{
  "abstract": "We report on the virological and epidemiological features of a severe hand foot and mouth disease outbreak in Vietnam in 2023. Enterovirus A71 (EV-A71) subgenogroup B5, first emerging around November 2022, and imported into Vietnam through a single introduction, was the primary cause. Convalescent plasma collected from patients infected with subgenogroups B5 in 2014 and 2023 could neutralize both contemporary viruses with comparable titers, suggesting no evidence of immune evasion. However, at one and six months before the start of the outbreak, only 6.7% of 0– < 3 year-old children in Ho Chi Minh City, an epicenter of the outbreak, had neutralizing antibodies against EV-A71. Seroprevalence increased as the outbreak progressed, coinciding with a drop in EV-A71 infected patients residing in Ho Chi Minh City, suggesting that serosurveillance could be a useful tool to assess the risk of pathogen emergence. Our collective findings have provided novel insights into the epidemiological factors driving EV-A71 emergence, and therefore would inform outbreak preparedness and response, and in particular the development of serosurveillance-based approach to assess the risk of pathogen emergence. EV-A71 infection represents an ongoing public health threat, currently affecting countries in the Asia-Pacific region, but with a high potential to become a global problem, and therefore should be closely monitored. Author summary: In 2023, Vietnam experienced a large and severe outbreak of hand food and mouth disease in children. Our investigations showed that enterovirus A71 (EV-A71) subgenogroup B5, first emerging around November 2022, and then introduced into Vietnam through a single event, was the main cause. Blood samples from patients who recovered from subgenogroups B5 infection in 2014 and 2023 could neutralize both contemporary viruses without evidence of immune evasion. Before the start of the outbreak, only 6.7% of 0– < 3 year-old children in Ho Chi Minh City, an epicenter of the outbreak, had neutralizing antibodies that can block EV-A71 infection. Seroprevalence increased as the outbreak progressed, while the number of the infected patients decreased. Monitoring population immunity against EV-A71 could help assess the risk of pathogen emergence. EV-A71 infection represents an ongoing public health threat, currently affecting countries in the Asia-Pacific region, but with a high potential to become a global problem, and therefore should be closely monitored.",
  "abstract_shown": true,
  "affiliations": [
    "Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.",
    "University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.",
    "Children's Hospital 1, Ho Chi Minh City, Vietnam.",
    "Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.",
    "Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.",
    "Department of Health, Ho Chi Minh City, Vietnam.",
    "Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom."
  ],
  "article_type": "Research Article",
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    {
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        0,
        1
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      "name": "Lam Anh Nguyet"
    },
    {
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        0
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      "name": "Nguyen To Anh"
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    {
      "affs": [
        2
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      "name": "Du Tuan Quy"
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    {
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        0
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      "name": "Nguyen Thi Thu Hong",
      "orcid": "0009-0004-4993-6616"
    },
    {
      "affs": [
        2
      ],
      "name": "Ngo Ngoc Quang Minh"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Phung Nguyen The Nguyen"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Pham Van Quang"
    },
    {
      "affs": [
        0
      ],
      "name": "Do Duong Kim Han"
    },
    {
      "affs": [
        0
      ],
      "name": "Nguyen Thi Han Ny"
    },
    {
      "affs": [
        0
      ],
      "name": "Le Nguyen Truc Nhu"
    },
    {
      "affs": [
        0
      ],
      "name": "Truong Hoang Chau Truc"
    },
    {
      "affs": [
        0
      ],
      "name": "Cao Thu Thuy"
    },
    {
      "affs": [
        0
      ],
      "name": "Nhung Ngoc Hoang",
      "orcid": "0000-0003-4670-9317"
    },
    {
      "affs": [
        0
      ],
      "name": "Tran Ba Thien",
      "orcid": "0009-0007-2964-7747"
    },
    {
      "affs": [
        0
      ],
      "name": "Le Kim Thanh"
    },
    {
      "affs": [
        2
      ],
      "name": "Nguyen Thanh Hung"
    },
    {
      "affs": [
        2
      ],
      "name": "Truong Huu Khanh"
    },
    {
      "affs": [
        2
      ],
      "name": "Cao Minh Hiep"
    },
    {
      "affs": [
        4
      ],
      "name": "Nghiem My Ngoc"
    },
    {
      "affs": [
        4
      ],
      "name": "Nguyen Thanh Dung"
    },
    {
      "affs": [
        2
      ],
      "name": "Le Nguyen Thanh Nhan"
    },
    {
      "affs": [
        5
      ],
      "name": "Nguyen Van Vinh Chau"
    },
    {
      "affs": [
        1
      ],
      "name": "Ha Manh Tuan"
    },
    {
      "affs": [
        0,
        6
      ],
      "name": "H Rogier van Doorn"
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    {
      "affs": [
        0,
        6
      ],
      "name": "Marc Choisy",
      "orcid": "0000-0002-5187-6390"
    },
    {
      "affs": [
        0
      ],
      "name": "Tran Tan Thanh"
    },
    {
      "affs": [
        0,
        6
      ],
      "name": "Le Van Tan",
      "orcid": "0000-0002-1791-3901"
    }
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  "published": "2026-10-05",
  "publisher": "Public Library of Science",
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  "title": "Virological and epidemiological investigations of a severe hand foot and mouth disease outbreak, Vietnam, 2023",
  "title_text": "Virological and epidemiological investigations of a severe hand foot and mouth disease outbreak, Vietnam, 2023",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:18:10Z",
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