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初夏已至，氣溫逐漸攀升，手足口病和皰疹性咽峽炎正悄然增多。這兩種疾病都是由多種常見的腸道病毒引起的傳染性疾病，多發生于5歲以下的嬰幼兒和學齡前兒童。手足口病有很強的傳染性，一年四季都可發生，但常見于夏秋季。據統計， 目前有二十多種的腸道病毒可引起手足口病和皰疹性咽頰炎，其中最常見的是柯薩奇病毒A型中的各類亞型。

Summer is coming and the temperature is expected to rise gradually. There is an increased incidence of hand, foot and mouth disease (HFMD) and Herpangina. These are two common viral illnesses that mainly affect infants and young children below five years of age. Both of them are contagious and easily spread from one person to another. HFMD and Herpangina can present throughout the year, but usually occur during the summer and fall months in China. They are both caused by about 20 serotypes of the Enterovirus A but particularly the various strains of Coxsackievirus A.

手足口病的癥狀一般出現于感染病毒3天到7天后，一周左右自愈， 一般不超過10天。發病早期的表現類似普通的感冒，食欲減退，口腔或咽喉疼痛，渾身不適，有時候可能會伴有發熱。

典型的手足口病一般在起病或發燒1到2天后，口腔頰粘膜，舌，或咽喉部會出現小而扁平的紅色斑點，并且逐漸發展為小皰疹， 然后破潰形成疼痛的小潰瘍?；純撼Ｒ蜃炖锏臐兲弁炊辉高M食和喝水，小年齡的孩子會有流口水比平時增多。同時手心和腳底會有這些扁平的小紅點，有時還會出現在膝蓋，肘關節，臀部和肛門周圍， 這些皮疹也會發展成小皰疹， 周圍有紅暈。手足口病的皮疹另一個特點是不會發癢。大多數患兒在一周內體溫下降，皮疹逐漸消退, 皰疹也在逐漸干燥結痂，脫痂后不留疤痕。

近年來發現的柯薩奇病毒A6和A10型，可能會伴有比較明顯的發熱，累及多處和較多的皮疹，除了手，足，口外，還會發生于四肢，面部，口唇，腹股溝，臀部，和會陰區域，還會出現多種皮膚受損，比如水皰大皰性皮損，糜爛，潰瘍和焦痂。持續時間會長至1-2周左右。另外，有時候會在手足口病1-3周后出現手心足底皮膚脫屑，1-2月發生指趾甲營養不良或脫落等。

皰疹性咽峽炎一般出現于感染病毒3天到7天后，通常會有發熱。因為口腔內有皰疹的關系，會有咽痛和吞咽困難。在小年齡嬰幼兒中，常會出現流口水，拒食，嘔吐，煩躁不安等情況。皰疹一般出現在口腔的后半部分，比如軟腭，腭舌弓，咽峽部，懸雍垂等。先表現為紅色的小紅點，然后生成周圍有紅暈的小水皰，之后破潰成邊緣發紅的小潰瘍。但和手足口病不同的是，皰疹和紅色皮疹不會出現在口腔粘膜以外的身體皮膚上。

需要注意的是，不是所有感染了這些腸道病毒的人都會有以上所有癥狀，有些人感染了病毒或許一點癥狀都沒有，卻仍可能傳染病毒給其他人，就是我們平時說的無癥狀帶毒者或隱性感染者，多見于成人。

1.What Are the Symptoms of HFMD and Herpangina?

HFMD

HFMD usually start 3 to 7 days after catching the infection and it can last from 7 to 10 days. Symptoms usually begin with a common cold, poor appetite, sore throat, a feeling of being unwell, and sometimes may accompany with fever.

A day or two after the fever starts, red spots can develop in the mouth, buccal mucosa, tongue, or throat which may turn to blisters and then ulcers. Since the mouth sores area quite painful, some young children may drooling more his usual and may not be able to swallowing enough liquid, thus might have the risk of dehydration. Small skin rash with flat red spots may also develop on the palms of the hands and soles of the feet. Sometimes a rash also occurs on the knees, elbows, buttocks and nappy area. This rash may also become blisters or bumps with erythema surroundings but won't itch. Symptoms and signs mostly typically resolved within 7 to 10 days with fever subsided, rash faded, and blister dry and crusted.

It has been reported in recent years that Coxsackievirus A6 and A10 HFMD may have higher fever and wider distribution of skin lesions. Apart from hand, foot and mouth, skin rash may involve the arms, legs, face, lips and perioral area, buttocks, groin, and perineum. Skin lesion may be presented as vesiculobullous lesions, bullae, erosions, ulcerations, and eschar formation. The condition may persist as long as one to two weeks. In addition, sometimes palmar and plantar desquamation, nail dystrophy may occur 1 to 3 weeks and 1 to 2 months after HFMD.

Herpangina

Herpangina generally occurs 3 to 7 days after catching the infection and it often cause fever. Sore throat and dysphagia are main complaints due to the painful blisters in the mouth. Infants and young children may present as dribbling, anorexia, emesis, fussiness and irritability. The blisters of Herpangina usually appear at the back of the mouth, such as the anterior pillars of the fauces, soft palate, tonsils, and uvula. The oral lesions start as papules in the mouth and turn to blisters with erythema rim surrounded. The blisters then rupture to small red ulcers. Blisters and papules only occur in the mouth without affecting other part of the body.

Not everyone who catching these enterovirus will get all of these symptoms. Some people, especially adults, may show no symptoms at all, but they can still pass the virus to others.

據統計有二十多種腸道病毒可導致手足口病和皰疹性咽頰炎。引起手足口病最常見的病毒是柯薩奇病毒A組的6型、16型，和腸道病毒71型。雖然絕大多數手足口病人會自然痊愈，但極少數會發展為重癥，據統計，這些重癥病例中有82%是由腸道病毒71型引起的。皰疹性咽頰炎則主要由柯薩奇病毒A組的1-6型，8型，10型和22型所引起。另外，引起手足口病的柯薩奇病毒A組的16型和腸道病毒71型也是皰疹性咽頰炎的常見病原之一。

2. What Are the Causes of HFMD and Herpangina?

There are about 20 serotypes of the Enterovirus A species can lead to HFMD and Herpangina. Coxsackie virus A6, A16 and Enterovirus 71 are the most common virus that caused HFMD. HFMD is a self-limited condition and it rarely causes severe complications. It has been shown that Enterovirus 71 account for 82% of the severe complications in HFMD. Herpangina is mostly caused by Coxsackie virus A1 to 6, 8, 10, and 22. In addition, enterovirus 71 and coxsackievirus A16 are also common cause of herpangina.

是的，潛伏期通常是3到5天。手足口病和皰疹性咽頰炎的傳播途徑多種多樣，比如呼吸道和胃腸道。在手足口病人中, 病毒或還可以通過接觸水皰液傳播。因為在感染者的鼻腔和口腔咽喉部分泌物里，水皰的皰液里，腸道和大便里會存在病毒顆粒。因此，不難想象，手足口病和皰疹性咽頰炎會通過

• 呼吸道和口腔分泌物傳播。比如，咳嗽打噴嚏的唾沫星子,口水，和鼻涕

• 密切接觸，比如親吻，擁抱，共用餐具，杯具和器皿； 接觸到便便， 比如換尿布;

• 接觸已經存在病毒的奶瓶，玩具， 衣物，家具等物品或其表面

• 接觸到皰液(手足口病)。

所以，手足口病在年幼兒童中比較常見有一個原因是在更換尿布或者如廁訓練時病毒的播散，并且也和幼兒經常會有吃手的習慣有關。

隱性感染者也是傳染途徑之一，有些兒童或者成年人雖然感染了手足口病或皰疹性咽頰炎的病毒后沒有表現出任何癥狀，但是仍然可以把病毒傳給其他人。

3. Is HFMD and Herpangina Contagious?

Yes. The incubation period is 3 to 7 days usually. The viruses that cause HFMD and Herpangina can be found in the infected person's nose and mouth secretions, blister fluids, or stool. Therefore HFMD and Herpangina are transmitted through the following ways:

? Airway: cough and sneezing droplets, saliva, or nasal discharge

? Close contact：kissing, hugging, or sharing cups and eating utensils

? Contact with stools, for example when changing a diaper,

? Touching objects or surfaces that have the virus on them, such as bottle, furniture, toys, or clothes

? Contact with blister fluid (HFMD)

HFMD is common in young children because of frequent diaper changes and potty training. Also, young child often put their hands in their mouths. Some people, especially adults, may not develop any symptoms, but can still spread the viruses to others.

雖然手足口病和皰疹性咽峽炎傳染性很強，但絕大多數病情都比較輕微，一般在7到10天內，自然痊愈。通常很少見有并發癥或重癥案例。因為口腔潰瘍的疼痛，有些患兒會有幾天的時間不愿進食和喝水，所以有時候可能會有脫水的風險。

據統計，只有極少數約1.1%的手足口病患兒可能發展為重癥，比如腦膜炎，腦炎，肺水腫，心肌炎等，這些重癥病例都是感染了腸道病毒71型。

4. Is HFMD and Herpangina Serious?

Usually not. Although HFMD and Herpangina are contagious, the illnesses are usually mild conditions and nearly most of the patients recover in 7 to 10 days without medical treatment. Complications are uncommon. The pain sores in the mouth may make child eats and drinks unwell for a few days and it may have the risk of dehydration. Rarely, in a very small number of EV 71 infected HFMD cases (1.1%), the virus may involve the brain and cause the infected person viral meningitis and encephalitis