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  1. Article ; Online: Implementing the World Health Organization Pandemic Influenza Severity Assessment framework-Singapore's experience.

    Pung, Rachael / Lee, Vernon Jian Ming

    Influenza and other respiratory viruses

    2019  Volume 14, Issue 1, Page(s) 3–10

    Abstract: Background: We report our experience in evaluating the severity of local influenza epidemics using the World Health Organization Pandemic Influenza Severity Assessment framework.: Methods: We assessed the severity of influenza by monitoring ... ...

    Abstract Background: We report our experience in evaluating the severity of local influenza epidemics using the World Health Organization Pandemic Influenza Severity Assessment framework.
    Methods: We assessed the severity of influenza by monitoring indicators of influenza transmissibility, seriousness of disease and impact on healthcare resource utilisation. Indicators were described by various parameters collected weekly from eight government hospitals, 20 government and 30 private primary care clinics, and the national public health laboratory. Transmissibility and seriousness of disease indicators were each represented by multiple parameters, and alert thresholds were set at the 70th and 90th percentile of a parameter's past 2-year surveillance data. We derived a collective measure for each indicator using the average percentile rank of the related parameters. Alert thresholds for the single impact parameter were set at predefined values and evaluated for its sensitivity, specificity and positive predictive value.
    Results: For the transmissibility and seriousness of disease parameters, calculation of the percentile rank was simple and independent of a parameter's underlying distribution. For the impact parameter, predefined alert thresholds had high sensitivity and specificity (>80%) but low positive predictive value (15%-30%). Assessment scales were used to qualitatively classify the activity of an indicator as low, moderate or high together with a confidence level.
    Conclusion: We applied different methods for threshold setting depending on the attributes of each parameter and indicator. For indicators represented by multiple parameters, an aggregated assessment of the indicator's level of activity and confidence level of the assessment was needed for effective reporting.
    MeSH term(s) Epidemiological Monitoring ; Humans ; Influenza, Human/epidemiology ; Influenza, Human/transmission ; Pandemics/statistics & numerical data ; Public Health ; Seasons ; Sentinel Surveillance ; Singapore/epidemiology ; World Health Organization
    Language English
    Publishing date 2019-10-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 2274538-5
    ISSN 1750-2659 ; 1750-2640
    ISSN (online) 1750-2659
    ISSN 1750-2640
    DOI 10.1111/irv.12680
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Healthcare workers in Singapore infected with COVID-19: 23 January-17 April 2020.

    Wong, Lai Yin / Tan, Aidan Lyanzhiang / Leo, Yee-Sin / Lee, Vernon Jian Ming / Toh, Matthias Paul Han Sim

    Influenza and other respiratory viruses

    2020  Volume 15, Issue 2, Page(s) 218–226

    Abstract: Objective: To describe the characteristics of healthcare workers (HCWs) infected with COVID-19 and to examine their sources of exposure.: Methods: A descriptive cross-sectional study using data extracted from the centralized disease notification ... ...

    Abstract Objective: To describe the characteristics of healthcare workers (HCWs) infected with COVID-19 and to examine their sources of exposure.
    Methods: A descriptive cross-sectional study using data extracted from the centralized disease notification system comprising individuals confirmed with COVID-19 in Singapore between 23 January and 17 April 2020. Occupation of HCWs was categorized into six categories. Their job nature was classified into "frontline" or "back-end" based on the frequency of direct patient contact, and source of exposure was classified as family/household, social interaction or workplace. Chi-square and median tests were used to identify differences between categorical groups and sample medians, respectively.
    Results: A total of 88 (1.7%) HCWs were identified from 5,050 cases. Their median age was 35 years. Chinese and Indians constituted 42.0% and 31.8%, respectively, and 43.2% were foreigners. The majority (63.6%) was serving at frontlines handling patient-facing duties, 15.9% were doctors, 11.4% were nurses and 44.3% were ancillary staff. About 81.8% acquired the infection locally, of which 40.3% did not have a clearly identifiable source of exposure. Exposure from the family/household was most common (27.8%), followed by workplace (16.7%) and social interaction (15.3%). All HCWs were discharged well with no mortality; three (3.4%) were ever admitted to intensive care unit and required increased care.
    Conclusion: Healthcare workers accounted for a small proportion of COVID-19 cases in Singapore with favourable outcomes. The possibility of transmission resulting from family/household exposure and social interactions highlights the need to maintain strict vigilance and precautionary measures at all times beyond the workplace.
    MeSH term(s) Adult ; Aged ; COVID-19/diagnosis ; COVID-19/epidemiology ; COVID-19/therapy ; COVID-19/transmission ; Contact Tracing/statistics & numerical data ; Cross-Sectional Studies ; Disease Transmission, Infectious/statistics & numerical data ; Female ; Health Personnel/classification ; Health Personnel/statistics & numerical data ; Humans ; Male ; Middle Aged ; SARS-CoV-2/isolation & purification ; Singapore/epidemiology ; Treatment Outcome
    Keywords covid19
    Language English
    Publishing date 2020-09-13
    Publishing country England
    Document type Journal Article
    ZDB-ID 2274538-5
    ISSN 1750-2659 ; 1750-2640
    ISSN (online) 1750-2659
    ISSN 1750-2640
    DOI 10.1111/irv.12803
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Results from a systematic programme of evaluating COVID-19 reinfection cases in the early phase of the pandemic, Singapore.

    Tan, Glorijoy Shi En / Gao, Christine Qiuhan / Ow, Jievanda Shu Ying / Tan, Thuan Thong / Ooi, Say Tat / Lin, Cui / Lin, Raymond Tzer Pin / Lee, Vernon Jian Ming / Chan, Monica / Leo, Yee Sin / Vasoo, Shawn

    BMC infectious diseases

    2023  Volume 23, Issue 1, Page(s) 93

    Abstract: Objectives: The objectives of this study were to describe the coronavirus disease caused by SARS-CoV-2 (COVID-19) reinfection evaluation algorithm used in the early phase of the pandemic in Singapore and analyze the clinical and laboratory ... ...

    Abstract Objectives: The objectives of this study were to describe the coronavirus disease caused by SARS-CoV-2 (COVID-19) reinfection evaluation algorithm used in the early phase of the pandemic in Singapore and analyze the clinical and laboratory characteristics of the cases evaluated.
    Methods: We performed a retrospective case-control analysis including all COVID-19 cases evaluated for possible reinfection under the local COVID-19 reinfection evaluation programme between 1 June 2020-30 June 2021. Whole genome sequencing (WGS) was used as confirmatory testing. We compared all reinfection ("RI") cases against those who were evaluated but eventually assessed not to be reinfection ("non-RI").
    Results: There were 74 possible reinfection cases evaluated through the programme, of which 32 were subsequently classified as RI. There was strong statistical evidence that RI cases had a longer interval between 1st and 2nd episode (mean 297 days; 95%-confidence interval (CI) 267-327) compared to non-RI cases (mean 186 days; 95%-CI 144-228). The cycle threshold (Ct) value of initial polymerase chain rection (PCR) at 2nd episode was also found to be significantly lower in RI cases (mean 23; 95%-CI 20-26) compared to non-RI cases (mean 34; 95%-CI 32-36). There was no significant difference in the proportion of individuals who had fever, acute respiratory symptoms or asymptomatic in both groups. Delta and beta variants were most commonly identified from WGS and provide indication of re-infection as these were not 'wild-type' and were not circulating during the time period of the index infection.
    Conclusions: Using a combination of serologic, microbiologic and genomic criteria to evaluate possible reinfection cases is useful and can provide a framework for evaluation that may be modified for future similar situations.
    MeSH term(s) Humans ; COVID-19/diagnosis ; COVID-19/epidemiology ; SARS-CoV-2/genetics ; Pandemics ; Reinfection/diagnosis ; Reinfection/epidemiology ; Retrospective Studies ; Singapore/epidemiology
    Language English
    Publishing date 2023-02-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 2041550-3
    ISSN 1471-2334 ; 1471-2334
    ISSN (online) 1471-2334
    ISSN 1471-2334
    DOI 10.1186/s12879-023-08056-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Living with COVID-19: The road ahead.

    Wei, Wycliffe Enli / Tan, Wei Keat / Cook, Alex Richard / Hsu, Li Yang / Teo, Yik Ying / Lee, Vernon Jian Ming

    Annals of the Academy of Medicine, Singapore

    2021  Volume 50, Issue 8, Page(s) 619–628

    Abstract: Introduction: The COVID-19 pandemic has affected the world for more than a year, with multiple waves of infections resulting in morbidity, mortality and disruption to the economy and society. Response measures employed to control it have generally been ... ...

    Abstract Introduction: The COVID-19 pandemic has affected the world for more than a year, with multiple waves of infections resulting in morbidity, mortality and disruption to the economy and society. Response measures employed to control it have generally been effective but are unlikely to be sustainable over the long term.
    Methods: We examined the evidence for a vaccine-driven COVID-19 exit strategy including academic papers, governmental reports and epidemiological data, and discuss the shift from the current pandemic footing to an endemic approach similar to influenza and other respiratory infectious diseases.
    Results: A desired endemic state is characterised by a baseline prevalence of infections with a generally mild disease profile that can be sustainably managed by the healthcare system, together with the resumption of near normalcy in human activities. Such an endemic state is attainable for COVID-19 given the promising data around vaccine efficacy, although uncertainty remains around vaccine immunity escape in emergent variants of concern. Maintenance of non-pharmaceutical interventions remains crucial until high vaccination coverage is attained to avoid runaway outbreaks. It may also be worthwhile to de-escalate measures in phases, before standing down most measures for an endemic state. If a variant that substantially evades immunity emerges, it will need to be managed akin to a new disease threat, with pandemic preparedness and response plans.
    Conclusion: An endemic state for COVID-19, characterised by sustainable disease control measures, is likely attainable through vaccination.
    MeSH term(s) COVID-19 ; Disease Outbreaks/prevention & control ; Humans ; Influenza, Human/epidemiology ; Influenza, Human/prevention & control ; Pandemics/prevention & control ; SARS-CoV-2
    Language English
    Publishing date 2021-09-02
    Publishing country Singapore
    Document type Journal Article
    ZDB-ID 604527-3
    ISSN 0304-4602
    ISSN 0304-4602
    DOI 10.47102/annals-acadmedsg.2021244
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Seroprevalence of IgG antibodies against diphtheria antitoxin among migrant workers in Singapore, 2016-2019.

    Ang, Li Wei / Gao, Qi / Cui, Lin / Farwin, Aysha / Toh, Matthias Paul Han Sim / Boudville, Irving Charles / Chen, Mark I-Cheng / Chow, Angela / Lin, Raymond Tzer-Pin / Lee, Vernon Jian Ming / Leo, Yee Sin

    BMC public health

    2022  Volume 22, Issue 1, Page(s) 111

    Abstract: Background: Since the last local case of diphtheria in 1992, there had not been any case in Singapore until an autochthonous case was reported in 2017. This fatal diphtheria case of a migrant worker raised concerns about the potential re-emergence of ... ...

    Abstract Background: Since the last local case of diphtheria in 1992, there had not been any case in Singapore until an autochthonous case was reported in 2017. This fatal diphtheria case of a migrant worker raised concerns about the potential re-emergence of locally transmitted toxigenic diphtheria in Singapore. We conducted a seroprevalence study to assess the immunity levels to diphtheria among migrant workers in Singapore.
    Methods: Residual sera from migrant workers who hailed from Bangladesh, China, India, Indonesia, Malaysia, Myanmar and the Philippines were tested for anti-diphtheria toxoid immunoglobulin G (IgG) antibodies. These migrant workers previously participated in a survey between 2016 and 2019 and had provided blood samples as part of the survey procedure.
    Results: A total of 2176 migrant workers were included in the study. Their overall mean age was 27.1 years (standard deviation 5.0), range was 20-43 years. The proportion having at least basic protection against diphtheria (antitoxin titres ≥ 0.01 IU/ml) ranged from 77.9% (95% confidence interval [CI] 72.8 - 82.3%) among migrant workers from Bangladesh to 96.7% (95% CI 92.5 - 98.6%) in those hailing from Malaysia. The proportion showing full protection (antitoxin titres ≥ 0.10 IU/ml) ranged from 10.1% (95% CI 6.5 - 15.4%) in Chinese workers to 23.0% (95% CI 17.1 - 30.3%) in Malaysian workers. There were no significant differences in the proportion with at least basic protection across birth cohorts, except for those from Bangladesh where the seroprevalence was significantly lower in younger migrant workers born after 1989.
    Conclusions: The proportions having at least basic protection against diphtheria in migrant workers from five out of seven Asian countries (India, Indonesia, Malaysia, Myanmar and the Philippines) were higher than 85%, the threshold for diphtheria herd immunity. Seroprevalence surveys should be conducted periodically to assess the level of immunity against diphtheria and other vaccine preventable diseases in migrant worker population, so that appropriate interventions such as booster vaccination can be implemented proactively to prevent sporadic outbreaks.
    MeSH term(s) Adult ; Antibodies, Bacterial ; Diphtheria/epidemiology ; Diphtheria/prevention & control ; Diphtheria Antitoxin ; Diphtheria Toxoid ; Humans ; Immunoglobulin G ; Seroepidemiologic Studies ; Singapore/epidemiology ; Transients and Migrants
    Chemical Substances Antibodies, Bacterial ; Diphtheria Antitoxin ; Diphtheria Toxoid ; Immunoglobulin G
    Language English
    Publishing date 2022-01-16
    Publishing country England
    Document type Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2041338-5
    ISSN 1471-2458 ; 1471-2458
    ISSN (online) 1471-2458
    ISSN 1471-2458
    DOI 10.1186/s12889-022-12528-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Prevalence of measles antibodies among migrant workers in Singapore: a serological study to identify susceptible population subgroups.

    Ang, Li Wei / Gao, Qi / Cui, Lin / Farwin, Aysha / Toh, Matthias Paul Han Sim / Boudville, Irving Charles / Chen, Mark I-Cheng / Chow, Angela / Lin, Raymond Tzer-Pin / Lee, Vernon Jian Ming / Leo, Yee Sin

    BMC infectious diseases

    2022  Volume 22, Issue 1, Page(s) 88

    Abstract: Background: In 2019, two clusters of measles cases were reported in migrant worker dormitories in Singapore. We conducted a seroprevalence study to measure the level of susceptibility to measles among migrant workers in Singapore.: Methods: Our study ...

    Abstract Background: In 2019, two clusters of measles cases were reported in migrant worker dormitories in Singapore. We conducted a seroprevalence study to measure the level of susceptibility to measles among migrant workers in Singapore.
    Methods: Our study involved residual sera of migrant workers from seven Asian countries (Bangladesh, China, India, Indonesia, Malaysia, Myanmar and the Philippines) who had participated in a survey between 2016 and 2019. Immunoglobulin G (IgG) antibody levels were first measured using a commercial enzyme-linked immunosorbent assay (ELISA) test kit. Those with equivocal or negative IgG results were further evaluated using plaque reduction neutralization test (PRNT).
    Results: A total of 2234 migrant workers aged 20-49 years were included in the study. The overall prevalence of measles IgG antibodies among migrant workers from the seven Asian countries was 90.5% (95% confidence interval 89.2-91.6%). The country-specific seroprevalence ranged from 80.3 to 94.0%. The seroprevalence was significantly higher among migrant workers born in 1965-1989 than those born in 1990-1999 (95.3% vs. 86.6%, p < 0.0005), whereas there was no significant difference by gender (90.8% in men vs. 89.9% in women, p = 0.508). 195 out of 213 samples with equivocal or negative ELISA results were tested positive using PRNT.
    Conclusion: The IgG seroprevalence in migrant workers was below the herd immunity threshold of 95% for measles. Sporadic outbreaks may occur in susceptible individuals due to high transmissibility of measles virus. Seroprevalence surveys can help identify susceptible subgroups for vaccination.
    MeSH term(s) Antibodies, Viral ; Female ; Humans ; Male ; Measles/epidemiology ; Middle Aged ; Prevalence ; Seroepidemiologic Studies ; Singapore/epidemiology ; Transients and Migrants
    Chemical Substances Antibodies, Viral
    Language English
    Publishing date 2022-01-25
    Publishing country England
    Document type Journal Article
    ZDB-ID 2041550-3
    ISSN 1471-2334 ; 1471-2334
    ISSN (online) 1471-2334
    ISSN 1471-2334
    DOI 10.1186/s12879-022-07066-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: The first imported case of monkeypox in Singapore during the 2022 outbreak - Reflections and lessons.

    Tan, Wilnard Yeong Tze / Wong, Chen Seong / Ho, Marc Zheng Jie / Said, Zubaidah / Cui, Lin / Lin, Raymond Tzer Pin / Chan, Monica / Vasoo, Shawn / Lee, Vernon Jian Ming / Leo, Yee Sin

    Travel medicine and infectious disease

    2022  Volume 50, Page(s) 102431

    Abstract: On June 21, 2022, Singapore reported its second ever case of imported monkeypox and first linked to the ongoing multi-country outbreak that has since been declared a public health emergency of international concern. There was quick initiation of public ... ...

    Abstract On June 21, 2022, Singapore reported its second ever case of imported monkeypox and first linked to the ongoing multi-country outbreak that has since been declared a public health emergency of international concern. There was quick initiation of public health measures including identification and quarantine of contacts, with post-exposure smallpox vaccination.
    MeSH term(s) Humans ; Mpox (monkeypox)/diagnosis ; Mpox (monkeypox)/epidemiology ; Singapore/epidemiology ; Disease Outbreaks/prevention & control ; Smallpox/epidemiology ; Public Health
    Language English
    Publishing date 2022-08-27
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2170891-5
    ISSN 1873-0442 ; 1477-8939
    ISSN (online) 1873-0442
    ISSN 1477-8939
    DOI 10.1016/j.tmaid.2022.102431
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Characterisation of respiratory syncytial virus activity in children and adults presenting with acute respiratory illness at primary care clinics in Singapore, 2014-2018.

    Ang, Li Wei / Mak, Tze Minn / Cui, Lin / Leo, Yee Sin / Lee, Vernon Jian Ming / Lin, Raymond Tzer-Pin

    Influenza and other respiratory viruses

    2020  Volume 14, Issue 4, Page(s) 412–419

    Abstract: Background: Respiratory syncytial virus (RSV) is an important respiratory pathogen that affects people of all ages.: Objectives: We examined the patterns of RSV circulation in 2014-2018, and investigated their age-specific differences in tropical ... ...

    Abstract Background: Respiratory syncytial virus (RSV) is an important respiratory pathogen that affects people of all ages.
    Objectives: We examined the patterns of RSV circulation in 2014-2018, and investigated their age-specific differences in tropical Singapore.
    Methods: Nasopharyngeal and/or throat swabs were taken from outpatient attendees for the national influenza virological surveillance among those who presented with acute respiratory illness in the community. Specimens tested negative for influenza were then tested for RSV and other respiratory pathogens.
    Results: Among 8436 influenza-negative specimens tested during the five-year period, 5.8% (95% confidence interval 5.3%-6.3%) were positive for RSV. The peak of RSV activity occurred around middle of the year. The age-specific proportion of RSV detections showed a reverse J-shaped pattern; RSV positivity was the highest in young children ≤2 years of age (10.9%), followed by those aged 3-5 years (6.4%) and persons aged ≥65 years (5.3%), while the nadir was observed in the age group of 15-24 years (1.2%). RSV type A was predominantly circulating in children ≤5 years of age from 2014 to 2015 and 2017, whereas in 2016, they were more affected by type B.
    Conclusion: Respiratory syncytial virus was more frequently detected among the two age groups that have been recommended for influenza vaccination; persons ≥65 years of age and children 6 months to <5 years of age. Characterisation of RSV activity in the community helps to better inform public health policies for effective prevention and control interventions.
    MeSH term(s) Adolescent ; Adult ; Age Factors ; Aged ; Ambulatory Care Facilities/statistics & numerical data ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Influenza, Human/epidemiology ; Male ; Middle Aged ; Nasopharynx/virology ; Primary Health Care/statistics & numerical data ; Respiratory Syncytial Virus Infections/diagnosis ; Respiratory Syncytial Virus Infections/epidemiology ; Respiratory Syncytial Virus, Human/genetics ; Respiratory Syncytial Virus, Human/isolation & purification ; Respiratory Syncytial Virus, Human/pathogenicity ; Sentinel Surveillance ; Singapore/epidemiology ; Young Adult
    Language English
    Publishing date 2020-02-24
    Publishing country England
    Document type Journal Article
    ZDB-ID 2274538-5
    ISSN 1750-2659 ; 1750-2640
    ISSN (online) 1750-2659
    ISSN 1750-2640
    DOI 10.1111/irv.12730
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article: Healthcare workers in Singapore infected with COVID-19: 23 January-17 April 2020

    Wong, Lai Yin / Tan, Aidan Lyanzhiang / Leo, Yee-Sin / Lee, Vernon Jian Ming / Toh, Matthias Paul Han Sim

    Influenza other respir. viruses

    Abstract: OBJECTIVE: To describe the characteristics of healthcare workers (HCWs) infected with COVID-19 and to examine their sources of exposure. METHODS: A descriptive cross-sectional study using data extracted from the centralized disease notification system ... ...

    Abstract OBJECTIVE: To describe the characteristics of healthcare workers (HCWs) infected with COVID-19 and to examine their sources of exposure. METHODS: A descriptive cross-sectional study using data extracted from the centralized disease notification system comprising individuals confirmed with COVID-19 in Singapore between 23 January and 17 April 2020. Occupation of HCWs was categorized into six categories. Their job nature was classified into "frontline" or "back-end" based on the frequency of direct patient contact, and source of exposure was classified as family/household, social interaction or workplace. Chi-square and median tests were used to identify differences between categorical groups and sample medians, respectively. RESULTS: A total of 88 (1.7%) HCWs were identified from 5,050 cases. Their median age was 35 years. Chinese and Indians constituted 42.0% and 31.8%, respectively, and 43.2% were foreigners. The majority (63.6%) was serving at frontlines handling patient-facing duties, 15.9% were doctors, 11.4% were nurses and 44.3% were ancillary staff. About 81.8% acquired the infection locally, of which 40.3% did not have a clearly identifiable source of exposure. Exposure from the family/household was most common (27.8%), followed by workplace (16.7%) and social interaction (15.3%). All HCWs were discharged well with no mortality; three (3.4%) were ever admitted to intensive care unit and required increased care. CONCLUSION: Healthcare workers accounted for a small proportion of COVID-19 cases in Singapore with favourable outcomes. The possibility of transmission resulting from family/household exposure and social interactions highlights the need to maintain strict vigilance and precautionary measures at all times beyond the workplace.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #760144
    Database COVID19

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  10. Article ; Online: Healthcare workers in Singapore infected with COVID‐19

    Wong, Lai Yin / Tan, Aidan Lyanzhiang / Leo, Yee‐Sin / Lee, Vernon Jian Ming / Toh, Matthias Paul Han Sim

    Influenza and Other Respiratory Viruses ; ISSN 1750-2640 1750-2659

    23 January‐17 April 2020

    2020  

    Keywords Public Health, Environmental and Occupational Health ; Epidemiology ; Pulmonary and Respiratory Medicine ; Infectious Diseases ; covid19
    Language English
    Publisher Wiley
    Publishing country us
    Document type Article ; Online
    DOI 10.1111/irv.12803
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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