Prevention Tips for Top Childhood Infectious Diseases

• Respiratory infections are mostly caused by viruses and can spread from person to person through bodily fluids such as saliva or mucus, which is typically transmitted through coughing and sneezing. The disease-causing agents thrive and spread more efficiently during periods of changing weather, especially during the rainy and cool seasons.
• Gastrointestinal infections can occur due to various reasons, with the most common being bacterial or viral infections. These infections most commonly occur through direct or indirect contact with contaminated food and liquids, while transmission commonly happens in the period after schools reopen because children tend to share meals and drinks, or interact without taking proper precautions.

In recent years, there have been reports of dengue fever claiming the lives of both children and adults. Dengue fever is an illness caused by the dengue virus, which is transmitted by mosquitoes. It is commonly found in tropical regions and tends to spike during rainy seasons. Symptoms range from mild ones that are unnoticeable, to a high fever, headache, muscle aches and nausea, and can even involve the risk of fatality if not promptly treated. Additionally, predicting whether the illness will become severe or not is challenging.

Causes of dengue fever

Dengue fever is caused by the dengue virus, which has four serotypes: DENV-1, DENV-2, DENV-3, and DENV-4. It is transmitted through the bite of infected aedes mosquitoes, particularly the female Aedes aegypti. After these mosquitoes feed on the blood of individuals who are infected with the dengue virus in its incubation period and they then bite others, the dengue virus spreads into the bloodstream of the bitten individuals, leading to a viral infection.

Dengue fever symptoms in children

Due to the circulation of all four serotypes of the dengue virus, there are alternating outbreaks on an annual basis, which can lead to individuals suffering multiple infections. In cases of a second infection which arises from a different serotype than the initial infection, symptoms may be more severe. The symptoms of dengue fever are divided into three phases, as follows:

Febrile phase: This phase is characterized by sudden high fever, typically ranging from 39 to 40 degrees Celsius, lasting continuously for 2 to 7 days. During this phase, fever-reducing medications often do not work. Other accompanying symptoms may include:

• Headache
• Pain behind the eyes
• Nausea and vomiting
• Muscle aches
• Loss of appetite
• Joint and bone pain
• Small red or purple spots on the skin
   

Critical phase: Following the febrile phase, patients may enter a critical phase where severe complications can occur, such as shock, loss of consciousness, cardiac arrest and even death. Symptoms during this phase may include:

• Severe abdominal pain (particularly on the right side of the abdomen)
• Persistent nausea and vomiting
• Inability to orally ingest food
• Bleeding from the gums or nose
• Blood in urine or stools, or vomiting blood
• Small spots of blood becoming visible under the skin
• Difficulty breathing
• Fatigue and lethargy
• Unstable blood pressure
• Circulatory collapse or shock, which can be fatal
   

Recovery phase: If the patient does not progress to the critical phase or recovers from it within 1-2 days after the febrile phase, they enter the recovery phase. During this phase, various symptoms start to improve and the body returns to normal functioning. It is a safe phase with the following indicators:

• Fever subsides
• Pulse normalizes
• Ability to urinate independently returns
• Appetite increases
• A faint, white-spotted rash appears on the body

Treating dengue fever

When the doctor confirms a dengue fever diagnosis, treatment begins with the aim of restoring the infected person's body to normalcy as quickly as possible and preventing shock. This includes:

• Administering intravenous fluids or saline solution
• Giving pain relief and fever reducing drugs
• Having the patient drink electrolyte powder to replenish lost fluids
• Giving a blood transfusion in cases of severe bleeding
• Treatment must involve periodic blood tests to monitor for signs of low platelets, low white blood cells, high hematocrit levels or low blood pressure

Preventing dengue fever

• Prevent mosquito bites by using mosquito repellent and wearing long-sleeved shirts
• Eliminate mosquito breeding grounds, especially stagnant or standing water
• Get vaccinated against dengue fever
• Currently, there is a campaign for vaccination against dengue fever, with the latest type of vaccine being highly effective in preventing all strains of dengue fever, offering an efficacy rate of up to 80.2% and preventing severe symptoms by up to 90.4%. The vaccine is administered in two doses three months apart, and can be given to individuals whether or not they previously had dengue fever.

• Influenza, commonly known as the flu, is a respiratory illness caused by influenza viruses. It can present with mild symptoms or progress to severe illness, including pneumonia, depending on the individual's immune response and whether or not they have received the flu vaccine. Influenza is classified into several strains, with the following being the top three strains that are most prevalent in Thailand:

• Influenza Strain A: 

  • Influenza Strain A (H1N1): This strain, which is prevalent during the late rainy season and early cool season, is spread through respiratory droplets, saliva, nasal discharge or any other bodily fluids from an infected person, with coughing and sneezing the most common means of transmission. Symptoms typically appear within 1-3 days and include general symptoms such as headache, body aches, high fever (above 38 degrees Celsius), coughing, vomiting and possibly diarrhea. Those at higher risk, such as the elderly, individuals with underlying health conditions and children, may experience severe symptoms leading to pneumonia.
  • Influenza Strain A (H3N2): This strain is more severe and can easily infect individuals, particularly children and the elderly with weakened immune systems. It may lead to severe illness or even death, with symptoms typically manifesting 1-3 days after infection and including fatigue, weakness, sore throat, coughing, headache, aches and pains, nasal discharge and high fever. 

• Influenza Strain B: 

  • Influenza Strain B (Victoria): Symptoms are generally less severe compared to strain A. This virus thrives well in humid conditions during the rainy season and in the cooler air of winter. Patients may experience muscle aches, headache, fever, phlegmy congestion, sore throat and dry cough.   
  • Influenza Strain B (Yamagata): The virus thrives in cooler conditions, although its symptoms are typically mild, such as headaches, aches and pains, nasal discharge, cough, sore throat and fever.
  • Influenza Strain C: This virus exhibits the mildest symptoms or may even be asymptomatic. It is less likely to spread from person to person. Therefore, vaccination against this strain is not necessary.

• Causes of influenza

• Strains A, B, and C of influenza all thrive in cooler, humid conditions and are found in bodily secretions, including phlegm, nasal discharge, saliva and perspiration.

• Symptoms of influenza

• Once an individual is infected with influenza, there will be a gestation period of 1-4 days before symptoms present. After this, individuals may experience any of the following symptoms:
• A fever higher than 38 degrees Celsius
• Loss of appetite
• Fatigue
• Aches and pains
• Nausea
• Headaches
• Sore throat
• Dry cough
• Runny nose
• Vomiting

• When to seek medical attention

• Patients with influenza may exhibit symptoms with varying degrees of severity. In serious cases or those involving complications arising from underlying conditions, it is crucial to promptly seek medical attention for diagnosis and treatment, especially if patients experience the following:
• High fever exceeding 38 degrees Celsius lasting more than 24-48 hours
• Fever persisting despite taking fever-reducing medication
• Difficulty breathing, chest pain or tightness in the chest
• Cyanosis of fingertips and toes
• Fainting
• Persistent vomiting and an inability to eat
• Symptoms lasting more than 7 days

• Treating influenza

• Treatment for influenza, especially for those with mild symptoms or no complications, typically involves:
• Taking decongestants to alleviate nasal congestion
• Using cough suppressants and expectorants to manage the cough and reduce mucus
• Administering antiviral medications to inhibit viral spread within the body
• Taking antibiotics if there are complications related to the lungs

• Preventing influenza

• Avoid crowded places
• Wear a face mask in crowded areas
• Wash hands frequently
• Avoid touching the face, mouth, nose, or eyes
• Receive the influenza vaccine

RSV, or Respiratory Syncytial Virus to give it its full name, is a type of enveloped virus with two strains: RSV-A and RSV-B. It causes respiratory infections, particularly in young children worldwide, tending to be more prevalent in children under 3 years old. RSV is also prone to outbreaks during the rainy season, from July to September, although it can affect children throughout the year.

Symptoms of RSV

It typically takes about 1 to 2 weeks to recover from RSV. This virus can cause symptoms ranging from mild cold-like symptoms to severe pneumonia, which can be life-threatening. There is also a risk of recurrence, especially in individuals with weakened immune systems. Most childhood cases of RSV infection begin with mild cold-like symptoms, such as low fever, runny nose and coughing. Subsequently, the symptoms may worsen and include the following:

• High fever
• Persistent coughing
• Difficulty breathing and wheezing
• Fatigue
• Refusal to eat
• Refusal to drink water or milk

When to seek medical attention

Children under 2 years old who experience the following symptoms should be taken to see a doctor immediately:

• High fever over 39 degrees Celsius
• Persistent fatigue
• Signs of dehydration such as dry mouth, decreased urination and dark yellow urine
• Severe coughing
• Labored or difficult breathing

Treatment 

Currently, there is no specific treatment for RSV viral infections. Treatment, which is typically focused on managing symptoms, may include:

• Using fever reduction drugs, cough suppressants and expectorants
• In cases of excessive mucus production, nebulization therapy, chest percussion therapy and mucus suctioning may be necessary
• Addressing dehydration by providing intravenous fluids 

Prevention

There are no RSV vaccinations currently available, meaning prevention must be conducted as follows:

• Maintain a strong, healthy body by eating a healthy diet containing the 5 main food groups in moderation, getting plenty of rest and engaging in regular exercise
• Wash hands frequently
• Avoid crowded places

Hand, foot and mouth disease (HFMD) is caused by enteroviruses, commonly including coxsackievirus and enterovirus 71 (EV71). It typically occurs during Thailand’s rainy season and primarily affects children under the age of 5. While symptoms are usually mild and can resolve on their own within 7-10 days, in rare cases severe complications leading to fatality can occur.

Symptoms of HFMD

• Fever
• Fatigue
• Loss of appetite
• Runny nose
• Sore mouth and sore throat
• Refusal to drink milk
• Decreased food consumption
• Red bumps or clear fluid-filled blisters may appear on the tissue inside the mouth, tongue, or gums
• Rashes may develop on the hands and feet, which can later turn into cloudy fluid-filled blisters that may dry up on their own without leaving any scarring

Complications of hand, foot and mouth disease can be severe and life-threatening. Therefore, it is important to be vigilant of symptoms and promptly seek medical attention if:

• Eating becomes difficult
• There is weakness in the arms or legs
• The child appears drowsy
• Seizures develop
• Nerve inflammation is observed
• Brain inflammation is suspected due to severe headache, drowsiness, seizure, or jerky arms or legs
• Blood circulation is abnormal, which could lead to heart failure and death

Treating HMFD

Currently, the treatment of hand, foot and mouth disease is aimed at addressing the symptoms:

• Taking fever-reduction drugs
• Using topical medications to relieve mouth soreness
• Consuming bland foods
• Sipping cool water or electrolyte drinks to prevent dehydration
• Rinsing the mouth with salt water to alleviate inflammation and pain
• Avoiding consumption of acidic fruits, fruit juices, or soda due to their acidity
• Consuming cold items, such as ice, ice cream and yogurt to alleviate pain.

Preventing HMFD

Hand, Foot, and Mouth Disease is transmitted through contact with the virus found in the fecal matter, fluid in blisters on the skin, or respiratory droplets and saliva of infected individuals. The best way to prevent the disease is to adhere to the main principles of personal hygiene:

• Should cases of hand, foot and mouth disease be detected in schools or childcare facilities, it is necessary to close those locations so that deep cleaning can take place
• During outbreaks, parents should avoid taking young children to crowded places or areas with large gatherings
• Wash hands with soap and water or use alcohol-based hand sanitizer before and after eating, and after using the restroom
• Keep fingernails short and maintain overall body cleanliness
• Avoid sharing items such as cups, utensils, towels, dishcloths, and toothbrushes
• Ensure cleanliness of shared items, toys, and living areas with regular cleaning
• Get the hand, foot and mouth vaccine
• There is now a hand, foot, and mouth disease vaccine available that offers protection against infection or reduces the severity of the disease. This vaccine can help prevent enterovirus 71 (EV71) infection, the main cause of severe cases that can lead to fatalities. The vaccine can be administered to children aged 6 months to 5 years, in 2 doses given one month apart.

Norovirus is a virus that causes inflammation of the stomach. It can withstand heat, various disinfectants and even alcohol, while it spreads easily and quickly, often transmitted through contaminated food and liquids. Outbreaks can occur in children throughout the year, especially in winter. Infected children often experience severe diarrhea, nausea and severe vomiting, which can be life-threatening in serious cases.

Symptoms of norovirus

The norovirus typically resides in the upper small intestine for 24-48 hours and presents several symptoms, including:

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Headache
• Fever
• Aches and pains

Treatment: There is no specific medication currently available to treat norovirus, and symptoms generally improve within 3-4 days with supportive care, which may include:

• Drinking electrolyte solutions in case of vomiting and diarrhea
• Consuming bland meals
• Taking anti-nausea and abdominal pain medications
• In cases of dehydration, hospitalization might be necessary to allow intravenous administration of saline and close monitoring of symptoms

Prevention: Prevention is crucial, as the disease spreads easily and rapidly. Measures to prevent the spread of the virus include:

• Washing hands frequently with soap and water for at least 15 seconds, especially after using the bathroom or changing diapers, and before eating
• Avoiding contaminated water and liquids
• Washing fresh fruits and vegetables thoroughly
• Consuming thoroughly cooked foods

Herpangina is an infectious disease caused by the same virus as hand, foot and mouth disease, which belongs to the enterovirus group. However, it presents with different symptoms, only involving sores in the mouth. Patients typically experience symptoms around 4-14 days after being infected (the incubation period of the disease). Infected individuals are capable of spreading the virus from the first day of infection until recovery, which usually takes about 1-2 weeks from the onset of symptoms. Transmission occurs through nasal secretions, coughing, and sneezing.

Symptoms

• An acute high fever of around 39.5 - 40 degrees Celsius, especially in young children
• Older children may complain of headaches and back pain
• Nausea
• Sore throat
• Soreness in the roof of the mouth
• Red spots on the soft palate, uvula, tonsils, or back of the throat
• Within 24 hours, red spots will develop into small red bumps starting at 1-2 millimeters in size, which then turn into fluid-filled bumps sized 2-4 millimeters. There may be small sores in the center of these bumps or there may be inflammation around the bumps.
• Fever typically subsides within 2-4 days, but sores may persist for about 1 week

Treatment: There are no specific medicines to treat herpangina. Treatment is therefore focused on alleviating symptoms, as follows:

• Using fever-reducing and pain-relieving medication
• Applying medication to alleviate pain from sores on the tongue or inner cheeks
• Consuming small but frequent amounts of liquid foods
• Seeking immediate medical attention if food intake is minimal and dehydration symptoms present, such as dry mouth, decreased urination and dark yellow urine

Prevention

Disease prevention is possible by isolating patients, avoiding close contact with unwell individuals and maintaining personal hygiene, as follows:

• Avoid crowded places
• Maintain personal hygiene
• Wash hands thoroughly with soap and water before eating and after using the bathroom

Monkeypox is a disease transmitted from animals to humans. It is particularly prevalent among monkeys, but can also be transmitted from rats, squirrels and rabbits, and can be spread from person to person through close contact with skin or respiratory secretions. There is also a possibility of infection from mother to infant through amniotic fluid or during childbirth. The virus belongs to the same genus as the smallpox and cowpox viruses, with symptoms initially presenting similar to those caused by influenza, followed by the appearance of red spots on the face and body.

Symptoms: Monkeypox typically has an incubation period of 6-13 days, and symptoms are classified into 2 stages:

• Early-stage symptoms of monkeypox (0-5 days): Fever, headache, muscle aches, back pain, fatigue and swollen lymph nodes. The noticeably swollen lymph nodes help distinguish monkeypox from smallpox and chickenpox.
• Rash-stage symptoms of monkeypox (1-3 days after the onset of fever): The rash tends to be more prominent on the face, arms, and legs than on the torso. It can also be found on the hands, feet, inside of the mouth, genitalia, conjunctiva and cornea. The rash starts as red spots, becomes raised bumps, turns into clear fluid-filled vesicles and finally develops into pustules.

When to seek treatmentAlthough monkeypox is generally less severe than other similar diseases and can resolve on its own within 2-4 weeks, cases of mortality have been reported, mostly among pediatric patients. Therefore, if complications occur that may exacerbate the severity of the disease, immediate medical attention is warranted. These complications include:

• Reinfection
• Pneumonia
• Blood infections
• Central nervous system infections
• Vision loss from infections affecting the cornea

Treatment

Patients with monkeypox can recover on their own, so treatment involves supportive care, such as:

• Providing adequate hydration and nutrition
• Preventing complications
• Using antiviral medications such as tecovirimat and cidofovir

Prevention

• Wash hands frequently with soap and water, and use alcohol-based hand sanitizer
• Avoid contact with infected individuals
• Avoid consuming undercooked meat
• Avoid contact with animals that could be carriers, such as rodents and monkeys
• Vaccination against smallpox or cowpox can prevent monkeypox infection

Regardless of whether returning to school for a new term, being stuck at home or going out with parents, children should receive comprehensive healthcare, including being taught about cleanliness and hygiene practices such as eating hot meals, using a central service spoon and washing hands properly. 

Additionally, they should have their immunity boosted by getting all necessary vaccinations, including:

• Dengue fever vaccine
• Influenza vaccine
• Hand, foot and mouth disease vaccine
• Other essential vaccinations according to the national immunization schedul

In order to build immunity, it is important that children eat a balanced diet consisting of all five food groups in moderation, ensure adequate rest with 8 hours of sleep per night, and engage in appropriate physical activity for at least 30 minutes every day. Parents should continue to support their children’s growth and development to help them enter adolescence feeling strong and healthy.