title: Seroepidemiology of Coxsackievirus A6, Coxsackievirus A16, and Enterovirus 71 Infections among Children and Adolescents in Singapore, 2008-2010.
abstract: Coxsackieviruses A6 (CV-A6) and A16 (CV-A16) and Enterovirus 71 (EV-A71) have caused periodic epidemics of hand, foot and mouth disease (HFMD) among children in Singapore. We conducted a cross-sectional study to estimate the seroprevalence of these enteroviruses among Singapore children and adolescents. The study was conducted between August 2008 and July 2010. It involved 700 Singapore residents aged 1-17 years whose residual sera were obtained following the completion of routine biochemical investigations in two public acute-care hospitals. The levels of neutralizing antibodies (NtAb) against CV-A6, CV-A16 and EV-A71 were analyzed by the microneutralization test. The age-specific geometric mean titer (GMT) of antibodies against each of the three enteroviruses and the 95% confidence intervals (CI) were calculated. The seroprevalence of CV-A6 and CV-A16 was high at 62.7% (95% CI: 59.1-66.2%) and 60.6% (95% CI: 56.9-64.1%), respectively. However, the seroprevalence of EV-A71 was significantly lower at 29.3% (95% CI: 26.0-32.8%). About 89.7% of the children and adolescents had been infected by at least one of the three enteroviruses by 13-17 years of age. About half (52.3%) were seropositive for two or all three enteroviruses, while only 16.1% had no NtAb against any of the three enteroviruses. High NtAb levels were observed in the younger age groups. CV-A6 and CV-A16 infections are very common among Singapore children and adolescents, while EV-A71 infections are less common. Infection is continually acquired from early childhood to adolescent age.
authors.affiliation: Epidemiology and Disease Control Division, Ministry of Health, Singapore, College of Medicine Building, 16 College Road, Singapore 169854, Singapore.
authors.forename: Li Wei
authors.initials: LW
authors.lastname: Ang
authors.affiliation: Communicable Diseases Division, Ministry of Health, Singapore, College of Medicine Building, 16 College Road, Singapore 169854, Singapore.
authors.forename: Joanne
authors.initials: J
authors.lastname: Tay
authors.affiliation: Department of Microbiology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, MD4, 5 Science Drive 2, Singapore 117545, Singapore.
authors.forename: Meng Chee
authors.initials: MC
authors.lastname: Phoon
authors.affiliation: Department of Microbiology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, MD4, 5 Science Drive 2, Singapore 117545, Singapore.
authors.forename: Jung Pu
authors.initials: JP
authors.lastname: Hsu
authors.affiliation: Communicable Diseases Division, Ministry of Health, Singapore, College of Medicine Building, 16 College Road, Singapore 169854, Singapore.
authors.forename: Jeffery
authors.initials: J
authors.lastname: Cutter
authors.affiliation: Epidemiology and Disease Control Division, Ministry of Health, Singapore, College of Medicine Building, 16 College Road, Singapore 169854, Singapore.
authors.forename: Lyn
authors.initials: L
authors.lastname: James
authors.affiliation: Communicable Diseases Division, Ministry of Health, Singapore, College of Medicine Building, 16 College Road, Singapore 169854, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore 117597, Singapore.
authors.forename: Kee Tai
authors.initials: KT
authors.lastname: Goh
authors.affiliation: Department of Microbiology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, MD4, 5 Science Drive 2, Singapore 117545, Singapore.
authors.forename: Vincent Tak-Kwong
authors.initials: VT
authors.lastname: Chow
mesh_terms: D000293:Adolescent; D057134:Antibodies, Neutralizing / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D029821:Enterovirus A, Human / Q000276:immunology*; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008297:Male; D016036:Seroepidemiologic Studies; D012846:Singapore / Q000453:epidemiology
chemical_list: D057134:Antibodies, Neutralizing