Epidemiology and Health

Volume 26 (1); June 2004

Original Articles

Outbreak of Measles among School Ages in Yeongju in 2000.: Hae Kwan Cheong, Geun Ryang Bae, Jin Hwa Jeong, Sue Kyung Park, Byung Chan Park, Jee Hee Kim, Joo Yeon Lee, Byung Kuk Na, Woo Joo Kim; Korean J Epidemiol. 2004;26(1):69-80.

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Abstract PDF: Abstract
BACKGROUND
The outbreak of measles from 2000 to 2001 was the biggest epidemic since measles vaccination was introduced in Korea. Outbreak of measles in Yeongju was one of the earliest milestones of the nationwide outbreak in the year 2000. The authors investigated epidemiologic characteristics of the outbreak in this area.
METHODS
The authors estimated attack rate through the investigation of all the school age cases of measles reported to local health authority between March and May, 2000. Case investigation was done to trace the source of the outbreak. One hundred seventy two cases were examined with medical examination, with interview on their clinical manifestations, and with serologic examination on the anti-measles IgM and IgG antibody.
RESULTS
Overall attack rate among the school children was 4.3%, with highest attack rate in middle school students (8.5%). The outbreak began in March in middle schools, which spread to elementary and high schools. IgG was positive in 160(93.0%) cases and IgM was positive in 94(54.6%) cases, among which 90 cases (95.7%) were also positive for IgG. IgM positive cases had higher prevalence of rash (91.5%) compared to those without IgM (70.5%). Diagnostic criteria based on the clinical manifestation and contact history showed the highest sensitivity (92.6%) compared to conventional diagnostic criteria in outbreak (40.4-44.7%) CONCLUSIONS: High proportion of susceptible children in the population due to primary or secondary vaccine failure played a key role in this outbreak. Clinical manifestation was milder than classical measles and adjustment of diagnostic criteria can be helpful in the management of outbreak.; Summary

Epidemiologic Investigation into an Outbreak of Typhoid Fever Recognized by Electronic Data Interchange in Gyeongsangbuk-do, 2003.: Hyun Sul Lim, Young Sun Min, Kwan Lee, Sang Hyuk Lim; Korean J Epidemiol. 2004;26(1):59-68.

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Abstract PDF: Abstract
Epidemiologic Investigation into an Outbreak of Typhoid Fever Recognized by Electronic Data Interchange in Gyeongsangbuk-do, 2003 PURPOSE: Fourteen cases of typhoid fever occurred in Gyeongsan-si, Gyeongsangbuk-do from May 22 to July 19, 2003. Especially, 6 cases were students of Y University located in Gyeongsan-si. This investigation was carried out to study the infection source and transmission of typhoid fever and to institute an effective prevention counterplan.
METHODS
The authors conducted an epidemiologic survey from June 25, 2003 among the 14 cases, restaurants and employees of the whole neighborhood of Y University. Widal test was carried out for the restaurant employees and schoolmates of the 13-year-old case Miss Kim. The authors executed a pulsed field gel electrophoresis (PFGE) for Salmonella typhi cultured from 9 cases. The authors collected data about chloride and turbid levels of treated water from April to June in Gyeongsan-si water treatment plant and repair work records of waterworks pipe line in Gyeongsan-si city hall.
RESULTS
All cases had used restaurants of the whole neighborhood of Y University within 2 months before the typhoid fever symptoms were developed, but the restaurant that was rarely visited by any of the patients had a case to be matched. In the results of the Widal test, 9 out of 45 of subjects (20.0%) were suspicious cases or showed a value to suggest past infection. In the results of PFGE test, there were 3 subtypes, and each subtype had a similar DNA fragments array. In all cases the patients drank tap water when they visited the restaurants. The restaurants provided drinking water from filtered tap water rather than boiled water, and all patients had drunk this water. The chlorine level of the treated water was the normal value in the Gyeongsan-si water treatment plant, but in 2 times the value was the minimum standard level. There was water pipe construction work in some regions of the whole neighborhood of Y University. The number of gastrointestinal patients in 2003 was approximately 2 times that in 2002 at the health center in Y University.
CONCLUSIONS
The possibility that typhoid fever was generated in the whole neighborhood of Y University is very high. Among various possibilities, the highest possibility is the pollution of tap water intake by water leakage of a water pipe. There was no case of patient infection after strengthening of the tap water disinfection. Thorough disinfection, boiled drinking water and a periodic carrier inspection are necessary to prevent additional local occurrences of these typhoid infections.; Summary

Development of the Individualized Health Risk Appraisal Model of Breast Cancer Risk in Korean Women.: Sun Ha Jee, Ji Won Song, Chung Mo Nam; Korean J Epidemiol. 2004;26(1):50-58.

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Abstract PDF: Abstract
OBJECTIVES
The objectives of this study were to develop a health risk appraisal (HRA) model of breast cancer and to evaluate the model's ability to accurately predict ndividual breast cancer risk.
METHOD
The sample data were from a prospective cohort study in Korea with a follow-up period of 8 years in Korea (1995-2002). The cohort was composed of 108,708 Korean women, aged 30 to 64 years, who received health insurance from the Korea Medical Insurance Corporation and who underwent a medical evaluation in 1994. Between 1995 and 2002 (1,138,349 person-year), there were 772 incident cases of breast cancer (67.8/100,000 person-years). First, we developed the HRA based on the Cox proportional hazard models using a prospective cohort data with half-split data (50% random sample). Second, using Cox proportional hazard models, we compared the probability of breast cancer predicted by the model to the actual number of cases observed in the other 50% of the random sample of the study population.
RESULTS
The HRA Cox proportional hazard model of breast cancer developed in the study included age, age2, age at menarche, and lactation. Multivariate Cox proportional hazards models were used to test the HRA model validation. Compared with women in the lowest 10 percentile of subjects, women in the highest 10 percentile had an increased risk of breast cancer (relative risk, 3.701; 95% confidence interval, 2.554 to 5.364).
CONCLUSION
The model's performance was satisfactory for estimating breast cancer risk for individual women aged 30-64 years.; Summary

Epidemiological Characteristics and Changes of Prevalence for Green Tobacco Sickness among Korean Tobacco Harvesters.: Joo Sub Lee, Sung Han Bae, Hyun Sul Lim, Kwan Lee; Korean J Epidemiol. 2004;26(1):39-49.

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Abstract PDF: Abstract
PURPOSE
This study was carried out to investigate the epidemiological characteristics and changes of prevalence for green tobacco sickness (GTS) for 2 years.
METHODS
The author conducted a questionnaire survey on the tobacco harvesters (875 persons from 478 out of 555 tobacco harvesting households surveyed last year) in Cheongsong-gun for 4 days from May 26 to 29, 2003.
RESULTS
The study subjects comprised 456 males and 419 females. The prevalence of GTS in 2002 was 50.5%, which was significantly higher than the 43.0% in 2001 (p<0.01). The incidence density of GTS in 2002 was 11.3 spells/100 person?working-days, which was lower than the 12.1 spells in 2001. Regardless of risk factors such as smoking, workingdays, and working hours, the prevalence of GTS in 2002 was higher than that in 2001. Among various GTS symptoms reported by the tobacco harvesters in 2002, cases of nausea were increased, while diarrhea, dyspnea and cough were decreased compared with 2001. The degree of GTS symptoms in 2002 was increased in 198 cases (64.5%), and decreased in 42 cases (13.7%). The proportion of harvesters who underwent treatment from their local medical facilities in 2002 was significantly decreased compared with that in 2001.
CONCLUSIONS
In Korea, there are many tobacco-harvesting households, most of which may be stricken with GTS. It is very important for doctors to diagnose the disease exactly and to develop prevention methods for GTS. I expect that more extensive epidemiological studies including the incidence and associated risk factors will be needed. In addition, surveillance system and measurements of urinary cotinine should be conducted.; Summary

An Epidemic Survey for Salmonellosis Occurred on a Baby's First Birthday Banquet in Jeju Island.: Sang Yeop Shin, Jung Yun Hong, Jong Myon Bae; Korean J Epidemiol. 2004;26(1):27-38.

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Abstract PDF: Abstract
OBJECTIVES
A field investigation was done to identify the level of epidemic and to evaluate the infection route of Salmonellosis occurred in a baby's first birthday banquet in Jeju Island.
METHODS
Among participants in the banquet given on a baby's first birthday, persons showing gastrointestinal symptoms were conducted by the structured questionnaire and stool culture. The symptomless persons were also surveyed by self-responded structured questionnaire. The causal relationship between food items and gastrointestinal symptoms was proved by odds ratio and Wilcoxon rank-sum test.
RESULTS
Salmonella london was identified in the stools of 12 subjects among 20 participants showing gastrointestinal symptoms, as well as in the boiled pork hock.
CONCLUSIONS
This outbreak event is thought to happen after participants took the boiled pork hock that contaminated with S almonella london during the storage process.; Summary

A Trial for Association between Oxidative Stress in Midterm Pregnancy and Postnatal Growth during the First Year of Life.: Hyesook Park, Young Ju Kim, Hwa Young Lee, Eun Ae Park, Nam Soo Chang, Eun Hee Ha, Bo Hyun Park, Bo Eun Lee, Ju Hee Hong; Korean J Epidemiol. 2004;26(1):17-26.

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Abstract PDF: Abstract
OBJECTIVES
We aims to construct Infant Growth Cohort for evaluating whether oxidative stress in midterm pregnancy has an adverse effect on postnatal growth.
METHODS
AND MATERIALS: From September 2001 to April 2004, we constructed an Ewha Infant Growth Cohort connected with the Ewha Pregnant Women Cohort. We excluded mother-and-child pairs in which the mother had experienced hypertension or diabetes during pregnancy and had multiple births for this study, which gave us 233 mother-and-child pairs for analysis. We measured maternal serum homocysteine and urinary 8-hydroxyguanosine (8-OHdG) and malondialdehyde (MDA) at 24~28 weeks of pregnancy, and infant weights at birth and at 6 and 12 months postnatally. We applied repeated measures ANOVA with PROC MIXED to assess the significance of differences.
RESULTS
We followed 64 and 85 infants at 6 and 12 months respectively. The mean body weights were 3146.4 g at birth, 8229.7 g at 6 months, and 1006.47 g at 12 months. The mean birth weight of infants was lower in mothers with higher homocysteine levels (third and fourth quartiles), but body weights from the first- and fourth-quartile groups of maternal homocysteine levels were lower than the others even though it was not statistically significant. Body weights at birth and at 6 months in third- and fourth-quartile groups of 8-OHdG levels were lower than the others. The body weights in the fourth quartile MDA group were significantly lower than the others at all time points.
CONCLUSIONS
Maternal oxidative stress in midterm pregnancy may cause postnatal growth retardation. But, there were high rate of follow up loss and various measurement errors. Therefore, we need to have efforts for compete follow up and valid and reliable measurements.; Summary

Analysis of Transmission Mode of Confirmed Shigellosis in Gyeongju, Korea.: Cheoll Jung, Hyun Sul Lim, Gyoung Yim Ha, Hee Su Kim; Korean J Epidemiol. 2004;26(1):1-16.

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Abstract PDF: Abstract
PURPOSE
This study was carried out to investigate the sources of infection and modes of transmission of an 107 (54males, 53 females) confirmed shigellosis in Gyeongju from Sept. 24 to Oct. 24, 1998.
METHODS
We reviewed hospital records of all confirmed shigellosis. Thirty-two strains of Shigella sonnei isolated were analyzed in order to trace the source of infections by plasmid profile, antimicrobial drug resistance pattern, biotyping and pulsed-field gel electrophoresis (PFGE).
RESULTS
The first source of infection was estimated to be contaminated underground water and simple piped water caused by leakage from the cess pool. Antimicrobial drug resistance pattern showed that all strains were multi-resistant. All isolates had the same XbaI and SfiI PFGE patterns, indicating the epidemiological relationship of the outbreaks strains in this area. The major characteristics of diarrhea were watery (84.2%) in nature. The clinical symptoms among the diarrheal cases included abdominal pain (86.1%), fever (83.2%), headache (78.2%), chill (45.5%) and tenesmus (41.6%). Six cases were asymptomatic. From initial manifestation to admission were 6.2+/-1.6 (median 6) days, so it could be transmitted to others in this infective period. Duration of admission were 5.5 +/-2.4 (median 6) days. We can find familial mean secondary attack rate were 38.5%.
CONCLUSION
It's transmission to other areas were certified by contaminated water and contact with shigellosis, and unknown cases were estimated to be transmitted by contacts with inapparent infection. By plasmid profile and PFGE, the epidemiological relationship of the outbreaks strains in this area seemed to be the same micro-organisms.; Summary

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