初夏已至，气温逐渐攀升，手足口病和疱疹性咽峡炎正悄然增多。这两种疾病都是由多种常见的肠道病毒引起的传染性疾病，多发生于5岁以下的婴幼儿和学龄前儿童。手足口病有很强的传染性，一年四季都可发生，但常见于夏秋季。据统计， 目前有二十多种的肠道病毒可引起手足口病和疱疹性咽颊炎，其中最常见的是柯萨奇病毒A型中的各类亚型。

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.

手足口病的症状一般出现于感染病毒3天到7天后，一周左右自愈， 一般不超过10天。发病早期的表现类似普通的感冒，食欲减退，口腔或咽喉疼痛，浑身不适，有时候可能会伴有发热。

典型的手足口病一般在起病或发烧1到2天后，口腔颊粘膜，舌，或咽喉部会出现小而扁平的红色斑点，并且逐渐发展为小疱疹， 然后破溃形成疼痛的小溃疡。患儿常因嘴里的溃疡疼痛而不愿进食和喝水，小年龄的孩子会有流口水比平时增多。同时手心和脚底会有这些扁平的小红点，有时还会出现在膝盖，肘关节，臀部和肛门周围， 这些皮疹也会发展成小疱疹， 周围有红晕。手足口病的皮疹另一个特点是不会发痒。大多数患儿在一周内体温下降，皮疹逐渐消退, 疱疹也在逐渐干燥结痂，脱痂后不留疤痕。

近年来发现的柯萨奇病毒A6和A10型，可能会伴有比较明显的发热，累及多处和较多的皮疹，除了手，足，口外，还会发生于四肢，面部，口唇，腹股沟，臀部，和会阴区域，还会出现多种皮肤受损，比如水疱大疱性皮损，糜烂，溃疡和焦痂。持续时间会长至1-2周左右。另外，有时候会在手足口病1-3周后出现手心足底皮肤脱屑，1-2月发生指趾甲营养不良或脱落等。

疱疹性咽峡炎一般出现于感染病毒3天到7天后，通常会有发热。因为口腔内有疱疹的关系，会有咽痛和吞咽困难。在小年龄婴幼儿中，常会出现流口水，拒食，呕吐，烦躁不安等情况。疱疹一般出现在口腔的后半部分，比如软腭，腭舌弓，咽峡部，悬雍垂等。先表现为红色的小红点，然后生成周围有红晕的小水疱，之后破溃成边缘发红的小溃疡。但和手足口病不同的是，疱疹和红色皮疹不会出现在口腔粘膜以外的身体皮肤上。

需要注意的是，不是所有感染了这些肠道病毒的人都会有以上所有症状，有些人感染了病毒或许一点症状都没有，却仍可能传染病毒给其他人，就是我们平时说的无症状带毒者或隐性感染者，多见于成人。

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.

据统计有二十多种肠道病毒可导致手足口病和疱疹性咽颊炎。引起手足口病最常见的病毒是柯萨奇病毒A组的6型、16型，和肠道病毒71型。虽然绝大多数手足口病人会自然痊愈，但极少数会发展为重症，据统计，这些重症病例中有82%是由肠道病毒71型引起的。疱疹性咽颊炎则主要由柯萨奇病毒A组的1-6型，8型，10型和22型所引起。另外，引起手足口病的柯萨奇病毒A组的16型和肠道病毒71型也是疱疹性咽颊炎的常见病原之一。

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，潜伏期通常是3到5天。手足口病和疱疹性咽颊炎的传播途径多种多样，比如呼吸道和胃肠道。在手足口病人中, 病毒或还可以通过接触水疱液传播。因为在感染者的鼻腔和口腔咽喉部分泌物里，水疱的疱液里，肠道和大便里会存在病毒颗粒。因此，不难想象，手足口病和疱疹性咽颊炎会通过

• 呼吸道和口腔分泌物传播。比如，咳嗽打喷嚏的唾沫星子,口水，和鼻涕

• 密切接触，比如亲吻，拥抱，共用餐具，杯具和器皿； 接触到便便， 比如换尿布;

• 接触已经存在病毒的奶瓶，玩具， 衣物，家具等物品或其表面

• 接触到疱液(手足口病)。

所以，手足口病在年幼儿童中比较常见有一个原因是在更换尿布或者如厕训练时病毒的播散，并且也和幼儿经常会有吃手的习惯有关。

隐性感染者也是传染途径之一，有些儿童或者成年人虽然感染了手足口病或疱疹性咽颊炎的病毒后没有表现出任何症状，但是仍然可以把病毒传给其他人。

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.

虽然手足口病和疱疹性咽峡炎传染性很强，但绝大多数病情都比较轻微，一般在7到10天内，自然痊愈。通常很少见有并发症或重症案例。因为口腔溃疡的疼痛，有些患儿会有几天的时间不愿进食和喝水，所以有时候可能会有脱水的风险。

据统计，只有极少数约1.1%的手足口病患儿可能发展为重症，比如脑膜炎，脑炎，肺水肿，心肌炎等，这些重症病例都是感染了肠道病毒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