什么是手足口病？
最近安徽阜阳爆发流行手足口病，到5月2日感染病例已经上升到3321例，已经死亡22例，据报道，湖北浙江香港澳门都相继出现感染病例，那么什么是手足口病，又怎么预防呢？
简单的说，手足口病（hand, foot, and mouth disease, HFMD）是常见的儿童疾病，特点是发热，口疮引发的口腔里的疼痛，皮疹水泡，一般多位于手和脚掌，这就是这个疾病名称的由来。一般感染儿童先发烧，食欲下降，然后出现口疮，之后出现皮疹，除了手脚掌外，臀部和生殖器部位也会出现皮疹。有些病例可能只有口疮，并不出现手脚的病变。
人们很容易从名字上把这个病和口蹄疫混淆，口蹄疫是发生的牛羊猪身上的疾病，和这个手足口病完全不同。引发手足口病的是一组肠道病毒，一般常见的是柯萨奇病毒A16，这次安徽阜阳发生的手足口病是肠道病毒EV71。
通常手足口病并不严重，如果是常见的柯萨奇病毒A16感染，表现很轻，一般无需治疗，7到10天可自愈。而EV71感染则要严重的多，可能引发无菌性脑膜炎，脑炎，和脊髓灰质炎类似的症状，就是看着像是得了小儿麻痹。EV71引发的脑炎可能是致命的。
手足口病中度传染，卫生部刚刚把这个病列入到传染病直接通报系列，传播途径是典型的粪-手-口传播，口腔排泄物，包括唾液，溃疡分泌物都具有传染性，传染是人-人传播，并不通过动物中介。被感染的儿童，潜伏期是3到7天，发热一般是首发症状。10岁以下儿童是易感人群，但成年人也能被感染，基本上讲，在流行区域，每个人都处于危险之中。
临床诊断并不难，确诊则需要病毒学诊断。目前没有有效的治疗方法，一般是对症处理，治疗并发症。1998年台湾发生了同样的手足口病流行，根据文献的报道，台湾长庚医院儿科诊断了177例EV71感染的手足口病，32%的患儿出现并发症，包括无菌性脊髓炎，脑炎，脑脊髓炎，12例患儿出现致命性肺水肿，全部死亡，还有2例死于脑炎。
良好的卫生习惯能有效预防手足口病，包括频繁洗手，特别是在接触患儿之后，包括换尿布后，对可能受到感染的物体，要用肥皂和水清洗，然后用稀释的漂白粉水消毒。出现流行后，要避免孩子们的接触，托儿所和学校要相应的关闭，这样能最大限度的减少疾病的传播，不知道阜阳是否做到了这一点。
查阅相关英文资料可以用hand, foot, and mouth disease, 或HFMD，这里列出的文献是台湾新加波等地的经验报道，供医生们参考。
· Chang LY, Lin TY, Huang YC, Tsao KC, Shih SR, Kuo ML, et al. Comparison of enterovirus 71 and coxsackie-virus A16 clinical illnesses during the Taiwan enterovirus epidemic, 1998. Pediatr Infect Dis J. Dec 1999;18(12):1092-6. [Medline].
· Chong CY, Chan KP, Shah VA, Ng WY, Lau G, Teo TE, et al. Hand, foot and mouth disease in Singapore: a comparison of fatal and non-fatal cases. Acta Paediatr. Oct 2003;92(10):1163-9. [Medline].
· Ahmad K. Hand, foot, and mouth disease outbreak reported in Singapore. Lancet. Oct 14 2000;356(9238):1338. [Medline].
· Chan KP, Goh KT, Chong CY, Teo ES, Lau G, Ling AE. Epidemic hand, foot and mouth disease caused by human enterovirus 71, Singapore. Emerg Infect Dis. Jan 2003;9(1):78-85. [Medline].
· Chan YF, AbuBaker S. Recombinant human enterovirus 71 in hand, foot and mouth disease patients. Emerg Infect Dis. Aug 2004;10(8):1468-70. [Medline].
· Chang LY, King CC, Hsu KH, Ning HC, Tsao KC, Li CC, et al. Risk factors of enterovirus 71 infection and associated hand, foot, and mouth disease/herpangina in children during an epidemic in Taiwan. Pediatrics. Jun 2002;109(6):e88. [Medline].
· Chen KT, Chang HL, Wang ST, Cheng YT, Yang JY. Epidemiologic features of hand-foot-mouth disease and herpangina caused by enterovirus 71 in Taiwan, 1998-2005. Pediatrics. Aug 2007;120(2):e244-52. [Medline].
· Chen SC, Chang HL, Yan TR, Cheng YT, Chen KT. An eight-year study of epidemiologic features of enterovirus 71 infection in Taiwan. Am J Trop Med Hyg. Jul 2007;77(1):188-91. [Medline].
· Chen TC, Chen GW, Hsiung CA, Yang JY, Shih SR, Lai YK, et al. Combining multiplex reverse transcription-PCR and a diagnostic microarray to detect and differentiate enterovirus 71 and coxsackievirus A16. J Clin Microbiol. Jun 2006;44(6):2212-9. [Medline].
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‘’安徽阜阳’’EV71’’手足口病‘’
五月 3rd, 2008 at 2:10 下午
明白了,很详尽的一篇文章.
[Reply]
瘦仔猪
reply on 五月 9, 2008:
手足口病中手脚掌附近的水泡是不是有点类似湿疹那样的?
青方好久不见了
我到北京工作了….
[Reply]
qingfang
reply on 五月 9, 2008:
和湿疹是不同的。祝你新工作顺利，以后常交流！
[Reply]
五月 4th, 2008 at 1:02 下午
这是一篇综述的摘要，作者McMinn PC, 来自澳大利亚，发表于FEMS Microbiol Rev. 2002 Mar;26(1):91-107.
Since its discovery in 1969, enterovirus 71 (EV71) has been recognised as a frequent cause of epidemics of hand-foot-and-mouth disease (HFMD) associated with severe neurological sequelae in a small proportion of cases. There has been a significant increase in EV71 epidemic activity throughout the Asia-Pacific region since 1997. Recent HFMD epidemics in this region have been associated with a severe form of brainstem encephalitis associated with pulmonary oedema and high case-fatality rates. The emergence of large-scale epidemic activity in the Asia-Pacific region has been associated with the circulation of three genetic lineages that appear to be undergoing rapid evolutionary change. Two of these lineages (B3 and B4) have not been described previously and appear to have arisen from an endemic focus in equatorial Asia, which has served as a source of virus for HFMD epidemics in Malaysia, Singapore and Australia. The third lineage (C2) has previously been identified [Brown, B.A. et al. (1999) J. Virol. 73, 9969-9975] and was primarily responsible for the large HFMD epidemic in Taiwan during 1998. As EV71 appears not to be susceptible to newly developed antiviral agents and a vaccine is not currently available, control of EV71 epidemics through high-level surveillance and public health intervention needs to be maintained and extended throughout the Asia-Pacific region. Future research should focus on (1) understanding the molecular genetics of EV71 virulence, (2) identification of the receptor(s) for EV71, (3) development of antiviral agents to ameliorate the severity of neurological disease and (4) vaccine development to control epidemics. Following the successful experience of the poliomyelitis control programme, it may be possible to control EV71 epidemics if an effective live-attenuated vaccine is developed.
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五月 6th, 2008 at 2:07 上午
从新闻报道的看，死亡的孩子大多有肺水肿，和1998年台湾的情况非常类似，从台湾的经验分析，这次爆发流行到目前为止仅仅是个开始。新英格兰医学杂志报道的数据，1998年台湾发生129106例，死亡78例，文中估计发病数字远比报道的多，预计有近150万人感染。从最近四川等地的报道看，HFMD正向全国蔓延，因此加强宣传，改善卫生习惯，勤洗手，特别是针对在幼儿园和小学校的儿童。
本人会一直关注这个问题。
[Reply]
五月 6th, 2008 at 11:39 下午
今天新闻里报道，中国感染人数已经超过12000人，死亡26例，北京感染1482例，本人估计，这仅仅是个开始。7，8月份可能达到高峰，继续关注。
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五月 9th, 2008 at 12:53 下午
到5月9日，感染病例上升至24932例，死亡34例，呈现快速上升的势头。
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