{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T10:27:41Z","timestamp":1784543261124,"version":"3.55.0"},"reference-count":32,"publisher":"Cambridge University Press (CUP)","issue":"5","license":[{"start":{"date-parts":[[2015,9,16]],"date-time":"2015-09-16T00:00:00Z","timestamp":1442361600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["journals.cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2016,4]]},"abstract":"<jats:title>SUMMARY<\/jats:title><jats:p>Coxsackievirus A6 (CV-A6), coxsackievirus A16 (CV-A16) and enterovirus 71 (EV-A71) were the major enteroviruses causing nationwide hand, foot and mouth disease (HFMD) epidemics in Singapore in the last decade. We estimated the basic reproduction number (<jats:italic>R<\/jats:italic><jats:sub>0<\/jats:sub>) of these enteroviruses to obtain a better understanding of their transmission dynamics. We merged records of cases from HFMD outbreaks reported between 2007 and 2012 with laboratory results from virological surveillance.<jats:italic>R<\/jats:italic><jats:sub>0<\/jats:sub>was estimated based on the cumulative number of reported cases in the initial growth phase of each outbreak associated with the particular enterovirus type. A total of 33 HFMD outbreaks were selected based on the inclusion criteria specified for our study, of which five were associated with CV-A6, 13 with CV-A16, and 15 with EV-A71. The median<jats:italic>R<\/jats:italic><jats:sub>0<\/jats:sub>was estimated to be 5\u00b704 [interquartile range (IQR) 3\u00b757\u20135\u00b716] for CV-A6, 2\u00b742 (IQR 1\u00b785\u20133\u00b736) for CV-A16, and 3\u00b750 (IQR 2\u00b736\u20134\u00b753) for EV-A71.<jats:italic>R<\/jats:italic><jats:sub>0<\/jats:sub>was not significantly associated with number of infected children (<jats:italic>P<\/jats:italic>= 0\u00b786), number of exposed children (<jats:italic>P<\/jats:italic>= 0\u00b794), and duration of the outbreak (<jats:italic>P<\/jats:italic>= 0\u00b705). These enterovirus-specific<jats:italic>R<\/jats:italic><jats:sub>0<\/jats:sub>estimates will be helpful in providing insights into the potential growth of future HFMD epidemics and outbreaks for timely implementation of disease control measures, together with disease dynamics such as severity of the cases.<\/jats:p>","DOI":"10.1017\/s0950268815002137","type":"journal-article","created":{"date-parts":[[2015,9,16]],"date-time":"2015-09-16T04:51:23Z","timestamp":1442379083000},"page":"1028-1034","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":48,"title":["Basic reproduction number of coxsackievirus type A6 and A16 and enterovirus 71: estimates from outbreaks of hand, foot and mouth disease in Singapore, a tropical city-state"],"prefix":"10.1017","volume":"144","author":[{"given":"C. T. K.","family":"LIM","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"JIANG","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"MA","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"JAMES","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. W.","family":"ANG","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2015,9,16]]},"reference":[{"key":"S0950268815002137_ref16","doi-asserted-by":"publisher","DOI":"10.1126\/science.1086616"},{"key":"S0950268815002137_ref32","unstructured":"Ministry of Health, Singapore. Hand, foot & mouth disease: updates. 2015 (https:\/\/www.moh.gov.sg\/content\/moh_web\/home\/diseases_and_conditions\/h\/hand_foot_mouth_disease.html). Accessed 17 February 2015."},{"key":"S0950268815002137_ref24","first-page":"66","volume-title":"Enterovirus Infection in Singapore \u2013 with Particular Reference to the EV71 Outbreak in 2000","author":"Ooi","year":"2002"},{"key":"S0950268815002137_ref29","doi-asserted-by":"crossref","DOI":"10.2807\/ese.16.21.19875-en","article-title":"Outbreak of hand, foot and mouth disease caused by Coxsackie A16 virus in a childcare centre in Croatia, February to March 2011","volume":"16","author":"Ljubin-Sternak","year":"2011","journal-title":"Eurosurveillance"},{"key":"S0950268815002137_ref15","doi-asserted-by":"publisher","DOI":"10.3201\/eid1301.020112"},{"key":"S0950268815002137_ref30","doi-asserted-by":"publisher","DOI":"10.1186\/1743-422X-9-248"},{"key":"S0950268815002137_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(10)70194-8"},{"key":"S0950268815002137_ref26","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268809991555"},{"key":"S0950268815002137_ref13","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.3201\/eid1311.070632","article-title":"Epidemiologic and virologic investigation of hand, foot, and mouth disease, Southern Vietnam, 2005","volume":"13","author":"Tu","year":"2007","journal-title":"Emerging Infectious Diseases"},{"key":"S0950268815002137_ref31","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0001476"},{"key":"S0950268815002137_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2010.07.006"},{"key":"S0950268815002137_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2010.02.002"},{"key":"S0950268815002137_ref18","doi-asserted-by":"publisher","DOI":"10.1186\/1756-0500-3-283"},{"key":"S0950268815002137_ref25","first-page":"133","volume-title":"Control of Communicable Diseases Manual","author":"Heymann","year":"2004"},{"key":"S0950268815002137_ref23","unstructured":"Ministry of Health, Singapore. Communicable diseases surveillance in Singapore 2012. Singapore: Ministry of Health, 2013."},{"key":"S0950268815002137_ref22","doi-asserted-by":"crossref","first-page":"106","DOI":"10.47102\/annals-acadmedsg.V38N2p106","article-title":"Epidemiology and control of hand, foot and mouth disease in Singapore 2001\u20132007","volume":"38","author":"Ang","year":"2009","journal-title":"Annals Academy Medicine of Singapore"},{"key":"S0950268815002137_ref9","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1097\/INF.0b013e3181e52945","article-title":"An investigation of epidemic enterovirus 71 infection in Taiwan, 2008","volume":"29","author":"Lee","year":"2010","journal-title":"Pediatric Infectious Disease Journal"},{"key":"S0950268815002137_ref7","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(10)70209-X"},{"key":"S0950268815002137_ref19","doi-asserted-by":"crossref","first-page":"66","DOI":"10.4269\/ajtmh.2009.80.66","article-title":"Intervention measures, turning point, and reproduction number for dengue, Singapore, 2005","volume":"80","author":"Hsieh","year":"2009","journal-title":"American Journal of Tropical Medicine and Hygiene"},{"key":"S0950268815002137_ref5","first-page":"1","article-title":"Enterovirus surveillance \u2013 United States, 1970\u20132005","volume":"55","author":"Khetsuriani","year":"2006","journal-title":"Morbidity and Mortality Weekly Report Surveillance Summary"},{"key":"S0950268815002137_ref21","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-11-270"},{"key":"S0950268815002137_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2010.02.2265"},{"key":"S0950268815002137_ref10","first-page":"181","article-title":"Epidemiology of hand, foot and mouth disease in China, 2008","volume":"25","author":"Wang","year":"2010","journal-title":"Disease Surveillance"},{"key":"S0950268815002137_ref11","doi-asserted-by":"publisher","DOI":"10.1186\/1743-422X-7-94"},{"key":"S0950268815002137_ref20","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e3182116e95"},{"key":"S0950268815002137_ref27","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0127999"},{"key":"S0950268815002137_ref1","first-page":"655","volume-title":"Field's Virology","author":"Melnick","year":"1996"},{"key":"S0950268815002137_ref8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1574-6976.2002.tb00601.x"},{"key":"S0950268815002137_ref6","doi-asserted-by":"publisher","DOI":"10.1002\/rmv.538"},{"key":"S0950268815002137_ref17","first-page":"291","article-title":"Estimation of the reproductive number R 0 for epidemic, highly pathogenic avian influenza subtype H5N1 spread","volume":"132","author":"Ward","year":"2004","journal-title":"Epidemiology and Infection"},{"key":"S0950268815002137_ref2","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.20534"},{"key":"S0950268815002137_ref28","volume-title":"Infectious Diseases of Humans: Dynamics and Control","author":"Anderson","year":"1992"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268815002137","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,14]],"date-time":"2023-08-14T04:51:42Z","timestamp":1691988702000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268815002137\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,9,16]]},"references-count":32,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2016,4]]}},"alternative-id":["S0950268815002137"],"URL":"https:\/\/doi.org\/10.1017\/s0950268815002137","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,9,16]]},"assertion":[{"value":"Copyright \u00a9 Cambridge University Press 2015\u00a0","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}