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. 2015 May 26;10(5):e0127999.
doi: 10.1371/journal.pone.0127999. eCollection 2015.

Seroepidemiology of Coxsackievirus A6, Coxsackievirus A16, and Enterovirus 71 Infections among Children and Adolescents in Singapore, 2008-2010

Li Wei Ang  1 , Joanne Tay  2 , Meng Chee Phoon  3 , Jung Pu Hsu  3 , Jeffery Cutter  2 , Lyn James  1 , Kee Tai Goh  4 , Vincent Tak-Kwong Chow  3
Affiliations

Seroepidemiology of Coxsackievirus A6, Coxsackievirus A16, and Enterovirus 71 Infections among Children and Adolescents in Singapore, 2008-2010

Li Wei Ang et al. PLoS One. .

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.

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Conflict of interest statement

Competing Interests: The authors have declared that no completing interests exist.

Figures

Fig 1
Fig 1. Monthly HFMD incidence and predominant circulating enteroviruses associated with peaks in HFMD cases, Singapore, 2005–2013.
Fig 2
Fig 2. Proportion (%) seropositive for CV-A6, CV-A16 and EV-A71 among 700 subjects aged 1–17 years, Singapore, 2008–2010.
Fig 3
Fig 3. Proportion (%) of subjects with neutralizing antibodies against any one, two or all three enteroviruses, CV-A6, CV-A16 and EV-A71, and those with no immunity (seronegative for all three enteroviruses) by age group, Singapore, 2008–2010.
The vertical lines indicate 95% confidence intervals. A subject was defined as immune if NtAb titre was ≥1:8.
Fig 4
Fig 4. Proportion (%) of seropositive subjects with low, moderate and high levels of neutralizing antibody titres against (A) CV-A6, (B) CV-A16 and (C) EV-A71 by age group, Singapore, 2008–2010.
The vertical lines indicate 95% confidence intervals.
Fig 5
Fig 5. Geometric mean titre (GMT) of neutralizing antibody among seropositive subjects against CV-A6, CV-A16 and EV-A71 by age group, Singapore, 2008–2010.
The vertical lines indicate 95% confidence intervals.
See this image and copyright information in PMC

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