At the height of the summer season of 2017, there were reports of the first sick tourists. Until the end of summer, the number of Koksaki virus infected in Turkey increased, but even with the onset of autumn, their numbers, even an approximate one, have not been established. In early August, Rospotrebnadzor opened a hot Internet line, which by the middle of the month had received over 500 messages about infected people. In early September, this figure exceeded 800 complaints, and the NTV channel reported the spread of infection in several regions of Russia.
Ahead of the velvet season. And if schoolchildren have already spent their holidays, then young children will be transported to the sea just right. What to do if tickets are bought, I really want to go to the resort, but the Koksaki virus in Turkey is scary? It is necessary to find out all the data on the hazard, weigh the degree of risk and only then make a decision.
General information
Today, the topic of the disease and the photos of the Coxsackie virus made in Turkey using an electron microscope have become especially popular on foreign sites. This pathogen belongs to enteroviruses, that is, those that are reproduced in the gastrointestinal tract. In the middle of the last century, it was discovered by New York scientists when they were looking for methods of treating poliomyelitis. The viruses recovered from laboratory material in a small settlement in Coxsackie (New York State) were first described, but the diseases caused by them were not known then.
It was later established that these viruses are one of the main factors causing aseptic meningitis. Of the two strains, 23 types of Koksaki A are known, 6 types are known as Koksaki B. Some of them pass without complications, others affect a number of organs and take a severe form. Until today, no one has answered the question, what strain and type of Koksaki in Turkey our tourists are infected. But cases leading to meningitis or other severe forms have not yet been reported.
Virus transmission
Not only sick people spread the infection. The number of healthy carriers with no visible symptoms of the disease is 17–46% of those who came into contact with the infection. Both of these sources for quite a long time, up to 14 days, threaten others with the danger of infection. Therefore, diseases caused by the Koksaki virus can occur not only in the poorest countries, but also in quite prosperous and prosperous ones.
Worldwide prevalence
Koksaki virus in Turkey is not an exceptional phenomenon. Schools in Greece were quarantined in 2002 due to an outbreak of strain B (46 infected). In 2016, the Daily Mail wrote about 17 Britons who got sick while traveling. Every year in the American press there are references to Coxsackie as a seasonal disease. It is worth mentioning that US residents most often make long journeys in Latin America. And this year, the Mexican media reported 394 cases in the country.
But there were two cases of the Koksaki virus epidemic that claimed their lives. Of the 2,600 children infected with tapa A, in Malaysia (1997), 29 died from severe forms and complications. The largest epidemic erupted in eastern China's Shandong province. 2005: 2477 cases and one dead were registered. 2006: 3030 people were infected, one deceased. 2007: more than 800 infected, one child killed. These are official figures. But according to Shandong bloggers, only 2007 killed 26 children.
Given this data, it cannot be argued that the Koksaki virus epidemic has begun in Turkey. So far, these are a few isolated foci of infection that erupted in hotel territories.
The mechanism and transmission paths
Enteroviruses are common throughout the world. The primary source of the virus is feces. The carrier is a person. Ways of infection: through the oral cavity, respiratory tract, transplantally (to the fetus from the mother). It is carried by food, water, objects, tactile contact, by airborne droplets. The means of transmission of the virus is worth considering in more detail.
- The Coxsacky expansion path often begins with unprocessed and uncontaminated organic fertilizers. Traces of fecal fertilizers can cause infection, remaining on poorly washed and consumed raw vegetables, herbs, wild berries.
- Fertilizers and the contents of cesspools with sediments and runoff enter open water bodies. If the environment is infected, the virus, along with water, gets into the nose or mouth during bathing, especially for children. The risk of infection also remains if you use such water to wash dishes or products.
- Handshakes and household items are dangerous provided that after touching them unwashed hands fall into the mouth or they take food (fruits, sweets, cookies, bread) and, again, go into the mouth. This is what children often do.
- In catering, the infection is transmitted through dishes and raw field crops if elementary rules for their processing are not observed.
- Aerosol spread is possible from an already ill person, because the virus, invading and multiplying in the nasopharynx, enters the air during a conversation, sneezing or coughing of the virus carrier.
- Placental infection is allowed, even if the mother did not have Coxsackie symptoms.
Understanding the mechanism of transmission of the virus, we can assume that not only the resort area is dangerous. Even knowing in which hotels in Turkey the Koksaki virus was detected, having escaped them, you can get infected on the way back home: in a bus that collects tourists from all hotels, at the airport, during boarding and even in the cabin.
Infection development
Once in the human body, the Coxsackie virus is introduced and begins to multiply in the submucosa of the intestine and nasopharynx. Then it penetrates and continues to multiply in the group of regional lymph nodes. On average, three days after the introduction, viruses from the lymph nodes through the blood vessels begin to spread to other tissues, where they settle and multiply again. This is the initial and subsequent spread of Coxsackie: movement through the blood channels to organs and tissues, infection, reproduction and further movement. This continues until the human body begins to produce characteristic antibodies. They are a major factor in self-healing, since there are no effective treatments for Koksaki in Turkey.
Symptoms
From penetration of viruses into the body to the appearance of painful signs, as a rule, 2-4 days pass. Sometimes the incubation period is extended to 10 days. The clinical nature of the infection may differ significantly from the previous ones. Some common symptoms of the Koksaki virus in Turkey can be distinguished, although they are ambiguous.
- The disease begins with fever up to 39–40 degrees, possible headaches, weakness, dizziness, sleep disturbances and appetite.
- Signs of poisoning appear: nausea with vomiting, sometimes multiple and severe. Functional gastrointestinal upsets can also manifest themselves in many different ways: from periodic spasms to acute diarrhea.
- Polymorphic exanthema (a rash that is different in shape and type) occurs in any part of the body, including the palms, feet, and mouth.
- Catarrhal phenomena: varying degrees of inflammation, redness of the nasal mucosa and throat, coated tongue.
- Characteristic signs of any enterovirus infection: hyperemia is noted on the skin of the upper body. These are redness, which come in various shapes, sizes and saturations. For the same reason, redness of the eyeballs is observed.
These are the symptoms characteristic of Coxsackie infections in Turkey. Not all of these symptoms can occur simultaneously, especially in adults or with a sluggish and slowed course of the disease.
The form and prognosis of the disease
Based on the symptoms described on the Web that were detected in those infected with the virus and information on how the disease progresses, it can be assumed that there are several forms, each of which is not life-threatening.
- Enterovirus exanthema: rashes appear at the peak or with a decrease in temperature, after the disappearance there are no traces and pigmentation.
- Enterovirus fever, or summer flu, is the most sparing form with a temperature condition for 1-3 days and mild general manifestations of enterovirus infection. Called by Coxsackie A with types 4, 9, 10, 21, 24.
- The catarrhal (respiratory) form is similar to flu. Fever lasts up to four days.
- Intestinal form: caused by types 1, 2, 5 of Koksaki B. It lasts 1-2 weeks at a 3-5 day high temperature, sometimes it proceeds in two waves.
The course of the disease and its prognosis are favorable for all four cases, and severe forms of this infection have not yet been noted.
Remedies for Coxsackie
The virus is resistant to ethers, 70% alcohol, 5% bactericidal solution of lysol, freezing, a wide range of pH, synthetic detergents. But it loses its biological activity or is destroyed:
- in a chlorine-containing solution (0.3-0.5 g per 1 liter of water) and 0.3% formaldehyde;
- with gradual heating to a temperature exceeding 56 degrees;
- upon drying;
- when exposed to UV radiation.
We can conclude on the basis of the listed factors: the water of pools affected by the Coxsackie virus in hotels in Turkey is most likely safe because it includes chlorine and is constantly exposed to ultraviolet radiation.
Treatment
The development of enterovirus vaccine has not yet yielded positive results. And as such, radical therapeutic agents aimed at treating the Koksaki virus in Turkey do not exist. In the manual for medical schools "Infectious Diseases for Children" L. G. Kuzmenko for various forms of enteroviral diseases, detoxification therapy and symptomatic drugs are recommended. The Network mentions antihistamines prescribed by a doctor for a child who is infected with the Coxsackie virus in Turkey. It is worth briefly explaining the need for two reliable recommendations.
Detoxification therapy
Medications by sorption remove harmful substances, thereby reducing the intoxication of the body. Used for gastrointestinal infections, diarrhea, allergic and viral rashes.
The most affordable and common tool is activated charcoal, but it is contraindicated in peptic ulcers, it can irritate the gastrointestinal mucosa. "Filtrum STI" is a similar action drug.
Significantly softer and more effective is "Smecta" (can be used for babies up to one year old), "Enterosgel" (for children under three years of age), "Polysorb".
Symptomatic preparations
They can reduce or temporarily eliminate individual symptoms, but do not affect the cause and process of the disease. These are painkillers and antipyretics (“Paracetamol”), restoring the water-alkaline balance with vomiting and diarrhea (“Regidron”), external use, healing and soothing skin itch (“Infagel”, “Viferon”), aerosols to reduce pain and inflammation throat.
Precautionary measures
If the decision to travel was made, then two questions arise: how to protect yourself from infection and in which hotels in Turkey the Koksaki virus is detected in order to bypass them?
Immunoprophylactic measures for enterovirus infections have not been developed. All in the same "Children's Infectious Diseases" L. G. Kuzmenko proposed emergency preventive measures for children aged one to three:
- The introduction of 0.3 ml of immunoglobulin, based on each kilogram of body weight.
- In the nose, 5 drops of interferon - three times a day, for a week.
The rest is hygiene products and strict control of clean hands. You can also advise to stock up on a large number of wet bactericidal wipes and never part with them. They will not destroy the virus, but they will effectively help in places where there is no way to wash your hands. You should also refrain from buying products, especially those that cannot be carefully processed. It will be useful to use only bottled water. And in a tourist bus, airport, plane, you don’t hesitate to put on a preventive mask.
Hotels
As for cities and hotels where outbreaks of the Koksaki virus in Turkey are noted, the reviews of tourists themselves indicate such:
- Nashira, Starlight in Side;
- Papillon in Belek;
- Limak Limra in Kemer;
- Delphin Deluxe Antalya.
No official reports for infected hotels were found. The impression is that the domestic media are also guided by the information of vacationers. And the Turkish authorities stubbornly resist the publication of a list of resorts where infection cases occurred.
What will be the velvet season of the Turkish coast? Are the foci of the disease expanding or extinguished? Nobody undertakes to predict this. The article provides the maximum information known about the Coxsackie virus today. Perhaps this data will help someone to navigate and make a final decision on the advisability of a trip to a Turkish resort.