As the High Incidence Season for Hand, Foot, and Mouth Disease Approaches, How Should We Prepare for Prevention?

As spring approaches and temperatures begin to rise, we are entering the peak season for hand, foot, and mouth disease, particularly in crowded environments such as schools and childcare facilities. It is crucial for parents and teachers to monitor for symptoms on the hands, feet, and mouths of children closely and to seek medical attention promptly if any abnormalities are detected.

 

Hand, foot, and mouth disease (HFMD) is a common acute infectious disease affecting mainly children under five years of age, caused by various enteroviruses. It can occur throughout the year, with peak occurrences in the spring and summer months from April to July, and a secondary peak in the autumn from September to November. The primary pathogens include Coxsackievirus A types 4 to 7, 9, 10, 16 (CVA4-7, 9, 10, 16) and B types 1 to 3, 5 (CVB1-3, 5), certain serotypes of Echovirus, and Enterovirus A71 (EV-A71). Historically dominated by EV-A71 and CVA16, the recent rise of CVA6 has led to it becoming a major pathogen post CVA16 and EV-A71. Infections with CVA6 can result in rashes that appear different and are more extensive than those caused by traditional strains. EV-A71 remains a leading cause of severe and fatal outcomes in cases of the disease.

 

 

The incubation period from infection to symptom onset for HFMD typically ranges between 2 to 10 days, with an average of 3 to 5 days. Clinical manifestations commonly include fever and vesicular lesions on the oral mucosa, as well as maculopapular and vesicular rashes on the hands, feet, and buttocks. Symptoms may also encompass coughing, runny nose, and appetite loss. The majority of cases in children are mild and self-limiting with generally favorable outcomes, usually resolving completely within 7 to 10 days. However, a small minority of severe cases can rapidly worsen, leading to neurological complications and multi-organ failure, which may be fatal. Additionally, a small proportion of patients infected with CVA6 or CVA10 may experience nail shedding 2 to 4 weeks after illness onset.

 

HFMD spreads primarily through close contact. The disease's infectious agents include both symptomatic patients and asymptomatic carriers, with a significant number of infections occurring via asymptomatic carriers. Infectivity begins before symptoms manifest, peaking within the first week after symptom onset.

 

Transmission can occur through multiple pathways, most commonly through direct contact with contaminated feces, blister fluid, nasopharyngeal secretions, and saliva. It can also spread by touching objects or surfaces contaminated by these substances, such as hands, towels, handkerchiefs, toothbrush holders, toys, utensils, bottles, and bedding. Additionally, HFMD can be transmitted through respiratory droplets released during coughing or sneezing, and by consuming water and food contaminated with the virus.

 

Avoiding Contact with Infected Individuals: Avoid hugging, sharing toys, or using the same utensils and bath products to prevent cross-infection.

 

Maintaining Hand Hygiene: Good hand hygiene is essential for preventing HFMD. Children should wash their hands after touching public items, returning home from playing, before eating, and after using the toilet. Parents and caregivers should wash their hands after coming home, before preparing food, and after changing diapers or handling items contaminated with feces. Regularly wash hands with soap and water, and use a chlorine-based disinfectant after contact with an infected person or contaminated objects.

Reducing Crowding. During periods of high HFMD transmission, avoid bringing children to crowded places with poor ventilation as these conditions facilitate the spread of the disease.

Ventilating Environments. Ensure that enclosed public spaces and living areas are regularly ventilated to maintain fresh air circulation.

Cleaning and Disinfection. Frequently touched surfaces such as door handles and countertops should be regularly cleaned and disinfected. Children’s toys and daily use items should be cleaned and disinfected regularly. Baby bottles, eating utensils, and other similar items should be sterilized by boiling. Clothing and bedding should be frequently aired in sunlight or disinfected using ultraviolet light.