Assoc. Prof. Dr. Kulkanlaya Chokpaiboonkit

Department of Pediatrics,
Faculty of Medicine Siriraj Hospital

Faculty of Medicine Siriraj Hospital

Hand-foot-mouth disease and enterovirus 71 disease are considered as one of the diseases that are prevalent in children that occur every year, especially during the beginning of the rainy season, which is the period when the rate of this disease is high. Therefore, let's learn more about this disease.

Hand, foot, and mouth disease

It is a common disease in children. Most patients are children under 5 years old. It usually spreads during the rainy season. This disease is caused by the enterovirus group, of which there are many types that can cause it. The most severe type is enterovirus 71, or EV71 for short, which is spreading severely in our neighboring countries. It is also EV71. In Thailand, we have also found EV71 along with other enteroviruses, but most of them are not very severe strains.

Symptoms of hand, foot, and mouth disease

Children with hand, foot, and mouth disease usually start with a fever, mouth sores, difficulty eating, drooling because of mouth sores that look like canker sores, and a rash with red spots or blisters on the palms of the hands, soles of the feet, and possibly on the torso, arms, and legs. Patients usually have severe symptoms for 2-3 days, then gradually improve and disappear within 1 week. Most have mild symptoms, but some have severe symptoms that prevent them from eating or drinking.

            This disease is usually not scary and will go away on its own without any problems. However, there is a small chance that it will become severe or have complications, especially if it is caused by EV71, which will increase the chance of severe disease.

            The most serious complication is brainstem inflammation, which causes respiratory and circulatory failure, which can be fatal very quickly. Sometimes, EV71 can cause severe encephalitis without the rash that is hand-foot-mouth. Children who develop severe complications or encephalitis will have dangerous signs such as lethargy, weakness, convulsions, hand tremors, staggering, shortness of breath, and vomiting. If these symptoms are found, they must see a doctor immediately. Although the outbreak of hand-foot-mouth disease in Thailand at this time is mostly of the mild type, we must be careful of severe symptoms, even though the chances are low.

Hand-foot-mouth disease treatment

            There is no specific treatment for this disease. The treatment principle is symptomatic. Children with severe complications need to receive intensive care.

Transmission of Hand-Foot-Mouth Disease

            This disease is transmitted by direct contact with the nasal mucus, saliva or feces of an infected person, or indirectly, such as through contact with toys, caregivers' hands, contaminated water and food. Therefore, this disease is often prevalent in kindergartens or daycare centers.

How to prevent hand, foot, and mouth disease

            There is no vaccine to prevent this disease. The most important prevention is to isolate infected people from contact with other children. All children, including adults who care for children, should wash their hands frequently to prevent the spread of infection. Clean toys and the environment daily. Clean with soap, detergent or general detergent and dry. Be careful about the cleanliness of water, food and all objects that children may put in their mouths. Do not let children share toys that may be contaminated with saliva or eating utensils. Children should be taught to use serving spoons and wash their hands before eating.

Schools should not admit sick children until they are well, which usually takes about a week, to prevent the spread of infection. Parents should take sick children to see a doctor and not take them to school. If they are found to have this disease, they should be treated according to the doctor's advice. And after recovering, children with this disease can still carry the virus in their stool for several weeks. Therefore, even after a child has recovered, they still need to be careful about fecal contamination for a long time. Emphasis should be placed on washing hands after using the toilet or changing diapers and before eating for all children and adults. Hands should be washed with soap and water because alcohol gel cannot kill enteroviruses.

            During an outbreak, children should not be taken to places where other children are congregating, as there is a chance that they will be infected, as there are children who have the disease and can spread the infection without any symptoms or only mild symptoms, who may be congregating.

Preventing outbreaks in childcare centers or kindergartens

            1. Screening for sick children, including children with fever, rash or mouth sores, is not allowed to attend school. This is because some patients have very mild symptoms, or some have a fever but no rash. A thermometer (mercury) should be provided for use in cases where a child is suspected of having a fever, and a teacher or nurse should check the child before entering school every day.

            2. There should be measures to clean toys and the environment every day or when they are stained with saliva, mucus or dirt.

            3. Strict measures for hand washing are in place for all levels of staff who care for young children, especially every time they may come into contact with mucus, saliva, or feces. Using alcohol gel to wash hands cannot kill germs.

            4. If there are multiple outbreaks, consider closing that class for 1 week, or if there are outbreaks in multiple classes, the school should be closed as well to stop the spread.

Source: http://www.si.mahidol.ac.th/sidoctor/e-pl/articledetail.asp?id=492