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HFMD is a significant public health concern, particularly in Asia. While the disease is generally mild, severe cases can lead to serious complications. Understanding the epidemiology, clinical manifestations, and prevention strategies is crucial for managing and mitigating the impact of HFMD.
Hand, foot, and mouth disease (HFMD) is a common viral illness that primarily affects children. It is characterized by fever, painful sores in the mouth, and a rash on the hands and feet. The disease is caused by various human enteroviruses, most notably Coxsackievirus A16 (CV-A16) and Enterovirus 71 (EV-A71)1 2 6.
Epidemiology
HFMD is prevalent worldwide but is particularly common in Asia. The disease exhibits seasonal patterns, peaking in summer in temperate regions and having biannual peaks in subtropical areas1 4. In China, HFMD has a significant burden, with millions of cases reported annually4 8. The incidence is highest among children aged 12-23 months4.
Clinical Manifestations
The typical clinical features of HFMD include fever, painful papules, and blisters on the extremities and genitalia, along with ulcerations in the mouth, palate, and pharynx2 7. While the disease is usually mild and self-limiting, severe cases can lead to neurological complications and even death, particularly when caused by EV-A715 6 7.
Atypical Presentations
Recent outbreaks have shown that HFMD can present atypically, especially in adults. These cases, often caused by Coxsackievirus A6, can involve extensive cutaneous disease, vesicobullous and erosive eruptions, and other severe manifestations2 9. Adults may also experience atypical symptoms such as petechial/purpuric eruptions and palmoplantar desquamation2 9.
Complications
Severe HFMD, particularly due to EV-A71, can lead to acute neurological diseases such as encephalitis and acute flaccid paralysis. The disease can also cause cardiopulmonary complications, which are the main causes of death in severe cases5 7. Long-term neurological sequelae are a significant concern, with a substantial burden of long-term complications reported in severe cases5.
Prevention and Management
Preventative measures include good personal hygiene and vaccination. Vaccines targeting EV-A71 have been developed and are crucial in high-risk areas6 7. Treatment is mainly supportive, focusing on hydration and pain relief. Severe cases may require intravenous immunoglobulin7 10. There are no specific antiviral treatments approved for HFMD, although several potential candidates are under investigation7.