Hand Foot Mouth Disease (HFMD) and Herpangina Management

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  • HFMD and herpangina are infections of the enterovirus which usually occur during the summer (May~June) and autumn (Septmber~October) periods. It is highly contagious and often breaks out within a community.
  • Enterovirus is transmitted from person to person via the fecal-oral route; that is, when the caretaker changes a diaper without washing his/her hands afterwards or when a young child gets stool on his/her hands and then touches objects that other children put in their mouths. The virus also spreads easily through direct contact with oral and respiratory secretions such as droplets from coughing and sneezing, as well as touching the vesicle fluids in HFMD.
  • Enteroviral infection often causes fever, sores in or on the mouth, and skin rash. In some cases, there are no symptoms at all or the symptoms are very mild that parents also catch the disease without any realization. Symptoms usually occur 3~6 days after being exposed to the virus.
  • The most commonly occurring types in Taiwan are herpangina and HFMD which in addition to the aforementioned symptoms, results in sores or vesicles usually 1~5mm in diameter on the hands, soles of the feet, knees, buttocks or legs. The sores may be painful. Infected children often complain of mouth or throat pain, and in children who have yet to speak often show refusal to eat. There may also be unexplainable fussiness, abdominal pain, vomiting, and diarrhea.
  • The illness usually doesn’t last more than a week or so. At first your child may feel tired, get a sore throat, or have a fever of around 38~39°C. Then in a day or two, sores or blisters may appear and they quickly rupture and crust over.
  • Enterovirus is infamous and often feared by parents because of how quickly and easily it spreads and its potential serious complications. Type A71 enterovirus has been associated with complications of the central nervous system (encephalitis, paralysis, meningitis), lung edema and hemorrhage, and heart failure.
  • There are more than 60 types of viruses in the group of enteroviruses. There is long-lasting immunity once infected, but only for that specific type of enterovirus. As there are so many types of enterovirus, it is possible to contract enterovirus again in the same year or possibly even the same season. Different types of enterovirus may cause similar symptoms. Therefore, the same patient may seem like he/she has gotten hand-foot-and-mouth disease or herpangina more than once. There is no specific antiviral therapy available for the treatment of the enteroviruses nor is there vaccines. Management is symptom relief, and most patients will be fully recovered within one week. However, children with complications may require hospitalization.
  • Fever management：
    1. Fever is when armpit temperature is over 37.5ºC or anal, forehead, or temporal temperature is over 38ºC.
    2. When your child has chills, keep him/her warm by adding another blanket or elevating the thermostat temperature. Do not give him/her an ice pillow.
    3. If your child has fever but the limbs are warm, give him/her a warm bath (water temperature 26~36ºC).
    4. Encourage your child to drink plenty of water to prevent dehydration. Dry off the sweat immediately. Do not wear too many layers of clothes or use too many blankets.
    5. Fever medication (antipyretics) may be given when the child’s temperature is above 38.5℃. Repeat if necessary with at least 4 to 6 hours between the antipyretics. If your child has a history of febrile convulsion, use antipyretics at a lower temperature to help prevent convulsion.
    6. Antipyretics usually need around 30 minutes to work. You may check your child’s body temperature every hour until the fever has reduced.
    7. Take antipyretics as instructed. Do not take aspirin.
  • IV (intravenous therapy) and IV pump care：
    1. Keep the dressing and injection cannula (the small plastic tube which is inserted into the vein) clean and dry.
    2. Periodically check that the the distal extremities (far end of the limb with the injection; ie. fingers or toes) that they are warm and pink.
    3. Keep the injected limb lowered to avoid IV fluid or blood refluxing into the tubes.
    4. Do not adjust the IV rate or touch the buttons of the pump by yourself. Inform the staff if you think adjustment is needed.
    5. The IV pump has a rechargeable battery. You may remove the electric the charging cable when walking around. Please keep the cable plugged in when possible.
    6. Gently compress the injection site for 1~3 minutes with a sterile cotton ball after the cannula has been removed. Remove the cotton balls if there is no more bleeding.
    7. If any of the following conditions occur, please inform the nursing staff：
      • Pain, swelling, redness, or wetness at the injection site.
      • Painful or reddening of the skin after the cannula was removed.
      • You heard the sound of pump alarm.
      • Your child needs a shower or change the clothes.
  • Oral ulcer management：
    1. Make observation of the changes of the oral ulcers at least once everyday.
    2. Practice good oral hygiene. Use a soft toothbrush or a gauze wrapped on a popsicle stick and clean the mouth and teeth with normal saline or boiled water. This will help promote wound healing and prevent bad breath from bacterial growth.
    3. Drink or gurgle directly from a cup instead of a straw to avoid contact pain from the straw or wound irritation from sucking motion.
    4. Cool soft diet will reduce the painful sensation during swallowing. Try ice cream, yogurt, jelly, cold milk, or flan.
    5. Try lip balms or vaseline to moisten the lips.
    6. Eat frequent small meals. Do not force feed.
    7. Always practice good hygiene. Gently wipe off drool with wet towelette. Always wash your hands before and after touching your child.
  • Avoid scratching or manipulating the skin rash to prevent secondary infection. Try gentle lotion on dry itchy skin.
  • Personal hygiene is the most important factor in disease prevention and outbreak control. Children younger than 3 years old are at most risk for complications and should be encouraged and helped with practicing good hand washing technique.
  • How should you wash your hands：
    1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
    2. Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.
    3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
    4. Rinse your hands well under clean, running water.
    5. Dry your hands using a clean towel or air dry them.
  • When to wash your hands：
    1. Before, during, and after preparing food
    2. Before eating food
    3. Before and after caring for someone who is sick or going to the hospital
    4. Before and after treating a cut or wound
    5. Before touching or making direct contact with a child
    6. After using the toilet
    7. After changing diapers or cleaning up a child who has used the toilet
    8. After blowing your nose, coughing, or sneezing
    9. After touching an animal, animal feed, or animal waste
    10. After handling pet food or pet treats
    11. After touching garbage
  • Disinfect common areas. Get in the habit of cleaning high-traffic areas and surfaces first with soap and water, then with a diluted solution of chlorine bleach and water. Child care centers should follow a strict schedule of cleaning and disinfecting all common areas, including shared items such as toys, as the virus can live on these objects for days. Clean your baby’s pacifiers often.
  • Children are most likely to spread the disease during the first week of the illness. But the virus can stay in the stool for several months and may spread to others. To help prevent the disease from spreading, isolate infected children at home, avoid close contact with other children including siblings, and don’t let your child share toys or give kisses.
  • Always have a balanced diet, regular exercise, and adequate sleep to help boost immunity.
  • Go to a hospital or inform our medical staff immediately if there are the following symptoms：
    1. Extreme sleepiness
    2. Myoclonic jerks (repeated jerk-like movements similar to a startling response involving muscle contractions of the whole body)
    3. Persistent vomiting
    4. Persistent fever
    5. Decreased activity or generalized weakness
    6. Irritable behaviour or crying
    7. Loss or change of consciousness
    8. Neck stiffness
    9. Paralysis
    10. Shortness of breath
    11. Increased heart rate or irregular pulse
      *special attention should be paid to young infants within the first 5 days of illness.
  • Sterilizing at home：
    1. Aldehydes and halogen-based disinfectants (such as commercially available chlorine bleach) can deactivate enterovirus activity. Try adding bleach into your laundry loads.
    2. Making disinfecting spray：
      mix 1 tbsp / 15~20mL household bleach (usually sold in 6% to 7% concentrations) in 5 L tap water and divide into appropriate size spray bottles
    3. Dry heat weakens and shortens the lifespan of the virus. Cook food thoroughly. Wash clothes with hot water and put the dryer on highest heat setting.
    4. UV (ultraviolet) light diminishes viral activity. Try drying cleaned objects in the sun.
 
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