Hand foot and mouth back for the season

By Zhao Hongyi

Spring is on its way back, and so is hand foot and mouth disease (HFMD). Doctors say it is more common between early spring and autumn, and parents should pay special attention since it most often strikes infants and children under the age of 10.

The Ministry of Health confirmed over the weekend it had received 11,5618 reports of HFMD and 50 patients died as of April 7. The epidemic is most serious in the border areas of Shandong, Henan, Anhui and Jiangsu. It is also spreading in remote parts of Guangdong, Guangxi and Yunnan.

“The epidemic is on the rise, and more reports will come,” Deng ihua, the ministry’s spokesman, said. It will peak between May and July.

The epidemic is spreading in Beijing too, the Municipal Health Bureau said. The capital now has 1,937 cases, of whom 88 percent are kids under five. The most seriously hit areas are Fengtai, Chaoyang, Haidian, Fangshan and Changping districts.

Last year, Beijing reported 18,488 cases of the disease, 119 of which were considered serious: two of the infected people died.

Where does the virus come from?

HFMD syndrome is caused by intestinal viruses from the Picornaviridae family. The most common strains that can cause symptoms to appear are the Coxsackie A virus and Enterovirus 71.

The disease is moderately contagious and spreads through direct contact with the mucus, saliva or feces of an infected person. It typically occurs in pocket epidemics in nursery schools or kindergartens. The usual incubation period is three to seven days.

The disease is extremely uncommon in adults. Most adults have strong enough immune systems to defeat the virus, but those with immune deficiencies can be very susceptible.

HFMD is not to be confused with foot-and-mouth disease, also called hoof-and-mouth disease, which is a syndrome affecting sheep, cattle and swine when exposed to a different Picornaviridae family virus.

A foot-mouth disease also exists in poultry, but it has never jumped to humans who were not poultry workers or who did not eat contaminated meat.

The viruses which cause HFMD take over the stomach and intestines. They can be spread like the flu by sharing daily utensils, flatware, food and toys.

Prevention still important

But the benefit of a lifetime of immunity is no excuse to slack off on prevention. Professor Zhang Baoyuan from the Capital Institute of Pediatrics said careful observation and good sanitation are the keys.

Familiarity: HMFD is most common in May, June and July among infants, kids and children. Parents should pay more attention to signs of infection in their children during these months.

Observation: Fever, low appetite, fatigue, panting or pneumonia is an indicator that it’s time to see a doctor. Large bumps and the appearance of cold sores indicate a serious problem.

Good personal hygiene is the first defense. Wash hands frequently, do not spit in public, keep a regular schedule, avoid kissing, hugging and avoid sharing eating utensils or cups.

Home sanitation is important. Open all the windows, because fresh air can kill stray bacteria and viruses. Try to get more sunshine, since it improves immunity.

Keep your house clean and tidy, avoid stacking things in bedrooms, wash and store your children’s toys and sterilize all kitchenware and toiletries.

Classic symptoms

A classic case of HFMD is characterized by fever, headache, vomiting, fatigue, malaise, sore throat, painful oral lesions and a non-itchy body rash. Later stages see the development of blisters on the palms and soles, oral ulcers, loss of appetite and diarrhea.

Early symptoms are likely to be fever followed by a sore throat. Loss of appetite and general malaise may also occur. Between one and two days after the onset of fever, painful sores (lesions) may appear in the mouth and/or throat. A rash may become evident on the hands and feet, and occasionally on the buttocks.

The fever and spots usually clear within a few days. The mouth ulcers can be painful, and may last up to a week.

In a very small number of cases, the virus affects the heart, lungs or brain, causing a serious inflammation. Such complications are rare. There is some evidence that infection during pregnancy may cause a miscarriage or poor fetal development.

Treatment

Since HFMD may cause inflammation in the heart, brain or lungs, children showing symptoms of the virus should see a doctor immediately. Home care includes keeping the child’s mouth clean and sanitary, and feeding him liquids. Follow-up checks are important, Sun Hongming, a professor at the Chinese Academy of Medical Sciences, said.

Because HFMD is caused by a virus, there is no specific treatment or medicine available. It must be allowed to run its course. Only in the most severe cases will medicine be prescribed. Individual symptoms, such as fever and pain, may be eased with medication.
 
Chinese herbal medicines, however, can help to shorten recovery time, said Yang Lixing, chief pediatrician at the Guangzhou Herbal Medical Center. Common prescriptions combine a number of dried herbs which are extracted and drank. Boil the herbs and drink for three to five days. The prescriptions vary with the phase of the illness, but recovery times as short as three to five days are not unheard of.

A child exposed to the virus will develop lifetime immunity, so it’s best to let the child fight it off on his or her own.