Prevention and treatment of hand, foot and mouth disease in children

Etiology of hand, foot and mouth disease in children

The temperature has been rising in recent days. While parents are protecting their children from heatstroke and cooling them down, they should also be vigilant against the invasion of hand, foot and mouth disease, a common disease in summer among children.

Hand, foot and mouth disease is caused by enterovirus. The main pathogenic serotypes include Coxsackievirus (CV) A group 4-7, 9, 10, 16 and B group 1-3, 5, some serotypes of echovirus and enterovirus 71 (Enterovirus A71, EV-A71), among which CV A16 and EV A71 are the most common, and severe and fatal cases are mostly caused by EV A71. In recent years, CV A6 and CV A10 have been increasing in some areas. There is no cross immunity between different types of enterovirus.

Clinical symptoms of hand, foot and mouth disease in children

Incubation period: mostly 2-10 days, average 3-5 days. Typical cases have an acute onset, with varying degrees of fever, loss of appetite, fatigue and other symptoms. Scattered small blisters, pain, and drooling appear on the oral mucosa, maculopapular rashes and herpes appear on the hands, feet, and buttocks, with inflammatory redness around the herpes. Rashes may also appear on the buttocks or knees, with less fluid in the blisters.

Clinical staging and classification of hand, foot and mouth disease

Stage 1 – Rash Stage

The main symptoms are fever, rash on the hands, feet, mouth, buttocks, etc., which may be accompanied by cough, runny nose, loss of appetite, etc. Some cases only present with rash or herpetic pharyngitis, and some cases may have no rash.

Stage 2 – Nervous system involvement

Central nervous system damage may occur in a minority of cases, usually occurring within 1 to 5 days of the disease course, manifested by poor spirits, drowsiness, weak sucking, easiness to startle, headache, vomiting, irritability, limb tremors, muscle weakness, and neck stiffness.

Stage 3 - Early stage of cardiopulmonary failure

It usually occurs within 5 days of the disease course, and is manifested by increased heart rate and breathing, cold sweats, cold extremities, pale skin, and increased blood pressure.

Stage 4 - Cardiopulmonary failure

Clinical manifestations include tachycardia (bradycardia in some children), rapid breathing, cyanosis of lips, coughing up pink foamy sputum or bloody fluid, hypotension or shock. Some cases also present with severe brain failure as the main manifestation, with convulsions and severe impaired consciousness.

Phase 5 – Recovery

The body temperature gradually returns to normal, the dependence on vasoactive drugs gradually decreases, the symptoms of nervous system involvement and cardiopulmonary function gradually recover, and a few may have residual nervous system sequelae. Some cases of hand, foot and mouth disease (mostly in patients infected with CV A6 and CV A10) have symptoms of nail loss 2 to 4 weeks after the onset of the disease, and new nails grow in 1 to 2 months.

Prevention of Hand, Foot and Mouth Disease in Children

Maintaining good personal hygiene habits is the key to preventing hand, foot and mouth disease.

Wash your hands frequently and do not let children drink raw water or eat raw or cold food.

Children's toys and items that they frequently touch should be cleaned and disinfected regularly.

Avoid close contact between children and children with hand, foot and mouth disease.

Actively get vaccinated.

References

[1] National Health Commission of the People's Republic of China. Guidelines for the diagnosis and treatment of hand, foot and mouth disease (2018 edition)[J]. Chinese Journal of Clinical Infectious Diseases, 2018, 11(3): 161-166.

[2] Zheng Yuejie, Wang Wenjian. Hand, foot and mouth disease in children[J]. Chinese Journal of Practical Pediatrics, 2013, 28(22): 1692-1694.

Source: Department of Pharmacy, Tianjin Children's Hospital

Author: Zhang Jinfen, Pharmacist

Reviewer: Sun Yanyan, Chief Pharmacist, Yu He, Chief Pharmacist