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Hand Foot and Mouth Disease Information

7 months ago

Hand, Foot, and Mouth Disease


Description

Hand, foot, and mouth disease (HFMD) is a common viral illness of infants and children. The disease causes fever and blister-like eruptions in the mouth and/or a skin rash. HFMD is often confused with foot-and-mouth (also called hoof-and-mouth) disease, a disease of cattle, sheep, and swine; however, the two diseases are not related-they are caused by different viruses. Humans do not get the animal disease, and animals do not get the human disease.

Illness

  • The disease usually begins with a fever, poor appetite, malaise (feeling vaguely unwell), and often with a sore throat.
  • One or 2 days after fever onset, painful sores usually develop in the mouth. They begin as small red spots that blister and then often become ulcers. The sores are usually located on the tongue, gums, and inside of the cheeks.
  • A non-itchy skin rash develops over 1-2 days. The rash has flat or raised red spots, sometimes with blisters. The rash is usually located on the palms of the hands and soles of the feet; it may also appear on the buttocks and/or genitalia.
  • A person with HFMD may have only the rash or only the mouth sores.

Cause

  • HFMD is caused by viruses that belong to the enterovirus genus (group). This group of viruses includes polioviruses, coxsackieviruses, echoviruses, and enteroviruses.
  • Coxsackievirus A16 is the most common cause of HFMD in the United States, but other coxsackieviruses have been associated with the illness.
  • Enteroviruses, including enterovirus 71, have also been associated with HFMD and with outbreaks of the disease.

How It Is Spread

  • Infection is spread from person to person by direct contact with infectious virus. Infectious virus is found in the nose and throat secretions, saliva, blister fluid, and stool of infected persons. The virus is most often spread by persons with unwashed, virus-contaminated hands and by contact with virus-contaminated surfaces.
  • Infected persons are most contagious during the first week of the illness.
  • The viruses that cause HFMD can remain in the body for weeks after a patient's symptoms have gone away. This means that the infected person can still pass the infection to other people even though he/she appears well. Also, some persons who are infected and excreting the virus, including most adults, may have no symptoms.
  • HFMD is not transmitted to or from pets or other animals.

Factors That Increase the Chance for Infection or Disease

  • Everyone who has not already been infected with an enterovirus that causes HFMD is at risk of infection, but not everyone who is infected with an enterovirus becomes ill with HFMD.
  • HFMD occurs mainly in children under 10 years old but can also occur in adults. Children are more likely to be at risk for infection and illness because they are less likely than adults to have antibodies to protect them. Such antibodies develop in the body during a person's first exposure to the enteroviruses that cause HFMD.
  • Infection results in immunity to (protection against) the specific virus that caused HFMD. A second case of HFMD may occur following infection with a different member of the enterovirus group.

Diagnosis

  • HFMD is one of many infections that result in mouth sores. However, health care providers can usually tell the difference between HFMD and other causes of mouth sores by considering the patient's age, the symptoms reported by the patient or parent, and the appearance of the rash and sores.
  • Samples from the throat or stool may be sent to a laboratory to test for virus and to find out which enterovirus caused the illness. However, it can take 2-4 weeks to obtain test results, so health care providers usually do not order tests.

Treatment and Medical Management

  • There is no specific treatment for HFMD.
  • Symptoms can be treated to provide relief from pain from mouth sores and from fever and aches:
    • Pain and fever can be treated with over-the-counter medications (caution: aspirin should not be given to children).
    • Mouthwashes or sprays that numb pain can be used to lessen mouth pain.
  • Fluid intake should be enough to prevent dehydration (lack of body fluids). If moderate-to-severe dehydration develops, it can be treated medically by giving fluids through the veins.

Prevention

  • A specific preventive for HFMD is not available, but the risk of infection can be lowered by following good hygiene practices.
  • Good hygiene practices that can lower the risk of infection include
    • Washing hands frequently and correctly (see Clean Hands Save Lives! ) and especially after changing diapers and after using the toilet
    • Cleaning dirty surfaces and soiled items, including toys, first with soap and water and then disinfecting them by cleansing with a solution of chlorine bleach (made by adding 1 tablespoon of bleach to 4 cups of water)
    • Avoiding close contact (kissing, hugging, sharing eating utensils or cups, etc.) with persons with HFMD

Vaccination Recommendations

  • No vaccine is available to protect against the enteroviruses that cause HFMD.

Complications

  • Complications from the virus infections that cause HFMD are not common, but if they do occur, medical care should be sought.
  • Viral or "aseptic meningitis can rarely occur with HFMD. Viral meningitis causes fever, headache, stiff neck, or back pain. The condition is usually mild and clears without treatment; however, some patients may need to be hospitalized for a short time.
  • Other more serious diseases, such as encephalitis (swelling of the brain) or a polio-like paralysis, result even more rarely. Encephalitis can be fatal.
  • There have been reports of fingernail and toenail loss occurring mostly in children within 4 weeks of their having hand, foot, and mouth disease (HFMD). At this time, it is not known whether the reported nail loss is or is not a result of the infection. However, in the reports reviewed, the nail loss has been temporary and nail growth resumed without medical treatment.

Trends and Statistics

  • Individual cases and outbreaks of HFMD occur worldwide. In temperate climates, cases occur more often in summer and early autumn.
  • Since 1997, outbreaks of HFMD caused by enterovirus 71 have been reported in Asia and Australia.
  • HFMD caused by coxsackievirus A16 infection is a mild disease. Nearly all patients recover in 7 to 10 days without medical treatment.
  • HFMD caused by enterovirus 71 has shown a higher incidence of neurologic (nervous system) involvement. And fatal cases of encephalitis (swelling of the brain) caused by enterovirus 71 have occurred during outbreaks. However, these serious outcomes are still very rare.

 

Head Lice Information

7 months ago

Head Lice Fact Sheet


1. What are head Lice? - Head lice or Pediculus humanus capitis are parasitic insects found on the heads of people. Having head lice is very common.


2. Who is at risk for getting head lice? - Anyone who comes in close contact (especially head-to-head contact) with someone who already has head lice is at risk. Occasionally, head lice may be acquired from contact with clothing (such as hats, scarves, coats) or other personal items (such as brushes or towels) that belong to an infested person. Preschool and elementary-age children, 3-11, and their families are infested most often. Girls get head lice more often than boys, women more than men. In the United States, African-Americans rarely get head lice. Personal hygiene or cleanliness in the home or school has nothing to do with getting head lice.


3. What do head lice look like? - There are three forms of lice: the egg (also called a nit), the nymph, and the adult.


a. Nits are very small, about the size of a knot in thread, hard to see, and are often confused for dandruff or hair spray droplets. Nits are laid by the adult female at the base of the hair shaft nearest the scalp. They are firmly attached to the hair shaft. They are oval and usually yellow to white. Nits take about 1 week to hatch. Eggs that are likely to hatch are usually located within 1/4 inch of the scalp.


b. The nit hatches into a baby louse called a nymph. It looks like an adult head louse, but is smaller. Nymphs mature into adults about 7 days after hatching. To live, the nymph must feed on blood.
c. The adult louse is about the size of a sesame seed, has six legs, and is tan to grayish-white. In persons with dark hair, the adult louse will look darker. Females, which are usually larger than the males, lay eggs. Adult lice can live up to 30 days on a person's head. To live, adult lice need to feed on blood. If the louse falls off a person, it dies within 2 days.


4. Where are head lice most commonly found? - They are most commonly found on the scalp, behind the ears and near the neckline at the back of the neck. Head Lice hold on to hair with hook-like claws found at the end of each of their six legs. Head lice are rarely found on the body, eyelashes, or eyebrows.


5. What are the signs and symptoms of head lice infestation? - Tickling feeling of something moving in the hair. Itching, caused by an allergic reaction to the bites. Irritability. Sores on the head caused by scratching. These sores can sometimes become infected.


6. How did my child get head lice? - Contact with an already infested person is the most common way to get head lice. Head-to-head contact is common during play at school and at home (sports activities, on a playground, slumber parties, at camp). Less commonly, people can get head lice by wearing clothing, such as hats, scarves, coats, sports uniforms, or hair ribbons, recently worn by an infested person. Other ways people could get Head Lice include using infested combs, brushes, or towels or by lying on a bed, couch, pillow, carpet, or stuffed animal that has recently been in contact with an infested person.


7. How is head lice infestation diagnosed? - An infestation is diagnosed by looking closely through the hair and scalp for nits, nymphs, or adults. Finding a nymph or adult may be difficult; there are usually few of them and they can move quickly from searching fingers. If crawling lice are not seen, finding nits within a 1/4 inch of the scalp confirms that a person is infested and should be treated. If you only find nits more than 1/4 inch from the scalp (and don't see a nymph or adult louse), the infestation is probably an old one and does not need to be treated. If you are not sure if a person has Head Lice, the diagnosis should be made by your health care provider, school nurse, or a professional from the local health department or agricultural extension service.


8. How are head lice treated? - The most important step in treating a head lice infestation is to treat the person and other family members with head lice with medication to kill the lice. Wash clothing and bedding worn or used by the infested person in the 2-day period just before treatment is started.


a. Treat the infested person: Requires using an over-the-counter (OTC) or prescription medication. Follow these treatment steps:
(1) Before applying treatment, remove all clothing from the waist up.


(2) Apply lice medicine according to label instructions. If your child has extra long hair (longer than shoulder length), you may need to use a second bottle. Pay special attention to instructions on the bottle regarding how long the medication should be left on and whether rinsing the hair is recommended after treatment. (WARNING: Do not use a creme rinse, or combination shampoo/conditioner before using lice medicine. Do not re-wash hair for 1-2 days after treatment.)


(3) Have the infested person put on clean clothing after treatment.


(4) If a few live lice are still found 8-12 hours after treatment, but are moving more slowly than before, do not retreat. Comb dead and remaining live lice out of the hair. The medicine may take longer to kill lice.


(5) If, after 8-12 hours of treatment, no dead lice are found and lice seem as active as before, the medicine may not be working. See your health care provider for a different medication; follow treatment directions.


(6) Nit (head lice egg) combs, often found in lice medicine packages, should be used to comb nits and lice from the hair shaft. Many flea combs made for cats and dogs are also effective.


(7) After treatment, check hair and comb with a nit comb to remove nits and lice every 2-3 days. Continue to check for 2-3 weeks until you are sure all lice and nits are gone.


(8) If using OTC medication, retreat in 7-10 days.


(9) If using the prescription drug Malathion retreat in 7-10 days ONLY if crawling bugs are found.


(10) Be sure to follow all package instructions.


b. Treat the household: Head lice do not survive long if they fall off a person and cannot feed. You don't need to spend a lot of time or money on housecleaning activities. Follow these steps to help avoid re-infestation by lice that have recently fallen off the hair or crawled onto clothing or furniture.


(1) To kill lice and nits, machine wash all washable clothing and bed linens that the infested person wore or used during the 2 days before treatment. Use the hot water (130°F) cycle. Dry laundry using high heat for at least 20 minutes.


(2) Dry clean clothing that is not washable, (coats, hats, scarves, etc.).
OR


(3) Store all clothing, stuffed animals, comforters, etc., that cannot be washed or dry cleaned into a plastic bag; seal for 2 weeks.
THEN


(4) Soak combs and brushes for 1 hour in rubbing alcohol, Lysol*, or wash with soap and hot (130°F) water.


(5) Vacuum the floor and furniture. The risk of getting re-infested from a louse that has fallen onto a carpet or sofa is very small. Don't spend a lot of time on this. Just vacuum the places where the infested person usually sits or lays. Do not use fumigant sprays; they can be toxic if inhaled or absorbed through the skin.


c. Prevent Re-infestation: Head lice are most commonly spread directly by head-to-head contact and much less frequently by lice that have crawled onto clothing or belongings. As a short-term measure to control a head lice outbreak in a community, school, or camp, you can teach children to avoid playtime and other activities that are likely to spread lice.


(1) Avoid head-to-head contact common during play at school and at home (sports activities, on a playground, slumber parties, at camp).


(2) Do not share clothing, such as hats, scarves, coats, sports uniforms, or hair ribbons.


(3) Do not share infested combs, brushes, or towels.


(4) Do not lie on beds, couches, pillows, carpets, or stuffed animals that have recently been in contact with an infested person.


9. For more information about head lice: http://www.cdc.gov/lice/
This fact sheet provides general information. Please contact your physician and/or veterinarian for specific clinical information related to you or your animal.

Flu Information

7 months ago

The simple steps that Pennsylvanians can take to prevent spreading the flu virus to others are:

  1. Sneeze or cough into a tissue or your sleeve (not your hand).
  2. Keep your hands away from your face and don't touch your mouth, nose, and eyes.
  3. Wash your hands with soap often.  An alcohol-based hand sanitizer will work as well.
  4. Keep frequently used surfaces clean, such as knobs, countertops, and desks.
  5. Stay home from work or school if you do get sick.

The influenza virus can infect a person from two to eight hours after being deposited on the surface of an object.  Additionally, an infected person may be able to infect others from one day before getting sick until up to 24 hours after the symptoms subside.  This is why you are encouraged to keep your child home if your child is sick with a flu-like illness.  These symptoms include fever, body aches, runny or stuffy nose, sore throat, nausea and may also include vomiting or diarrhea.  Children should stay home for at least 24 hours after the fever is gone without the use of fever-reducing medicines.  Because of the risk of Reye's Syndrome, Aspirin products should not be given to children.