Health tips for hand-foot-and-mouth disease | Updated: 2023-04-07
Hand-foot-and-mouth disease (HFMD) is an infectious disease in children caused by a variety of enteroviruses. Starting in March each year, the epidemic of HFMD gradually intensifies, and will typically enter the high incidence period from April to June.What are the enteroviruses that cause HFMD?
Enteroviruses belong to the RNA virus family, and have over 100 serotypes. According to their genetic characteristics, they are divided into four groups: A, B, C and D. There are more than 30 serotypes of enteroviruses that cause HFMD in China. The most common serotypes are Enterovirus 71 (EV-A71), Coxsackievirus A16 (CV-A16), Coxsackievirus A6 (CV-A6), and Coxsackievirus A10 (CV-A10).EV-A71 remains the main cause of severe HFMD.

What are the clinical symptoms of HFMD?
The incubation period for HFMD is 2-10 days, with an average of 3-5 days. The condition is mild and self-limiting, with a good prognosis. The main clinical manifestations for most children are fever, scattered blisters on the oral mucosa, and macular papules and blisters on the hands, feet, and buttocks, which can be accompanied by symptoms such as coughing, a runny nose, and loss of appetite.
Only a few patients will experience rapid deterioration of their condition, involving the brain, lungs and heart, resulting in serious complications such as encephalitis, brainstem encephalitis, acute flaccid paralysis, pulmonary edema, pulmonary hemorrhage, and cardiopulmonary failure.
How are enteroviruses transmitted?
Exposure to infectious patients and latent infections is the main cause of infection, and is most contagious during the first week of onset. The transmission of enteroviruses is diverse, mainly through direct contact with a patient's feces, herpes fluid, nasopharyngeal secretions, saliva, or contaminated hands, towels, handkerchiefs, dental cups, toys, tableware, nursing bottles, and other items or environments. They can also be transmitted through the respiratory tract (coughing, sneezing), or by ingesting contaminated food and water.
What precautions should be taken when treating or isolating children with HFMD at home?
(1) Health monitoring: During the period of home isolation, parents and caregivers should observe the child's condition. Children below 3 years old, who are infected with EV-A71 and are in the first three days of the disease, are at higher risk of developing severe conditions. If the infected child develops a sustained high fever (body temperature above 38.5 C for over 3 days) and neurological abnormalities (such as mental depression, drowsiness, irritability), it may result in severe illness, and the child should be taken to the hospital immediately for treatment.
(2) Home disinfection: Clean furniture, toys and floors every day, and disinfect them using chlorine-containing disinfectant -1-2 times a week. The patient's secretions, vomitus or excreta, as well as any contaminated items or environment, should be promptly wiped with or soaked in chlorine-containing disinfectant for 30 minutes, before wiping or rinsing thoroughly with clean water.
(3) Isolation: The recommended time for home isolation is one week after all the symptoms have disappeared. During this period, the child should avoid going out, especially to kindergartens and public places, and should avoid contact with other children. 
Vaccination to prevent HFMD
At the end of 2015, China's inactivated vaccine for enterovirus 71 (EV71 vaccine) was launched. To obtain immune protection as early as possible, it is recommended that children complete the vaccination program between the age of 6 and 12 months. For children over 5 years old, it is not recommended that they receive the EV71 vaccine.
Due to the variety of enteroviruses that cause HFMD, and the lack of cross protection between different vaccines, receving the EV71 vaccine can only prevent HFMD and related diseases caused by EV-A71 infection, and cannot prevent other infections caused by such viruses as CV-A16, CV-A6 and CV-A10, but it can reduce the risk of severe cases.
How to prevent HFMD in daily life?
(1) Maintain hand hygiene is an effective measure to prevent HFMD. Children should wash their hands with hand sanitizer or soap after touching public objects, saliva or respiratory secretions, as well as after using the toilet and before eating. Parents and caregivers should wash their hands before processing food, and after changing diapers or handling items contaminated with feces.
(2) Avoid contact with sick children, avoid sharing tableware, towels or other personal items to prevent cross infection.
(3) Maintain a clean home environment and ventilate rooms. Regularly clean and disinfect surfaces (countertops, door handles) and children's toys.
(4) Bottles and their teats used by infants and young children, as well as tableware, should be thoroughly cleaned and disinfected before and after use. The diapers of infants and young children should be cleaned or disinfected in time. Do not let children drink untreated water or eat raw or cold food.
(5) During the epidemic of HFMD, it is not advisable to bring children to crowded public places with poor air circulation.
(6) Inoculate children with the EV71 vaccine can effectively prevent HFMD and other related diseases caused by EV-A71 infection, and significantly reduce the occurrence of severe cases and deaths caused by these diseases. Children aged between 6 and 12 months are encouraged to complete the entire vaccination process.
How can childcare institutions prevent outbreaks of HFMD?
(1) Monitoring and case management. Childcare institutions should implement morning and afternoon examinations. Once children with a fever or skin infections are found, they should get medical help and be quarantined. The institution should disinfect the items and environment touched by the infected children.
(2) Cleaning, ventilation and disinfection of the environment. Regularly clean and ventilate classrooms and public areas, and disinfect surfaces, such as door handles, handrails, toilets and elevator buttons.
(3) Cleaning and disinfection of toys and daily necessities. Regularly clean and disinfect personal belongings, such as children's toys, water cups, towels and tableware.
(4) Education on personal hygiene. Childcare institutions should tell children to wash their hands in a timely and correct manner before meals, after using the toilet and after going out to play, and not to mix towels or water cups, among other good hygiene habits.
(5) Standardization of cleaning and disinfection. Cleaning personnel at childcare institutions should take personal protective measures, prepare disinfectant correctly, standardize the cleaning and disinfection of the environment and items.