Reasonable prevention and control to help children stay away from hand, foot and mouth disease
May-July of each year is the high incidence of hand-foot-mouth disease. According to the province's hand-foot-mouth disease pathogenic monitoring results, EV71 and Coxsackie A16 are the main pathogens of hand-foot-mouth disease in our province, of which EV71 accounts for 54%. EV71 has a higher probability of severe illness and death. In severe cases of infection, EV71 accounts for 91%, and the situation of prevention and treatment is severe. Since our hospital reported the first hand, foot and mouth case of the year on April 6, 2015, up to now, a total of 22 cases have been reported, of which 20 cases occurred after May, and all were mild cases.
Hand-foot-mouth disease (HFMD) is a common infectious disease in children caused by a variety of human enteroviruses. It is a Class C infectious disease that is legally reported in China. Hand, foot and mouth disease often occurs in crowded units such as child care institutions.
1. What are the etiological characteristics of hand-foot-mouth disease virus?
Enteroviruses are suitable for survival and transmission in humid and hot environments. 75% alcohol and 5% lysin cannot inactivate them (hence, we cannot choose alcohol disinfectants when disinfecting). Diethyl ether, dechlorocholate It is not sensitive; it is sensitive to ultraviolet rays and drying. Various oxidants (such as chlorine-containing disinfectants), formaldehyde, iodine, and 56 ° C for 30 minutes can inactivate the virus. The virus can survive for one year at 4 ° C, can be stored for a long time at -20 ° C, and can survive for a long time in the external environment.
2. What is the source of hand, foot and mouth disease? By what channels? Which groups are susceptible?
Source of infection: Human is the sole host of human enterovirus. Patients and recessive infections are the source of infection of this disease. Recessive infections are difficult to identify and find. A few days before the onset of infection, the virus can be detected in the throat and feces of the infected person, usually the most contagious within one week after the onset of infection.
Route of transmission: Enteroviruses can be transmitted through the gastrointestinal tract (fecal-oral route), or through the respiratory tract (droplets, cough, sneezing, etc.), or due to contact with patients' oral and nasal secretions, skin or mucosal herpes And contaminated hands and objects. It is unclear whether it can be transmitted by water or food.
Susceptibility: The population is generally susceptible to enteroviruses. The incidence is mainly children aged 5 years and younger, especially children aged 3 and youngest.
3. What are the main clinical manifestations of hand, foot and mouth disease?
The incubation period of hand, foot and mouth disease is 2-10 days, with an average of 3-5 days, and the course of disease is generally 7-10 days.
Acute onset, fever, scattered herpes in the oral mucosa, maculopapular rash, herpes on the hands, feet, and buttocks, inflammatory redness around the herpes, and less fluid in the herpes. May be accompanied by cough, runny nose, loss of appetite and other symptoms. Some patients had no fever, only showing a rash or herpes. Generally, the prognosis is good; in a few cases, especially children with EV71 infection, meningitis, encephalitis, encephalomyelitis, neurogenic pulmonary edema, and circulatory disorders can occur. The disease is dangerous and can cause death or sequelae.
4. What are the indications for early identification of severe cases?
Infants under 3 years of age, the course of disease within 5 days, pay attention to sympathetic hyperthyroidism. One of the following conditions is indicated as a severe case:
(1) High fever: short-term high fever, body temperature (axillary temperature) is greater than 39 ° C, the conventional antipyretic effect is not good; after the temperature drops, high fever reappears or repeatedly high fever; or persistent high fever.
(2) Nervous system performance: appearing debilitated or irritable, vomiting, easy to panic, limb shaking, weakness, instability of standing or sitting, lethargy, etc.
(3) Respiratory abnormalities: faster, slower or irregular rhythm. If the breathing rate exceeds 30-40 beats / min (by age) in the quiet state, be aware of neurogenic pulmonary edema (in the absence of basic conditions such as primary heart, lung, kidney, etc.).
(4) Circulatory dysfunction: increased heart rate (> 140-150 beats / min, pay attention to exclude the increase in heart rate due to age, high fever or crying), cold sweats, cold limbs, skin pattern, and increased blood pressure.
(5) WBC count in peripheral blood increased: more than 12 × 109 / L, excluding other infection factors.
(6) Elevated blood sugar: stress hyperglycemia occurs.
Children who are premature, obese, and are using hormones for other diseases, children with previous EB virus infection, non-breastfeeding, combined respiratory virus or mycoplasma infection, and those with underlying diseases such as asthma, congenital heart disease, etc. may be severe hand, foot and foot Early warning factors for the occurrence of oral diseases should be given full attention.
5. What is the cluster epidemic of hand-foot-mouth disease? What is an outbreak of hand, foot and mouth disease?
Aggregated outbreaks refer to 5 or more cases of HFMD in the same childcare institution or school within one week; or 2 or more cases of HFMD in the same class (or dormitory); or the same natural village / residential committee 3 or more cases of HFMD; or 2 or more cases of HFMD in the same family.
An outbreak refers to the occurrence of 10 or more cases of hand-foot-mouth disease in the same childcare institution or school within one week; or five or more cases of hand-foot-mouth disease in the same natural village / neighborhood.
6. What are the requirements for hand, foot and mouth disease epidemic report?
(1) Case report: After the first doctor finds a case of hand, foot and mouth, he should report it to the sensory control department in accordance with the requirements of C-type infectious diseases. If it is a severe case, please select "Yes" in the "Serious Patient" and call the Medical Department and Sensory Control Department in a timely manner.
(2) Report of severe cases: After the first-time doctor finds a severe case, he should immediately report to the medical department and request in-patient consultation while actively treating. The report of severe cases must be made by 2 members of the expert team of medical treatment of hand, foot and mouth disease Deputy Chief Physician and above diagnosis. In case of difficult and severe cases, provincial or municipal expert groups can be invited for consultation on the basis of consultations with the expert group of our hospital.
(3) Aggregated case report: After the first consultation doctor finds the clustered epidemic situation, he should report to the control department and medical department in time. When a medical institution discovers a cluster epidemic, it shall report it to the local county-level disease prevention and control institution within 24 hours.
(4) Report on the outbreak: First-time doctors should report to the medical and sensory departments immediately after the outbreak is found. Medical institutions should report the local disease prevention and control agencies as soon as possible after detecting the outbreak.
7. What preventive control measures should be taken as a medical institution?
(1) Strengthen the pre-checking and triage, and if necessary, set up a consultation room (stage) to receive fever and rash cases. Increase the frequency of cleaning and disinfection in waiting areas and consultations. Wet cleaning should be used during indoor cleaning.
(2) After diagnosing, treating and caring for each case, medical personnel should wash their hands or disinfect their hands carefully, or replace and use disposable gloves.
(3) During disinfection, medium-effect or high-efficiency disinfectants such as chlorine-containing disinfectants, iodophors, peroxyacetic acid, etc. should be selected for disinfection, and the use value of the disinfection objects and environmental pollution should be avoided as much as possible.
(4) During the hand, foot and mouth disease epidemic, preventive disinfection should be done in pediatric clinics, fever clinics, and pediatric wards, including disinfection of various diagnostic instruments and supplies, indoor air, and surface disinfection.
(5) Disinfect at any time. Disinfect the children's contaminated items and places in a timely manner. They can be reused only after disinfection of medical supplies and instruments, such as tongue depressors, sphygmomanometers, thermometers, beds, tables and chairs. Always pay attention to the secretions or excreta (feces, herpes fluid, respiratory secretions, etc.) and their contaminated places and items.
(6) Pediatric clinics, fever clinics and other diagnosis and treatment places should strengthen indoor ventilation (including natural ventilation and mechanical ventilation), and can also use circulating air sterilizers for air disinfection. Ultraviolet disinfection of air in unmanned conditions is not necessary. Spray disinfectant to disinfect indoor air.
(7) After daily work at pediatric clinics, fever clinics, hand-foot-and-mouth disease clinics, and after the patient's ward recovers, dies or leaves, the terminal disinfection should be done, including: floor, wall , Disinfection of tables, chairs, bedside tables, bed frames and other surfaces and toilets.
8. As medical staff, what precautions should we tell the public about hand, foot and mouth disease?
(1) Develop good hygienic habits. Wash your hands with hand sanitizer or soap before meals, after going out, and after going out. Wash and disinfect tableware used by children. Do not let your baby drink raw water or cold food.
(2) Caregivers should wash their hands before touching the child, changing diapers for the child, and handling the child's stool.
(3) Avoid contact with children suffering from hand, foot and mouth disease. Do not bring your baby to crowded public places with poor air flow during the epidemic.
(4) Keep the family environment sanitary, the room should be ventilated frequently, and the clothes should be regularly washed.
(5) You can check your child's skin (mainly palms, feet) and mouth for abnormalities every morning in the epidemic period. Pay attention to changes in the child's body temperature. When your baby has related symptoms, go to a medical institution in time.
Hand and foot disease can be prevented and treated, with emphasis on prevention. Summarize the 15-word policy for the prevention of hand, foot and mouth disease: "Wash your hands, drink boiled water, eat cooked food, ventilate, and quilt."
The Sense Control Department reminds the medical staff of the hospital, especially my colleagues in key departments such as pediatrics, emergency department, fever clinic, outpatient department: We must fully understand the serious situation facing the prevention and treatment of hand, foot and mouth disease, overcome lax paralysis, and seriously study hand, foot and disease Knowledge of prevention and control, master diagnostic points and prevention and control measures, timely screening of severe cases, and take effective measures to effectively achieve early detection, isolation, early reporting and early treatment.