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However, the transmissibility of AHC remains unclear. This study aimed to calculate the transmissibility of the disease with and without interventions. An AHC outbreak dataset from January 2007 to December 2016 in different schools was built in Hunan Province. A Susceptible-Infectious-Recovered (SIR) model was adopted to calculate the effective reproduction number (<jats:italic>R<\/jats:italic><jats:sub><jats:italic>eff<\/jats:italic><\/jats:sub>) of AHC. <jats:italic>R<\/jats:italic><jats:sub><jats:italic>eff<\/jats:italic><\/jats:sub> was divided into two parts (<jats:italic>R<\/jats:italic><jats:sub><jats:italic>unc<\/jats:italic><\/jats:sub> and <jats:italic>R<\/jats:italic><jats:sub><jats:italic>con<\/jats:italic><\/jats:sub>) where <jats:italic>R<\/jats:italic><jats:sub><jats:italic>unc<\/jats:italic><\/jats:sub> and <jats:italic>R<\/jats:italic><jats:sub><jats:italic>con<\/jats:italic><\/jats:sub> represent the uncontrolled and controlled <jats:italic>R<\/jats:italic><jats:sub><jats:italic>eff<\/jats:italic><\/jats:sub>\u200a, respectively. Based on <jats:italic>R<\/jats:italic><jats:sub><jats:italic>unc<\/jats:italic><\/jats:sub> and <jats:italic>R<\/jats:italic><jats:sub><jats:italic>con<\/jats:italic><\/jats:sub>, an index of effectiveness of countermeasures (<jats:italic>I<\/jats:italic><jats:sub><jats:italic>eff<\/jats:italic><\/jats:sub>) was developed to assess the effectiveness of countermeasures in each outbreak. During the study period, 34 AHC outbreaks were reported in 20 counties of 9 cities in Hunan Province, with a mean total attack rate of 7.04% (95% CI: 4.97\u20139.11%). The mean <jats:italic>R<\/jats:italic><jats:sub><jats:italic>unc<\/jats:italic><\/jats:sub> of AHC outbreaks was 8.28 (95% CI: 6.46\u201310.11). No significance of <jats:italic>R<\/jats:italic><jats:sub><jats:italic>unc<\/jats:italic><\/jats:sub> was observed between rural and urban areas (<jats:italic>t<\/jats:italic>\u2009=\u2009\u22121.296, <jats:italic>P<\/jats:italic>\u2009=\u20090.205), among college, secondary, and primary schools (<jats:italic>F<\/jats:italic>\u2009=\u20090.890, <jats:italic>P<\/jats:italic>\u2009=\u20090.459), different levels of school population (<jats:italic>F<\/jats:italic>\u2009=\u20090.738, <jats:italic>P<\/jats:italic>\u2009=\u20090.538), and different number of index cases (<jats:italic>F<\/jats:italic>\u2009=\u20091.749, <jats:italic>P<\/jats:italic>\u2009=\u20090.180). The most commonly implemented countermeasures were case isolation, treatment, and health education, followed by environment disinfection, symptom surveillance, and school closure. Social distance, prophylaxis, and stopping eye exercises temporary were implemented occasionally. The mean value of <jats:italic>R<\/jats:italic><jats:sub><jats:italic>con<\/jats:italic><\/jats:sub> was 0.16 (range: 0.00\u20131.50). The mean value of <jats:italic>I<\/jats:italic><jats:sub><jats:italic>eff<\/jats:italic><\/jats:sub> was 97.16% (range: 71.44\u2013100.00%). The transmissibility of AHC is high in small-scale outbreaks in China. Case isolation, treatment, and health education are the common countermeasures for controlling the disease.<\/jats:p>","DOI":"10.1038\/s41598-019-56850-9","type":"journal-article","created":{"date-parts":[[2020,1,10]],"date-time":"2020-01-10T11:03:47Z","timestamp":1578654227000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Transmissibility of acute haemorrhagic conjunctivitis in small-scale outbreaks in Hunan Province, China"],"prefix":"10.1038","volume":"10","author":[{"given":"Siyu","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qingqing","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhihong","family":"Deng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shixiong","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fuqiang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shanshan","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruoyun","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunlei","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongye","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lidong","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tianmu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,1,10]]},"reference":[{"key":"56850_CR1","first-page":"173","volume":"45","author":"PW Wright","year":"1992","unstructured":"Wright, P. W., Strauss, G. H. & Langford, M. P. Acute hemorrhagic conjunctivitis. American family physician 45, 173\u2013178 (1992).","journal-title":"American family physician"},{"key":"56850_CR2","doi-asserted-by":"publisher","first-page":"495","DOI":"10.3201\/eid1205.051173","volume":"12","author":"FN Tavares","year":"2006","unstructured":"Tavares, F. N. et al. Acute hemorrhagic conjunctivitis and coxsackievirus A24v, Rio de Janeiro, Brazil, 2004. Emerging infectious diseases 12, 495\u2013497, https:\/\/doi.org\/10.3201\/eid1205.051173 (2006).","journal-title":"Emerging infectious diseases"},{"key":"56850_CR3","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1093\/oxfordjournals.aje.a113904","volume":"120","author":"SH Waterman","year":"1984","unstructured":"Waterman, S. H. et al. Acute hemorrhagic conjunctivitis in Puerto Rico, 1981\u20131982. 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Jama 249, 1283\u20131289 (1983).","journal-title":"Jama"},{"key":"56850_CR8","first-page":"1","volume":"8","author":"WK Chang","year":"1977","unstructured":"Chang, W. K., Liu, K. C., Foo, T. C., Lam, M. W. & Chan, C. F. Acute haemorrhagic conjunctivitis in Hong Kong 1971\u20131975. The Southeast Asian journal of tropical medicine and public health 8, 1\u20136 (1977).","journal-title":"The Southeast Asian journal of tropical medicine and public health"},{"key":"56850_CR9","doi-asserted-by":"publisher","DOI":"10.1038\/srep45202","volume":"7","author":"L Zhang","year":"2017","unstructured":"Zhang, L. et al. Molecular epidemiology of acute hemorrhagic conjunctivitis caused by coxsackie A type 24 variant in China, 2004\u20132014. Scientific reports 7, 45202, https:\/\/doi.org\/10.1038\/srep45202 (2017).","journal-title":"Scientific reports"},{"key":"56850_CR10","doi-asserted-by":"publisher","first-page":"897532","DOI":"10.1155\/2014\/897532","volume":"2014","author":"B Chen","year":"2014","unstructured":"Chen, B. et al. A modeling and experiment framework for the emergency management in AHC transmission. Computational and mathematical methods in medicine 2014, 897532, https:\/\/doi.org\/10.1155\/2014\/897532 (2014).","journal-title":"Computational and mathematical methods in medicine"},{"key":"56850_CR11","first-page":"75","volume":"34","author":"TM Chen","year":"2013","unstructured":"Chen, T. M. & Liu, R. C. Study on the efficacy of quarantine during outbreaks of acute hemorrhagic conjunctivitis outbreaks at schools through the susceptive-infective-quarantine-removal model. 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