The causative agent :

Enteroviruses are small RNA viruses divided into 5 groups and many types, including Polioviruses (3 types), Coxsackieviruses A (23 types), Coxsackieviruses B (6 types), ECHO viruses (31 types), and Enteroviruses (4 types, EV-68 to EV-71).

Mode of Transmission :

• Enteroviruses enter the body via ingestion and they are shed in the faeces and from the oropharynx.
• Young children are its main target and reservoir but adults can also be infected.
• The viruses are readily transmitted by the faecal-oral route but can also be spread by direct contact with respiratory secretions.

Clinical Manifestation :

• Enteroviral infections are mostly mild.
• Hand-foot-mouth disease (HFMD) is one of the common presentation of enterovirus infections. It might be associated with fever lasting for 4-5 days, painless bubbles and rash at hand, foot and buttock. Painful ulcers are present in the mouth and around the tongue, causing difficulties in swallowing. The condition usually last for 7-10 days.
• More severe complications are rare, but include aseptic meningitis, encephalitis, myocarditis and acute flaccid paralysis.

Preventive measures :

Personal hygiene is most important in avoiding the acquisition and transmission of enterovirus infection.

1. Wash hands thoroughly before eating, after going to the toilet or handling nappy/excreta.
2. Cover mouth and nose when coughing or sneezing.
3. Clean thoroughly surfaces of toys and other appliances.
4. If a child is suffering from HFMD/herpangina,
   • he/she should stay at home, take adequate rest until the illness is over;
   • refrain from going to school or day-care centres until the illness is over;
   • avoid sharing of eating utensils among household members;
   • attend Accident and Emergency Department or consult a doctor when the child has any of the following conditions :
     • persistent high fever;
     • repeated vomiting and poor feeding;
     • extreme tiredness and sleepiness;
     • irritability;
     • abdominal distension;
     • urine retention;
     • shortness of breath;
     • fast heart beat or pulse (>160/min.);
     • unsteady gait or limb weakness;
     • muscle jerks;
     • abnormal eye movement;
     • cold sweating and poor circulation.
   • observe closely for similar symptoms or signs among other children of the household and consult a doctor as soon as possible when they arise.