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Title: An epidemiological surveillance of hand foot and mouth disease in paediatric patients and in community: A singapore retrospective cohort study, 2013–2018
Authors: Min, Nyo 
Ong, Yasmin Hui Binn
Han, Alvin X.
Ho, Si Xian 
Yen, Emmerie Wong Phaik
Ban, Kenneth Hon Kim 
Maurer-Stroh, Sebastian 
Chong, Chia Yin 
Chu, Justin Jang Hann 
Issue Date: 10-Feb-2021
Publisher: Public Library of Science
Citation: Min, Nyo, Ong, Yasmin Hui Binn, Han, Alvin X., Ho, Si Xian, Yen, Emmerie Wong Phaik, Ban, Kenneth Hon Kim, Maurer-Stroh, Sebastian, Chong, Chia Yin, Chu, Justin Jang Hann (2021-02-10). An epidemiological surveillance of hand foot and mouth disease in paediatric patients and in community: A singapore retrospective cohort study, 2013–2018. PLoS Neglected Tropical Diseases 15 (2) : Jan-15. ScholarBank@NUS Repository.
Rights: Attribution 4.0 International
Abstract: Background While hand, foot and mouth disease (HFMD) is primarily self-resolving—soaring incidence rate of symptomatic HFMD effectuates economic burden in the Asia-Pacific region. Singapore has seen a conspicuous rise in the number of HFMD cases from 2010s. Here, we aims to identify the serology and genotypes responsible for such outbreaks in hospitals and childcare facilities. Methods We studied symptomatic paediatric HFMD cases from 2013 to 2018 in Singapore. Surveillance for subclinical enterovirus infections was also performed in childcares at the same time period. Results Genotyping 101 symptomatic HFMD samples revealed CV-A6 as the major etiological agent for recent outbreaks. We detected infections with CV-A6 (41.0%), EV-A71 (7%), CV-A16 (3.0%), coxsackievirus A2, CV-A2 (1.0%) and coxsackievirus A10, CV-A10 (1.0%). Phylogenetic analysis of local CV-A6 strains revealed a high level of heterogeneity compared against others worldwide, dissimilar to other HFMD causative enteroviruses for which the dominant strains and genotypes are highly region specific. We detected sub-clinical enterovirus infections in childcare centres; 17.1% (n = 245) tested positive for enterovirus in saliva, without HFMD indicative symptoms at the point of sample collection. Conclusions CV-A6 remained as the dominant HFMD causative strain in Singapore. Silent subclinical enteroviral infections were detected and warrant further investigations. © 2021 Min et al.
Source Title: PLoS Neglected Tropical Diseases
ISSN: 1935-2727
DOI: 10.1371/journal.pntd.0008885
Rights: Attribution 4.0 International
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