Epidemiology and Health

Volume 28 (1); June 2006

Original Articles

An Epidemiological Survey on the Outbreak of Cholera of Overseas Travelers in Daejeon.: Sun Mi Jin, Tae Yong Lee; Korean J Epidemiol. 2006;28(1):119-128.

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PURPOSE
This study was coducted to describe the epidemiological, characteristics of the outbreak of cholera of overseas travelers on Aug. 2005 in Daejeon. MATERIALS AND METHODS: Interview using a standard questionnaire and rectal swab were conducted to 15 overseas travelers ,27 persons who contacted with travelers RESULTS: Epidemiological characteristics of the 2005 cholera epidemic of Daejeon are as follows: 1. Isolated species were Vibrio cholerae, O1 El Tor Ogawa. There were 6 culture-proven patients, 4 culture-not proven patients and 2 asymptomatic carriers. There was no case of person to person infection and no fatal cases 2. The sex distribution of cholera patients was equal. The most of cholera patients were at the age of fifties. 3. The duration of diarrhea was 4.4 days. The number of diarrhea per 1day was 5.5. 4. Source of Vibrio cholerae in this outbreak was suggested to be the contaminated food from the overseas traveling to epidemic area, Mandalay, Myanmar on Aug. 8, 2005 CONCLUSIONS: It is recommended that the government should be prepared to prevent cholera of overseas travelers effectively. To prevent the outbreak of cholera by chronic carriers, we need to strengthen the monitoring sytem of diarrhoeal diseases.; Summary

Case Series of Pediatric Mycoplasma Pneumoniae Pneumonia Inpatients in A Hospital.: Young Sun Min, Hyun Sul Lim; Korean J Epidemiol. 2006;28(1):112-118.

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OBJECTIVES
The aim of this report is to examine characteristics of pediatric Mycoplasma Pneumoniae pneumonia inpatients.
METHODS
The authors conducted a medical record survey among 236 children under seventeen were hospitalized in a university hospital due to Mycoplasma Pneumoniae pneumonia, 2001-2003. The author reviewed gender, age, address, developed date of symptoms, admission day, discharge day, etc.
RESULTS
The number of inpatients was increased during late summer and fall. The mean age of all cases was 3.7+/-2.9 years old. One hundred ninety three cases (81.8%) had lung infiltration findings. The mean symptomatic period was 11.9+/-6.4 days (maximum 44 days, minimum 4 days, median 10 days), the mean hospital length of stay was 5.2+/-2.5 days (maximum 17 days, minimum 0 day, median 5 days).
DISCUSSION
The authors reviewed characteristics during last 3 years for Mycoplasma Pneumoniae pneumonia. This report is meaningful with its basic data for the epidemiologic characteristics of Mycoplasma Pneumoniae pneumonia inpatients.; Summary

Outbreak of Scabies at Geriatric Long-Term Care Facilities in Korea.: Mo Ran Ki, Hyun Jin Moon, Hyoun Cho; Korean J Epidemiol. 2006;28(1):100-111.

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OBJECTIVES
To investigate an outbreak of scabies that occurred in geriatricfacilities located in Kyounggi-province, Korea, between September 2004 and September 2005.
METHODS
We carried out an epidemiologic investigation on the scabies outbreak. All workers except two were interviewed and the charts of the patients were reviewed.
RESULTS
Among workers, the attack rate was 58.6% (17/29). The rate was 86.0%(37/43) in patients. Secondary cases also occurred among the family members of workers, with a secondary attack rate of 15.8%. The 95% confidence interval was 6%~31.3%. The transmission of scabies began from one index case who had scabies and moved from another facility. She was hospitalized on the 4th floor of this facilitywhere dependent patients resided. After the activities (picnic and yard sale) in May 2005, and the ward rotation of care givers between the 3rd and 4th floor in July 2005, the incidence of scabies increased. The last cases occurred in Sep. 2005.
CONCLUSIONS
This outbreak investigation has importance because it is the first report of ascabies outbreak in geriatric long-term care facilities in Korea. Recently, the reports on a scabies epidemic are increasing with the augmentation of geriatric long-term care facilities. It is important to educate and inform workers and staff in long-term care facilities about scabies and other contagious skin diseases. More facilities for senility and dementia will be opened and we need to lookinto contagious diseases in long-term care facilities.; Summary

Smoking-Attributable Mortality Among Korean Adults: 1981-2003.: Sun Ha Jee, Ja Kyoung Lee, Il Soon Kim; Korean J Epidemiol. 2006;28(1):92-99.

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OBJECTIVES
Cigarette smoking has been widely recognized as a major risk factor for lung cancer and other diseases in Western countries. In Korea, male cigarette smoking prevalence is among the world's highest and smoking has also become a strong risk factor for lung cancer and cardiovascular diseases. The objectives of the study were to calculate the smoking-attributable mortality in Korea and to predict future smoking-attributable mortality based on the observed data.
METHODS
Number of smoking-attributable deaths were calculated by applying the percentages of population attributable risks (PARs) to the estimated number of deaths by diseases. In this study, PARs were obtained by using relative risks from Korean Cancer Prevention Study and population smoking prevalence.
RESULTS
Among adult male, the smoking-attributable mortality (40,087) represents 30.75% of total 2003 mortality, whereas the smoking-attributable mortality (6,120) for adult females was 5.70%. Smoking was supposed to be responsible for 37.29% of all male cancer and 26.73% of all male cardiovascular diseases, whereas smoking for 4.68% of all female cancer and 5.93% of all female cardiovascular diseases in Korea.
CONCLUSION
Smoking actually represents a remarkable burden of avoidable deaths in Korea. Smoking-attributable mortality appears to continue increasing in the last years.; Summary

International Cooperation in the Control and Prevention of Emerging and Reemerging Infectious Diseases.: Hae Kwan Cheong; Korean J Epidemiol. 2006;28(1):85-91.

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This paper discusses the recent increase in the incidence of emerging and reemerging infectious diseases and the role of international cooperation in coping with such public health threats. The historical background and its evolution are reviewed and the need, advantages, and possible areas of international cooperation are presented. A current example and model of international cooperation at various levels is described. Finally, two of the main issues in the process of international cooperation are discussed: the ethical aspect of scientific communication and national interest, and intellectual property issues.; Summary

Perspectives of Policies on HIV/AIDS and Tuberculosis Control in Korea.: Bo Youl Choi; Korean J Epidemiol. 2006;28(1):75-84.

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Since the early 1990s, Korea has made efforts to strengthen its National Communicable Disease Control System. In 2005, the Korea government developed various goals for communicable diseases control as a part of Health Plan 2010. The goals include 40 objectives, for the achievement of which a variety of programs and research subjects have been developed. These efforts will contribute to raising the preparedness for and response to the global threat of emerging and reemerging infectious diseases. The author reviewed the status, management goals and future tasks of HIV/AIDS and tuberculosis in Korea. HIV/AIDS is an emerging infectious disease, and tuberculosis is an endemic disease in Korea. These two diseases are included in the UN Millennium Development Goal 6. The number of HIV/AIDS cases reported in Korea at the end of December 2005 was 3,829, of which 721 have died. The reported HIV prevalence rate among adults aged in 15-49 years is below 0.1%, and the infection level is categorized as "very low". However, the number of newly infected cases has been rising rapidly. The goal of HIV/AIDS control in Health Plan 2010 is to reduce the increasing rate of HIV/AIDS to 35% in 2010. Compared with the global Millennium Development Goal, which is to halt and reverse the spread of HIV/AIDS by 2015, we should set up long-term, high level goals, in addition to a comprehensive national plan for the prevention and control of HIV/AIDS. Korea first implemented a Nationwide Tuberculosis Control Program in the 1960s. By 2005, the prevalence of radiologically active tuberculosis had fallen to 0.35% which is one-fifteenth of the level of 1965. Nevertheless, the current prevalence of and death rate from tuberculosis continue to be much higher than those of advanced nations. Given this such a level of infection, the goals of tuberculosis control need to be specified, and an enhanced tuberculosis control program needs to be implemented to reduce the incidence of tuberculosis and associated death rates.; Summary

Implementation of Effective Policies on Emerging and Reemerging Infectious Diseases.: Duk hyoung Lee; Korean J Epidemiol. 2006;28(1):69-74.

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The history of emerging infectious diseases was recently reawakened with the SARS outbreak in 2003 that resulted in 8,098 cases and 774 deaths in 26 countries. Korea dealt with 20 suspect or probable cases. From this experience of managing SARS, the public health system has been reinforced and the system's flexibility improved. The Korea Centers for Diseases Control and Prevention (KCDC) was inaugurated in January 2004 as a technically advanced and leading national organization. Thanks to SARS, multiple related Ministries and Agencies realized the need for their involvement in the case of global and national public health threat. The joint WHO/OIE/FAO consultation that was held in May 2004 in Geneva agreed that the next candidateemerging infectious disease that would affect global public health as seriously as SARS would almost certainly originate from animal infection (zoonosis) and that the most probable disease would be avian influenza. Thanks to the pandemic influenza issue, global cooperation and national preparedness for avian and pandemic influenza has been enhanced and this will provide a template for global cooperation to address all types of public health emergencies. The main strategies to develop the preparedness against the public health threat of emerging infectious diseases are firstly maintaining basic public health scheme with capacity building, and secondly establishing disease-specific supplement. As to pandemic influenza, the government is building core capacities in its organizational and functional operation, including stockpiling of antiviral (oseltamivir) and personal protective equipment. In the plan of action on public health emergency, the additional issues to be dealt with include the development of public risk communication scenarios, measures to increase social distance, disinfection measures, especially hand washing, table top exercises, and manpower mobilization. International and regional contribution and collaboration have now become prerequisites for every country. We work to ensure transparency in reporting, immediate sharing of epidemiological data and samples, capacity building and collaboration with in-country and international partners.; Summary

Modeling and Simulations for Infectious Diseases.: Mo ran Ki; Korean J Epidemiol. 2006;28(1):64-68.

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Modeling and simulations of infectious diseases are useful tools to estimate epidemic size and determine effective intervention methods. Models are idealized, simplified representations of reality. Therefore, a simple model should be the first design, with complex models always able to be added later to better represent reality. The following recommendations are made to ensure accurate simulations: (1) minimal feasible complexity, (2) mathematically well-defined, models should be constructed with well characterized stochastic processes rather than 'ad-hoc'behavioral models, (3) if predictions are being made, unknown parameters need to be robustly estimated using the model from epidemiological data, (4) where data is unavailable, a detailed sensitivity analysis needs to be undertaken, and (5) even if models are only being used to explore dynamics, sensitivity analysis is important to understand mechanisms. For the effective control of infectious diseases with models and simulations, we need effective information systems (laboratory and clinical data) for communicable disease control as a permanent infrastructure, closer collaboration between academic and service providers on new developments in communicable disease control, and enhanced monitoring of veterinary infections and 'minor' zoonoses, particularly in resources poor settings.; Summary

Epidemic modeling and Table-top Exercise for Emerging Infectious Diseases in Korea.: Byung Chul Chun; Korean J Epidemiol. 2006;28(1):47-63.

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Understanding the spread of infections is of vital importance in the control of epidemics and the development of proper policies toprevent infectious diseases. Theory and techniques have been developed for the study of both the evolution of diseases with individual people and the transmission of infections through populations. From broad theoretical issues to specific practical problems, the mathematical modeling studies of infectious diseases have provided great insight to solve the mechanisms of disease spread and to predict the course of epidemics. Emerging and reemerging infectious diseases have attracted widespread concern in Korea. While preparing the influenza pandemic plan in 2004, we developed a model of the new influenza pandemic to estimate the number of cases and deaths, the shortage of medical resources, and the effect of interventions such as isolation and vaccination. Based on this model, we constructed a possible pandemic scenario of the emerging virus, and designed a table-top exercise for public health officials and related administration staff. On March 30th, 2005, the exercise was performed and the results were evaluated as successful. In the case of bioterrorism, a model of small pox epidemic was developed in 2005 to examine the speed of the disease spread in the population and to evaluate the intervention effects in a Korean city. The simulation results were also helpful to form a guideline to prepare for a small pox epidemic. These two experiments confirmed the usefulness of epidemic modeling in Korea.; Summary

New Vaccine Technology for Control of Emerging and Reemerging Infectious Diseases.: Jin Han Kang; Korean J Epidemiol. 2006;28(1):41-46.

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Although the development of vaccines has been one of the most important contributions of immunology to medicine and public health, and despite vaccination having been proven as the most effective and cheapest medical practice to prevent infectious diseases, infectious diseases still remain the main cause of human deaths and new infectious diseases continue to emerge. Furthermore, we face an unprecedented succession of new pathogens able to jump species barriers and infect humans, even as we continue to be frustrated in our efforts to control devastating diseases such as HIV, malaria and tuberculosis. Hence the need to develop new vaccines and improve existing vaccines. Other challenges for scientists include rapid identification and response to emerging diseases and successful intervention in re-emerging infectious diseases. Remarkable progress in molecular biology and biotechnology is making possible the development and improvement of new and old vaccines. Recombinant DNA technology, genetic attenuation of viral and bacterial pathogens and their use as vectors for heterologous proteins, naked DNA vaccines and peptide vaccines represent the most popular approaches hitherto adopted. Reverse genetics and reverse vaccinology are now used to investigate new vaccines. Genome-based reverse vaccinology is very useful and a major tool in vaccine development. The rapid identification of the genome sequence to new pathogens enables the speedy development of diagnostic tools as well as recombinant expression of targets for vaccine. Strengthening research and development in vaccines, including international cooperation, may be the most effective next step to control and prevent infectious diseases worldwide.; Summary

Control of Avian Influenza: Calls for International Collaboration.: Baik Lin Seong, Eun Ju Jung; Korean J Epidemiol. 2006;28(1):36-40.

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The 1918 "Spanish Flu", cause of the largest causality rate ever recorded in human history with 50 million deaths, is genetically related to the current H5N1 virus, suggesting the potential emergence of H5N1 influenza as the next pandemic wave. In the process of co-infection and genetic reassortment of human and H5N1 avian influenza, the H5N1 strain could acquire human viral gene(s) to ignite the human to human spread, as occurred in 1957 and 1976 pandemics. All countries are vulnerable to infection as no effective vaccine has yet been developed for avian influenza. Once developed into a pandemic, the socio-economic impact of avian influenza would be enormous. In response to this danger, Korea recently proposed to establish an international consortium, the Pandemic Influenza Consortium, Korea (PICK), to emphasize close collaboration, especially among Pacific Rim countries. PICK proposes to support the following three areas: 1) international efforts in the implementation of national and regional preparedness plans through the development of epidemiological, microbiological and clinical tools and mechanisms for early detection of pandemic influenza epidemics, 2) the development and clinical evaluation of pandemic influenza candidate vaccine, and 3) the establishment of appropriate mechanisms to ensure the capacity to produce, the availability of supply, and the rational distribution of pandemic influenza vaccines to countries suffering from or at high risk of experiencing outbreaks. Finally, the effort is expected to serve as a basis for initiating, establishing and strengthening the international infrastructure for investigation of the infection mechanism and devising prophylactic and therapeutic responses to various infectious diseases.; Summary

Perspectives of Communicable Disease Surveillance in Korea.: Hyun Sul Lim; Korean J Epidemiol. 2006;28(1):28-35.

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Environmental and climatic changes and the mobility of ever-increasing numbers of people increase the risks for the emergence and reemergence of infectious diseases. Since communicable disease trends change rapidly, many nations have developed individualized communicable disease surveillance systems. In Korea, notification of the incidence of communicable diseases has been the most important form of surveillance since 1954. In addition, the government has established various surveillance systems since the late 1990s. Current problem areas of surveillance systems are the low reporting rate, a lack of representativeness, a lack of participation, and poor utilization. The government has not fully evaluated these systems. For many diseases, it is of critical importance to maintain the confidentiality of surveillance data. Issues of confidentiality are critical and must be considered in order to obtain valid data and protect those surveyed. In the future, we have to improve the reporting rate, enhance collaborations with veterinarians and gain the full support from the governmental departments of agriculture and defense. Surveillance systems should be evaluated regularly. The most dynamic and important part of surveillance is the feedback mechanism. To develop positive feedback, we must disseminate the collected and analyzed information and give reimbursement to the reporters. We have to built close partnerships with governmental agencies, international organizations, research institutes, private health corporations, and academia.; Summary

Surveillance System for Communicable Disease in Korea.: Ok Park; Korean J Epidemiol. 2006;28(1):22-27.

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Korea has experienced sporadic cases or outbreaks of emerging and reemerging infectious diseases since the 1980s. Confirmed outbreaks have included leptospirosis and legionellosis in 1984, HIV infection in 1985, enterohemorrhagic E-coli infection in 1998, staphylococcus aureus infection with decreased vancomycin susceptibility in 1999, brucellosis in 2002, and botulism in 2003. Korea has also suffered from reemerging diseases such as vivax malaria along the Demilitarized Zone (DMZ) since 1993. Owing to globalization, imported cases of diarrheal diseases, malaria, and dengue have been increasing. In addition, the overall incidence of acute infectious diseases such as shigellosis, scrub typhus, and mumps, which had been decreasing since 1970 until the late 1990s, began to increase again after the late 1990s. The range of emerging and reemerging diseases poses serious public health threats to the public. The Korean government has been striving to build capacity to detect and respond to these infectious disease threats in a timely manner since the late 1990s. For this, the government revised the Communicable Disease Prevention Law, reorganized the government structure for communicable disease control, and developed human resources through field epidemiology and various other training programs. SARS and highly pathogenic avian influenza provided momentum to accelerate these endeavors. Korea has thus far achieved significant improvements in the field of infectious disease surveillance. There are, however, gaps that need to be addressed including insufficient capacity for disease surveillance and response for emerging infectious disease at the local government level, inadequate operation of various surveillance systems, insufficient integration among surveillance systems, and low participation rate for notification among physicians. Therefore, the Korean government plans to improve infectious disease surveillance by implementing the following procedures: establishment of a web-based reporting system, integration of EDI and laboratory surveillance systems, extension of the electronic reporting system to the private sector, continuous development of human resources to build capacity, and enhancement of collaboration with the private sector.; Summary

Epidemiologic Transition of Communicable Diseases in Korea: Academia's Contributions to the National Communicable Disease Prevention and Control Programs.: Joung Soon Kim, Hae Kwan Cheong; Korean J Epidemiol. 2006;28(1):4-21.

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This paper describes the transition of communicable diseases in Korea since 1970s. Some of Korean's general living background and health indicators are introduced, followed by trends in the changes during the last several decades in socioeconomic, demographic, and living environmental status, which are closely associated with the transition of communicable diseases. The current incidence of classified, notifiable disease, the incidence by year, and the transition of communicable diseases are presented. Governmental responses to prevent and control communicable diseases, including both emerging and re-emerging infectious diseases, which have become recognized as having public health importance are described. Finally, the role played by academia during the last several decades in the successful control of communicable diseases is analyzed.; Summary

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