title: Estimation of the basic reproduction number of enterovirus 71 and coxsackievirus A16 in hand, foot, and mouth disease outbreaks.
abstract: BACKGROUND
  Coxsackievirus A16 (Cox A16) and enterovirus 71 (EV71) are common pathogens causing hand, foot, and mouth disease (HFMD) in pediatric population. Little is known about the basic reproductive number (R0) for these enteroviruses.
  
  
  METHODS
  We estimated the R0 of EV71 and of Cox A16 from laboratory-confirmed HFMD outbreaks reported to the Department of Health, from 2004 to 2009. We derived a mathematical model and calculated R₀ based on the cumulative number of cases at the initial growth phase of the outbreaks, as determined by the epidemic curves. We tested the association of R₀ with settings and sizes of the institution and total number of persons affected.
  
  
  RESULTS
  We analyzed 34 outbreaks, 27 caused by Cox A16 and 7 caused by EV71. Assuming the incubation period to be 5 days, the median R₀ of EV71 was 5.48 with an interquartile range of 4.20 to 6.51, whereas the median R₀ of Cox A16 was 2.50 with an interquartile range of 1.96 to 3.67. The R₀ of EV71 was significantly higher than that of CoxA16, P = 0.002; and sensitivity analysis showed the same results. The R₀ was not associated with outbreak settings, sizes of the institutions, or number of persons affected.
  
  
  CONCLUSIONS
  The R₀ for EV71 and for Cox A16 was determined using a model which showed that the R₀ for EV71 was higher than that of Cox A16. This finding helps better understand the transmission dynamics of HFMD outbreaks and formulate public health measures for controlling the disease.
authors.affiliation: Communicable Disease Division, Surveillance and Epidemiology Branch, Centre for Health Protection, Department of Health, Kowloon, Hong Kong Special Administrative Region. edmond_ma@dh.gov.hk
authors.forename: Edmond
authors.initials: E
authors.lastname: Ma
authors.forename: Connie
authors.initials: C
authors.lastname: Fung
authors.forename: Steven H L
authors.initials: SH
authors.lastname: Yip
authors.forename: Christine
authors.initials: C
authors.lastname: Wong
authors.forename: Shuk Kwan
authors.initials: SK
authors.lastname: Chuang
authors.forename: Thomas
authors.initials: T
authors.lastname: Tsang
mesh_terms: D050936:Basic Reproduction Number; D002675:Child, Preschool; D003384:Coxsackievirus Infections / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D004196:Disease Outbreaks; D004770:Enterovirus / Q000302:isolation & purification* / Q000472:pathogenicity; D029821:Enterovirus A, Human / Q000302:isolation & purification* / Q000472:pathogenicity; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D006801:Humans; D007223:Infant; D008962:Models, Theoretical