这是 达医晓护的第1780 篇文章
初夏已至，气温逐渐攀升，手足口病和疱疹性咽峡炎正悄然增多。这两种疾病都是由多种常见的肠道病毒引起的传染性疾病，多发生于5岁以下的婴幼儿和学龄前儿童。手足口病有很强的传染性，一年四季都可发生，但常见于夏秋季。据统计， 目前有二十多种的肠道病毒可引起手足口病和疱疹性咽颊炎，其中最常见的是柯萨奇病毒A型中的各类亚型。
Summer is coming and the temperature is expected to rise gradually. There is an increased incidence of hand, foot and mouth disease (HFMD) and Herpangina. These are two common viral illnesses that mainly affect infants and young children below five years of age. Both of them are contagious and easily spread from one person to another. HFMD and Herpangina can present throughout the year, but usually occur during the summer and fall months in China. They are both caused by about 20 serotypes of the Enterovirus A but particularly the various strains of Coxsackievirus A.
1. 手足口病和疱疹性咽颊炎分别有什么表现呢？
手足口病
手足口病的症状一般出现于感染病毒3天到7天后，一周左右自愈， 一般不超过10天。发病早期的表现类似普通的感冒，食欲减退，口腔或咽喉疼痛，浑身不适，有时候可能会伴有发热。
典型的手足口病一般在起病或发烧1到2天后，口腔颊粘膜，舌，或咽喉部会出现小而扁平的红色斑点，并且逐渐发展为小疱疹， 然后破溃形成疼痛的小溃疡。患儿常因嘴里的溃疡疼痛而不愿进食和喝水，小年龄的孩子会有流口水比平时增多。同时手心和脚底会有这些扁平的小红点，有时还会出现在膝盖，肘关节，臀部和肛门周围， 这些皮疹也会发展成小疱疹， 周围有红晕。手足口病的皮疹另一个特点是不会发痒。大多数患儿在一周内体温下降，皮疹逐渐消退, 疱疹也在逐渐干燥结痂，脱痂后不留疤痕。
近年来发现的柯萨奇病毒A6和A10型，可能会伴有比较明显的发热，累及多处和较多的皮疹，除了手，足，口外，还会发生于四肢，面部，口唇，腹股沟，臀部，和会阴区域，还会出现多种皮肤受损，比如水疱大疱性皮损，糜烂，溃疡和焦痂。持续时间会长至1-2周左右。另外，有时候会在手足口病1-3周后出现手心足底皮肤脱屑，1-2月发生指趾甲营养不良或脱落等。
疱疹性咽颊炎
疱疹性咽峡炎一般出现于感染病毒3天到7天后，通常会有发热。因为口腔内有疱疹的关系，会有咽痛和吞咽困难。在小年龄婴幼儿中，常会出现流口水，拒食，呕吐，烦躁不安等情况。疱疹一般出现在口腔的后半部分，比如软腭，腭舌弓，咽峡部，悬雍垂等。先表现为红色的小红点，然后生成周围有红晕的小水疱，之后破溃成边缘发红的小溃疡。但和手足口病不同的是，疱疹和红色皮疹不会出现在口腔粘膜以外的身体皮肤上。
需要注意的是，不是所有感染了这些肠道病毒的人都会有以上所有症状，有些人感染了病毒或许一点症状都没有，却仍可能传染病毒给其他人，就是我们平时说的无症状带毒者或隐性感染者，多见于成人。
1.What Are the Symptoms of HFMD and Herpangina?
HFMD
HFMD usually start 3 to 7 days after catching the infection and it can last from 7 to 10 days. Symptoms usually begin with a common cold, poor appetite, sore throat, a feeling of being unwell, and sometimes may accompany with fever.
A day or two after the fever starts, red spots can develop in the mouth, buccal mucosa, tongue, or throat which may turn to blisters and then ulcers. Since the mouth sores area quite painful, some young children may drooling more his usual and may not be able to swallowing enough liquid, thus might have the risk of dehydration. Small skin rash with flat red spots may also develop on the palms of the hands and soles of the feet. Sometimes a rash also occurs on the knees, elbows, buttocks and nappy area. This rash may also become blisters or bumps with erythema surroundings but won't itch. Symptoms and signs mostly typically resolved within 7 to 10 days with fever subsided, rash faded, and blister dry and crusted.
It has been reported in recent years that Coxsackievirus A6 and A10 HFMD may have higher fever and wider distribution of skin lesions. Apart from hand, foot and mouth, skin rash may involve the arms, legs, face, lips and perioral area, buttocks, groin, and perineum. Skin lesion may be presented as vesiculobullous lesions, bullae, erosions, ulcerations, and eschar formation. The condition may persist as long as one to two weeks. In addition, sometimes palmar and plantar desquamation, nail dystrophy may occur 1 to 3 weeks and 1 to 2 months after HFMD.
Herpangina
Herpangina generally occurs 3 to 7 days after catching the infection and it often cause fever. Sore throat and dysphagia are main complaints due to the painful blisters in the mouth. Infants and young children may present as dribbling, anorexia, emesis, fussiness and irritability. The blisters of Herpangina usually appear at the back of the mouth, such as the anterior pillars of the fauces, soft palate, tonsils, and uvula. The oral lesions start as papules in the mouth and turn to blisters with erythema rim surrounded. The blisters then rupture to small red ulcers. Blisters and papules only occur in the mouth without affecting other part of the body.
Not everyone who catching these enterovirus will get all of these symptoms. Some people, especially adults, may show no symptoms at all, but they can still pass the virus to others.
2. 手足口病和疱疹性咽颊炎分别是什么引起的？
据统计有二十多种肠道病毒可导致手足口病和疱疹性咽颊炎。引起手足口病最常见的病毒是柯萨奇病毒A组的6型、16型，和肠道病毒71型。虽然绝大多数手足口病人会自然痊愈，但极少数会发展为重症，据统计，这些重症病例中有82%是由肠道病毒71型引起的。疱疹性咽颊炎则主要由柯萨奇病毒A组的1-6型，8型，10型和22型所引起。另外，引起手足口病的柯萨奇病毒A组的16型和肠道病毒71型也是疱疹性咽颊炎的常见病原之一。
2. What Are the Causes of HFMD and Herpangina?
There are about 20 serotypes of the Enterovirus A species can lead to HFMD and Herpangina. Coxsackie virus A6, A16 and Enterovirus 71 are the most common virus that caused HFMD. HFMD is a self-limited condition and it rarely causes severe complications. It has been shown that Enterovirus 71 account for 82% of the severe complications in HFMD. Herpangina is mostly caused by Coxsackie virus A1 to 6, 8, 10, and 22. In addition, enterovirus 71 and coxsackievirus A16 are also common cause of herpangina.
3. 手足口病和疱疹性咽颊炎会传染吗？
是的，潜伏期通常是3到5天。手足口病和疱疹性咽颊炎的传播途径多种多样，比如呼吸道和胃肠道。在手足口病人中, 病毒或还可以通过接触水疱液传播。因为在感染者的鼻腔和口腔咽喉部分泌物里，水疱的疱液里，肠道和大便里会存在病毒颗粒。因此，不难想象，手足口病和疱疹性咽颊炎会通过
呼吸道和口腔分泌物传播。比如，咳嗽打喷嚏的唾沫星子,口水，和鼻涕
密切接触，比如亲吻，拥抱，共用餐具，杯具和器皿； 接触到便便， 比如换尿布;
接触已经存在病毒的奶瓶，玩具， 衣物，家具等物品或其表面
接触到疱液(手足口病)。
所以，手足口病在年幼儿童中比较常见有一个原因是在更换尿布或者如厕训练时病毒的播散，并且也和幼儿经常会有吃手的习惯有关。
隐性感染者也是传染途径之一，有些儿童或者成年人虽然感染了手足口病或疱疹性咽颊炎的病毒后没有表现出任何症状，但是仍然可以把病毒传给其他人。
3. Is HFMD and Herpangina Contagious?
Yes. The incubation period is 3 to 7 days usually. The viruses that cause HFMD and Herpangina can be found in the infected person's nose and mouth secretions, blister fluids, or stool. Therefore HFMD and Herpangina are transmitted through the following ways:
• Airway: cough and sneezing droplets, saliva, or nasal discharge
• Close contact：kissing, hugging, or sharing cups and eating utensils
• Contact with stools, for example when changing a diaper,
• Touching objects or surfaces that have the virus on them, such as bottle, furniture, toys, or clothes
• Contact with blister fluid (HFMD)
HFMD is common in young children because of frequent diaper changes and potty training. Also, young child often put their hands in their mouths. Some people, especially adults, may not develop any symptoms, but can still spread the viruses to others.
4. 手足口病和疱疹性咽颊炎严重吗？
虽然手足口病和疱疹性咽峡炎传染性很强，但绝大多数病情都比较轻微，一般在7到10天内，自然痊愈。通常很少见有并发症或重症案例。因为口腔溃疡的疼痛，有些患儿会有几天的时间不愿进食和喝水，所以有时候可能会有脱水的风险。
据统计，只有极少数约1.1%的手足口病患儿可能发展为重症，比如脑膜炎，脑炎，肺水肿，心肌炎等，这些重症病例都是感染了肠道病毒71型。
4. Is HFMD and Herpangina Serious?
Usually not. Although HFMD and Herpangina are contagious, the illnesses are usually mild conditions and nearly most of the patients recover in 7 to 10 days without medical treatment. Complications are uncommon. The pain sores in the mouth may make child eats and drinks unwell for a few days and it may have the risk of dehydration. Rarely, in a very small number of EV 71 infected HFMD cases (1.1%), the virus may involve the brain and cause the infected person viral meningitis and encephalitis
5. 得了手足口病和疱疹性咽峡炎怎么办？
手足口病和疱疹性咽峡炎是一种病毒感染疾病，有自限性的特点，不需要特殊治疗，使用抗生素无效。通常症状和体征会在7-10天内消失。治疗的主要目的在于减轻症状，给予支持治疗，尽可能缓解患儿的不舒适感。换句话说，就是这个活可以全权委托宝宝的免疫系统，不用去管他，自己慢慢会好的。我们可以做的，就是做好宝宝的后勤支持工作，尽量让宝宝舒服些。
吃吃喝喝对宝宝来说是个头等大事啊，但是因为口腔溃疡的疼痛和发热生病的不适感，宝宝会不愿意进食或喝水。这个时候呢，我们要适当鼓励孩子尽量多饮水或其他液体，也可以频繁地小口啜吸，保证宝宝摄入足够的液体，以防止脱水。这里小编列出来几点小贴士鼓励宝宝进食并减少进食和饮水时的疼痛：
冷的食物和液体，比如可以给宝宝吮吸棒冰或冰沙，吃冰激凌，或喝冷的饮料诸如冷牛奶，冰水或果汁。担心宝宝吃冰容易拉肚子的可以采取少量摄入的方法，当宝宝感觉疼痛不适减轻时可以接着给予准备好的常温食物或液体。
比较软的，容易吞咽不需要咀嚼食物，比如布丁，奶冻等，当然在低龄儿童中要注意防止窒息风险；
温盐水漱口；
避免酸性的食物及饮料，比如柑橘类水果，果汁，以及苏打水；
避免咸的，辣的或其他刺激性的食物。
对于有疼痛和发热的孩子，还可以使用退热镇痛药，比如泰诺或美林来缓解不适，不过在有脱水的情况下应先纠正脱水。
另外，不要刺破或挤压手心和足底，或身体其他部位的水疱，应该让其自然干结。
5. How To Treat HFMD and Herpangina?
There is no specific treatment for HFMD or Herpangina. There are viral diseases and antibiotics will not work on them. Symptoms and signs usually clear up in 7 to 10 days. Treatment is aim to ease symptoms and make the person as comfortable as possible until it resolved.
The pain sores in the mouth, fever, and a feeling of being unwell may make child reluctant to eat and drink. Encourage the child drink fluid, even frequent sip of drinks to prevent dehydration. Tips for eating and drinking more tolerable are as follows:
·Have cold food and beverages, for example, suck on ice pops or ice chips, eat ice cream or sherbet, drink milk or ice water.
·Eat soft foods that don't require much chewing, such as pudding and custard. Be aware the choking hazard in younger children.
·Rinse the mouth with warm salt water.
·Avoid acidic foods and beverages, such as citrus fruits, fruit drinks and soda.
·Avoid salty or spicy foods.
Fever reduces and pain killers, such as Tylenol, Panadol, Advil, or Motrin can be used to relieve the pain, fever and general discomfort. However, these medicine should be avoided in children with dehydration until it has been corrected.
In addition, remember to leave the blisters to dry naturally. Do not pierce or squeeze them.
6. 我的孩子得过手足口病和疱疹性咽峡炎了，还会再得吗？
是的。现在发现大约有二十多种病毒可以导致手足口病和疱疹性咽峡炎，宝宝感染手足口病以后只是对引起此次感染的这种肠道病毒或柯萨奇病毒产生一定的免疫力，并不是对其他的相关病毒有抵抗力，所以比较郁闷的事实是完全有可能感染手足口病不止一次，但是病毒的相似性会帮助免疫系统更快更好地在下一次感染的战役中取得胜利。
6. Can My Child Get HFMD and Herpangina More Than Once?
Yes. There are about 20 viral strains that can cause HFMD and Herpangina. Even though a child can develop immunity to the specific virus after infection, that he infected, he will get the disease again if he encounter another strain.
7. 手足口病和疱疹性咽峡炎可以预防吗？
可以通过注意手的卫生，切断病毒的传播途径来预防，另外目前肠道病毒71型引起的手足口病还可以通过接种疫苗来预防。
切断传播途径
洗手：饭前便后要洗手，宝宝和爸爸妈妈都要记住要经常用肥皂和流动的水洗手，每次至少二十秒。特别是大小便或更换尿布前后，准备食物或进食以前，以及外出回家后。
培养良好的个人卫生习惯：避免用没有洗过的手接触眼睛，鼻子和嘴巴，比如吃手，揉眼睛，抠鼻子等。咳嗽和打喷嚏时要遮住口和鼻子，可以用一次性纸巾或胳膊肘。因为成人也有可能感染手足口病的病毒，而且因为免疫力比儿童强所以往往是无症状的隐性感染者，所以也要注意培养良好的个人卫生习惯，避免成为传染源。另外，要带宝宝在别人咳嗽喷嚏时尽量避开。
消毒经常接触的物品表面和公共区域，比如餐桌，料理台，玩具，家具和门把手之类：因为宝宝探索世界爱到处摸，一不注意还会放进嘴里尝尝。病毒可以在这些物品上生存数天，所以可以先用肥皂和水，然后用稀释的含氯漂白剂和水擦洗。
手足口病流行的高峰期尽量避免带宝宝去人流密集，空气流通差的公共场所。 在家里也要注意开窗通风。
隔离确诊的手足口病患者： 避免密切接触2周以上 （比如亲吻拥抱，共用杯具，餐具， 毛巾等）。确诊的手足口病患儿，应该隔离在家2周后并且水疱干结为止才能返校。
不要故意去挤破或戳破水疱：因为疱液具有传染性，而且挤破会有继发感染的风险。
肠道病毒71型疫苗接种 （EV71）
从2016年的上半年开始，全球首个手足口病疫苗---由中国自主研发的EV71疫苗，在全国各地陆续上市了。值得注意的是，这个疫苗主要预防肠道病毒EV71所引起的手足口病，将会降低患重症，危重症手足口病的危险和住院率，但并不能预防其他肠道病毒所引起来的手足口病。
那么，问题来了，为什么这个疫苗只针对肠道病毒71型呢？为什么不能覆盖所有的引起手足口病的病毒呢！？ 因为肠道病毒71型所引起的手足口病是相对最严重的，引起重症手足口病风险最高的类型。统计发现，重症病例中82%和死亡病例中的93%都是这个类型病毒所引起来的。另外，引起手足口病的病毒类型较多，很难在短期内研发出针对每一型病毒的疫苗。
EV71疫苗目前属于二类疫苗，是自费接种的，接种对象为6个月到5岁的孩子，一共接种2次，间隔一个月。最好在1岁以前完成接种，在易感的年龄早日获得保护性。
7. Can HFMD and Herpangina Be prevented?
You can reduce the chance of passing on HFMD and Herpangina by practicing good hygiene and teaching your child how to keep away from the virus. In addition, Entervirus 71 HFMD can be prevented from vaccination now.
Prevent the Spread
∙Wash hands: keep in mind to wash the hands often with soap and water for 20 seconds, especially after using the toilet or changing diapers and before preparing food, eating and when back to home.
∙Good hygiene. Avoid touching eyes, nose and mouth with unwashed hands. Cover the nose and mouth when cough and sneezing.
∙Disinfect frequently touched surfaces and common areas, such as toys, doorknobs. First with soap and water then with diluted solution of chlorine bleach and water because the virus can live on these objects for days.
∙Separate people who are infected. Avoid close contact (kissing, hugging) . Not to share cups, eating utensils, towels etc for several weeks. Children who get HFMD should stay home from school, kindergarten, child care or play group for 2 weeks and until all the fluid in the blisters has dried.
∙Do not deliberately pierce blisters, as the fluid is infectious.
EV 71 Vaccination
In 2016, a new vaccine, targets enterovirus 71, has been available on the market in China. It is a China developed shots which can effectively prevent enterovirus 71-associated disease as well as hospitalizations of the severe HFMD. However, it should be noted that this vaccine will only help protect against Entervirus 71 HFMD.
作者：澳大利亚墨尔本大学医学院儿科博士
百汇医疗（中国）儿科医师
蒋本然
延伸阅读
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