{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T10:09:21Z","timestamp":1768817361222,"version":"3.49.0"},"reference-count":36,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,12,5]]},"abstract":"<jats:p>Singapore implements a school closure policy for institutional hand, foot, and mouth disease (HFMD) outbreaks, but there is a lack of empirical evidence on the effect of closure on HFMD transmission. We conducted a retrospective analysis of 197,207 cases of HFMD over the period 2003\u20132012 at the national level and of 57,502 cases in 10,080 institutional outbreaks over the period 2011\u20132016 in Singapore. The effects of school closure due to 1) institutional outbreaks, 2) public holidays, and 3) school vacations were assessed using a Bayesian time series modeling approach. School closure was associated with a reduction in HFMD transmission rate. During public holidays, average numbers of secondary cases having onset the week after dropped by 53% (95% credible interval 44\u201362%), and during school vacations, the number of secondary cases dropped by 7% (95% credible interval 3\u201310%). Schools being temporarily closed in response to an institutional outbreak reduced the average number of new cases by 1,204 (95% credible interval 1,140\u20131,297). Despite the positive effect in reducing transmission, the effect of school closure is relatively small and may not justify the routine use of this measure.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0099","type":"journal-article","created":{"date-parts":[[2018,10,23]],"date-time":"2018-10-23T07:01:02Z","timestamp":1540278062000},"page":"1625-1632","source":"Crossref","is-referenced-by-count":36,"title":["The Effect of School Closure on Hand, Foot, and Mouth Disease Transmission in Singapore: A Modeling Approach"],"prefix":"10.4269","volume":"99","author":[{"given":"Yirong","family":"Chen","sequence":"first","affiliation":[{"name":"Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hishamuddin","family":"Badaruddin","sequence":"additional","affiliation":[{"name":"Ministry of Health, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vernon J.","family":"Lee","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore;"},{"name":"Ministry of Health, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffery","family":"Cutter","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore;"},{"name":"Ministry of Health, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex R.","family":"Cook","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Ann Acad Med Singapore","first-page":"106","article-title":"Epidemiology and control of hand, foot and mouth disease in Singapore, 2001\u20132007","volume":"38","author":"Ang","year":"2009"},{"key":"b2","series-title":"Pediatr Infect Dis J","first-page":"e285","article-title":"The epidemiology of hand, foot and mouth disease in Asia: a systematic review and analysis","volume":"35","author":"Koh","year":"2016"},{"key":"b3","series-title":"MMWR Morb Mortal Wkly Rep","first-page":"213","article-title":"Notes from the field: severe hand, foot, and mouth disease associated with coxsackievirus A6-Alabama, Connecticut, California, and Nevada, November 2011\u2013February 2012","volume":"61","author":"Centers for Disease Control and Prevention (CDC)","year":"2012"},{"key":"b4","series-title":"Emerg Infect Dis","first-page":"1702","article-title":"Hand, foot, and mouth disease caused by coxsackievirus A6","volume":"18","author":"Flett","year":"2012"},{"key":"b5","series-title":"J Clin Microbiol","first-page":"2826","article-title":"Epidemiology of enterovirus 71 in The Netherlands, 1963 to 2008","volume":"47","author":"van der Sanden","year":"2009"},{"key":"b6","author":"CDC"},{"key":"b7","series-title":"Pediatrics","first-page":"e1785","article-title":"Long-term cognitive and motor deficits after enterovirus 71 brainstem encephalitis in children","volume":"118","author":"Huang","year":"2006"},{"key":"b8","series-title":"N Engl J Med","first-page":"1226","article-title":"Neurodevelopment and cognition in children after enterovirus 71 infection","volume":"356","author":"Chang","year":"2007"},{"key":"b9","series-title":"Clin Infect Dis","first-page":"678","article-title":"Outbreak study group. 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