1. Hand-foot-and-mouth disease

Control measures:

1. Hand hygiene, diaper changing, and respiratory hygiene

2. Surface disinfection:

   1. ทั่วไป: Sodium hypochlorite at least 500 ppm

   2. ปนเปื้อน: Sodium hypochlorite 5000 ppm

   3. Alcohol ฆ่าไม่ตาย

เกณฑ์ ปิดห้องเรียน 

• ห้องเรียนเดียวกัน มากกว่า 2 คน ภายใน 1 สัปดาห์ > ปิดห้อง 5 วันทําการ 

• มีผู้ป่วยมากกว่า 1 ห้อง > อาจปิด ศูนย์เด็กเล็ก/โรงเรียน/ สถานศึกษาชั่วคราวเป็นเวลาอย่าง น้อย 5 วันทําการ 

• เด็กป่วย: หยุดเรียน 1 สัปดาห์

Vaccine EV71: 6 เดือน- ไม่เกิน 6 ปี

Chickenpox

Diagnosis:

• Clinical: papules, vesicles, crusting, hemorrhagic skin lesions (severe)

• Lab: PCR, serology (IgG, IgM)

Control measures: Airborne and contact precaution

• Case : Isolation until rash crusted 

• Contacts :

  • General: Airborne and contact precaution 

    • at Day 8-21 after exposure

    • at Day 8-28 after exposure in VZIG/IVIG patient

  • Newborn: Airborne and contact precaution until aged 21 days 

    • until aged 21 days 

    • until aged 28 days in VZIG/IVIG patient

Neonate: Can be fed by pumped/expressed milk in mothers those have no lesions on breast

การให้ VZIG

Contacts: Immunity status : Positive

• Documented agedappropriated varicella vaccine

• Laboratory evidence of immunity or laboratory confirmation of disease

• Varicella or herpes zoster diagnosed by a clinician

Contacts: Immunity status : Negative: considered age and availability of medications

• Age > 1 yr: varicella vaccine within 3 - 5 days after exposure

• Preterm newborn (all GA<28, GA> 28 with maternal un-documented immune status), 

  • newborn with mother onset 5 before & 2 after delivery, pregnancy, immuno-compromised host: 

  • ต้องให้ VZIG/IVIG within 10 days after exposure

• Contacts those can not receive vaccine & VZIG: 7-day oral acyclovir (or valacyclovir) day 7 after exposure

PEP vaccine efficacy

• < 3 days : > 90%

• < 5 days : 70%

• Modification of severity: 100%

Zoster

Zoster:

• Disseminated (both immunocompromised/competent) : Airborne and contact precaution Localized:

• Compromised: Airborne and contact precautions until disseminated lesion be ruled out

• Competent: standard precaution

Influenza

• Causative organism : Influenza viruses type A,B,C

• Incubation period : 1-4 days (mean 2 days)

• Route of transmission : mainly droplet, direct/indirect contact

• Contagious period : 1 day before until 7 days after onset (peak 1-3), long-lasting 10 days in young children & immuno-compromised host

• Asymptomatic infection: can spread virus to contacts

• Diagnosis:

  • Commercial tests: Ag detection

  • RT-PCR, IFA, cell culture: NP → best yield, combined midturbinate & throat → increase yield, ETT suction

• Other specimens: blood, CSF, urine, stool: not used for routine

• Control measures:

  • Standard with droplet precaution

  • Direct/indirect contact precaution

• In close settings: boarding school, prison, military camp → isolation 7 days (contagious phase)

• Cocooning immunity

Chemoprophylaxis:

• not be substituted for immunization

• Simultaneously with LAIV → not OK, but OK with IIV not recommended for infants < 3 months

Contact with infected individual: Recommended duration is 7 days after last known exposure

In outbreak situation: minimum of 2 weeks and continuing up to 1 week after the last known case was identified

Measles

Who Are Pregnant or Immunocompromised