Publications

emerging and re-emerging epidemic encephalitis: a tale of two viruses.	two major epidemics of viral encephalitis occurred in asia in 1997 and 1998. the first was a re-emergence of neurovirulent strains of enterovirus 71, which caused severe encephalomyelitis in children in malaysia, taiwan and japan, on a background of hand, foot and mouth disease. necropsy studies of patients who died of enterovirus 71 infection showed severe perivascular cuffing, parenchymal inflammation and neuronophagia in the spinal cord, brainstem and diencephalon, and in focal areas in the c ...	2000	10931364
phylogenetic analysis of enterovirus 71 strains isolated during linked epidemics in malaysia, singapore, and western australia.	enterovirus 71 (ev71) is a frequent cause of hand, foot, and mouth disease (hfmd) epidemics associated with severe neurological sequelae in a small proportion of cases. there has been a significant increase in ev71 epidemic activity throughout the asia-pacific region since 1997. recent hfmd epidemics in this region have been associated with a severe form of brainstem encephalitis associated with pulmonary edema and high case fatality rates. in this study, we show that four genetic lineages of ev ...	2001	11462047
echovirus 7 associated encephalomyelitis.	hand, foot, and mouth disease (hfmd) is endemic in malaysia. in 1997, a large outbreak of enterovirus 71 (ev-71) associated hfmd resulted in 41 deaths due to severe left ventricular dysfunction and central nervous system infection with extensive damage to the medulla and pons. the clinical presentation in all these patients were rapid cardio-respiratory decompensation leading to cardiac arrest. another large outbreak of hfmd with 55 fatal cases and a similar clinical picture was reported in taiw ...	2002	11595594
direct detection of enterovirus 71 (ev71) in clinical specimens from a hand, foot, and mouth disease outbreak in singapore by reverse transcription-pcr with universal enterovirus and ev71-specific primers.	a recent outbreak of hand, foot, and mouth disease in singapore in 2000 affected several thousand children and resulted in four deaths. the aim of this study was to determine the applicability of reverse transcription-pcr (rt-pcr) with universal pan-enterovirus primers and enterovirus 71 (ev71) type-specific primers for the direct detection of enteroviruses in clinical specimens derived from this outbreak. with the universal primers, ev71 rna sequences were successfully detected by rt-pcr and di ...	2002	12149336
seroepidemiology of human enterovirus 71, singapore.	human enterovirus 71 has caused outbreaks in many parts of the world, especially southeast asia, with some fatal cases. the epidemiology of this viral infection is not well understood. we conducted a serologic survey in singapore children, and the results indicate that infection occurs largely in preschool settings.	2002	12194783
complete sequence analyses of enterovirus 71 strains from fatal and non-fatal cases of the hand, foot and mouth disease outbreak in singapore (2000).	enterovirus 71 (ev71) is a major aetiological agent of hand, foot and mouth disease (hfmd). in recent years, several outbreaks in east asia were associated with neurological complications and numerous deaths. an outbreak in singapore in october 2000 afflicted thousands of children, resulting in four fatal cases from three of whom ev71 was isolated. the genomes of two representative ev71 strains isolated from a fatal case and a surviving patient were completely sequenced, and their nucleotide and ...	2002	12516778
epidemic hand, foot and mouth disease caused by human enterovirus 71, singapore.	singapore experienced a large epidemic of hand, foot and mouth disease (hfmd) in 2000. after reviewing hfmd notifications from doctors and child-care centers, we found that the incidence of hfmd rose in september and declined at the end of october. during this period, 3,790 cases were reported. we performed enteroviral cultures on 311 and 157 specimens from 175 hfmd patients and 107 non-hfmd patients, respectively; human enterovirus 71 (hev71) was the most frequently isolated virus from both gro ...	2003	12533285
clinical characteristics of an outbreak of hand, foot and mouth disease in singapore.	we experienced a hand, foot and mouth disease (hfmd) outbreak in late year 2000 in singapore. between 14 september 2000 and 14 november 2000, a total of 3526 cases of hfmd were notified. there were 652 patients clinically suspected to have hfmd, who were seen at the children's emergency department of kk women's and children's hospital of singapore.	2003	12854382
hand, foot and mouth disease in singapore: a comparison of fatal and non-fatal cases.	an epidemic of hand, foot and mouth disease (hfmd) occurred in singapore between september and november 2000. during the epidemic, there were four hfmd-related deaths and after the epidemic, another three hfmd-related deaths. this study sought to determine the risk factors predictive of death from hfmd disease.	2003	14632332
epidemiology and control of hand, foot and mouth disease in singapore, 2001-2007.	we reviewed the epidemiology of hand, foot and mouth disease (hfmd) in singapore after the 2000 epidemic caused by enterovirus 71 (ev71), with particular reference to the cyclical pattern, predominant circulating enteroviruses and impact of prevention and control measures in preschool centres.	2009	19271036
the largest outbreak of hand; foot and mouth disease in singapore in 2008: the role of enterovirus 71 and coxsackievirus a strains.	during 2008, singapore experienced its largest ever outbreak of hand, foot and mouth disease (hfmd), resulting in 29686 cases, including four cases of encephalitis and one fatality.	2010	20952237
The changing seroepidemiology of enterovirus 71 infection among children and adolescents in Singapore.	Enterovirus 71 (EV71) has caused recurrent epidemics of hand, foot and mouth disease among children in Singapore. Between August 2008 and July 2010, we conducted a survey to estimate the seroprevalence of EV71 infection among children and adolescents aged 1-17 years. We compared our EV71 seroepidemiologic findings with a previous study conducted in 1996-1997.	2011	21988931
progress on the research and development of inactivated ev71 whole-virus vaccines.	the prevalence of diseases caused by ev71 infection has become a serious public health problem in the western pacific region. due to a lack of effective treatment options, controlling ev71 epidemics has mainly focused on the research and development (r&d) of ev71 vaccines. thus far, five organizations have completed pre-clinical studies focused on the development of inactivated ev71 whole-virus vaccines, including vaccine strain screening, process optimization, safety and immunogenicity evaluati ...	2013	23744508
seroepidemiology of coxsackievirus a6, coxsackievirus a16, and enterovirus 71 infections among children and adolescents in singapore, 2008-2010.	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 in ...	2015	26011735
risk factors for severe hand foot mouth disease in singapore: a case control study.	hand foot mouth disease (hfmd) is a common childhood infection that can potentially lead to serious complications. the aim of this study is to identify risk factors of acquiring severe hfmd in our population.	2015	26520791
basic reproduction number of coxsackievirus type a6 and a16 and enterovirus 71: estimates from outbreaks of hand, foot and mouth disease in singapore, a tropical city-state.	coxsackievirus a6 (cv-a6), coxsackievirus a16 (cv-a16) and enterovirus 71 (ev-a71) were the major enteroviruses causing nationwide hand, foot and mouth disease (hfmd) epidemics in singapore in the last decade. we estimated the basic reproduction number (r 0) of these enteroviruses to obtain a better understanding of their transmission dynamics. we merged records of cases from hfmd outbreaks reported between 2007 and 2012 with laboratory results from virological surveillance. r 0 was estimated ba ...	2016	26374168
the impact of hand, foot and mouth disease control policies in singapore: a qualitative analysis of public perceptions.	hand foot and mouth disease (hfmd) is a widespread pediatric disease in asia. most cases are relatively mild and caused by coxsackie viruses, but in epidemics caused by enterovirus 71, severe complications can occur. in response to the deaths of dozens of children in a 1997 outbreak (podin in bmc public health 6:180,1 abubakar in virus res 61(1):1-9,2 who in3), singapore practices childcare centre surveillance, case-isolation, and short-term closure of centres. we conducted 44 in-depth interview ...	2017	28533530