Hand, foot and mouth disease (HFMD) is an infectious disease caused by enteroviruses. It mostly occurs in infants and young children. It can cause herpes on the hands, feet, mouth and other parts of the body. In some patients, It can cause complications such as myocarditis, pulmonary edema, and aseptic meningoencephalitis. There are more than 20 types of enteroviruses that cause hand, foot and mouth disease, including coxsackievirus group A types 16, 4, 5, 9, and 10, group B types 2 and 5, and enterovirus 71. Among the common pathogens of hand, foot and mouth disease, coxsackievirus A16 (Cox A16) and enterovirus 71 (EV 71) are the most common. The incubation period of the disease is 2 to 7 days, and the sources of infection include patients and latent infections. During the epidemic, patients are the main source of infection. The patient can excrete the virus from the throat during the acute stage of the disease; the herpes fluid contains a large amount of virus, and the virus leaks out when the herpes ruptures; several weeks after the illness, the patient can still excrete the virus from the feces. The disease is transmitted in various ways, mainly through close contact between people. The virus can be transmitted through indirect contact through hands, towels, handkerchiefs, dental cups, toys, tableware, milk utensils, bedding, underwear, etc. contaminated by saliva, herpes fluid, feces, etc.; the virus in the patient's throat secretions and saliva can be transmitted through Droplet transmission; if you come into contact with water sources contaminated by the virus, you can also be infected through water; cross-infection in outpatient clinics and unqualified disinfection of oral instruments are also one of the causes of transmission. The population is generally susceptible to the enteroviruses that cause hand, foot and mouth disease, and immunity can be acquired after infection. Since antibodies lack cross-protection after infection with different pathogen types, people can be infected repeatedly and become ill. Most adults have acquired corresponding antibodies through latent infection. Therefore, patients with hand, foot and mouth disease are mainly preschool children, with the highest incidence rate in the age group ≤3 years old. According to foreign literature reports, it can become popular among people every 2 to 3 years. Hand, foot and mouth disease is widely distributed and has no obvious regional characteristics; it can occur in all seasons, with the highest incidence in summer and autumn. The disease often occurs in outbreaks and then sporadic outbreaks; during epidemics, collective infections are prone to occur in kindergartens and nurseries, and clusters of infections can also occur in families. The disease is highly contagious and has complex transmission routes, and can cause a large-scale epidemic in a short period of time. 2. Epidemic Overview and Trend Forecast (1) International Epidemic Overview. Hand, foot and mouth disease is a global infectious disease, with epidemic reports in most parts of the world. The disease was first reported in New Zealand in 1957, coxsackie virus was isolated in 1958, and the name "hand, foot and mouth disease" was proposed in 1959. Hand, foot and mouth disease caused by various types of coxsackie, echovirus and EV 71 often occurs in the United States, Australia, Italy, France, the Netherlands, Spain, Romania, Brazil, Canada, Germany and other countries. Japan is a country with a high incidence of hand, foot and mouth disease. There have been many large-scale epidemics in history. The epidemic in 1969-1970 was mainly caused by Cox A16 infection. The two epidemics in 1973 and 1978 were caused by EV71. The epidemic in 1997-2000 Hand, foot and mouth disease became active again in Japan in 2015, and both EV 71 and Cox A16 viruses were isolated. In the late 1990s, EV 71 began to wreak havoc in East Asia. In 1997, an epidemic of hand, foot and mouth disease occurred in Malaysia, mainly caused by EV 71. From April to August, 2,628 cases were reported, and 29 patients died from April to June alone. The average age of the deceased was 1.5 years old. In 1998, an outbreak of hand, foot and mouth disease and herpangina caused by EV 71 occurred in Taiwan Province of my country. During the two waves of epidemics in June and October, 129,106 cases, 405 severe cases, and 78 deaths were detected. Most of the fatal cases were children under 5 years old, and complications included encephalitis, aseptic meningitis, pulmonary edema or pulmonary hemorrhage, acute paralysis, and myocarditis. (2) Overview of the epidemic situation in my country. Since the disease was discovered in Shanghai in 1981 in my country, it has been reported in more than a dozen provinces (cities) including Beijing, Hebei, Tianjin, Fujian, Jilin, Shandong, Hubei, and Guangdong. In 1983, an outbreak of hand, foot and mouth disease caused by Cox A16 occurred in Tianjin, with more than 7,000 cases occurring from May to October. After two years of sporadic epidemics, another outbreak occurred in 1986, mainly in nurseries and kindergartens. In 1995, the Wuhan Institute of Virology isolated EV 71 virus from hand, foot and mouth patients, and in 1998, the Shenzhen Health and Epidemic Prevention Station isolated two strains of EV 71 virus from patients. From May to August 2000, there was an outbreak of hand, foot and mouth disease in children in Zhaoyuan City, Shandong Province. The Municipal People's Hospital received 1,698 children, including 1,025 males and 673 females, with the youngest being 5 months old and the oldest being 14 years old; 3 cases were combined in the outbreak Death from myocarditis. In 2006, 13,637 cases of hand, foot and mouth disease were reported nationwide (8,460 male cases, accounting for 62.04%; 5,177 female cases, accounting for 37.96%), and 6 deaths (4 male cases, 2 female cases). In addition to the Tibet Autonomous Region, cases have been reported in 31 provinces, autonomous regions, and municipalities across the country. The top ten provinces with the highest number of reported cases are Shandong (3030 cases), Shanghai (2883 cases), Beijing (2210 cases), Hebei (1133 cases), Zhejiang (793 cases), Guangdong (670 cases), Heilongjiang (576 cases) (cases), Sichuan (335 cases), Jiangsu (287 cases) and Fujian (240 cases). As of May 21, 2007, 5,459 cases of hand, foot and mouth disease had been reported nationwide, including 2 deaths.
Compared with the same period last year (2488 cases), the number of reported cases increased by 119.41%. (3) Epidemic trend prediction. Since hand, foot and mouth disease has not yet been included in the management of notifiable infectious diseases in my country, the epidemic data currently available mostly come from surveillance or outbreak investigation data, making it difficult to make an accurate and comprehensive judgment on the epidemic situation. Judging from epidemic data reported in recent years, the annual peak incidence of hand, foot and mouth disease is around July. Since the temperature across the country rose earlier in 2007, experts predict that the peak incidence of hand, foot and mouth disease may be brought forward earlier, and the number of reported cases of hand, foot and mouth disease nationwide in 2007 will further increase. 3. Prevention and control measures (1) Strengthen the work of infectious disease departments in medical institutions and do a good job in pre-screening, triage, diagnosis and treatment of infectious diseases. 1. Clinical diagnosis of hand, foot and mouth disease cases is made based on the clinical characteristics of the cases and combined with the epidemiological history. Clinical features: acute onset, fever; scattered herpes the size of rice grains appear on the oral mucosa, with obvious pain; herpes the size of rice grains appear on the palms or soles of the feet, and occasionally the hips or knees may be affected. There is an inflammatory redness around the blister, and there is less fluid in the blister. Some children may have symptoms such as cough, runny nose, loss of appetite, nausea, vomiting, and headache. The disease is a self-limiting disease, and most patients have a good prognosis and leave no sequelae. A very small number of children can develop serious complications such as meningitis, encephalitis, myocarditis, flaccid paralysis, and pulmonary edema. Understanding the epidemiological contact history will help diagnose the case, including: there are similar epidemics in local kindergartens or schools, or the case has a history of contact with similar patients, etc. The affected subjects are mainly preschool children. 2. Mild cases are mainly treated with outpatient symptomatic treatment. Severe cases (with neurological symptoms or cardiovascular symptoms, etc.) should be hospitalized and focused on treatment. 3. Strengthen hospital infection control to avoid nosocomial cross-infection. Hospitals should implement a pre-diagnosis system and set up special clinics for fever and herpes cases; focus on strengthening the disinfection of hospital delivery rooms and pediatric wards to prevent nosocomial infections of newborns and infants that may lead to serious consequences. (2) Carry out epidemic surveillance and epidemiological investigations to understand epidemic trends. 1. Strengthen epidemic monitoring and management of key areas and groups such as child care institutions and schools; go to medical institutions to learn about the epidemic in a timely manner, and encourage medical institutions to proactively report the epidemic. 2. Pay attention to distinguishing hand, foot and mouth disease from viral encephalitis, and carry out surveillance and investigation of viral encephalitis and other related diseases to ensure the accuracy of epidemiological investigations. 3. In areas where hand, foot and mouth disease is endemic, morning inspections should be strengthened in day care institutions and primary schools to detect cases in a timely manner. If a child with herpes is found, parents should immediately mobilize the child for home isolation treatment until the child recovers before returning to school. 4. Child care institutions should clean and disinfect toys, utensils, etc. every day to reduce indirect contact transmission. 5． Strengthen food and environmental hygiene supervision to reduce the spread of hand, foot and mouth disease through food and public places. 6． For newly diagnosed patients, specimens should be collected promptly for etiological diagnosis. (3) Carry out publicity, education and health promotion work. In day care institutions, primary and secondary schools, hospitals and other places, carry out health education on hand washing before meals and after using the toilet, promoting room ventilation and other related content; print relevant promotional materials to popularize health knowledge among the masses and advocate the establishment of good personal hygiene habits; suggestions Parents should try to keep their children in crowded public places as little as possible to reduce the chance of infection. If symptoms such as fever and rash occur, seek medical treatment immediately and isolate yourself immediately.