Chinese guidelines for the diagnosis and treatment of hand, foot and mouth disease (2018 edition)
- 171 Downloads
Hand, foot, and mouth disease (HFMD) is a common infectious disease in childhood caused by an enterovirus (EV), and which is principally seen in children under 5 years of age. To promote diagnostic awareness and effective treatments, to further standardize and strengthen the clinical management and to reduce the mortality of HFMD, the guidelines for diagnosis and treatment have been developed.
National Health Commission of China assembled an expert committee for a revision of the guidelines. The committee included 33 members who are specialized in diagnosis and treatment of HFMD.
Early recognition of severe cases is utmost important in diagnosis and treatment of patients with HFMD. The key to diagnosis and treatment of severe cases lies in the timely and accurate recognition of stages 2 and 3 of HFMD, in order to stop progression to stage 4. Clinicians should particularly pay attention to those EV-A71 cases in children aged less than 3 years, and those with disease duration less than 3 days. The following indicators should alert the clinician of possible deterioration and impending critical disease: (1) persistent hyperthermia; (2) involvement of nervous system; (3) worsening respiratory rate and rhythm; (4) circulatory dysfunction; (5) elevated peripheral WBC count; (6) elevated blood glucose and (7) elevated blood lactic acid. For treatment, most mild cases can be treated as outpatients. Patients should be isolated to avoid cross-infection. Intense treatment modalities should be given for those severe cases.
The guidelines can provide systematic guidance on the diagnosis and management of HFMD.
KeywordsDiagnosis Guidelines HFMD Treatment
The Chinese version of this Guideline was published in the June issue of Chin J Infect Dis in 2018. We acknowledge the editing assistance of the English version of HFMD guidelines from Stephen Toovey, MD, PhD, and Jim Wu PhD, and also thank Mi Yao and Zhi-Jie Xu for translation support.
LXW, NX, QSY: contributed equally to this guideline. All the other authors confirmed the final version of the guideline.
The National Clinical Key Department of Infectious Diseases; The Key Medical Specialty Program of Sailing Plans organized by Beijing Municipal Administration of Hospitals (No. ZYLX201602)
Compliance with ethical standards
Conflict of interest
No financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.
- 1.Zhang SB, Liao H, Huang CH, Tan QY, Zhang WL, Huang Y, et al. Serum types of enterovirus and clinical characteristics of 237 children with hand, foot and mouth disease in Shenzhen. Chin J Contemp Pediatr. 2008;10:38–41 (in Chinese).Google Scholar
- 4.Zhou HT. Epidemiological and clinical characteristics of hand, foot and mouth disease in Guangdong Province during 2009–2013. South Med Univ. 2014.Google Scholar
- 5.Yang YP, Chen MM, Ju Y, Wang J, Huang J, Tan Y. Epidemiology and pathogen distribution of hand-foot-mouth disease in Guangxi, 2008–2014. Appl Prev Med. 2015;21:365–8.Google Scholar
- 6.Chen GP, Shi YL, Zhang J, Cao MH, Wu JB, Hu WF, et al. Analysis of the epidemiological characteristics of hand-foot-and-mouth disease in Anhui Province between 2008 and 2014. Mod Prev Med. 2016;43:588–90.Google Scholar
- 8.Zhang C. The study of epidemiology and influencing factors of hand, foot and mouth disease in Guangxi Province from, 2008 to 2015. Guangxi Med Univ J. 2016:1–69 (in Chinese).Google Scholar
- 12.Wu J, Cheng YB, Li ZF, Li YF, Li YP, Xu HM, et al. Evaluation of adrenocortical function in children with severe and critical enterovirus 71 infection. Chin J Pediatr. 2012;50:249–54 (in Chinese). Google Scholar
- 16.Hu J, Shi XH, Tang Y, Ge XH, Yu Y, Yang J, et al. Analysis of course of 94 cases of severe hand, foot and mouth disease complicated with viral meningitis encephalitis. Acta Univ Med Nanjing (Nat Sci). 2009;29:1616–8 (in Chinese).Google Scholar
- 22.Clinical Experts Group of the Ministry of Health for Hand, Foot and Mouth Disease. Experts consensus on rescue and treatment of severe cases with enterovirus 71 (EV71) infection. Zhonghua Er Ke Za Zhi. 2011;49:675–8 (in Chinese). Google Scholar
- 23.Wang XW, Zhong TY, Tian Y. Analysis of myocardial zymogram in children with severe hand, foot and mouth disease. Med J Nat Defending Forces Southwest China. 2009;19:1001–2 (in Chinese). Google Scholar
- 24.National Health and Family Planning Commission of the People's Republic of China. Guideline for the diagnosis and treatment of hand, foot and mouth disease (2010 Edition). http://www.nhfpc.gov.cn/yzygj/s3593g/201306/6d935c0f43cd4a1fb46f8f71acf8e245.shtml. Accessed 15 Apr 2017.
- 27.Jin L, Huang XM. HFMD rash and the identification. Med Recapitulate. 2012;18:1680–3. Google Scholar
- 30.Lu GP. Diagnosis and treatment of neurogenic pulmonary edema in children with severe hand, foot and mouth disease. Chin Pediatr Emerg Med. 2011;18:8–10 (in Chinese). Google Scholar
- 31.Mao YY, Yao JH, Cao LF, Wang QL, Chen LH, Si MQ. Analysis of the treatment response and prognosis of severe hand-foot-mouth disease. Chin J Infect Dis. 2009;27:35–8 (in Chinese). Google Scholar
- 32.Huang T, Li QF, Shen XL, Fu XQ, Cun JP. Analysis of the risk factors for severe hand-foot-and-mouth disease (HFMD) in Yunnan Province. Mod Prev Med. 2017;44:1115–9.Google Scholar
- 34.Huang Y. Curative effect observation on recombinant human interferon α2b Spray in hand-foot-and-mouth disease. China Pract Med. 2014;9:47–8 (in Chinese). Google Scholar
- 35.Lin H, Huang L, Zhou J, Lin K, Wang H, Xue X, et al. Efficacy and safety of interferon-α2b spray in the treatment of hand, foot, and mouth disease: a multicenter, randomized, double-blind trial. Adv Virol. 2016;161:1–8.Google Scholar
- 37.Wei CH. Clinical and Virological Efficacy of Recombine Human Interferon α-2b for Hand-foot-mouth Disease in Children. Eval Anal Drug-use Hosp China. 2013;13:1018–20 (in Chinese). Google Scholar
- 38.Zong WY. Observation of the effects of adjunctive therapy of recombinant human interferon α2b Spray on hand, foot and mouth disease. Hebei Med J. 2011;33:2808–9 (in Chinese). Google Scholar
- 40.Tan J, Wang WM, Lei KJ. Gamma globulin intravenous drip combined with interferon aerosol inhalation on severe hand, foot and mouth disease in children. J Pediatr Pharm. 2017;23:21–3.Google Scholar
- 41.Zhang XD, Tian YK, Xiong F, Mou DL, Wang W. Clinical observation of recombinant human interferon α-2b injection by aerosol inhalation in treatment of hand-foot-mouth disease of children. Drugs Clin. 2014;29:404–7 (in Chinese). Google Scholar
- 42.Zeng JS, Qian SY. Characteristics and diagnosis and treatment for severe hand foot and mouth disease. Chin J Crit Care Med. 2008;28:752–3 (in Chinese). Google Scholar
- 43.Li YL, Wang WH, Yang HR. Efficacy observation on the treatment of hand foot mouth disease by Multi-channel application of interferon α-2b. Tianjin Med J. 2013;41:78–9 (in Chinese). Google Scholar
- 44.Xu Y, Li Y, Chen Y, Xin S, Xie L, Liang Y, et al. A multicenter and contrasted clinical study on efficacy and safety of recombinant human interferon α2b spray in the treatment of hand-foot-and-mouth disease in kids. Chin J Infect Dis. 2018;36:101–7 (in Chinese).Google Scholar
- 51.Zhu FC, Meng FY, Li JX, Li XL, Mao QY, Tao H, et al. Efficacy, safety, and immunology of an inactivated alum-adjuvant enterovirus 71 vaccine in children in China: a multi centre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2013;381:2024–32. CrossRefPubMedCentralGoogle Scholar