Mao Qunan, director of the National Health and Health Commission CDC (National Ai Health Office), said at a regular press conference on April 9 that this year, the national hand, foot and mouth disease has shown the characteristics of high incidence the next year. It is expected that the overall intensity of hand, foot and mouth disease this year will be higher than last year, and 2018 is the peak year. Recently, it was found that the cases of hand, foot and mouth disease in March have reached 28,000 cases, which is more than twice the incidence rate in February.
Hand -and -mouth disease (HFMD) is infectious disease caused by intestinal virus, which occurs in infants under 5 years of age, but also involved adolescents and sometimes involved in adults. It can cause rash and ulcers in fever and hand, feet, oral, and other parts. Individual patients can cause complications such as myocarditis, pulmonary edema, aseptic meningitis, and spinal cord -like paralysis. There are more than 20 types of intestinal viruses that cause hand, foot and mouth disease, of which COX ASCKIEVIRUS A16 (Cox A16) and Enterovirus 71 (EV71) are the most common.
History of hand, foot and mouth disease
Hand -foot and mouth disease is a global infectious disease, and there are reports of this disease in most parts of the world. In 1957, New Zealand reported that the Kocci virus was separated in 1958, and in 1959, HFMD (Hand, FOOT, and Mouth Disease) was proposed. The pathogens of the early discovery of hand, foot and mouth disease were mainly COX A16. Reports related to the infection of EV71 in hand, foot and mouth were started since the early 1970s. In 1972, EV71 was first confirmed in the United States. Since then, the EV71 infection and COX A16 infection have occurred alternately, becoming the main pathogen of hand, foot and mouth disease. Australia, like the United States, and Sweden, is one of the earliest countries that occur in EV71 infection. In 1986 and 1999, EV71 became popular in Australia. Most of the patients with severe patients were accompanied by the central nervous system symptoms (CNS). Some patients also had severe respiratory symptoms. In the mid -1970s, Bulgaria and Hungary successively broke out EV71 with CNS as the main clinical characteristics. Other countries such as Italy, France, the Netherlands, Spain, Romania, Brazil, Canada, Germany also often occurred by various types Hand -foot disease caused by virus and EV71. Japan is a country with more diseases and mouth diseases, and there are many large -scale popularity in history. In 1997, hand, foot and mouth disease was mainly caused by EV71.
In my country, China has begun to see this disease in Shanghai in 1981. After that, more than a dozen provinces and cities including Beijing, Hebei, Tianjin, Fujian, Jilin, Shandong, Hubei, Xining, and Guangdong have reported. In 1983, the outbreak of hand, foot and mouth disease caused by COX A16 occurred in Tianjin. More than 7,000 cases occurred in May to October. After two years of popularization, the outbreak occurred in 1986. 2.3 %and 1.9 %. In 1995, the EV71 virus was separated from the patients, foot, and mouth patients. In 1998, the Shenzhen Health Epidemic Prevention Station also separated two EV71 viruses from patients and foot and mouth disease. In 1998, EV71 was infected with a large number of hand, foot, and mouth disease and herpeshamilitis in Taiwan Province. Among the two waves of popularity in June and October, a total of 129 106 cases were monitored. Children under the age include encephalitis, sterile meningitis, pulmonary edema or pulmonary hemorrhage, acute soft paralysis and myocarditis. From May to August 2000 to August, Zhaoyuan Children’s Hand -Houki disease broke out in Shandong Province. In more than 3 months, 1,698 children were visited by the People’s Hospital of Zhaoyuan City, including 1025 men, 673 women, and the ratio of men and women. It is 1.5: 1, the youngest is 5 months, and the maximum is 14 years old.
Hand -foot disease has become one of China’s serious public health issues since 2007. China established the hand, foot, and mouth disease laboratory and epidemiological monitoring system in 2008. Virus data provided by the laboratory network shows that the EV71 virus infection is the main cause of severe cases and death cases. However, the main causes of large -scale outbreaks in 2008 and 2009 include both EV71 virus and the Kazakh virus A16.
The pathogen of hand, foot and mouth disease
Intestinal virus is the pathogen of hand, foot and mouth disease. At least 20 group A intestinal virus serum type can cause hand, foot and mouth disease, with intestinal virus type 71 (EV71), Kedica virus type A16 (CV-A16), Kedassic virus type A6 (CV-A6) (CV-A6) The CV-A10 (CV-A10) is the most common, among which severe and death are caused by EV71 infection.
Intestinal virus is suitable for survival and dissemination in wet and hot environments. 75%alcohol and 5%come to the Soviet Union cannot be activated. (Potassium permanganate, bleaching powder, etc.), formaldehyde, iodine, and 56 ° C for 30 minutes can be extinguished virus. The virus can survive at 4 ° C for 1 year, -20 ° C for a long time, and can survive for a long time in the external environment.
The source of infection of hand, foot and mouth disease
The source of infection of hand, foot and mouth disease is patients and hidden infections, and only stored in the human body. During the epidemic, patients were the main source of infection. The patient excreted the virus from 1 to 2 weeks of the disease, and the virus was discharged from the feces for about 3 to 5 weeks. The herpes containing a large number of viruses, and the virus overflowed when the ulceration was broken. Cases with poison and light distribution are the main sources of epidemic and epidemic. The way of transmission of hand, foot and mouth disease
Mainly spread through close contact between crowds. Patient’s throat secretions and viruses in saliva can be transmitted through air droplets. Hands, towels, handkerchiefs, handkerchiefs, tooth cups, toys, cups, cups, milk utensils, and underwear such as daily contact with daily contacts are spread through daily contact. In contact with the water contaminated by the virus, it can also be infected by the mouth and often causes popularity. Outpatient cross infection and disinfection of oral equipment can also cause spread.
Miserable crowd of hand, foot and mouth disease
The intestinal virus that causes hand, foot and mouth disease is generally susceptible, and can obtain immunity after being felt. All age groups can be infected with onset. Recessive infection obtains the corresponding antibody. Therefore, patients with hand, foot and mouth disease are mainly preschool children, especially the highest incidence of age in the age of ≤ 3, accounting for 85%to 95%of the disease within 4 years of age. According to foreign observation reports, in the crowd, it is popular every 2 to 3 years. It is mainly due to the birth of newborns during the non -popular period. When the susceptible person gradually accumulates, when it reaches a certain number, it provides prerequisites for new popularity. After the popularity of Tianjin in my country in 1983, it continued to distribute cases. In 1986, it was again popular, and both of them were caused by Cox Al6 twice.
Popularity of hand, foot and mouth disease
Hand -foot and mouth disease is widely distributed and has no strict regionality. Both seasons can occur in the four seasons, and it is more common in summer and autumn, and the onset of winter is rare. This disease often occurs after the epidemic of the upstream. During the epidemic of the disease, collective infections are prone to kindergartens and nursery. Families also have such incidence gathering phenomena. The cross -infection of the hospital’s outpatient clinic and the disinfection of oral equipment are not strict, and it can also cause communication. Tianjin’s twice is more popular, and the incidence of children in young units is significantly higher than that of scattered children. Family distributing, one example of the family; family outbreak, a family of many or children and adults infected. This disease is contagious, the transmission pathway is complicated, the popularity is high, and the spread is fast, which can cause great popularity in a short time.
Clinical manifestations of hand, foot and mouth disease
Hand -foot and mouth disease is a common feature of intestinal virus infection. From the most common asymptomatic or only mild discomfort, it can occur in severe complications and even death. The incubation period is generally 3 ~ 7 d. There are no obvious symptoms of front -wheel drive, and most patients suddenly get sick. About half of the patients have fever at the same time 1 ~ 2 d or the onset of the onset, mostly about 38 ° C. The main violations of the four parts of the hands, feet, mouth, and hips (fourth parts); because the rash is not like mosquito bites, unlike medicine rash, not like the lip, gums, herpes, not like chickenpox , Four non -characteristics of non -itching, not crushing, and not scarring. Some patients had mild symptoms in the early stage, such as cough, runny nose, nausea, vomiting and so on. Due to the pain of oral ulcers, the child’s saliva refused to eat. Oral mucosal rash appears earlier. At first, it was corn -like mobilization or blisters. There were redness around, mainly located in the tongue and cheeks. The flat or convex pimples or herpes appeared in the remote parts of the hand, feet, the rash is not itchy, the spots of mackerel changes from red at about 5 d, and then retreated; The liquid, the long diameter is the same as the leather pattern, such as the size of the soybeans, generally no pain and itching, and there is no trace after healing. Hand, feet, and oral diseases may not all appear in the same patient. Bles and rash usually fade back within a week.
Hand -foot and mouth disease is manifested on the skin and oral cavity, but the virus invades important organs such as heart, brain, and kidney. The clinical monitoring of patients should be strengthened during the epidemic of this disease. If other infection stoves cannot be found in high fever and unknown reasons for unknown white blood cells, they must be alert to the occurrence of outbreak myocarditis. In recent years, there are more opportunities to have aseptic meningitis more opportunities to occur than hand -foot, foot and mouth disease caused by COX AL6. Red pimples, even dotted bleeding points. The symptoms of the central nervous system are more common in children within 2 years of age.
(1) Strengthening monitoring and improving the sensitivity of monitoring are the key to controlling the popularity of this disease. Collect the qualified specimen in time to clarify the diagnosis of the original disease;
(2) Do a good job in the epidemic report, discover patients in time, and actively take preventive measures to prevent the spread of the disease from spreading;
(3) The childcare institution does a good morning medical examination and finds suspected patients, and timely isolates treatment;
(4) Disinfection of daily necessities and utensils contaminated. Children’s feces and excreta are soaked with 3%bleaching powder to clarify the liquid, the clothes are exposed to the sun, and the indoor is kept ventilated and ventilated.
(5) When popular, do a good job of environment, food hygiene and personal hygiene;
(6) Washing your hands before meals to prevent the disease from the mouth;
(7) Parents should try to make their children go to crowded public places to reduce the chance of being infected;
(8) Pay attention to the nutrition and rest of infants and young children, avoid sunlight exposure, prevent excessive fatigue, reduce the body’s resistance;
(9) The hospital strengthens the pre -diagnosis and sets up a special treatment room to prevent cross -infection.
Treatment and vaccine
Hand -foot and mouth disease is a common infectious disease caused by multiple intestinal virus in summer and autumn. The disease is mainly transmitted by dung-mouth channels, and the ill people are mainly concentrated in children aged 0 to 3. The course of hand, foot and mouth disease can be divided into 4 stages based on clinical progress and complications, which are herpes pharyngeal stalpitis, the stage of the nervous system, the stage of cardiopulmonary failure, and the stability period of life signs. Clinical use of antibacterials and antiviral drugs is generally used according to the clinical manifestations of patients, and corresponding treatment measures are used according to the patient’s occurrence. The EV71 Initiative vaccine was approved by the State Food and Drug Administration in December 2015 to be listed. It is a new vaccine developed independently and has independent intellectual property rights. It is mainly used to prevent hand, foot and mouth disease caused by EV71 infection.
Because hand, foot and mouth disease can be caused by a variety of intestinal viruses, and there are no cross -crossing immunity between different types. The current EV71 active vaccine on the market only prevents the hand, foot and mouth disease caused by EV71, and cannot prevent the Koco group group A. Type 16 and other intestinal virus caused by hand, foot and mouth disease, but because the EV71 virus is the main pathogen of hand, foot and mouth disease and death cases, vaccination will reduce the occurrence of hand, foot and mouth disease and death.
Hand-foot-and-mouth diseases are mainly children with 5 years of age and below. From the age of June, the disease has gradually increased. Children at 1-2 years old have the highest risk of onset. Therefore, inoculation in June can provide protection for prone to children in time. The sooner the vaccination, the better, and encouraging the vaccination procedures before December to play a protective role as soon as possible. For children over 5 years old, because most of them have been infected naturally, they are not recommended to vaccinate EV71. The basic immune procedure of EV71 vaccine is 2 doses, which is one month interval.
At present, the EV71 activity vaccine currently belongs to the second type of vaccine, and parents need to choose to take vaccination at their own expense and voluntarily. Qualified vaccination units provide EV71 activity vaccination services, and you can consult the local illness and control center or vaccination clinic.