. It mainly infringes on domestic animals such as pigs, cattle and horses. Although it will cause disease to people, it is not sensitive. It generally occurs in animal husbandry areas, and adult herders are common all year round. Oral mucosal rash is easy to fuse into a larger ulcer, and there is a rash between the back of the hand and fingers and toes, which is itchy and painful.
(2) Herpetic stomatitis can occur in all seasons, mainly scattered. Generally, there is no rash, and occasionally herpes can appear in the lower abdomen.
(3) Herpetic pharyngeal and buccal inflammation, which can be caused by Coxsackie virus and the lesion is in the back of the mouth; Such as tonsil, soft palate and uvula, rarely involving buccal mucosa, tongue and gums. Atypical and sporadic HFMD are difficult to distinguish from rash fever, so etiology and serum examination are needed.
Doctors can usually distinguish hand, foot and mouth disease from oral ulcers caused by other reasons according to the age of patients, symptoms complained by patients or parents, rashes and ulcers. Swallow swabs or stool samples can be sent to the laboratory for virus testing, but it takes 2-4 weeks for virus testing to produce results, so doctors usually don't recommend this kind of testing. Basis: Epidemiological data, clinical manifestations, laboratory examination and diagnosis must be based on pathogenic examination.
[Edit this paragraph] Six nursing strategies
1, disinfection and isolation
Once found infected with hand, foot and mouth disease, the baby should seek medical advice in time to avoid contact with the outside world. It usually takes 2 weeks to isolate.
Baby's used items should be thoroughly disinfected: they can be soaked with chlorine-containing disinfectants, and items that are not suitable for soaking can be exposed to the sun.
The baby's room should be ventilated regularly to keep the air fresh, circulating and at the right temperature. Conditional families can use lactic acid fumigation for air disinfection every day. Reduce the number of people entering and leaving the nursery, prohibit smoking, prevent air pollution and avoid secondary infection.
2. Dietary nutrition
If you get sick in summer, your baby is prone to dehydration and electrolyte disorder, and needs proper hydration and nutrition.
The baby should stay in bed 1 week and drink plenty of warm water.
Because of fever and oral herpes, the child has a bad appetite and is unwilling to eat. It is advisable to give your baby a light, warm, delicious and digestible soft liquid or semi-liquid, and avoid irritating foods such as cold, spicy and salty.
3. Oral care
Babies will refuse to eat, salivate, cry and sleep because of oral pain. To keep your baby's mouth clean, rinse your mouth with normal saline before and after meals. For babies who can't rinse their mouths, gently clean their mouths with cotton swabs dipped in normal saline.
Vitamin B _ 2 powder can be directly applied to oral erosion, or cod liver oil, or taken orally with vitamin B _ 2 and vitamin C, supplemented by ultrasonic atomization inhalation, so as to relieve pain, promote the early healing of erosion and prevent secondary bacterial infection.
4, rash care
Baby clothes and bedding should be clean, comfortable, soft and changed frequently.
Cut your baby's nails short and wrap your baby's hands if necessary to prevent scratching the rash.
Babies with a rash on their buttocks should clean up their urine and urine at any time to keep their buttocks clean and dry.
Calamine lotion can be applied at the initial stage of hand and foot rash, and 0.5% iodophor can be applied when herpes forms or breaks.
Pay attention to keep the skin clean to prevent infection.
Hand, foot and mouth disease in children is generally low or moderate fever, which can make the baby drink more water without special treatment.
Physically cool the baby whose body temperature is between 37.5℃ and 38.5℃, such as dissipating heat, drinking more warm water and taking a warm bath.
[Edit this paragraph] Seven major international epidemics
Hand, foot and mouth disease is a global infectious disease, which has been reported in most parts of the world. The disease was first reported in New Zealand on 1957. 1958 isolated coxsackie virus, 1959 put forward the name of hand, foot and mouth disease. The main pathogen of hand, foot and mouth disease is Cox A 16, which was first diagnosed in the United States 1969 EV7 1. Since then, EV7 1 infection and Cox A 16 infection have appeared alternately, becoming the main pathogen of hand, foot and mouth disease.
In the mid-1970s, an EV7 1 epidemic with central nervous system as the main clinical feature broke out in Bulgaria and Hungary. 1975 Bulgaria reported 750 cases, of which 149 were paralyzed and 44 died. 1994 An outbreak of hand, foot and mouth disease caused by Cox A 16 occurred in Britain. Most of the patients were infants aged 1-4 years, and most of them had mild symptoms. Epidemiological data since UK 1963 show that the epidemic interval of hand, foot and mouth disease is 2-3 years. In the late 1990s, EV7 1 became popular in East Asia. 1997, an outbreak of hand, foot and mouth disease mainly caused by EV7 1 occurred in Malaysia. From April to August, 2628 people became ill, and from April to June, 29 patients died. Japan is a country with many hand, foot and mouth diseases, and there have been many large-scale epidemics in history. 1969 ~ 1970 was dominated by CoxA 16, and 1973 and 1978 were caused by EV7 1 and 1978. At the end of 1990s, EV7 1 began to wreak havoc in East Asia. 1997, an outbreak of hand, foot and mouth disease mainly caused by EV7 1 occurred in Malaysia. There were 2628 cases from April to August, and only 29 cases died from April to June, with an average age of 1.5 years. 1998, hand, foot and mouth disease and herpetic angina broke out in Taiwan Province province, China. June and June 10, * * monitoring 129 106 cases, 405 cases were severe and 78 cases died, most of them were children under 5 years old.
[Edit this paragraph] VIII. Prevalence of hand, foot and mouth disease in China
The disease was found in Shanghai from China 198 1, and has been reported in ten Yu Sheng cities, including Beijing, Hebei, Tianjin, Fujian, Jilin, Shandong, Hubei and Guangdong. 1983, hand-foot-mouth disease (HFMD) caused by CoxA 16 broke out in Tianjin, with more than 7,000 cases in May and June. Two years after the epidemic, 1986 broke out again in nurseries. 1In 995, Wuhan Virus Research Institute isolated EV7 1 virus from hand-foot-mouth patients, and in 998, Shenzhen Health and Epidemic Prevention Station isolated two strains of EV7 1 virus from patients. From May to August, 2000, an epidemic of hand, foot and mouth disease in children occurred in Zhaoyuan City, Shandong Province. The Municipal People's Hospital admitted 1.698 children, including 1.025 males and 673 females, ranging from 5 months to 0/.4 years old. 3 cases died of fulminant myocarditis.
In 2006, hand-foot-mouth disease 13637 cases were reported nationwide (8460 cases were male, accounting for 62.04%; 5 177 women, accounting for 37.96%, and 6 cases (4 men and 2 women) died. Except Xizang Autonomous Region, 3 1 provinces, autonomous regions and municipalities have reported cases. The top ten provinces with reported cases are Shandong (3030 cases), Shanghai (2883 cases), Beijing (22 10 cases), Hebei (1 133 cases), Zhejiang (793 cases), Guangdong (670 cases) and Heilongjiang (670 cases)
May 2, 200712007 In 2007, 5459 cases of hand, foot and mouth disease were reported, and 2 cases died. Compared with the same period last year (2488 cases), the number of reported cases increased by 1 19.38+0%.
In May 2008, more than 76,000 cases of hand-foot-mouth disease/KLOC-0 were reported nationwide, with 40 deaths.
According to the epidemic data reported in recent years, the annual peak of hand, foot and mouth disease is around July. As the national temperature rose earlier in 2007, experts predicted that the peak incidence of hand, foot and mouth disease might be advanced, and the reported cases of hand, foot and mouth disease would further increase in 2007.
Since 2008, hand, foot and mouth disease has been spreading, and it broke out in Anhui, Guangdong, Tianjin, Ningxia and other places in spring, and it has been effectively controlled.
Epidemic situation report
(a) Since May 2, 2008, hand, foot and mouth disease has been included in the management of Class C infectious diseases. All kinds of medical institutions at all levels shall, in accordance with the relevant provisions of the Law of People's Republic of China (PRC) on the Prevention and Control of Infectious Diseases and the Management Standard for Information Reporting of Infectious Diseases, report cases of hand, foot and mouth disease that meet the definition of the above cases.
(2) Contents and methods of the report
When patients with hand, foot and mouth disease are found, fill in the column of "Other infectious diseases under legal management and key monitoring" in the Report Card of Legal Infectious Diseases in People's Republic of China (PRC). Medical institutions that implement direct online reporting should conduct direct online reporting within 24 hours. Medical institutions that have not implemented direct online reporting should issue infectious disease report cards within 24 hours. Reported cases are divided into "clinical diagnosis cases" and "laboratory diagnosis cases". If it is a laboratory diagnosis case, the specific type of enterovirus should be indicated in the "Remarks" column of the report card, and if it is a severe case, it should also be indicated in the "Remarks" column.
(III) When an epidemic situation or outbreak occurs in local areas or collective units, timely report the information of public health emergencies in accordance with the Regulations on Emergency Response to Public Health Emergencies, the National Emergency Plan for Public Health Emergencies, the Administrative Measures for Reporting Monitoring Information of Public Health Emergencies and Infectious Diseases and relevant regulations.
(4) Analysis and feedback of report information
Disease prevention and control institutions at all levels should review the epidemic situation report information step by step. County-level disease prevention and control institutions should browse and analyze the monitoring data every day, and find that cases or deaths are abnormally increased or clustered, and should promptly verify and report to the health administrative department at the same level and the disease prevention and control institutions at higher levels. Disease prevention and control institutions at all levels should promptly feed back epidemic analysis information to lower-level disease control institutions and medical institutions.
[Edit this paragraph] 9. Difference between hand, foot and mouth disease and foot-and-mouth disease
Foot-and-mouth disease and hand-foot-mouth disease are two completely different infectious diseases, and the main differences are as follows:
(a) the name of the disease is different from the classification of the disease.
Foot-and-mouth disease is listed as ICD- 10B08.802 in the International Classification of Diseases (ICD).
Hand-foot-mouth disease is classified into ICD-9074.3 and ICD- 10b08+0 in the International Classification of Diseases (ICD).
(2) Different pathogens
The pathogen of foot-and-mouth disease is foot-and-mouth disease virus, which belongs to zoonotic pathogens.
Hand, foot and mouth disease is caused by several enterovirus infections. Coxsackie virus (CoxAl6) is a common pathogen prevalent everywhere.
(3) Different sources of infection
Foot-and-mouth disease virus only causes cloven-hoofed animals such as cattle, sheep, pigs, deer and camels. And become the source of infection of foot-and-mouth disease in the population. Only when there is an animal epidemic can people get sick.
The source of infection of hand, foot and mouth disease is patients and recessive infected people, which belongs to human diseases.
Different routes of transmission
Foot-and-mouth disease is infected through skin and mucous membrane by contacting ulcers and scars on the mouth and hoof crown of sick animals. Occasionally infected by eating unheated (pasteurized) milk contaminated with viruses. Therefore, the number of people suffering from foot-and-mouth disease is very small.
Hand, foot and mouth disease is caused by contact with patients. It can be spread through the respiratory tract through the pollution of daily necessities, utensils and toys. Therefore, there can be epidemics of different scales.
(5) The patients are different.
People suffering from foot-and-mouth disease rely on contact with sick animals, and people suffering from foot-and-mouth disease are of a wide age;
Hand-foot-and-mouth disease (HFMD) is mainly an infectious disease of children and adolescents, and children under 3 years old account for the vast majority.
(6) Different symptoms and signs
Foot-and-mouth disease and hand-foot-mouth disease are both located in the mouth, fingers and toes, and they are similar, but their symptoms and signs are different. After the onset of foot-and-mouth disease, the main symptoms are fever and other systemic poisoning symptoms and local herpes damage.
Hand, foot and mouth disease has no fever or low fever, only respiratory tract infection, oral mucosal herpes and papules on fingers, feet, buttocks and knees.
(7) Different diagnostic basis.
Foot-and-mouth disease requires local livestock to have or epidemic foot-and-mouth disease, contact with sick animals, or drink contaminated and unheated sick animal milk.
Hand-foot-and-mouth disease (HFMD) is obviously contagious, showing epidemic transmission and different clinical manifestations. Foot-and-mouth disease and hand-foot-mouth disease can be diagnosed on the clinical basis, and the virus can be isolated for etiological diagnosis if necessary.
[Edit this paragraph] X. Popular links and popular features
Infected people are the source of infection of this disease, and patients, recessive infected people and asymptomatic carriers are the main sources of infection of this disease. During the epidemic, patients are the main source of infection. In the acute stage, the feces were detoxified for 3-5 weeks and the pharynx was detoxified for 1-2 weeks. Healthy carriers and light sporadic cases are the main sources of infection in intermittent and epidemic periods.
The route of transmission is mainly through close contact between people. Viruses in patients' throat secretions and saliva can be spread by airborne droplets. Hands, towels, handkerchiefs, tooth cups, toys, tableware, milk utensils, bedding, underwear, etc. Contaminated by saliva, herpes fluid and feces, it can be transmitted through daily contact or oral.
Being in the same room as a patient is the most susceptible to infection. Contact with virus-contaminated water sources can also be infected through oral cavity, which often causes epidemics. Cross-infection in outpatient department and lax disinfection of oral instruments can also cause transmission.
Susceptible people are generally susceptible to CoxAl6 and EV7 1 enterovirus, and can gain immunity after infection. Hand, foot and mouth disease patients are mainly preschool children, especially the age group ≤3 years old, accounting for 85%-95% of cases under 4 years old.
Epidemic pattern The disease often appears sporadically after an outbreak. During the epidemic, kindergartens and nurseries are prone to collective infection. The family also has this disease aggregation phenomenon. Cross-infection in hospital outpatient department and lax disinfection of oral instruments can also cause transmission. The disease is highly contagious, with complicated transmission routes, strong epidemic intensity and fast transmission speed, which can cause an epidemic in a short time.
[Edit this paragraph] XI. Complications of hand, foot and mouth disease
Hand, foot and mouth disease is manifested in the skin and mouth, but the virus can invade important organs such as heart, brain and kidney. When the disease is prevalent, the clinical monitoring of patients should be strengthened. If there is high fever and unexplained leukocytosis, we should be alert to the occurrence of fulminant myocarditis. In recent years, it has been found that EV7 1 is more susceptible to aseptic meningitis than CoxAl6, and its symptoms are fever, headache, stiff neck, vomiting, irritability and restless sleep. Occasionally, nonspecific red papules and even punctate bleeding spots can be found in the body. People with central nervous system symptoms are more common in children under 2 years old.
[Edit this paragraph] XII. Treatment of hand, foot and mouth disease
Western medicine treatment
If there are no complications, most children with hand, foot and mouth disease can recover within one week. The principle of treatment is mainly symptomatic treatment, taking vitamins B and C and antiviral drugs under the guidance of doctors. In addition, hand, foot and mouth disease can be combined with myocarditis, encephalitis, meningitis and other diseases, and should be reviewed in time.
Traditional therapy in China
★ Flos Lonicerae, Radix Isatidis, Fructus Forsythiae each 6g, and Rhizoma Coptidis 3g, washed with clear water.
★ If the pain is severe or the gums are red and swollen, Radix Isatidis 10g, Radix Scutellariae 6g, Cortex Dictamni Radicis 6g, Flos Lonicerae 3g, Folium Bambusae 2g and Herba Menthae 2g can be decocted and gargled.
★ Hands and feet are obviously red and swollen, and Scutellaria baicalensis Georgi 10g, Coptidis Rhizoma 10g and Carthamus tinctorius 6g can be decocted.
★ If you feel itchy, you can use Radix Rehmanniae, Cortex Moutan, Radix Isatidis, Cortex Dictamni Radicis, Fructus Kochiae each 10g, Caulis Lonicerae 20g, and Flos Carthami 6g to decoct for three times a day, for a total of 1 week.
Diet therapy party
★ Lotus leaf porridge: 2 pieces of fresh lotus leaves and 50 grams of white rice. Chop up the lotus leaves and cook porridge for the baby.
★ 20 pieces of bamboo leaves, 10 wick, 15g lentils, 6g talcum, add a little sugar, and give it to the baby in water.
[Edit this paragraph] Thirteen principles of treatment and prevention
1, treatment principle In terms of treatment, if there are no complications, the prognosis of this disease is generally good and it will be cured within one week. The principle of treatment is mainly symptomatic treatment. You can take antiviral drugs, Chinese herbal medicines for clearing away heat and toxic materials, vitamins B and C, etc. Patients with complications can be intramuscular injected with gamma globulin. During the illness, it is necessary to strengthen the care of children and do a good job in oral hygiene. Rinse your mouth with normal saline or warm water before and after eating, and it is advisable to use liquid and semi-liquid food as non-irritating food. Hand, foot and mouth disease can be complicated with myocarditis, encephalitis, meningitis, flaccid paralysis, etc., so we should strengthen observation and not treat it lightly. 2, the principle of prevention, there is no specific prevention method for this disease. Strengthening monitoring and improving monitoring sensitivity are the key to control the epidemic of the disease. All localities should do a good job in reporting the epidemic situation, and kindergartens should do a good job in morning check-ups, find patients in time, collect specimens, make a clear etiological diagnosis, and disinfect patients' feces and utensils to prevent the spread of diseases. During the epidemic, parents should try to let their children go to crowded public places as little as possible to reduce the chance of infection. Hospitals should strengthen prevention and set up special consultation rooms to prevent cross-infection. In the epidemic area of hand, foot and mouth disease with serious complications, weak infants who are in close contact with patients can be injected with gamma globulin intramuscularly. 3. Prevention and control measures Hand, foot and mouth disease spreads in various ways, and infants are generally susceptible. Doing a good job in children's personal, family and kindergarten health work is the key to prevent this disease infection.
(1) Personal preventive measures
1. Wash children's hands with soap or hand sanitizer before and after meals and after going out. Don't let children drink raw water, eat cold food and avoid contact with sick children.
2. Nurses should wash their hands before touching children, change diapers and dispose of feces for children, and properly handle dirt;
3. Bottles and nipples used by babies should be fully cleaned before and after use;
4. During the epidemic period of this disease, it is not advisable to take children to public places where people gather and the air circulation is poor. Pay attention to keep the family environment clean, often ventilate indoors, and often dry clothes and quilts;
5. Children with related symptoms should go to medical institutions in time. Children treated at home should not touch other children. Parents should dry or disinfect clothes in time and disinfect feces in time. Mild children do not need to be hospitalized, but should be treated and rested at home to reduce cross-infection.
(2) child care institutions and primary schools.
1. In the popular season, classrooms and dormitories should be well ventilated;
2. Clean and disinfect toys, personal hygiene utensils, tableware and other items every day;
3. When cleaning or disinfecting (especially cleaning toilets), the staff should wear gloves. Wash your hands immediately after cleaning;
4. Wipe and disinfect the surfaces of door handles, stair handrails, desktops and other objects every day;
5. Educate and guide children to develop the habit of washing hands correctly;
6. Have a morning check every day. When suspicious children are found, measures should be taken to send them to the hospital in time and rest at home. Articles used by children should be disinfected immediately;
7. When the number of children increases, it is necessary to report to the health and education departments in time. According to the needs of epidemic control, education and health departments can decide to take holiday measures in kindergartens or primary schools.
(3) Preventive and control measures of medical institutions
1. During the epidemic, hospitals should implement pre-inspection and triage, set up special consultation rooms (stations) to receive suspected hand, foot and mouth patients, and guide children with fever and rash to special consultation rooms (stations). The frequency of cleaning and disinfection should be increased in areas such as waiting for medical treatment and medical treatment, and wet cleaning should be adopted when cleaning indoors;
2. Medical personnel should wash or disinfect their hands carefully after diagnosis, treatment and nursing for each patient;
3. Non-disposable instruments and articles used in the process of diagnosis, treatment and nursing patients should be wiped and disinfected;
4. Children with other non-enterovirus infections should not be admitted to the same ward. Severely ill children should be treated separately;
5 hospital beds, tables and chairs and other facilities and articles used by hospitalized children must be disinfected before they can continue to be used;
6 children's respiratory secretions and feces and their contaminated items should be disinfected;
7. Medical institutions shall immediately report to the local health administrative department and disease control institutions when they find the increase or death of hand, foot and mouth patients related to enterovirus infection.
[Edit this paragraph] 14. Hand, foot and mouth disease vaccine
There is no vaccine for hand, foot and mouth disease at present. Please don't believe rumors, lest you be cheated. Pan stressed that at present, there is no vaccine to prevent hand, foot and mouth disease in China, and there is no specific medicine. Any vaccine to prevent hand, foot and mouth disease and the specific medicine to treat hand, foot and mouth disease are rumors. People should never believe it casually to avoid being deceived.
Besides paying attention to personal hygiene and environmental hygiene, preventive measures such as "washing hands frequently, drinking boiled water, eating cooked food, ventilating frequently and drying clothes and quilts" should be taken, and the following preventive measures of traditional Chinese medicines (prescriptions) are suggested: honeysuckle 6g, reed rhizome 10g, isatis indigotica 10g, bamboo leaves 3g and licorice 3g, which are decocted twice a day. Infants under 3 years old can take less; Children aged 3 to 6 can take this dose; People over 6 years old can take it in moderation.