Back to school season | 5 common infectious diseases in children in spring, parents must be vigilant!

As the saying goes, "Early spring, early spring, beware of spring plague." In spring, everything comes back to life, the grass grows and the birds fly, and various infectious diseases are also prevalent. Recently, schools have started to open in various parts of the country. Be vigilant about the five common infectious diseases among children.

01

measles

Measles is an acute respiratory infectious disease caused by the measles virus and is a Class B infectious disease among the infectious diseases listed in my country.

The disease is highly contagious and is prone to epidemics in densely populated areas where vaccination is not universal. Measles can occur throughout the year, but the peak season is winter and spring.

Main symptoms: fever, cough, sneezing, runny nose and other upper respiratory tract catarrhal symptoms, conjunctivitis, oral measles mucosal spots and skin maculopapular rashes.

Incubation period: Average 10 to 14 days, but can be extended to 3 to 4 weeks for those who have received measles vaccine.

Susceptible population: The general population is susceptible to the measles virus. Anyone who has never had measles or has not been vaccinated against measles is susceptible.

The disease is mainly prevalent between the ages of 6 months and 5 years. In recent years, some mild measles cases have also been seen in older children and adults. The main reason is that they were not vaccinated against measles or revaccinated as infants, which reduced the level of antibodies in the body and made them susceptible.

Transmission route: Respiratory droplet transmission is the main transmission route, and measles patients are the only source of infection.

The virus mainly exists in the patient's oral, nasal, pharyngeal, and conjunctival secretions. When the patient coughs or sneezes, the virus enters the susceptible person through the mouth, pharynx, nose, or conjunctival membrane with the discharged droplets. Close contacts can also spread the virus through hands contaminated with the virus. Indirect transmission through a third party or clothing is rare.

The typical clinical course of measles can be divided into three stages:

1. Prodromal period: The prodromal period lasts from fever to rash, and generally lasts 3 to 4 days. The main symptoms of the prodromal period are fever, cough, runny nose, conjunctival congestion, photophobia, tearing, etc., and there may be measles mucosal spots (Koplik spots, 0.5-1mm needle-sized gray-white dot-like protrusions on the cheek mucosa, with a red halo outside). Infants and young children may have gastrointestinal symptoms such as vomiting and diarrhea. Some patients may develop a transient rubella-like rash on the neck, chest and abdomen, which disappears within a few hours, called measles prodromal rash.

2. Rash stage: Starting from the 3rd to 4th day of the disease and lasting for about 1 week, a characteristic rash appears. The rash is scattered and initially appears as light red maculopapules of varying sizes, 2 to 3 mm in diameter, and the skin between the rashes is normal.

The rash first appears behind the ears and at the hairline, then on the forehead, face and neck, and then from top to bottom to the trunk and limbs. After 2 to 3 days, it spreads all over the body and finally reaches the palms and soles of the feet. The rash may be accompanied by drowsiness or irritability, even delirium, convulsions, and may also be accompanied by superficial lymph nodes and enlarged liver and spleen.

3. Recovery period: After the rash reaches its peak and lasts for 1 to 2 days, systemic symptoms are significantly alleviated and the rash disappears in the order in which it appeared, with fine skin desquamation when the rash disappears.

The course of disease in patients without complications is generally 10 to 14 days. The main complications are bronchopneumonia, myocarditis and laryngitis, and occasionally encephalitis. The long-term complication is subacute sclerosing panencephalitis.

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02

rubella

Rubella is an acute rash-causing infectious disease caused by the rubella virus. It is a common respiratory infectious disease in children and is classified as a Class C infectious disease in my country's statutory infectious diseases. Rubella rashes come and go quickly, like a gust of wind, hence the name "rubella". Rubella can occur throughout the year, with the highest incidence in winter and spring.

Susceptible population: Generally more common in children, those who have never had rubella are susceptible. During the epidemic period, it is not uncommon for young people, adults and the elderly to get sick. It can be prevalent in kindergartens, schools and other gatherings.

Incubation period: generally 14 to 21 days, average 18 days.

Transmission route: mainly through respiratory droplets, but also through virus-contaminated utensils, clothing and direct contact. Pregnant women infected with rubella virus can pass it to the fetus through the placenta. Both patients and latently infected people are sources of infection. The disease is most contagious on the day of onset and the day before. The virus can be isolated from the patient's oral, nasal, and pharyngeal secretions, as well as blood, urine, etc.

Symptoms: Clinically, it is characterized by low fever, rash, and swollen lymph nodes behind the ears and in the occipital region.

Prodromal period: Short, usually only 1 to 3 days. There are mild upper respiratory tract infection symptoms such as low or moderate fever, headache, loss of appetite, fatigue, sore throat, cough, runny nose, sneezing, conjunctival congestion, etc., which are often ignored because of mild symptoms or short duration.

Rash stage: Usually, the rash appears 1-2 days after the fever. Most of them are scattered maculopapular rashes, but they can also appear as large patches of red skin or pinpoint scarlet fever-like rashes. They start on the face and spread downward quickly, spreading to the neck, trunk and limbs within 24 hours, but the palms and soles of the feet are usually free of rashes. The rash on the face usually subsides before the rash on the lower limbs appears, which usually lasts for 3 days. Some people also call it "three-day measles". After the rash subsides, there is generally no pigmentation or desquamation.

The rash period is often accompanied by low fever, mild upper respiratory tract inflammation, splenomegaly, and superficial lymphadenopathy throughout the body, especially the lymphadenopathy behind the ears, occipital region, and back of the neck, which is most obvious and accompanied by tenderness. The swollen lymph nodes often take several weeks to return to normal.

Rubella is generally mild, with a short course, few complications and a good prognosis. Only a few patients may develop otitis media, pharyngitis, bronchitis, pneumonia, myocarditis, pancreatitis, hepatitis, arthritis, thrombocytopenic purpura, hemolytic anemia, nephrotic syndrome, nephritis, encephalitis, etc.

03

Mumps

Mumps is an acute respiratory infectious disease caused by the mumps virus, which is a Class C infectious disease in my country's statutory infectious diseases. Mumps virus belongs to the Paramyxoviridae family of RNA viruses, mainly invading the parotid glands, and is characterized by fever, swelling and pain in the parotid glands.

The disease can occur throughout the year, with the peak incidence in winter and spring.

Susceptible population: The general population is susceptible, mainly children and adolescents. After infection, they can acquire lasting immunity and few people will develop the disease again.

Incubation period: 14 to 25 days, average 18 days.

Transmission route: through air droplets and saliva of close contact with infected people. Patients and latently infected people are the source of infection, and the disease is most contagious 2 days before onset.

Symptoms: A small number of patients have prodromal symptoms such as fever, headache, fatigue, and decreased appetite. Typical manifestations are fever and parotid swelling centered on the earlobe, with unclear edges and mild tenderness. It starts on one side and then affects the contralateral side. The parotid swelling begins to subside after 3 days and can last for 7 to 10 days.

The virus invades other glands, often causing complications such as meningoencephalitis, orchitis, oophoritis, pancreatitis, etc., and the patient can gain lasting immunity after the illness.

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04

Scarlet fever

Scarlet fever is an acute respiratory infectious disease caused by group A beta-hemolytic streptococci. It is a bacterial disease and is classified as a Class B infectious disease in my country's statutory infectious diseases. It can occur throughout the year, but is more common in winter and spring.

Susceptible population: The general population is susceptible, and it is more common in preschoolers and school-age children.

Incubation period: average 2 to 5 days.

Transmission route: Airborne droplet transmission is the main mode of transmission. The main source of infection is scarlet fever patients, especially from 24 hours before the onset of the disease to the acute stage, through breathing, coughing, sneezing, talking and other ways to produce droplets, which are transmitted through the respiratory tract. Normal people can also carry bacteria (colonization) in the nasopharynx and skin, but without any clinical symptoms. Such people are called carriers. Carriers are contagious to a certain extent.

Symptoms: Clinical manifestations include sudden high fever, sore throat, diffuse congestive punctate rash all over the body, and obvious desquamation after the rash subsides. A small number of patients may develop allergic heart, kidney, and joint damage after the disease.

Prodromal stage: sudden high fever, body temperature can reach 39-40℃, accompanied by chills, headache, sore throat, nausea and vomiting, etc. The soft palate is congested and edematous, and sometimes rice-sized red macules or hemorrhagic spots can be seen, that is, mucosal rash, and purulent changes may be found in the tonsils.

Rash stage: The main feature is the appearance of rash. The typical rash is a dense and uniform dot-shaped red rash the size of a needle tip scattered on the basis of redness and congestion of the skin all over the body. It feels like sandpaper when touched, and all disappears when pressed by hand, but reappears after the pressure is removed. It usually appears on the first or second day of onset, often starting from behind the ears, neck and upper chest, quickly spreading to the trunk, and then to the limbs, often accompanied by itching. There is usually no rash on the palms and soles of the feet, but it may show congestion, and the skin between the rashes is abnormal; the rash is more dense in the skin folds such as elbows and groins, forming a linear shape, called "Pa's line"; the rash is obvious on the cheeks but not around the mouth, forming a "perioral pale circle"; the tongue is covered with white fur, and the tongue papillae are swollen and protrude above the white fur, forming a "strawberry tongue", and after the tongue fur fades, it forms the well-known "bayberry tongue".

Recovery period: The rash usually lasts for 2 to 5 days before fading. The order of fading is the same as the order of rash onset. It may be accompanied by peeling and desquamation. The face and trunk often show bran-like desquamation, and the fingers, palms, and soles show membranous desquamation. The peeling can last for 2-4 weeks.

It may be complicated by suppurative otitis media, sinusitis, mastoiditis, cervical lymphoproliferative tissue inflammation, sepsis, toxic gastroenteritis, hepatitis and acute renal insufficiency, etc. A small number of patients may develop allergic heart, kidney and joint damage after the disease.

05

influenza

Influenza, also known as flu, is an acute respiratory infectious disease caused by influenza virus and is classified as a Class C infectious disease in my country's statutory infectious diseases. Influenza viruses, especially influenza A viruses, are prone to mutation, making the population generally susceptible, and have caused outbreaks around the world many times.

In northern my country, influenza mostly occurs in winter and spring, while in southern China, it can also be prevalent in summer.

Susceptible population: The general population is susceptible. After infection, they will gain a certain degree of immunity to the same subtype, but there is no cross-immunity between different subtypes, so the human body can get sick repeatedly. Patients with low immunity, children under 5 years old, elderly patients over 65 years old, pregnant women, obese people and patients with chronic diseases are prone to severe symptoms.

Incubation period: Influenza has a short incubation period, is highly contagious, and spreads quickly.

Transmission route: mainly through respiratory droplets or aerosols, but can also be transmitted through direct contact or indirectly through virus-contaminated objects. The main source of infection is influenza patients, followed by latently infected people. The disease is most contagious in the first 2 to 3 days.

Symptoms: The main symptoms are severe systemic poisoning symptoms such as sudden high fever, headache, fatigue and body muscle aches, while respiratory symptoms such as sore throat, runny nose and cough are relatively mild. Children may experience gastrointestinal symptoms such as diarrhea and vomiting, which may be complicated by pneumonia, encephalitis, toxic shock, toxic myocarditis, etc.

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06

How to take protective measures for children?

To deal with measles, rubella, mumps, scarlet fever and influenza, protective measures can be taken from three aspects: managing the source of infection, cutting off the transmission route and protecting susceptible groups.

1. During the epidemic season, avoid going to crowded public places or crowded places, pay attention to respiratory isolation, and wear a mask when entering and leaving.

2. Open windows regularly to ventilate the room, pay attention to environmental disinfection, and promote air circulation.

3. Maintain good personal hygiene habits. Wash hands frequently, do not spit, avoid coughing directly at others, dry clothes and quilts frequently, and wash daily necessities and toys in time.

4. Eat a balanced diet and get enough rest.

5. Vaccines are an effective means of preventing infectious diseases. Vaccination can be given to susceptible people and those who have not yet developed the disease. The measles/mumps vaccine is a combined vaccine. Measles, rubella, and mumps represent different vaccine components that can prevent corresponding diseases. The most effective way to prevent influenza is still influenza vaccination. my country currently uses whole virus inactivated vaccines, split vaccines, and subunit vaccines, all of which have good immunogenicity and safety.

Author | Yu Xiaomin, deputy chief physician, Department of Infection and Clinical Microbiology, Beijing Chaoyang Hospital

Review | Gu Li, Director of the Department of Infection and Clinical Microbiology, Beijing Chaoyang Hospital, Chief Physician

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