HAND FOOT AND MOUTH DISEASE

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HAND FOOT AND MOUTH DISEASE Powered By Docstoc
					                 PREPARED BY :
             MOHD NOOR BIN ISMAIL
2ND YEAR STUDENT, CHARLES UNIVERSITY IN PRAGUE,
     FACULTY OF MEDICINE IN HRADEC KRALOVE
COMMUNICABLE DISEASES         INCIDENCE RATE    MORTALITY RATE
AIDS                                     6.91              3.66
HIV                                     21.88              1.43
Cholera                                  0.89              0.01
Dengue Fever                            64.37              0.01
Dengue Haemorrhagic Fever                4.10              0.25
Diphtheria                               0.00                0
Dysentery (All Format)                   0.39                0
Food Poisoning                          26.04                0
Gonococcal Infections                    1.90                0
Hand, Foot & Mouth Disease              19.30              0.02
Relapsing Fever                            0                 0
Syphilis (All Forms)                     3.06              0.01
Tetanus Neonatorum                       0.04              0.01
Tetanus (Adult)                          0.06                0
Tuberculosis (All Forms)                62.56              5.37
Typhoid and Paratyphoid                  0.77              0.02
Viral Hepatitis (All Forms)              9.37              0.18
Malaria                                 19.87              0.08
Measles                                  2.27                0
Whooping Cough                           0.02                0
INTRODUCTION

   Hand-foot-mouth disease (HFMD) is endemic in
    Sarawak. Prior to 1997, there was no baseline
    data on the epidemiology of HFMD in Sarawak.
    This is due to the fact that HFMD is not a notifiable
    disease in Malaysia and in Sarawak.
   Between 15 April and 30 June 1997, 31 previously
    healthy infants and young children in Sarawak
    died after a short febrile illness against a
    background of an outbreak of HFMD in the State.
    Sibu was badly affected during this outbreak as 11
    of the death cases were reported from Sibu
    followed by Sarikei with 7 death cases.
WHAT IS HAND, FOOT AND MOUTH
DISEASE (HFDM)? CO JE TO?
   Hand, foot, and mouth disease (HFMD) is a common illness
    of infants and children caused by a virus. It most often occurs
    in children under 10 years old. It is characterized by fever,
    sores/ulcers in the mouth, and a rash with blisters. The
    blisters may appear in the mouth, palms of the hands and
    soles of the feet. The rashes may also appear on buttocks
    and on the legs and arms. The ulcers in the mouth usually
    appear on the tongue, the sides of the cheeks, gums or near
    the throat.
WHAT CAUSES HFMD?
   The most common causes of Hand, Foot
    and Mouth disease are coxsackie virus
    A16, enterovirus 71 (EV71) and other
    enteroviruses. The enterovirus group
    includes polioviruses, coxsackieviruses,
    echoviruses and other enteroviruses.
WHEN AND WHERE DOES HFMD OCCUR?

   Individual cases and outbreaks of HFMD occur
    worldwide, more frequently in summer and early
    autumn (in temperate countries). In the recent
    past, major outbreaks of HFMD attributable to
    enterovirus EV71 have been reported in Malaysia
    in 1997 and in Taiwan in 1998. HFMD is endemic
    in Malaysia and occurs every year. In Sarawak,
    the number of cases of HFMD tends to increase
    from February to June.
IS HFMD SERIOUS?
   HFMD caused by coxsackie virus A16 infection is
    a mild disease and nearly all patients recover
    within 7 to 10 days. Complications are uncommon.
    HFMD caused by Enterovirus EV71 may be
    associated with neurological complications such
    as aseptic meningitis and encephalitis. Cases of
    fatal encephalitis which occurred during outbreaks
    of HFMD in Malaysia in 1997 and in Taiwan in
    1998 were caused by EV71.
IS HFMD CONTAGIOUS?
   Yes, HFMD is moderately contagious. A person is
    most contagious during the first week of the
    illness. The virus can be transmitted from person
    to person via direct contact with nose and throat
    discharges, saliva, fluid from blisters, or the stool
    of infected persons. The virus may continue to be
    excreted in the stools of infected persons up till 1
    month. HFMD is not transmitted to or from pets or
    other animals.
HOW SOON WILL SOMEONE BECOME ILL
AFTER GETTING INFECTED?
   The usual period from infection to onset of
    symptoms (incubation period) is 3 to 7
    days. Fever is often the first symptom of
    HFMD followed by blister/rash.
WHAT ARE THE CLINICAL SIGNS AND
SYMPTOMS?
   HFMD begins with a mild fever, poor appetite,
    malaise ("feeling sick"), and frequently a sore
    throat. One or 2 days after the fever begins,
    painful sores develop in the mouth. They begin as
    small red spots that blister and then often become
    ulcers. They are usually located on the tongue,
    gums, and inside of the cheeks. The skin rash
    develops over 1 to 2 days with flat or raised red
    spots, some with blisters on the palms of the hand
    and the soles of the feet. A person with HFMD
    may have only the rash or the mouth ulcers.
  Blister on the palm of the hand    Blister on the dorsum of the feet




                                    Blister on the soles of the feet


Blister then becomes ulcer on the
inner gum
HOW FOOT, HAND AND MOUTH
DISEASE DIAGNOSED?
   Based on a complete history and physical examination of
    your child. It is generally suspected on the appearance of
    blister-like rash on hands, feet and mouth in children with a
    mild febrile illness.
    Usually, the doctor can distinguish between HFMD and other
    causes of mouth sores based on the age of the patient, the
    pattern of symptoms reported by the patient or parent, and
    the appearance of the rash and sores on examination. A
    throat and/or blister swab collected preferably within 2 days
    of onset of HFMD may be sent to a laboratory to determine
    which enterovirus caused the illness.
HOW IS HFMD TREATED?
   Presently, there is no specific effective antivirul drugs and
    vaccine available for the treatment of HFMD. Symptomatic
    treatment is given to provide relief from fever, aches, or pain
    from the mouth ulcers. Dehydration is a concern because the
    mouth sores may make it difficult and painful for children to
    eat and drink. Should their affected children be having fever,
    the parents are advised to dress their children in light, thin
    clothing, to do tepid sponging with water (room temperature)
    as often as necessary, and to expose them under the fan.
    Taking enough liquids is very important apart from body
    temperature monitoring.
WHO IS AT RISK FOR HFMD?
   Mainly in children under 10 years old, but may
    also occur in adults too. Everyone is at risk of
    infection, but not everyone who is infected
    becomes ill. Infants, children, and adolescents are
    more likely to be susceptible to infection and
    illness from these viruses, because they are less
    likely than adults to have antibodies and be
    immune from previous exposures to them.
    Infection results in immunity to the specific virus,
    but a second episode may occur following
    infection with a different virus belonging to the
    enterovirus group.
WHAT ARE THE RISKS TO PRAGNANT
WOMEN EXPOSED TO CHILDREN WITH
HFMD?
   Because enteroviruses, including those causing HFMD, are very
    common, pregnant women are frequently exposed to the virus as
    well. As for any other adults, the risk of infection is higher for
    pregnant women who do not have antibodies from earlier
    exposures to these viruses, and who are exposed to young children
    - the primary spreaders of enteroviruses.
   Most enterovirus infections during pregnancy cause mild or no
    illness in the mother. Although the available information is limited,
    currently there is no clear evidence that maternal enteroviral
    infection causes adverse outcomes of pregnancy such as abortion,
    stillbirth, or congenital defects. However, mothers infected shortly
    before delivery may pass the virus to the newborn. Babies born to
    mothers who have symptoms of enteroviral illness around the time
    of delivery are more likely to be infected. Strict adherence to
    generally recommended good hygienic practices by the pregnant
    woman might help to decrease the risk of infection during
    pregnancy and around the time of delivery.
SUGGESTIONS FOR THIS PROBLEM

   Frequent hand washing, especially after diaper
    changes, after using toilet and before preparing
    food
   Maintain cleanliness of house, child care center,
    kindergartens or schools and its surrounding
   Cleaning of contaminated surfaces and soiled
    items with soap and water, and then disinfecting
    them with diluted solution of chlorine-containing
    bleach (10% concentration)
SUGGESTIONS FOR THIS PROBLEM
   Parents are advised not to bring young children
    to crowded public places such as shopping
    centers, cinemas, swimming pools, markets or
    bus stations
   Bring children to the nearest clinic if they show
    signs and symptoms.Refrain from sending them
    to child care centers, kindergartens or schools
   Avoidance of close contact (kissing, hugging,
    sharing utensils, etc.) with children having
    HFMD illness to reduce of the risk of infection