{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T15:00:54Z","timestamp":1786719654265,"version":"build-2736575974"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2017,11,28]],"date-time":"2017-11-28T00:00:00Z","timestamp":1511827200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2017,11,28]],"date-time":"2017-11-28T00:00:00Z","timestamp":1511827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Hand, foot and mouth disease (HFMD) is a childhood disease causing large outbreaks frequently in Asia and occasionally in Europe and the US. The incubation period of HFMD was typically described as about 3\u20137 days but empirical evidence is lacking. In this study, we estimated the incubation period of HFMD from school outbreaks in Hong Kong, utilizing information on symptom onset and sick absence dates of students diagnosed with HFMD. A total of 99 HFMD cases from 12 schools were selected for analysis. We fitted parametric models accounting for interval censoring. Based on the best-fitted distributions, the estimated median incubation periods were 4.4 (95% CI 3.8\u20135.1) days, 4.7 (95% CI 4.5\u20135.1) days and 5.7 (95% CI 4.6\u20137.0) days for children in kindergartens, primary schools and secondary schools respectively. From the fitted distribution, the estimated incubation periods can be longer than 10 days for 8.8% and 23.2% of the HFMD cases in kindergarten and secondary schools respectively. Our results show that the incubation period of HFMD for secondary schools students can be longer than the ranges commonly described. An extended period of enhanced personal hygiene practice and disinfection of the environment may be needed to control outbreaks.<\/jats:p>","DOI":"10.1038\/s41598-017-16705-7","type":"journal-article","created":{"date-parts":[[2017,11,22]],"date-time":"2017-11-22T10:32:05Z","timestamp":1511346725000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Estimating the incubation period of hand, foot and mouth disease for children in different age groups"],"prefix":"10.1038","volume":"7","author":[{"given":"Zhongzhou","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiqi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6297-7154","authenticated-orcid":false,"given":"Benjamin J.","family":"Cowling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6688-9637","authenticated-orcid":false,"given":"Eric H. Y.","family":"Lau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2017,11,28]]},"reference":[{"key":"16705_CR1","unstructured":"Pallansch, M. A., Oberste, M. S. & Whitton, J. L. In Fields virology (eds David, M. Knipe & Peter, M. Howley) 490\u2013530 (Wolters Kluwer\/Lippincott Williams & Wilkins Health, 2013)."},{"key":"16705_CR2","doi-asserted-by":"publisher","first-page":"1682","DOI":"10.1016\/S0140-6736(99)04434-7","volume":"354","author":"LY Chang","year":"1999","unstructured":"Chang, L. Y. et al. Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease. Lancet \n                           354, 1682\u20131686, https:\/\/doi.org\/10.1016\/S0140-6736(99)04434-7 (1999).","journal-title":"Lancet"},{"key":"16705_CR3","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1016\/S1473-3099(13)70342-6","volume":"14","author":"W Xing","year":"2014","unstructured":"Xing, W. et al. Hand, foot, and mouth disease in China, 2008\u201312: an epidemiological study. The Lancet Infectious Diseases \n                           14, 308\u2013318, https:\/\/doi.org\/10.1016\/s1473-3099(13)70342-6 (2014).","journal-title":"The Lancet Infectious Diseases"},{"key":"16705_CR4","doi-asserted-by":"publisher","first-page":"2","DOI":"10.2807\/1560-7917.ES.2015.20.34.30005","volume":"20","author":"C Hassel","year":"2015","unstructured":"Hassel, C. et al. Transmission patterns of human enterovirus 71 to, from and among European countries, 2003 to 2013. Eurosurveillance \n                           20, 2\u201312, https:\/\/doi.org\/10.2807\/1560-7917.Es.2015.20.34.30005 (2015).","journal-title":"Eurosurveillance"},{"key":"16705_CR5","first-page":"213","volume":"61","author":"Centers for Disease Control and Prevention","year":"2012","unstructured":"Centers for Disease Control and Prevention. Notes from the field: severe hand, foot, and mouth disease associated with coxsackievirus A6 - Alabama, Connecticut, California, and Nevada, November 2011-February 2012. MMWR Morb Mortal Wkly Rep \n                           61, 213\u2013214 (2012).","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"16705_CR6","doi-asserted-by":"publisher","first-page":"e1001975","DOI":"10.1371\/journal.pmed.1001975","volume":"13","author":"JT Wu","year":"2016","unstructured":"Wu, J. T. et al. Routine Pediatric Enterovirus 71 Vaccination in China: a Cost-Effectiveness Analysis. Plos Med \n                           13, e1001975, https:\/\/doi.org\/10.1371\/journal.pmed.1001975 (2016).","journal-title":"Plos Med"},{"key":"16705_CR7","unstructured":"Emerging Disease Surveillance and Response Division of Health Security and Emergencies Western Pacific Regional Office. Hand, Foot and Mouth Disease Information Sheet, http:\/\/www.wpro.who.int\/emerging_diseases\/hfmd.information.sheet\/en\/ (2012)."},{"key":"16705_CR8","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1093\/aje\/kwg251","volume":"158","author":"PEM Fine","year":"2003","unstructured":"Fine, P. E. M. The interval between successive cases of an infectious disease. Am J Epidemiol \n                           158, 1039\u20131047, https:\/\/doi.org\/10.1093\/aje\/kwg251 (2003).","journal-title":"Am J Epidemiol"},{"key":"16705_CR9","unstructured":"World Health Organization. Hand, Foot and Mouth Disease, http:\/\/www.wpro.who.int\/mediacentre\/factsheets\/fs_10072012_HFMD\/en\/ (2012)."},{"key":"16705_CR10","doi-asserted-by":"publisher","first-page":"e285","DOI":"10.1097\/INF.0000000000001242","volume":"35","author":"WM Koh","year":"2016","unstructured":"Koh, W. M. et al. The Epidemiology of Hand, Foot and Mouth Disease in Asia: A Systematic Review and Analysis. Pediatr Infect Dis J \n                           35, e285\u2013300, https:\/\/doi.org\/10.1097\/INF.0000000000001242 (2016).","journal-title":"Pediatr Infect Dis J"},{"key":"16705_CR11","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1097\/00006454-200104000-00004","volume":"20","author":"M Richardson","year":"2001","unstructured":"Richardson, M., Elliman, D., Maguire, H., Simpson, J. & Nicoll, A. Evidence base of incubation periods, periods of infectiousness and exclusion policies for the control of communicable diseases in schools and preschools. Pediatr Infect Dis J \n                           20, 380\u2013391 (2001).","journal-title":"Pediatr Infect Dis J"},{"key":"16705_CR12","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/S1875-9572(08)60023-6","volume":"49","author":"LY Chang","year":"2008","unstructured":"Chang, L. Y. Enterovirus 71 in Taiwan. Pediatr Neonatol \n                           49, 103\u2013112, https:\/\/doi.org\/10.1016\/S1875-9572(08)60023-6 (2008).","journal-title":"Pediatr Neonatol"},{"key":"16705_CR13","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1007\/s00705-012-1566-6","volume":"158","author":"F Qiaoyun","year":"2013","unstructured":"Qiaoyun, F., Xiongfei, J., Lihuan, L. & Angao, X. Epidemiology and etiological characteristics of hand, foot and mouth disease in Huizhou City between 2008 and 2011. Arch Virol \n                           158, 895\u2013899, https:\/\/doi.org\/10.1007\/s00705-012-1566-6 (2013).","journal-title":"Arch Virol"},{"key":"16705_CR14","doi-asserted-by":"crossref","unstructured":"Virlogeux, V. et al. Association between the Severity of Influenza A(H7N9) Virus Infections and Length of the Incubation Period. Plos One \n                           11 (2016).","DOI":"10.1371\/journal.pone.0148506"},{"key":"16705_CR15","unstructured":"Chuang, S. Centre for Health Protection, Government of the Hong Kong Special Administrative Region. Communicable Diseases Watch, http:\/\/www.chp.gov.hk\/files\/pdf\/cdw_compendium_2016.pdf (2016)."},{"key":"16705_CR16","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1097\/01.ede.0000254660.07942.fb","volume":"18","author":"BJ Cowling","year":"2007","unstructured":"Cowling, B. J. et al. Alternative methods of estimating an incubation distribution - Examples from severe acute respiratory syndrome. Epidemiology \n                           18, 253\u2013259, https:\/\/doi.org\/10.1097\/01.ede.0000254660.07942.fb (2007).","journal-title":"Epidemiology"},{"key":"16705_CR17","doi-asserted-by":"crossref","unstructured":"Heymann, D. L. Control of communicable diseases manual. (American Public Health Association, 2014).","DOI":"10.2105\/CCDM.2745"},{"key":"16705_CR18","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1097\/INF.0b013e3182116e95","volume":"30","author":"E Ma","year":"2011","unstructured":"Ma, E. et al. Estimation of the basic reproduction number of enterovirus 71 and coxsackievirus A16 in hand, foot, and mouth disease outbreaks. Pediatr Infect Dis J \n                           30, 675\u2013679, https:\/\/doi.org\/10.1097\/INF.0b013e3182116e95 (2011).","journal-title":"Pediatr Infect Dis J"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-017-16705-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-017-16705-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-017-16705-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,23]],"date-time":"2022-12-23T14:12:40Z","timestamp":1671804760000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-017-16705-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,28]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2017,12]]}},"alternative-id":["16705"],"URL":"https:\/\/doi.org\/10.1038\/s41598-017-16705-7","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11,28]]},"assertion":[{"value":"6 June 2017","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 November 2017","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 November 2017","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"B.J.C. has received research funding from MedImmune Inc. and Sanofi Pasteur, and consults for Crucell N.V. The authors report no other potential conflicts of interest.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}],"article-number":"16464"}}