Hand, foot and mouth disease: What you need to know

The article was written by Specialist Doctor I Pham Thi Suu - Pediatrician - Vinmec Royal City International Clinic.

Hand, foot and mouth disease is an infectious disease that spreads from person to person. Two groups of common pathogens are Coxsackievirus A16 and Enterovirus 71 (Ev71). The main manifestation is skin and mucosal lesions in the form of blisters in special locations such as oral mucosa, palms - feet, buttocks, knees.

The disease is transmitted mainly through the gastrointestinal tract. The main source of transmission is the saliva, blisters and feces of infected children. In addition, other routes of transmission of the virus that cause hand, foot and mouth disease include:
Children in direct contact with infected people.

Inhalation, swallowing secretions, saliva of sick people when eating, drinking, coughing, sneezing, talking. Direct contact with the fluid of blisters, blisters, feces of the patient. The healthy child holds the toys and touches the objects of the sick child. Spread through the hands of the caregiver. The disease occurs sporadically all year round, can occur at any age, is common in children under 5 years old, especially concentrated in the group under 3 years old. Factors of collective activities such as children going to kindergartens, kindergartens, and concentrated play places are risk factors for disease transmission, especially during outbreaks.

Incubation period: 3-7 days
Onset phase: 1-2 days with symptoms such as mild fever, fatigue, sore throat, anorexia, diarrhea several times a day.
Full-blown phase: Can last from 3-10 days with typical symptoms of the disease:
Mouth ulcers: red sores or blisters ~ 2-3mm in diameter on the oral mucosa, gums, tongue causing pain mouth, stop eating, stop sucking, increase salivation. Urticaria-like rash: on palms - feet, buttocks, knees, short-lived (less than 7 days) then can leave bruises, very rarely ulceration or superinfection. Mild fever Vomiting If the child has a high fever and vomits a lot, there is a risk of complications. Neurological, cardiovascular and respiratory complications: usually appear early from 2-5 days of the disease.

Remission phase: Usually 3-5 days later, the child recovers completely if there are no complications.
Clinical forms of hemorrhagic fever include:
Fulminant form: The disease progresses very quickly, with severe complications such as circulatory failure, respiratory failure, coma leading to death within 24-48 hours. Acute form: With 4 typical stages as above. Atypical form: Signs of rash are not clear or can only ulcerate the mouth or only neurological, cardiovascular, respiratory symptoms without visible rash and mouth ulcers.

Diagnosis of the case: Based on clinical symptoms and epidemiological factors
Diagnosis of the disease:
Based on the Ev71 rapid test, This method determines the presence of Ev71 IgM antibodies in the body. The results are fast but the specificity is not high. Test by molecular biology technique (RT-PCR) to determine viral DNA, This method gives accurate results, high sensitivity and specificity. Differential diagnosis:
Manifestations of mouth ulcers: Mouth ulcers (stomatitis) are deep, exudative, or recurrent ulcers.
Diseases with skin rash:
Typhus: erythema multiforme with few papules, often with lymph nodes behind the ears. Allergies: erythema multiforme, no blistering. Purulent dermatitis: red, painful, purulent. Chickenpox: water burns of many ages, scattered all over the body. Meningococcal bacteremia: hemorrhagic plaques on the skin, with central necrosis. Dengue hemorrhagic fever: petechiae, bruises, mucosal hemorrhages. Meningitis : Bacterial meningitis, other viral encephalitis. Sepsis, septic shock, pneumonia.

5.1 Principles of prevention There is currently no specific vaccine. Apply standard precautions and precautions for gastrointestinal infections, with particular attention to direct contact with the source of infection. 5.2 Prevention at medical facilities Isolation in groups of patients Medical staff: Wear masks, wash and disinfect hands before and after providing care. Disinfect surfaces, beds, and chambers with 2% Chloramin B. Note disinfecting the seats of patients and relatives at the examination area. Dispose of patient waste, clothing, bed linen, and reusable care equipment according to procedures to prevent gastrointestinal disease. 5.3 Prevention in the community Personal hygiene, washing hands with soap (especially after changing clothes, diapers, after contact with feces, saliva). Wash toys, utensils, floors. Wipe the floor with 2% Chloramin B disinfectant solution or other disinfectant solutions. Isolate sick children at home. Do not go to kindergartens, schools, where children play in the first 10-14 days of illness. Currently, there is no vaccine or specific drug for hand, foot and mouth disease, so it is necessary to raise awareness of disease prevention by personal hygiene. Once a child shows signs of illness, they should immediately take them to reputable facilities for timely examination.
Pediatrics department at Vinmec International General Hospital is the address for receiving and examining diseases that infants and young children are susceptible to: viral fever, bacterial fever, otitis media, pneumonia in young, ... With modern equipment, sterile space, minimizing the impact as well as the risk of disease spread. Along with that is the dedication from the doctors with professional experience with pediatric patients, making the examination no longer a concern of the parents.
If there is a need for consultation and examination at the Hospitals of the National Health System, please book an appointment on the website to be served.

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