“To everything there is a season,” and this applies to viruses as well. In the winter, children are confronted with viruses that cause respiratory disease, such as rhinovirus, and gastrointestinal disease, such as norovirus.
In the summer, a group of viruses called enteroviruses appear, which like their wintertime brethren, cause mini-epidemics of disease among children. Enteroviruses begin with non-specific symptoms such as fever, loss of appetite and fatigue. The most notable enterovirus, polio, has thankfully been eliminated from the U.S. and majority of the world. A polio outbreak going on now in Somalia is causing concern in that region.
Since nature abhors a vacuum, two other enteroviruses, enterovirus 71 and coxsackievirus A, typically appear in the summertime. Much of our understanding of the scope of disease caused by these viruses came from an epidemic in Taiwan in 1998.
Children under the age of 5 who develop enteroviruses are the most susceptible to hand foot mouth disease or herpangina. The enteroviruses, coxsackievirus and enterovirus 71, are responsible for most cases of the disease. Patients with hand foot mouth disease (no relation to foot and mouth disease in animals) develop a characteristic rash which begins as flat red spots on the palms and soles and mouth pain. In its most robust form, the lesions will develop into blisters on the palms, soles, and in the mouth. Ultimately, these lesions will break and create open sores prior to healing. Children with herpangina exhibit the mouth lesions without involvement of the hands and soles.
Less commonly, children with enteroviral infections may develop a non-specific rash involving the trunk, abdomen and arms; a gastrointestinal illness with vomiting and diarrhea; or a fever-like illness with no other associated findings.
The vast majority of children with enteroviral infections recover and resume normal activities within 7 to 10 days. No treatment is needed, nor is it available. Significant complications are unusual ( < 1% of those infected) and occur predominately in children infected with enterovirus 71. Encephalitis (infection of the brain) and meningitis (infection of the lining of the brain) with or without lung problems are the most common serious complications. Infections of the heart and a post infectious, polio-like syndrome occur rarely.
Enteroviruses are moderately contagious and are spread by coughing or sneezing, or contact with blister fluid or stool. The virus can remain on surfaces for an extended period of time. Scrupulous washing of the hands can reduce the incidence of infection. Disinfection of counter surfaces and other areas in the house can also reduce infection rates.
There is no vaccine that will prevent infection with enterovirus 71 or coxsackievirus. If your child becomes ill, contact your healthcare provider. Watch closely for changes in how you child interacts with you and the surroundings. Confusion or difficulty with awakening, decreased tolerance for exercise, excessive cough, and inability to tolerate exercise should be evaluated immediately.
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