What are the main differences between chicken pox and hand, foot and mouth disease. How can parents distinguish between these two viral infections. What are the typical symptoms and treatments for each condition. How do these illnesses affect children versus adults.

Understanding Chicken Pox: Causes, Symptoms, and Prevalence

Chicken pox is a highly contagious viral infection caused by the varicella-zoster virus. It primarily affects children, with those under 2 years old being at the highest risk. The hallmark symptom of chicken pox is its distinctive itchy, red, blistered rash that appears all over the body.

What are the key symptoms of chicken pox?

• Extremely itchy red rash that turns into fluid-filled blisters
• Blisters that crust over after about a day
• Fever
• Fatigue
• Loss of appetite
• Headache

Chicken pox tends to be more severe in older children, teens, and adults. Those with weakened immune systems are also at risk for more serious cases. Vaccination has significantly reduced chicken pox cases, but breakthrough infections can still occur, usually with milder symptoms.

Hand, Foot and Mouth Disease: An Overview of the Coxsackievirus Infection

Hand, foot and mouth disease (HFMD) is caused by the coxsackievirus, most commonly type A16. While it can affect people of all ages, it’s most prevalent in children under 10 years old. The name of the disease describes its characteristic symptoms – a rash or blisters on the hands, feet, and in the mouth.

What are the typical symptoms of hand, foot and mouth disease?

• Painful red rash or blisters on palms, soles, and inside the mouth
• Fever
• Sore throat
• Loss of appetite
• Irritability in infants and toddlers

HFMD is generally a mild illness that resolves on its own within a week. However, it can be uncomfortable for children and cause difficulties with eating and drinking due to mouth sores.

Comparing the Rashes: How to Differentiate Chicken Pox from HFMD

The rashes caused by chicken pox and HFMD can appear similar at first glance, but there are key differences that can help parents and healthcare providers distinguish between the two conditions:

Chicken Pox Rash Characteristics:

• Appears all over the body, including scalp, face, and trunk
• Extremely itchy
• Progresses from red bumps to fluid-filled blisters to crusted scabs
• New spots continue to appear for several days

HFMD Rash Characteristics:

• Primarily affects hands, feet, and mouth
• Can also appear on buttocks and genitals
• Often painful rather than itchy
• Appears as red spots that may blister
• Mouth sores can be particularly painful

How can parents determine which rash their child has? While visual inspection can provide clues, it’s essential to consult a healthcare provider for an accurate diagnosis, especially since other conditions can cause similar rashes.

Transmission and Contagiousness: Preventing the Spread of Chicken Pox and HFMD

Both chicken pox and HFMD are highly contagious viral infections, but they spread through slightly different mechanisms:

Chicken Pox Transmission:

• Airborne droplets from coughing or sneezing
• Direct contact with fluid from blisters
• Contagious from 1-2 days before rash appears until all blisters have crusted over

HFMD Transmission:

• Close personal contact
• Respiratory droplets from coughing or sneezing
• Contact with contaminated surfaces or objects
• Exposure to an infected person’s saliva, stool, or blister fluid
• Contagious during the first week of illness, but virus can remain in stool for weeks

What precautions can families take to prevent the spread of these infections? Proper hand hygiene, avoiding close contact with infected individuals, and staying home when sick are crucial steps in limiting transmission. For chicken pox, vaccination is an effective preventive measure.

Treatment Approaches: Managing Symptoms of Chicken Pox and HFMD

While both chicken pox and HFMD are viral infections that typically resolve on their own, treatment focuses on managing symptoms and providing comfort to the affected individual:

Chicken Pox Treatment:

1. Calamine lotion or oatmeal baths to relieve itching
2. Acetaminophen for fever (avoid aspirin due to risk of Reye’s syndrome)
3. Antiviral medications in severe cases or for high-risk individuals
4. Keeping fingernails short to prevent scratching and potential infection

HFMD Treatment:

1. Pain relievers like acetaminophen or ibuprofen
2. Mouth rinses or sprays to numb mouth pain
3. Cold foods like popsicles to soothe sore throat
4. Plenty of fluids to prevent dehydration

When should parents seek medical attention for these conditions? While most cases can be managed at home, it’s important to consult a healthcare provider if symptoms are severe, if the child is very young, or if there are signs of complications such as high fever or difficulty breathing.

Complications and Long-term Effects: What Parents Need to Know

Although both chicken pox and HFMD are generally mild illnesses, they can lead to complications in some cases:

Potential Chicken Pox Complications:

• Bacterial skin infections
• Pneumonia
• Encephalitis (inflammation of the brain)
• Reactivation of the virus later in life as shingles

Potential HFMD Complications:

• Dehydration due to painful mouth sores
• Rare neurological complications like viral meningitis
• Fingernail and toenail loss (temporary)

What long-term effects should parents be aware of? While most children recover fully from both infections without lasting effects, the varicella-zoster virus that causes chicken pox can remain dormant in the body and reactivate as shingles later in life. HFMD typically doesn’t have long-term consequences, but recurrent infections are possible as immunity to one strain doesn’t protect against others.

Vaccination and Prevention: Strategies for Protecting Against Chicken Pox and HFMD

Vaccination plays a crucial role in preventing chicken pox, but currently, there is no vaccine available for HFMD. Let’s explore the prevention strategies for each condition:

Chicken Pox Prevention:

• Varicella vaccine: Recommended for all children, adolescents, and adults who haven’t had chicken pox
• Two-dose series, typically given at 12-15 months and 4-6 years of age
• Highly effective at preventing severe cases of chicken pox

HFMD Prevention:

• Proper hand hygiene, especially after diaper changes and using the toilet
• Disinfecting frequently touched surfaces and shared toys
• Avoiding close contact with infected individuals
• Teaching children to cover their mouth and nose when coughing or sneezing

How effective is the chicken pox vaccine? The varicella vaccine is about 90% effective at preventing chicken pox. Even in breakthrough cases, vaccinated individuals typically experience milder symptoms and faster recovery.

Special Considerations for Adults: How Chicken Pox and HFMD Differ in Older Populations

While both chicken pox and HFMD are often considered childhood diseases, they can affect adults as well, often with different implications:

Chicken Pox in Adults:

• Generally more severe than in children
• Higher risk of complications like pneumonia
• Can be particularly dangerous for pregnant women and their unborn babies
• May require antiviral treatment

HFMD in Adults:

• Often milder or asymptomatic compared to children
• Can still transmit the virus even with minimal symptoms
• May experience atypical rash patterns
• Rare cases of more severe symptoms reported

What should adults do if they suspect they have chicken pox or HFMD? It’s crucial for adults to seek medical attention promptly if they suspect either infection, especially if they have no history of chicken pox or vaccination. Proper diagnosis and management can help prevent complications and reduce the risk of transmission to vulnerable individuals.

Understanding the differences between chicken pox and hand, foot and mouth disease is essential for parents and caregivers. While both conditions can cause distress and discomfort, being able to recognize their unique characteristics can lead to proper care and management. Always consult with a healthcare provider for accurate diagnosis and treatment recommendations, especially in cases of severe symptoms or for high-risk individuals.

The Differences Between Coxsackievirus & Chickenpox, To Get Your Kid Proper Care

Life

asafaric / Fotolia

July 25, 2018

Any time your kid gets sick can be scary, especially when red skin rashes are involved. So knowing how to tell the subtle differences between coxsackievirus and chickenpox is important info for all parents. They are different viral infections that have similar looking symptoms, which can get super confusing and concerning.

First, consider the Coxsackievirus. Although its name may not be immediately familiar, you’ve probably heard of the condition it causes. Hand, foot, and mouth disease is an infection caused by the Coxsackievirus, as explained by the New York State Department of Health (NYSDOH). Most commonly affecting children under the age of 10, hand, foot, and mouth disease is often characterized by the blister-like rash it causes to appear on the skin, as further explained by the NYSDOH. The rash associated with Coxsackievirus tends to appear on the palms of the hands, soles of the feet, and inside the mouth, according to Medicine Net.

In addition, children affected by the Coxsackievirus often experience mild flu-like symptoms, nausea, or headaches, as noted in Kids Health. Although the symptoms and rash may alarm parents, the coxsackievirus infection is generally not problematic and often resolves within about a week, as noted in the Mayo Clinic.

Chickenpox is another matter entirely. Caused by the varicella-zoster virus, chickenpox is a contagious infection that produces a red rash all over the skin, as noted in WebMD. The chickenpox rash is notoriously itchy, red, and blistered in appearance, according to Medicine Net. Once you’ve encountered this nasty rash, it’s something you’ll never forget.

The vast majority of cases affect young kids, and children under the age of 2 are at the highest risk for chickenpox, as further explained in WebMD. People who have been vaccinated against the infection may experience a milder version of the disease, whereas people with compromised immune systems or those over the age of 12 are likely to get a serious case of chicken pox, according to the Centers for Disease Control and Prevention. Basically, chickenpox gets worse with age. If you have to get a case of it, then it’s better to deal with when you’re young.

Because both of these viral infections can result in skin rashes, fatigue, and general feelings of illness, it’s difficult to tell the difference between chickenpox and Coxsackievirus by sight alone. But there are distinctions. The chickenpox blisters tend to be extremely itchy, and they crust over after about a day, as noted in Hudson Valley Today. (Yeah, it’s a super gross infection overall.) On the other hand, the Coxsackievirus infection can cause a painful red rash that tends to appear on the hands, feet, and mouth, as further explained by Hudson Valley Today. In general, all-over itchy marks may point toward chickenpox, whereas a painful rash limited to the hands, feet, and mouth could be Coxsackievirus.

That said, it’s a great idea to visit your pediatrician immediately if your kid is experiencing any rash and other illness symptoms. Only a doctor’s checkup can really determine the cause of your kid’s malady. Hopefully, though, your child won’t have a tough time with either of these infections.

Hand, Foot, and Mouth Disease – StatPearls

Continuing Education Activity

Hand, foot, and mouth disease (HFMD) is a common viral illness usually affecting infants and children but can affect adults. The infection usually involves the hands, feet, mouth, and sometimes, even the genitals and buttocks. The cause of hand, foot, and mouth disease is coxsackievirus A type 16 in most cases, but the infection can also be caused by many other strains of coxsackieviruses and Enteroviruses. The coxsackievirus is a member of the Picornaviridae family, which includes non-enveloped single-stranded RNA viruses. This activity reviews the pathophysiology and clinical presentation of HFMD and highlights the role of the interprofessional team in managing patients with this disease.

Objectives:

• Identify the etiology of HFMD.

• Describe the presentation of a patient with HFMD.

• Outline the management options available for HFMD.

• Describe interprofessional team strategies for improving care coordination and communication to advance the management of HFMD and improve outcomes.

Access free multiple choice questions on this topic.

Introduction

Hand, foot, and mouth disease (HFMD) is a common viral illness usually affecting infants and children but can affect adults. The infection usually involves the hands, feet, mouth, and sometimes, even the genitals and buttocks. The cause of hand, foot, and mouth disease is coxsackievirus A type 16 in most cases, but the infection can also be caused by many other strains of coxsackievirus. In the western Pacific, hand, foot, and mouth disease has been linked to enterovirus. The coxsackievirus is a member of the Picornaviridae family, which includes non-enveloped single-stranded RNA viruses.[1][2][3]

Etiology

Hand, foot, and mouth disease is a viral exanthem, and it is most commonly caused by the coxsackievirus of the Enterovirus family. Coxsackievirus A16 and enterovirus A71 are the serotypes most commonly implicated as causative agents.[4][5][6] Coxsackievirus A6 has recently emerged as another cause of HFMD in the USA and worldwide.[7] Coxsackievirus A10 has been implicated in severe disease.[8] Coxsackievirus A4 to A7, A9, B1 to B3, and B5 have also been less commonly associated with HFMD.[9]

Epidemiology

This viral infection is not indigenous to one area in particular but occurs worldwide. As children (particularly those younger than seven years of age) tend to be infected at a higher rate than adults, you can see outbreaks in daycares, summer camps, or within the family. Large-scale surveillance from China demonstrated that more than 90% of HFMD cases occurred in children less than five years of age, mortality was around 0.03%, and that cases tended to occur more frequently during late spring and early summer.[10] A study from Vietnam showed a positive correlation between an increase in environmental temperature and humidity and an increase in the incidence of HFMD. [11]

In 2021, French surveillance found a rapid increase in HFMD cases, with more than 3400 cases. Although more than 90% of sequenced cases were found to be linked to Enterovirus, atypical cases were found to be associated with Coxsackievirus A6 and A16.[12] Coxsackievirus A6 remains the dominant cause of HFMD in the United States.[7] 

Pathophysiology

The spread of the human enterovirus is mediated by oral ingestion of the shed virus from the gastrointestinal or upper respiratory tract of infected hosts or via vesicle fluid or oral secretions.[13] Patients tend to be most infectious in the first week of the disease, with an incubation period ranging between 3 to 6 days.[13] After ingestion, the virus replicates in the lymphoid tissue of the lower intestine and the pharynx and spreads to the regional lymph nodes. This can be spread to multiple organs, including the central nervous system, heart, liver, and skin.

History and Physical

Hand, foot, and mouth disease can start with a low-grade fever, reduced appetite, and general malaise. The most common hand, foot, and mouth disease presenting symptom is usually mouth or throat pain secondary to the enanthem. The presence of vesicles is surrounded by a thin halo of erythema, eventually rupturing and forming superficial ulcers with a grey-yellow base and erythematous rim. The exanthem can be macular, papular, or vesicular. The lesions are about 2 mm to 6 mm in size, are non-pruritic, and are typically not painful. They last about ten days, tend to rupture, and result in painless and shallow ulcers that do not leave a scar. The exanthem can involve the dorsum of the hand, feet, buttocks, legs, and arms. Oral lesions commonly involve buccal and tongue ulcers but may also involve the soft palate.[13]

HFMD can also present with atypical features like concomitant aseptic meningitis. Enterovirus infections that cause hand, foot, and mouth disease are notorious for involving the central nervous system (CNS) and may cause encephalitis, polio-like syndrome, acute transverse myelitis, Guillain-Barre syndrome, benign intracranial hypertension, and acute cerebellar ataxia. [13]

Evaluation

The diagnosis of hand, foot, and mouth disease is usually made clinically. The virus can be detected in the stool for about six weeks after infection; however, shedding from the oropharynx is generally less than four weeks. Light microscopy of biopsies or scrapings of vesicles will differentiate HFMD from varicella-zoster virus and herpes simplex virus. While serology is not sensitive to making a diagnosis of HFMD, levels of IgG can be used to monitor recovery.

In some centers, serology is used to differentiate enterovirus 71 from coxsackievirus, as this has prognostic significance. Today, polymerase chain reaction assays are available in most centers to confirm the diagnosis of coxsackievirus. A swab of the lesion can detect coxsackievirus or enterovirus using real-time PCR assays.[14][7]

Treatment / Management

Hand, foot, and mouth disease is a mild clinical syndrome and will resolve within 7 to 10 days. Treatment is primarily supportive. Pain and fever can be managed with NSAIDs and acetaminophen. Making sure the patient remains well-hydrated is important. Additionally, a mixture of liquid ibuprofen and liquid diphenhydramine can be used to gargle, which helps coat the ulcers, easing the pain.[15][16] Steroids were found to increase the risk of severe HFMD.[17]

Over the past decade, researchers have developed specific treatments to manage enterovirus 71-induced hand, foot, and mouth disease because of its severe neurological complications. So far, no drug has been approved, but promising novel agents include molecular decoys, translation inhibitors, receptor antagonists, and replication inhibitors. An antiviral agent that has shown promise in the treatment of enterovirus 71 is pleconaril, an anti-picornaviral agent. However, there are currently no licensed antivirals for the treatment of HFMD.[18] Anecdotal reports have shown some clinical response to acyclovir, but large-scale trials have not established this.[19]

Several vaccine candidates have been developed against HFMD and Enteroviruses. Currently, strain-specific inactivated whole-virus aluminum-adjuvant vaccines have been developed in China and are approved for widespread use.[10] In a study with 10,077 participants, a three-dose regimen of the EV71 C4a vaccine showed an overall efficacy of 94.7% (95% CI 87.8–97.6), with protection lasting for around two years.[20] virus-like particles (VLPs) vaccines, DNA vaccines, peptide vaccines, and subunit vaccines have been developed but are in various stages of clinical trials.[21]

Differential Diagnosis

The differential diagnosis for HFMD should include conditions that present with maculopapular or vesicular rashes with or without oral lesions.[13] These conditions include:

• Erythema multiforme

• Herpangina

• Herpes simplex

• Herpes zoster

• Kawasaki disease

• Viral pharyngitis

• Monkeypox – In the context of an ongoing outbreak, it becomes important to consider the difficulty in clinically differentiating between monkeypox and HFMD[22]

Prognosis

The prognosis for most patients with hand, foot, and mouth disease is excellent. Most patients recover within a few weeks without any residual sequelae. Acute illness usually lasts 10 to 14 days, and the infection rarely recurs or persists. However, some patients with hand, foot, and mouth disease may develop serious complications, which include the following:

• Persistent stomatitis is associated with painful ulcers. The pain can be severe enough to limit food intake, and dehydration can result, especially in young children.

• Aseptic meningitis can occur, but this is more common with enterovirus 71. This particular virus is associated with a higher rate of neurological involvement compared to coxsackievirus. The individual may develop acute cerebellar ataxia, polio-like syndrome, encephalitis, benign intracranial hypertension, and Guillain-Barre syndrome. The virus is believed to induce damage to the gray matter, resulting in motor dysfunction.[23]

• Coxsackievirus can rarely cause interstitial pneumonia, myocarditis, pancreatitis, and pulmonary edema. [24]

• Some studies indicate that coxsackievirus infections may also be associated with spontaneous abortions.[25]

Complications

Pneumonia, myocarditis, pancreatitis, and pulmonary edema, as well as serositis involving other major organs, are rarely associated with HFMD.[24] A large meta-analysis of children with HFMD suggested that lethargy, pneumo-edema/pneumorrhagia, seizures, dyspnoea, and coma were risk factors for death in HFMD.[26] The case fatality rate associated with enterovirus 71 was found to be 1.7% in a systematic review and meta-analysis.[27]

Deterrence and Patient Education

Patient/parental education is paramount in reducing the transmission of HFMD among children and also between children and adults. Handwashing has been proven to be an effective strategy in the prevention of HFMD transmission.[28] A community intervention study showed that intensive education on hand hygiene techniques led to an improvement in the personal hygiene of both parents and children. This subsequently reduced the incidence of HFMD in the study population.[29] The parents should also be advised to keep the child away from immunosuppressed individuals due to the potential risk of serious illness. 

Pearls and Other Issues

The majority of patients with coxsackievirus-induced hand, foot, and mouth disease are treated as outpatients, but those who have CNS involvement may require admission for close monitoring. These patients often require imaging studies of the brain to guide treatment and recovery. Infants may develop dehydration, especially if they develop painful oral ulcers and may require Intravenous hydration. Admission is highly recommended for any infant with hand, foot, and mouth disease who shows signs of severe disease and lethargy. The virus is shed in the stools for a few weeks; hence, patients should be educated about hand washing and maintenance of good personal hygiene.

Enhancing Healthcare Team Outcomes

Cases of HFMD are on the rise, and clinicians need to know how to make the diagnosis. Because many recent cases have involved the brain, a neurological consult may be necessary. An interprofessional team that includes clinicians (MDs, DOs, NPs, or PAs), specialists (neurologist, pediatrician, internist, infectious disease expert), nursing staff, and a pharmacist should be involved. Clinicians will diagnose and initiate therapy and decide which referrals may be necessary. Pharmacists can assist with medication management, perform medication reconciliation, and answer questions about the agents used. Nurses will coordinate activities with other interprofessional team members, help with patient examination, and counsel patients and/or parents. Everyone on the team must communicate openly with the rest of the care team to ensure the best care leading to optimal outcomes. [Level 5]

The outcomes for most patients with HFMD are excellent, with full recovery occurring within 7 to 21 days. [Level 1]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Hand and Mouth. Contributed by DermNetNZ

References

1.

Woodland DL. Hand, Foot, and Mouth Disease. Viral Immunol. 2019 May;32(4):159. [PubMed: 31038400]

2.

Zhu L, Yin H, Sun H, Qian T, Zhu J, Qi G, Wang Y, Qi B. The clinical value of aquaporin-4 in children with hand, foot, and mouth disease and the effect of magnesium sulfate on its expression: a prospective randomized clinical trial. Eur J Clin Microbiol Infect Dis. 2019 Jul;38(7):1343-1349. [PubMed: 31028503]

3.

Wu CY, Lin FL. Hand-foot-and-mouth-disease-induced Koebner phenomenon in psoriasis. J Dtsch Dermatol Ges. 2019 May;17(5):549-551. [PubMed: 30994243]

4.

Muzumdar S, Rothe MJ, Grant-Kels JM. The rash with maculopapules and fever in children. Clin Dermatol. 2019 Mar-Apr;37(2):119-128. [PubMed: 30981292]

5.

Nelson BR, Edinur HA, Abdullah MT. Compendium of hand, foot and mouth disease data in Malaysia from years 2010-2017. Data Brief. 2019 Jun;24:103868. [PMC free article: PMC6441719] [PubMed: 30976640]

6.

Tsai YH, Huang SW, Hsieh WS, Cheng CK, Chang CF, Wang YF, Wang JR. Enterovirus A71 Containing Codon-Deoptimized VP1 and High-Fidelity Polymerase as Next-Generation Vaccine Candidate. J Virol. 2019 Jul 01;93(13) [PMC free article: PMC6580961] [PubMed: 30996087]

7.

Kimmis BD, Downing C, Tyring S. Hand-foot-and-mouth disease caused by coxsackievirus A6 on the rise. Cutis. 2018 Nov;102(5):353-356. [PubMed: 30566537]

8.

Bian L, Gao F, Mao Q, Sun S, Wu X, Liu S, Yang X, Liang Z. Hand, foot, and mouth disease associated with coxsackievirus A10: more serious than it seems. Expert Rev Anti Infect Ther. 2019 Apr;17(4):233-242. [PubMed: 30793637]

9.

Sarma N. Hand, foot, and mouth disease: current scenario and Indian perspective. Indian J Dermatol Venereol Leprol. 2013 Mar-Apr;79(2):165-75. [PubMed: 23442455]

10.

Esposito S, Principi N. Hand, foot and mouth disease: current knowledge on clinical manifestations, epidemiology, aetiology and prevention. Eur J Clin Microbiol Infect Dis. 2018 Mar;37(3):391-398. [PubMed: 29411190]

11.

Nguyen HX, Chu C, Tran QD, Rutherford S, Phung D. Temporal relationships between climate variables and hand-foot-mouth disease: a multi-province study in the Mekong Delta Region, Vietnam. Int J Biometeorol. 2020 Mar;64(3):389-396. [PubMed: 31720856]

12.

Mirand A, Cohen R, Bisseux M, Tomba S, Sellem FC, Gelbert N, Béchet S, Frandji B, Archimbaud C, Brebion A, Chabrolles H, Regagnon C, Levy C, Bailly JL, Henquell C. A large-scale outbreak of hand, foot and mouth disease, France, as at 28 September 2021. Euro Surveill. 2021 Oct;26(43) [PMC free article: PMC8555367] [PubMed: 34713796]

13.

Saguil A, Kane SF, Lauters R, Mercado MG. Hand-Foot-and-Mouth Disease: Rapid Evidence Review. Am Fam Physician. 2019 Oct 01;100(7):408-414. [PubMed: 31573162]

14.

Broccolo F, Drago F, Ciccarese G, Genoni A, Porro A, Parodi A, Chumakov K, Toniolo A. Possible long-term sequelae in hand, foot, and mouth disease caused by Coxsackievirus A6. J Am Acad Dermatol. 2019 Mar;80(3):804-806. [PubMed: 30661911]

15.

Rasti M, Khanbabaei H, Teimoori A. An update on enterovirus 71 infection and interferon type I response. Rev Med Virol. 2019 Jan;29(1):e2016. [PMC free article: PMC7169063] [PubMed: 30378208]

16.

Coates SJ, Davis MDP, Andersen LK. Temperature and humidity affect the incidence of hand, foot, and mouth disease: a systematic review of the literature – a report from the International Society of Dermatology Climate Change Committee. Int J Dermatol. 2019 Apr;58(4):388-399. [PubMed: 30187452]

17.

He Y, Yang J, Zeng G, Shen T, Fontaine RE, Zhang L, Shi G, Wang Y, Li Q, Long J. Risk factors for critical disease and death from hand, foot and mouth disease. Pediatr Infect Dis J. 2014 Sep;33(9):966-70. [PubMed: 24577041]

18.

Kim B, Moon S, Bae GR, Lee H, Pai H, Oh SH. Factors associated with severe neurologic complications in patients with either hand-foot-mouth disease or herpangina: A nationwide observational study in South Korea, 2009-2014. PLoS One. 2018;13(8):e0201726. [PMC free article: PMC6086402] [PubMed: 30096160]

19.

Velástegui J, Cova L, Galarza Y, Fierro P, León Baryolo L, Bustillos A. [A case report of hand, foot, and mouth disease with necrotizing mucocutaneous lesions]. Medwave. 2019 Aug 14;19(7):e7683. [PubMed: 31442216]

20.

Li JX, Song YF, Wang L, Zhang XF, Hu YS, Hu YM, Xia JL, Li J, Zhu FC. Two-year efficacy and immunogenicity of Sinovac Enterovirus 71 vaccine against hand, foot and mouth disease in children. Expert Rev Vaccines. 2016;15(1):129-37. [PubMed: 26460695]

21.

Nayak G, Bhuyan SK, Bhuyan R, Sahu A, Kar D, Kuanar A. Global emergence of Enterovirus 71: a systematic review. Beni Suef Univ J Basic Appl Sci. 2022;11(1):78. [PMC free article: PMC9188855] [PubMed: 35730010]

22.

Lewis A, Josiowicz A, Hirmas Riade SM, Tous M, Palacios G, Cisterna DM. Introduction and Differential Diagnosis of Monkeypox in Argentina, 2022. Emerg Infect Dis. 2022 Oct;28(10):2123-2125. [PMC free article: PMC9514367] [PubMed: 35960545]

23.

Gonzalez G, Carr MJ, Kobayashi M, Hanaoka N, Fujimoto T. Enterovirus-Associated Hand-Foot and Mouth Disease and Neurological Complications in Japan and the Rest of the World. Int J Mol Sci. 2019 Oct 20;20(20) [PMC free article: PMC6834195] [PubMed: 31635198]

24.

Park B, Kwon H, Lee K, Kang M. Acute pancreatitis in hand, foot and mouth disease caused by Coxsackievirus A16: case report. Korean J Pediatr. 2017 Oct;60(10):333-336. [PMC free article: PMC5687981] [PubMed: 29158768]

25.

Ogilvie MM, Tearne CF. Spontaneous abortion after hand-foot-and-mouth disease caused by Coxsackie virus A16. Br Med J. 1980 Dec 06;281(6254):1527-8. [PMC free article: PMC1714960] [PubMed: 6254606]

26.

Ni XF, Li X, Xu C, Xiong Q, Xie BY, Wang LH, Peng YH, Li XW. Risk factors for death from hand-foot-mouth disease: a meta-analysis. Epidemiol Infect. 2020 Feb 27;148:e44. [PMC free article: PMC7058831] [PubMed: 32102711]

27.

Zhao YY, Jin H, Zhang XF, Wang B. Case-fatality of hand, foot and mouth disease associated with EV71: a systematic review and meta-analysis. Epidemiol Infect. 2015 Oct;143(14):3094-102. [PMC free article: PMC9151022] [PubMed: 25721492]

28.

Zhang D, Li Z, Zhang W, Guo P, Ma Z, Chen Q, Du S, Peng J, Deng Y, Hao Y. Hand-Washing: The Main Strategy for Avoiding Hand, Foot and Mouth Disease. Int J Environ Res Public Health. 2016 Jun 18;13(6) [PMC free article: PMC4924067] [PubMed: 27322307]

29.

Guo N, Ma H, Deng J, Ma Y, Huang L, Guo R, Zhang L. Effect of hand washing and personal hygiene on hand food mouth disease: A community intervention study. Medicine (Baltimore). 2018 Dec;97(51):e13144. [PMC free article: PMC6320109] [PubMed: 30572426]

Disclosure: Amanda Guerra declares no relevant financial relationships with ineligible companies.

Disclosure: Emily Orille declares no relevant financial relationships with ineligible companies.

Disclosure: Muhammad Waseem declares no relevant financial relationships with ineligible companies.

Coxsackie virus. Memo to the tourist | Association of Tour Operators

ATOR Bulletin has collected the main questions that concern tourists in connection with the spread of information about the Coxsackie virus in Turkey, and answers to them from specialists – doctors, lawyers and tourism industry professionals.

IS TURKEY REALLY A COXACHI EPIDEMIC?

No. Not a single federal authority in Russia or Turkey confirms the existence of an epidemic. About the current situation cannot be characterized as an epidemic , not only the Turkish Ministry of Health, but also the Russian Rospotrebnadzor say. The Consulate General of the Russian Federation in Antalya also does not see mass appeals of Russians on this issue.

This type of virus is characteristic of the southern coastal countries and its manifestations were observed both in Turkey and in other countries before – on hotel forums you can find panic questions from tourists regarding the Coxsackie virus and the “epidemic”, dating back to 2014 and 2015.

Finally, insurance companies, which have a real opportunity to quickly count those who fall ill, unanimously say that the number of requests for medical assistance due to enterovirus diseases in Turkey this year is within the statistical norm for the summer season – in other words, “it was before, it’s not an epidemic.”

WHAT IS AN EPIDEMIC AND WHO Announces It?

An epidemic is the rapid and continuous spread of an infectious disease within a defined population or region. At the same time, the spread of the disease should0003 is significantly higher than the incidence rate normally recorded in the area and thus be a possible source of emergency.

Usually, the official announcement of an epidemic in a country is given by its Ministry of Health. In Russia, informs citizens about the epidemiological situation Rospotrebnadzor . In the future, information about the unsafe situation in a particular country appears on the website of Rostourism . Specifically for this information should be guided by tourists and travel agencies. We note, for our part, that there are no warnings about the “need to be careful” on vacation in Turkey from government agencies at the moment .

HOW DOES THE COXSACKIE VIRUS MANIFEST, WHAT IS IT?

The virus called Coxsackie belongs to the group of enteroviruses . The disease is manifested by fever (high temperature) and rash (red or brownish spots on the body with blisters in the center). The rash is usually located on arms, legs and mouth . Therefore, the Coxsackie virus is called hand-foot-mouth virus .

A rash on the skin may resemble chickenpox (red spots / papules, and / or full-fledged watery vesicles) – but the Coxsackie virus has nothing to do with chicken pox (chickenpox) – so you do not need to be vaccinated against it in the hope of avoiding Coxsackie enterovirus. A rash in the mouth may resemble herpetic stomatitis – however, if it is Coxsackie, then drugs like Zyrtec will not help.

WHO CAN GET COXACKIE ILL?

Most often, children under 5-6 years old get sick – as a rule, on a beach holiday. Quite often, children, however, “bring” the virus from a regular kindergarten (perhaps other children who returned from vacation bring it).

Adults can also get Coxsackie virus. It is believed that the risk of recurrence is extremely unlikely – Coxsackie gives lifelong immunity.

IN WHICH COUNTRIES CAN COXACKIE BE POSSIBLE? IS IT ONLY Türkiye?

No, the hand-foot-mouth virus is also found and spreading in other countries of the world (above we indicated the countries in which the virus has been noted in the past few years). The most favorable conditions for the spread of the virus are hot weather and a humid climate.

Rosgosstrakh notes that most of the calls for enterovirus infection this year are about the illness of children under 7 years old on a beach holiday – not only in Turkey, but also, for example, in Thailand, Bulgaria, Spain, etc. .

Finally, outbreaks of virus infection in different years were repeatedly recorded and in various regions of Russia – especially during those periods when hot weather was established in a particular region.

HOW IS COXACKIE TRANSMITTED? IS THERE A COXACKIE VIRUS VACCINATION?

If one child falls ill in a family, then all other family members are at risk, especially children under 10 years old, says pediatrician Sergei Butriy. The virus does not “fly through the air”, but is transmitted only by contact . Therefore, a sick child should have their own separate dishes and toys, and it is recommended that all family members often treat their hands with alcohol-containing antiseptics.

Vaccinations against Coxsackie enterovirus do not exist – neither in our country nor abroad.

HOW CAN YOU PREVENT A CHILD TO COXSACKIE VIRUS ON HOLIDAYS?

Travel agent and doctor Svetlana Oboyanskaya gives the following recommendations for parents who want to minimize the risks of a child getting the Coxsackie virus on vacation:

• Be sure to observe personal hygiene – wash your hands, vegetables and fruits, children’s plastic dishes.
• If possible, avoid visiting the children’s pool, try to swim only in the sea.
• In the kids club, children should wear only socks; during peak seasons with a large number of children, it is better to exclude visiting it altogether.
• Raise the child’s immunity even before rest: fresh vegetables, fruits, physical exercises, a lot of fresh air in the child’s everyday “pre-holiday” life reduce the risk of getting sick on vacation, because. First of all, children with weak immunity become victims of any viruses.

HOW LONG DOES COXACKIE TAKE?

As a rule, the period of infection with the virus lasts about 10 days. The temperature can last for 1-4 days, then it usually returns to normal on its own. Pain when swallowing persists for 1-6 days.

A person who has been ill with Coxsackie can return to the team after normalization of body temperature and general condition, but the main indicator will be the disappearance of the elements of the rash. Up to this point, the sick person may be contagious.

HOW TO TREAT A CHILD WITH COXSACKIE? SHOULD I TAKE ANTIBIOTICS?

No, you don’t need to take antibiotics – doctors say so. Coxsackie is a virus, and antibiotics only kill bacteria. The disease belongs to the category passing independently . The patient only needs relief. Parents and physicians need just to stay hydrated and watch for complications (only then antibiotics may be needed, but they must be prescribed by a doctor).

Antipyretics such as ibuprofen or paracetamol can be taken to reduce body temperature . In order to avoid dehydration, especially in children, it is recommended to frequently give the patient cool water to drink – cold can serve as an anesthetic, because ulcers make swallowing difficult. Pediatrician Sergey Butriy also recommends to give the patient ice cream – this is additional calories, and light anesthesia in the throat .

HOW TO DO NOT MISS COXSACKIE COMPLICATIONS AND CALL THE DOCTOR IN TIME

The most common complications of these diseases are dehydration and secondary bacterial infection .

Dr. Evgeny Komarovsky recommends URGENTLY see a doctor or call an ambulance in two cases:

If the child is dehydrated due to complete refusal to eat and drink . Signs of this condition:

child has not urinated for more than 8 hours

A sharply sunken fontanel on the head is palpable in an infant

child cries without tears

His lips are chapped and dry.

If there are signs of a secondary bacterial infection . They can be:

Blisters on the body filled with pus or became sharply painful.

The aphthae in your child’s mouth are so painful that he does not open his mouth, completely refusing to eat and drink.

CANCELLED TOUR TO TURKEY. WHAT COMPENSATION CAN YOU COUNT?

Officials of did not impose any restrictions on the sale and formation of tours to Turkey . Thus, if a tour is canceled before its start date, the tour operator has the legal right to withhold the costs incurred for organizing this tour.

The final amount of expenses actually incurred by him depends on the date of termination of the contract and many other factors. The exact figure is not indicated in the law and depends only on the terms of the contract for the sale of the tourist product, but the closer to the date of the trip, the greater the fine will be .

IF THE SITUATION IS SUDDENLY RECOGNIZED AS UNSAFE, THEN IT WILL BE POSSIBLE TO REFUND THE WHOLE AMOUNT OF THE TOUR?

Nadezhda Efremova, head of the ATOR legal service, explains that the statements of the Federal Tourism Agency in case of danger to tourists in a particular country can be divided into two types.

The first is a recommendation to be careful on vacation. This wording of does not introduce any prohibitions or restrictions on travel to country . In this case, if the tourist wishes to abandon the tour “because he is afraid”, the refund is made in accordance with the terms of the contract for the sale of the tourist product – on the terms signed by the parties.

The second option may include restrictions on the formation and implementation of tours to a particular country. In this regard, changes in flight programs may also be made. In this case, the return of funds for unfulfilled obligations to the tourist is made in full – but there are currently no such notifications for Turkey .

HOW TO REFUND MONEY FOR EARLY RETURN HOME.

Such a question can be asked by tourists who are afraid that upon arrival at the hotel they will find vacationers with suspicious rashes. If situation is not recognized as epidemic , the tourist can apply to the operator with a request for compensation for lost services.

However, since the refusal of services occurred at the time of their provision, then the partners of the tour operator will not be able to sell them to other tourists. The same applies to the return flight. Thus, a refund for unused services unlikely .

WHAT SHOULD I DO IF A TOURIST OR HIS CHILD IS ILL ON HOLIDAY ON THE EVE OF THE FLIGHT BACK TO THE HOMELAND AND THE DOCTOR DOES NOT RECOMMEND FLIGHT BECAUSE OF THE RISKS TO YOUR OWN HEALTH OR THE RISK OF INFECTION TO OTHERS?

On this issue, it makes sense to contact your insurance company . The answer to the question will depend on the conditions of the insurance company in which the policy was purchased. Sometimes such risks are included in the standard package, but it happens that the contract does not provide for this.

Yulia Alcheeva, Executive Director of ERV, recommends that tourists contact their insurer on the eve of the trip and clarify whether such quarantine risks are covered by the insurance policy . If the standard policy does not include such risks, it makes sense to purchase extended insurance .

WHAT ELSE SHOULD YOU PAY ATTENTION TO WHEN ISSUING INSURANCE FOR GOING ABROAD?

An insurance policy is cheaper if it provides for the so-called franchise . Usually this is an amount of about 50-100 euros, which a tourist will have to pay for treatment from his own pocket. The insurance company compensates for expenses only in excess of the specified amount.

Rosgosstrakh calculated that the average cost of medical care provided in connection with the virus depends on the country of treatment and the severity of the disease and can vary from 60 euros in Bulgaria, 80 euros in Turkey and up to 1500 USD in the United States.

If the policy is included in the tour package, you should check in advance whether it provides for a deductible. If it provides for, and there are concerns about a possible Coxsackie disease on vacation, then it makes sense for a tourist (especially with children) consider buying an additional insurance policy – no deductible .

GBUZ “City polyclinic”| What you need to know about chickenpox |

Chickenpox (Varicella) is a worldwide acute, highly contagious disease with a characteristic blistering rash. Susceptibility to chickenpox is unique – it reaches, according to various sources, 90-100%. After the appearance of the first case of this infection in a particular children’s group, it is almost impossible to prevent an outbreak. Prior to the start of immunization for varicella in the United States, up to 4 million cases of this infection were recorded annually, with 10 thousand cases requiring hospitalization. In our country, up to 700 thousand cases of chickenpox are registered per year. In Udmurtia, more than 10,000 people get chickenpox every year.

The causative agent of chicken pox is the Varicella-Zoster virus (varicella-zoster, VVZ), belonging to the herpesvirus family, according to the modern classification, it is type III herpesvirus. Despite the fact that the description of chickenpox has been known since ancient times, and its infectious nature was proven in 1875, the virus itself was isolated only in 1958.

Varicella (chickenpox) is traditionally considered a common childhood infection and can affect young children or preschoolers. While in childhood it is a relatively mild disease, in adults it occurs in a more severe form – in the form of herpes zoster – lichen (herpes zoster). The fact is that, like for herpes simplex viruses, the causative agent of chickenpox is characterized by the ability to persist (stay) for a long time in the ganglia of nerve cells, where it enters during infection of the child and continues to stay there after his recovery in the form of a “dormant infection”. Virus reactivation can occur after many years and even decades. This is mainly due to a decrease in the intensity of immunity in adulthood and old age. According to various studies, about 20% of the elderly suffer from herpes zoster.

Susceptibility to the causative agent of varicella (varicella zoster virus refers to herpes viruses) is quite high. About 90% or more of contact persons who have not been ill develop chickenpox. This virus has a high degree of volatility, is transmitted by airborne droplets and a child can become infected in close proximity to the patient. The patient is considered contagious already in the last days of the incubation period and during the entire period of rashes. You can also get infected from a patient with herpes zoster, since the causative agents of these infections are similar. The incubation period ranges from 14 to 21 days, with an average of 14 days. The disease begins with the appearance of a rash. Usually it is one or two reddish spots, similar to a mosquito bite. These elements of the rash can be located on any part of the body, but most often they first appear on the stomach or face. Usually the rash spreads very quickly – new elements appear every few minutes or hours. Reddish spots, which at first look like mosquito bites, the next day take the form of bubbles filled with transparent contents. These blisters are very itchy. The rash spreads throughout the body, to the limbs, to the scalp. In severe cases, there are elements of the rash on the mucous membranes – in the mouth, nose, on the conjunctiva of the sclera, genitals, intestines. By the end of the first day of the disease, the general state of health worsens, the body temperature rises (up to 39-40 degrees C and above). The severity of the condition depends on the number of rashes: with scanty rashes, the disease proceeds easily, the more rashes, the more difficult the child’s condition. For chickenpox, a runny nose and cough are not characteristic, but if there are elements of the rash on the mucous membranes of the pharynx, nose and on the conjunctiva of the sclera, then pharyngitis, rhinitis and conjunctivitis develop due to the addition of a bacterial infection. Bubbles open in a day or two with the formation of sores, which are covered with crusts. Headache, feeling unwell, fever persist until new rashes appear. This usually happens from 3 to 5 days (depending on the severity of the course of the disease). Within 5-7 days after the last sprinkling, the rash disappears.

The treatment of chickenpox is to reduce itching, intoxication and prevent bacterial complications. The elements of the rash must be lubricated with antiseptic solutions (usually an aqueous solution of brilliant green or manganese). Treatment with coloring antiseptics prevents bacterial infection of rashes, allows you to track the dynamics of the appearance of rashes. It is necessary to monitor the hygiene of the mouth and nose, eyes – you can rinse your mouth with a solution of calendula, the mucous membranes of the nose and mouth also need to be treated with antiseptic solutions. In order to avoid secondary inflammation, you need to rinse your mouth after each meal. In addition, you need to do general baths with a weak solution of potassium permanganate. Diets for chickenpox are not required, but easily digestible warm semi-liquid dairy and vegetable dishes are preferable, and meat dishes are ground, steamed. You need a plentiful cool drink – tea with lemon, berry fruit drinks, juices, compotes. Bed rest is determined by the condition of the child: if he feels well, the regimen can be at home. In severe cases, hospitalization in infectious diseases hospitals is indicated. It is important to ensure that the baby’s fingernails are cut short (so that he cannot comb the skin – scratching predisposes to bacterial infection). To prevent infection of rashes, bed linen and clothes of a sick child should be changed daily. The room in which the child is located must be regularly ventilated, making sure that the room is not too hot. These are general rules. Complications of chickenpox include myocarditis – inflammation of the heart muscle, meningitis and meningoencephalitis (inflammation of the meninges, brain matter), inflammation of the kidneys (nephritis). Fortunately, these complications are quite rare. After chickenpox, as well as after all childhood infections, immunity develops. Re-infection happens, but very rarely.

Cases of congenital varicella in children born from women who had this infection in the first half of pregnancy, and varicella in newborns whose mothers fell ill with chickenpox in the period 5 days before or 48 hours after the birth of a child are described.

Immunoprophylaxis against varicella is carried out in many countries of the world, is included in the national vaccination schedules of Japan, USA, Canada, Germany, Finland, etc.

The first country where the varicella vaccine was first registered and immunoprophylaxis was started is Japan. Here, a lot of experience has been accumulated in evaluating its effectiveness. According to Japanese researchers, immunity to chicken pox after vaccination persists for 10-20 years. The work of American researchers has shown that varicella vaccine provides protection against infection in 70-90% of vaccinated children and more than 95% of them can be protected from severe disease within 7-10 years after immunization.

Vaccination against varicella in healthy children is indicated from 12 months of age, its inclusion in the national calendar for young children would allow, with proper coverage (90-95%), to eliminate this infection. Today, vaccination against chickenpox is not included in the national vaccination calendar and is recommended as an individual immunization of healthy children and children from “risk groups”, in particular, patients with oncological, autoimmune diseases, people with immunodeficiency or immunosuppression; contact persons in the foci of infection, professional groups, pupils of institutions with permanent residence of children.