Differentiate between chickenpox and hand, foot and mouth disease in children

Posted by Doctor Le Tuyet Nga - Pediatric Center - Vinmec Times City International General Hospital

Chickenpox is an acute infectious disease that can become an epidemic. This disease occurs in both adults and children, but it is mainly seen in children and is highly contagious. In hospitals, the number of chickenpox cases showed signs of increasing with many dangerous complications.
In fact, clinically, children with chickenpox and children with hand, foot and mouth disease have many symptoms that are easy to confuse, so here are some signs for parents to help distinguish the disease.

Chickenpox is a contagious skin disease caused by the Varicella Zoster virus. More than 90% of people who have not been vaccinated are at risk of infection. The disease usually appears in the spring in mainly children under 10 years old. However, the disease can also affect adults, especially pregnant women.
This disease has a rapid transmission rate, passing directly from person to person. The route of disease transmission is usually through the air, healthy people will get sick if they catch saliva from chickenpox patients when they sneeze, cough, ... If not prevented in time, it will explode into an outbreak.
In addition, chickenpox can be spread from burn wounds when they break or broken skin, sores from chickenpox patients. In particular, pregnant women with chickenpox have a very high risk of transmitting it to the fetus through the placenta.

Symptoms of chickenpox
The signs of chickenpox are divided into 3 stages:
Incubation period : 14-17 days (usually no clinical symptoms).
Onset period:
Onset phase: similar to other viral infections, patients have symptoms such as fever, headache, muscle aches,... Especially, chickenpox in children I usually have no warning signs of the disease. About 1 day, there may be no fever or low fever, young children often refuse to play or cry. There is a case of high fever 39-40 degrees Celsius, tossing and turning, delirium convulsions, accompanied by sore throat, inflammation of upper respiratory tract secretions, swollen lymph nodes behind the ears, the signs at this stage are easy to confuse with flu. Usually, so it's important to see a doctor as soon as possible, especially during the epidemic season. Full outbreak (rash growth period):
At first, a red maculopapular rash, a few hours later becomes a clear, very shallow blister. As if placed on the skin surface, after 24 to 48 hours, it turns yellow, has 2mm floating spheres on the skin surface. The rash is scattered all over the body, including the hairline and in the mouth. Almost no nodules on the soles of the feet and hands. The rash appears every 3-4 days, so on one area of ​​the skin can see rashes of different ages. After 4-6 days of illness, if there is no complication or infection, the blisters will burst, dry, scab and gradually recover, the chickenpox nodule dries on its own, scabs dark brown and falls off after a few days. the week. Chickenpox does not leave permanent scars, unless ulcers and superinfection are present. After recovering from the disease, the child's body will be immune to the virus that causes the disease. Children with chickenpox only get sick once
Medicine has provided an effective vaccine to prevent chickenpox

Hand, foot and mouth disease is mainly caused by Enterovirus group of intestinal viruses, the most common are Coxsackie A16 and Enterovirus type 71. In which, Coxsackie A16 virus causes less neurological complications and can resolve on its own within a few days. . In contrast, Enterovirus type 71 (EV71) causes many dangerous complications of encephalitis, meningitis, pneumonia, myocarditis and can lead to death.
In addition to Coxsackie A16 and Enterovirus type 71, some other strains of group A viruses such as Coxsackie A4-A7, A9, A10 or group B Coxsackie viruses (B1-B3, and B5) may also be the cause.
Symptoms of hand, foot and mouth disease:
The disease is usually characterized by fever, sore throat and a rash with blisters.
Incubation period 3 – 6 days.
The onset period begins with noticeable symptoms including:
The child has a fever, fatigue, low fever (37.5-38 degrees Celsius) or high fever (38-39 degrees Celsius). Sore throat. Lesions, pain in the teeth and mouth. Lots of saliva. Anorexic. Diarrhea several times a day.

The full-blown period (usually begins 1-2 days after the onset of the disease), the child begins to show typical symptoms of the disease such as:
The child has a blister-like rash on the palms, feet, head pillow, butt. The water balloons are 2 – 10mm in diameter, gray in color, oval in shape. They can grow protruding or hidden under the skin, feel lumpy, painless, and not itchy. Mouth ulcers: In the mucous membranes of the cheeks, gums and tongue of the child, blisters of 2-3mm in diameter appear, which are fragile. When broken, they form sores that cause pain when eating and crying. On the buttocks of infants and young children appear sores, blisters. Systemic signs: disturbances of consciousness, delirium, convulsions, In addition to the typical symptoms above, depending on the location, hand, foot and mouth disease also appears more symptoms such as: Very little blisters alternating with erythema or only the appearance of erythema. In some cases, only mouth ulcers appear. If the condition is mild, after 7-10 days of home care, the child will fully recover. In case the baby has a high fever (above 39 degrees Celsius) lasting for more than 48 hours with symptoms such as vomiting, trembling hands and feet, convulsions, rapid heartbeat, difficulty breathing, streaked skin, the family needs to take the child to the hospital. right away. After recovering from the disease, the child's body will be immune to the virus that causes the disease. However, according to the results of many studies, children can get hand, foot and mouth disease many times and the next time the illness is caused by different strains of the virus than the previous one. There is currently no specific vaccine in Vietnam.

Chickenpox is considered benign but can still cause serious complications if not treated promptly. Some common complications such as:
Infection of blisters, internal bleeding: this condition is common in the case of chickenpox in children because it is difficult for children to control, causing blisters to burst or peel to cause infection, rash. pus and ulcers. Encephalitis and meningitis: common complications in adults and children. This complication usually occurs 7 days after the bubble floats. However, adults are at higher risk of this complication than children. If not treated promptly, it can lead to death. Chickenpox pneumonia: easy to catch in adults with signs such as coughing a lot, even coughing up blood, chest pain and shortness of breath. Perinatal varicella: complications in pregnant women. If the mother has chickenpox before or after giving birth from 2 to 5 days, it is very dangerous to the fetus. Children can be infected with diseases from their mothers or become disabled or die. Shingles : Although the disease has been cured, the chickenpox virus is still attached to the nerve roots. If the nervous system weakens, the virus will reactivate and cause shingles

The following suggestions help parents take care of their children properly and reduce the risk of complications from the disease as well as help the baby recover quickly:
Children with chickenpox need to be in a pressure isolation room negative to prevent infection to healthy people. After being discharged from the hospital, they still need to be isolated until they are completely cured. The person raising the disease must wear an N95 mask (for people who have not had chickenpox) and a surgical mask (for those who have a history of the disease or have been vaccinated against chickenpox). When taking the child to a specialist examination or performing tests, it is also necessary to wear a mask for the baby. In addition, it is necessary to clean before and after taking care of the baby. Use a solution of blue - methylene or castellani to apply to blisters or burns that have broken. Absolutely do not allow children to scratch, causing blisters and pus to appear on the surrounding skin. It is best for children to wear cloth gloves to avoid impacting the blisters. Combination of antibiotics or fever reducers for chickenpox patients must be under the guidance of a doctor. Clean the nose and throat every day with 0.9% physiological saline. Dress children in soft, sweat-wicking clothes and especially keep their skin clean to prevent unwanted complications. Bathe your baby with warm water and change clothes right in the bathroom. Give your child soft, liquid foods that are easy to swallow and digest. In particular, let your child drink a lot of water or juice. Use separate personal items from towels, glasses, spoons, chopsticks, etc. Avoid contact with crowded areas to prevent infection. Limit exposure to the wind because the body is susceptible to cold and makes the disease worse. Currently, medicine has provided an effective vaccine to prevent chickenpox. In particular, young children need to be vaccinated against chickenpox. Parents with young children need to monitor and vaccinate their children on schedule

For those who have not been vaccinated against chickenpox but come into contact with a patient with chickenpox, they must get vaccinated within 3 days. Note: Do not share personal items or touch the blisters of someone with chickenpox. Chickenpox patients must be isolated from family members and the community. Room of chickenpox patient must be cleaned with cleaning solution. Chickenpox in children can be cured if detected in time and treated properly. Parents should take care of their children as well as themselves carefully to avoid the risk of infection Chickenpox vaccination helps prevent disease effectively. Customers can register for chickenpox vaccination at Vinmec International General Hospital.
Vinmec International General Hospital uses a source of high quality vaccines, of clear origin, suitable for the age to be vaccinated, ensuring safety from registration, storage to use. Before vaccination, all customers are screened before vaccination with specialist doctors to ensure the best health when vaccinated. 100% of vaccinated customers are monitored and re-evaluated before leaving. In particular, the post-vaccination monitoring room is fully equipped with emergency facilities; the team of doctors - nurses are trained in anaphylaxis emergency management to ensure timely and correct treatment when an incident occurs.