Epidemiology and Health

MERS-Letter

Lessons learned from new emerging infectious disease, Middle East Respiratory Syndrome coronavirus outbreak in Korea: Joung Soon Kim; Epidemiol Health. 2015;37:e2015051. Published online November 17, 2015; DOI: https://doi.org/10.4178/epih/e2015051

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Abstract

Summary

Korean summary
어떤 새로운 전염성 병원체가 침입할지 모르는 상황에서 모든 보건 의료계 전문가들은 눈을 크게 뜨고 감시를 게을리 하지 말아야 하며 사태가 발생하면 즉각 우리가 알고 있는 관리 원칙에 입각하여 기관간, 전문분야간, 지역간 원활한 협동 하에 지식과 기술을 발휘하여 과감히 조처해야한다. 전염병관리는 전쟁과 같아서 순간의 머뭇거림이 승패를 결정하므로 이번 메르스의 경우처럼 작은 이기적 이해 때문에 머뭇거리다 실기하여 수십 배의 손실을 초래할 수도 있음을 명심해야 한다.

Citations

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Original Articles

A seroepidemiological study on leptospiral infection in a ruralcommunity.: Soon Jin Lee, Seok Yong Lee, Bo Youl Choi, Ung Ring Ko, Sae Jung Oh, Joung Soon Kim; Korean J Epidemiol. 1992;14(1):79-90.

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A seroepidemiological follow-up survey for antibody to Leptospirae was undertaken twice, the first one in Oct.-Dec. 1988 and the second in Dec. 1989-Mar. 1990 among adult inhabitants of over 20 years of age in Yang-pyeong Gun, Kyeong-ki Do. The sera of 480 persons in 1988 and 328 persons in 1989 were tested for Leptospirae by microscopic agglutination test (MAT) and interview was used for additional inforamtion. The serologic test was performed against 4 strains, which were Icterohemorrhagiae lai and Canicola canicola Hond Utrecht IV as standard strains, and 6P-049-1 and YP-35-1 as strains isolated in 1986 in Korea, in accordance with WHO guideline. The results of the test showed that 106 of 480 sera(22.1%) in 1988, and 84 of 328 sera(25.6%) in 1989 turned out to be positive to Leptospirae. The seropositive rates for Leptospirae by district in 1988 and 1989 were 12.9~33.3% and 15.0~42.2% respectively and the difference was statistically significant. One district, mainly a commercial area was newly added in 1989. The seropositive rate of that district was 15% and it was significantly low when compared with 32.8% of seropositive rate of the other rural districts. No difference was observed among age groups of 20~30, 40~50 and over 60 years as well as among sexes. The seropositive rate of farmers and non-farmers were 23.0% versus 10.0% in 1988 and 31.1% versus 17.7% in 1989 showing higher rate among farmers. A total of 143 persons were followed up 14 months and it was observed that 37.0% (10/27) of seropositive subjects remained positive, and 31.9%(37/116) of seronegatives were converted to seropositive. The duration of persistent antibody titer over 1 : 80 against Leptospirae that be calculated by formula(prevalence=incidence*duration) was 8.3 months. As for the seropositive reaction with or without febril illness, 29.3% (17/58) of subjects with febrile illness and 24.7 (66/267) of subjects without febrile illness turned out to be positive, showing no significant difference between them.; Summary

A study on the health status of the inhabitants exposed to cementdust.: Hae Kwan Cheong, Joung Soon Kim, Byung Soon Choi, Chung Bum Kim, Sung Il Cho, Yun Mi Song, Hyun Sul Lim; Korean J Epidemiol. 1992;14(1):59-69.

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A health impact of environmental cement dust exposure among inhabitants around a cement factory was carried out with special emphasis on finding bronchial asthma cases in this area. Questionnaire survey and physical examination were done on 437 persons in two villages located within 1km distance from the cement factory. On the basis of questionnaire survey and physical examination, 56 persons with suspicion of bronchial asthma were screened, who were further examined to establish diagnosis by physical examination, pulmonary function test and bronchodilator test.
Results
are as follows : 1. Inhabitants in surveyed area had high prevalence of acute and chronic diseases, particularly respiratory diseases and dermatologic diseases. 2. Respiratory symptoms complained were sputum(23.9%), cough(23.0%), dyspnea(19.1%), chest tightness(14.6%), and wheezy breath sound(13.1%). On physical examination, pterygium(29.5%), decreased breath sound(3.0%), wheezing(3.3%), and rales(2.7%) were found. 3. On diagnostic examination, 32 cases (prevalence rate 7.3%) of bronchial asthma and 10 current cases (prevalence rate 2.3%) of bronchial asthma were confirmed. Thus it is postulated that high prevalence of bronchial asthma and respiratory diseases in this area may be related to environmental exposure to the cement dust. Further study, however, such as bronchial provocation test may be necessary to establish definite conclusion on causal relationship between bronchial asthma and environmental cement dust exposure.; Summary

A study on leptospiral infection status and biological characteristics of the strains isolated from wild rats in some areas of Korea.: Seon Il Park, Joung Soon Kim; Korean J Epidemiol. 1991;13(2):169-184.

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In order to study Leptospiral infection status and biological characteristics of the strains isolated from wild rats, a total of 34 wild rats were captured alive from three locations including Hwasung-gun, Yangju-gun and Seoul city during the period of four months from the December 1990 to the March 1991. Rodents were anesthetisized with ether, blood was taken from heart puncture and then autopsied. Blood and kidney specimens were inoculated into tubes of EMJH semisolid medium and incubated at 30°C for six weeks. These cultures were examined 6 times by dark field microscopy at weekly intervals. Serogroup and serovar of isolates were identified by micro-agglutination test and cross-agglutination absorption test Lung, liver and kidney were sectioned with a sharp scalpel and touch printed on slide glasses and then silver-stained. Blood specimens were allowed to clot and sera were collected for serologic test. These procedures were necessary to see the distribution of Leptospira by tissues and antibody titer as the length of infection gets longer. Pathogenicity test and horizontal infection test were also carried out on Guinea pigs and mice with the strains isolated. The summarized results are as followings : 1. Kidney tissue and blood sample from 34 rats were cultured for Leptospira and four(11.8%) strains were isolated. All strains belonged to Leptospira interrogans Icterohemorrhagiae serogroutp 1 out of 1 Apodemus agrarius, 2 out of 10 Rattus rattus, 1 out of 16 Rattus norvegicus, none out of 7 Mus musculus. Of 4 isolates, cultured H-9 was identified as Serogroup Icterohemorrhagiae serovar lai. 2. Leptospiras were seen in 8 of 34 (23.5%) silver-stained kidney sections, 5 in lung sections (14.7%), and 4 in liver sections (11.8%) 3. All strains isolated were Gram negative, resistant to 5-FU, sensitive to 8-Azaguanine, spherical conversion in 1 M NaCl ; typical Leptospiras with hook in E.M. were observed These strains did not grow in 13℃ culture temperature. Thus all strains demonstrated Leptospim interrogans characteristics. 4. The overall Leptospira seropositive rate was 20.6% (7 samples/ in 34 blood of wild rats. Of 7 seropositive rat sera, 3 (8.8%) were positive for L. Icterohemorrhagiae, 2 (5.9%) for 87M-67 (local lai), one showed cross reaction between L. Sejroe and L. Bataviae. 5. As Guinea pigs and mice were inoculated intraperitoneally with 1 ml of 7 day old culture containing approximately 2 x 108org/ml of Y-2 isolated strain, massive hemorrhage and inflammatory cell infiltration (lymphocyte, plasma cell,) were major pathological findings in heimatoxylin-eosin stained sections. LD50 by probit analysis was 1.87 x 1011 org/ml [y(probit)=-13.530+1.644 Log x] and horizontal infection between mice was confirmed. 6. Leptospires were seen in blood of experimental animals at 24 hours after experimental inoculation and they disappeared around 288 hours. Leptospires were observed in liver first and then in all organs by 4 days after experimental infection. 7. Antibody was detectable in 2 days after the experimental infection and then increased gradually. Although the titer dropped incidentally to 1 : 20 at 6 days after infection, relatively high titer was maintained from 12 days of infection. Key words : Leptospira, wild rat isolation, serology, histopathology.; Summary

Hypertensive diseases among rural adults: Joung Soon Kim; Korean J Epidemiol. 1979;1(1):69-75.

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This study was carried out in 1976 on rural adult population older than 15 years. The study population was randomly sampled by village unit, in which 9.2% of the total households and 9.3% of the total population was included. The population studied consisted of 663 males and 813 females comprising 45% of the population sampled. Following the individual interview by household visit, each individual was examined by medical doctor at the temporary local clinic furnished with simple laboratory tests. Some sophisticated laboratory tests and cases who needed further diagnostic study were refered to hospitals. Criteria for hypertension and hypertensive heart disease were based on WHO criteria and U.S. Health Survey criteria. Blood pressure was measured twice for each individual, the first by a trained nurse and the second by examining doctor, and averaged. Measurements of height and weight to compute relative body weight were done by trained nurses at the tield. The result s obtained are as following： 1. The mean systolic blood pressure was 127±8.4 mmHg for males and 123.1±17.5 mrmHg for females, and it increased with advancing ages ; for example the mean systolic blood pressure for 15-19 years was 120±11.4 mmHg compared with 140.3±25.3 mmHg for the group older than 70 years in males. The increase of the mean blood pressure was the most abrupt at age 50 years . 2. The mean diastolic blood pressure was 82.4±11.7 mmHg for males and 80.7±11.4 mmHg for females with slow and gradual increase in accordance with the advancing ages. 3. The prevalences of definite and borderline hypertension were 7.7% and 9.5% for males whereas they were 6.5% and 8.1% for females respectively. As was in the case of mean systolic blood pressure, the prevalence of definite hypertension showed abrupt increase at age 50 years for both sexes. 4. The prevalence of hypertensive heart disease among the study population was 2.1%, the proportion of hypertensive heart disease was 3.9% and 25.0% among borderline hypertensives and definite hypertension patients respectively. 5. Frequency and distribution of other diseases except the hypertensive heart disease did not show much difference between normotensives and hypertensives. 6. Among suspected contributing factors to the hypertension analysed, the association of hypertension with relative body weight appeared to be the most strong. Also when age was controlled to 45 years and the above, alcohol drinkers had significantly higher risk of hypertension than non-drinkers. 7. The multiple correlation coefficient on relationship between the variation of blood pressure and some selected variables, i.e., age, socioeconomic status, relative body weight, and degree of cigarette smoking, was 0.305 being able to explain the relationship only in 9.3% for systolic blood pressure and 6% for diastolic blood pressure by these tour variables.; Summary

A study of hypertension on medium-sized city population: Joo Young Kim, Joung Soon Kim, Young Woo Lee; Korean J Epidemiol. 1979;1(1):55-67.

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This study was conducted on an apartment resident older than 15 years of age inhabiting in a medium-sized city of Korea. The objective of the study was to measure prevalence hypertension and hypertensive heart disease, and to identify contributing factors relevant to the occurrence of hypertension. The apartment selected for the study consisted of 1,200 households with 3,333 residents oder then 15 years. The socioeconomic status is rather lower than the Korean average; the apartment was built aided by the Korean Government for this people who lost their houses and shelters around the railroad station-a slum-at the explosion accident in 1977. The population composition by age and sex was not much different from the Korean average though with much higher proportion of illiterates. Blood pressure was measured twice in spaced time and information necessary to identify risk factors were collected through household interview by trained nurses. The definitions of definite and borderline hypertension were based on WHO criteria, and the criteria for hypertensive heart disease was adopted from the US National Health Survey. Seventy percent of the eligible residents were checked for blood pressure and interviewed individually. Electrocardiogram and indirect chest x-ray, however, were taken only on about 40% of the eligible. The resulted summarize as following； 1. Mean systolic and diastolic blood pressures were higher among males than females with gradual increase as age advances for both sexes. 2. The prevalence of definite hypertension was 7.5% for males 8.0% for females, which also showed an increase with age；the prevalence of borderline hypertension was 16.0% for males and 7.1% for females. 3. The percent of hypertensive heart disease among the patients with definite hypertension was 35.8% for males and 41.7% for females. Among borderline hypertensive patients 5.9% only females had hypertensive heart disease. An estimated prevalence of hypertensive heart disease was 2.6% for males and 4.1% for females. 4. Relative body weight and family history of hypertension were most strongly associated with hypertension ; relative salt intake, cigarette smoking and alcohol drinking did not show definite association. 5. Among patients with definite hypertension 63.2% were diagnosed as hypertension by medical doctors of whom only 38.5% have been on treatment. Thirty nine patients out of 78 treated stayed in definite hypertension, 18 patients became borderline hypertension, and only 6 patients to the level of normotension.; Summary

An epidemiologic study of phlebitis due to intravenous infusion in an university hospital: S.E Lee, Joung Soon Kim; Korean J Epidemiol. 1987;9(2):271-277.

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Since phlebitis following intravenous (IV) infusion which is the most widely used in medical care for patients has remained as a frequent and important hospital infection, it is neccessary to have a fundamental epidemiologic information on the incidence for a successful control program. Two hundred and eighty one patients registered in two general surgical units of an university hospital were studied to find out the incidence rate of the IV induced phlebitis and risk factors involved in it for 2 months from August to September, 1987. Following are summary of the findings; 1) One hundred and ten cases (39.1%) out of 281 patients discharged from the surgical units had experienced phlebitis during the study period. The incidence rate of phlebitis (per 100 IV infused cases) was 14.6. 2) Among various IV devices, the use of IV cannula was found to be the most risky, which caused the highest incidence rate (per 100) 16.9. None of the other devices was comparable to IV cannula in terms of the incidence rate. 3) Proporional increase in incidence rate of phlebitis by the duration of continuous use of the IV infusion was observed. Almost one third of the IV infused cases for more than 73 hours found to have phlebitis. 4) The higher incidence rate as noticed in patients who were in old age group and hospitalized longer. 5) Forty eight percent of the phlebitis cases were classified into severity grade 2 and 3. In conclusion, the incidence rate of phlebitis found in this study was 14.6 per 100 IV infusions and 39.1 per 100 patients discharged and experienced phlebitis is much higher than that of U.S. And the risk factors identified were the devices used for the intravenous infusion, lenth of the hospitalization and age of the patients. This finding strongly suggests that more aggressive preventive intevention need to be excuted, especially for better preparation of the IV devices and selection of the safest method.; Summary

Epidemiologic characteristics of leptospirosis and febrile disease in population in special service at high risk of infection: Joung Soon Kim, Yong Heo, H.W Chung, W.Y Lee, H.G Byun, J.D Suh, C.M Sung, M.Y Ahn, J.M Choi, S.J Lee, Y.C Hahn; Korean J Epidemiol. 1987;9(2):278-287.

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This is a part of serial works on leptospirosis. In this study, a correct characterization of all of the hemorrhagic disease accompanying high fever which might be caused by various agents such as leptospira, rickettsia, viruses, and others if any was attempted by classifying the symptoms and identifing the etiologic agent which is responsible for the cases. And also serologic studies along with fundamental epidemiologic investigation on the clinical signs of the patients selected from the study area were done to draw a comprehensive conclusion. The specific aim which is the major focus of this part of study is to find out prevalence rate of true leptospira patients among patients with high fever and to characterize the clinical pictures, such as clinical signs and symptoms, which might be specific for the true cases of leptospiral infection which is confirmed by bacterial isolation from the cases. One hundred and nineteen patients hospitalized because of high fever (more than 38°C) for more than 24 hours were studied during 10 month (Aug., 1986-May 1987). The findings are summarized as follows; 1) At the time of admission, leptospira isolation rate was 5.8% (6/103) and this became 13.7% (7/44, average 8.4%) after one week of hospitalization. 2) The serum samples were testeded for the presence of the antibodies specific to 22 different servar in which 3 strains isolated in this laboratory from human blood employing microagglutination tests. The positive rate was 34.9% when the first blood samples which were collected at the time of admission tested. And it became 50.9% when the second samples were tested one after the first. The antibody conversion rate within one week was 32.4%. Only one out of 16 cases who were antibody positive at the first test was found to be negatively converted. When these were grouped by their antibody titer, 83.7% of whole antibody positive samples (64) demonstrated antibody titer 1.400 or lower and only 3.1% of them demonstrated higher than 1:3200. 3) Significantly higher positive rate were found when the sera were tested with the fresh strains isolated from that area. The majority (32.4%) of the sera from Chullwon area positively reacted with locally isolated L. icterhemorrhagiae lai and 17.1% of sera from Yangoo area with locally isollated L. canicola. In Chullwon area, 65% of the serum samples were identified belonging to 3 serovars, L. icterohemorrhagiae lai (32.4%), L. canicola (14.7%), and L. ictervhemorrhagiae copenhageni (17.6%). In Yangoo area, 54% of the scrum samples were positive for 4 serovars, L. icterohemorrhagiae lai (14.6%), L. hebdomadis (12.2%), L. icterohemorrhagiae copenhageni (9.8%) and above mentioned local isolate. 4) among 92 patients with high fever 19 cases (20.2%) were confirmed to be leptospiral infection by the both tests for bacterial isolation and serology. Sixteen cases (16%) were the suspicious cases of leptospirosis. The rest of them, 60 patients (63.8%) were found to be uninfected with the bacteria. 5) When the seasonal changes of incidence of the feverrile disease were comparatively analyzed, the cases belonged to confirmed as leptospirosis occured maily in Autumn whereas the others occured throughout the year except the spring in which time a slight decreased cases were recorded. The incidence of the confirmed cases were higher in groups which had been exposed to field trainings. Sore throat, runny nose, hematemesis, and muscle pain were found to be significantly frequent signs complained by the confirmed cases and diastolic blood pressure of the cases was higher. 6) amomg the confirmed cases only 5.3% of them were primarily diagnosed as leptospirosis and majority were diagnosed as fever with unknown reason (47.3%) when they were adimitted because of the high fever. Whereas among the cases confirmed as uninfected 25% was fever with unknown reason and 46.7% for the others. The proportion of cases diagnosed as leptospirosis was 5.0%.; Summary

Epidemiologic characteristics of leptospiral infection in healthy population in special service and their neighboring civilians in Korea: Joung Soon Kim, J.S Kim, Y Heo, H.W Chung, W.Y Lee, Y.C Hahn, H.G Byun, J.D Suh, H.K Chung; Korean J Epidemiol. 1987;9(2):264-270.

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The specific aim of this study was to provide epidemiologic information on leptospiral infection in healthy population in special service. These are considered to be the most important group in leptospirosis control not only due to the fact that they have frequent chance of exposure to the potentially dangerous environment for leptospiral infection but also the fact that an efficient preventive measure is urgently required for them. Seven hundred and fifty six service men and 197 their civilian neighbor were subjected for the study. The study included an epidemiologic analysis of the population through interview survey and this was further supported by bacteriologic and serologic confirmatory tests. Leptospira were isolated from the peripheral blood samples from those cases. The isolation positive rate were 0.5% of service men and 1.3% of the civilians. Percent of sereum antibody positives for microagglutination test (MAT) were varied from 8.3% of service men to 12.1% of the civilians. When the same population were subjected to the bacteridogical and serologic studies following the exposure to the time of harvesting, the percent of positives in both tests were increased 2.5 times comapared to those found in the same population before harvest season. Almost all of the bacteria positives (6/7) were found to be cases of inapparent infection. Only one out of the seven suffered from mild symptoms of leptospirosis complaining fever, conjuctival hemorrhage, headache, and nausea. More than half (53%) of the serum samples were reacted with L. icterohemorrhagiae serovar lai and 22% with L. irterohemorrhagiae serovar copenhageni. The rests (25%) were reacted with other groups, L. bataviae, L. canicola, L. grippothyposa, L. automnalis, and L. semaranga. none of the bacteria positives were antibody positives. The seroconversion rate following the expousre (harvest period) were 7.6% in service men and 9.3% in civilians, which were studies on month after the time.; Summary

Special edition

Validity of reported cases by estimating proportion of reported cases: Joung Soon Kim; Korean J Epidemiol. 1987;9(2):157-160.

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Original Articles

A study on the epidemiologic trends of reported major-communicable disease in Korea: Sie Baek Han, Joung Soon Kim; Korean J Epidemiol. 1987;9(2):236-263.

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In Korea several changes have occured in patterns of health and disease due to improved economic situation, living standard and medical technology. The objective of this study is to understand the changing patterns of the major communicable diseases in Korea during last several decades. The trends of incidence and mortality and the changing patterns of epidemiologic characteristics of the major communicable diseases, which occured in Korea during the period from 1910 to 1986 were studied by reviewing reported cases to the Ministry of Health and Social Affairs. Some important features obtatined are as follows. 1) The trends of incidence and mortality of reported communicable diseases showed gradual increase until 1950’s. After the great epidemic occured in pre and post-Korean War period at the boundary of 1950’s, it showed a sudden decrease and remained at a certain level by 1960's. There has been further decrease in 1970’s & 1980's. Fatality rate has remakably dropped since the introduction of antibiotics. 2) The age group which used to show the highest incidence rate for water-borne diseases such as cholera, typhoid fever, paratyphoid fever has been changed to older age group by year. Age specific incidence rates of diphtheria and Japanese B. encephalitis were higher among younger ages between 0 and 14 years but the differences among age groups are getting smaller by year. 3) The differences of incidence between male and female, and among age groups were considered to be determined by chance of exposure but not by susceptibility. 4) In seasonal variation of water-borne communicable diseases such as cholera, typhoid fever, paratyphoid fever, dysentery and Japanese B. encephalitis and poliomyelitis, the occurences were higher during summer compared with other seasons, wheares the occurences of respiratory communicable diseases such as diphtheria, whooping cough, measles were higher in winter and spring. Seasonal fluctuation, however, became less prominent in 1980’s than the past decades. 5) Geographical distribution of water-borne communicable diseases (cholera, typhoid fever, paratyphoid fever, dysentery etc.) and respiratory communicable diseases (diphtheria, whooping cough, measles etc.) showed that metropolitan cities such as Seoul and Busan had higher incidence and fatality rates than other smaller cities or towns.; Summary

Current status of cancer research and future goals: Won Young Lee, Joung Soon Kim; Korean J Epidemiol. 1988;10(1):64-74.

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The current status of cancer research have been briefly summarized to clarify the problems remained to be solved for the cancer control. Cancer control program can be divided into three steps which are the general principle of disease control; the primary, the secondary, and the tertiary prevention. For the primary prevention, it is neccessary to iden¬tify the etiologic agent for the desease to be controlled. It has been reported that the agents associated with human cancers cannot be singled out. Furthermore, the genes which act a critical role(s) in pathways of tumorigenesis are our own in every normal cells. Thus, the primary prevention for the cancer can not be applicable at present except for the public health education especially when a certain risk factors are avoidable by changing human behaviors and working environments(eg; smoking and lung cancer). The tertiary prevention provides measures to help the persons recovered from the cancer to adapt to the society. However, this is applicable only when the secondary prevention measures are satisfactory and successful. Therefore, the only step we have to put our major efforts for the cancer control today may be the field of research for the secondary prevention. Since the secondary prevention depend upon the measures for the diagnosis and therapy for the patients suffering from the cancer, this is the urgently needed field not only for the patients but also the medical workers in this fields. Chemotherarpy and radiotherapy except surgery are the methods of cell killing by use of cytotoxic effect of the chemotherapeutics and radiation. The others are hyperthermia and photodynamic therapy which are not widely used at present. All of these methods have the limitation in use mainely due to the lack of the specificty. One of the methods to increase the specificity of these method were the introduction of the immunologic tools including monoclonal antibodies which can be used independently or in combinatory ways. However, practical value of the methods were not so much appreciated due to the heterogeneic nature of the tumor cells in various aspects. Also the use of the various types of the biological response modifiers have been extensively studied for the clinical applications. Those have been proved to be strong immune-adjuvants in vitro. Their role(s) in vivo especially for the tumor control remained to be analized. Emergence of the resistant cells, especially the fraction of the stem cell population following tumor therapy regardless the types of the therapy, chemotherapy or radiotherapy is the major problem to be solved. Thus, it is necessary to develope highly sensitive and specific chemotherapeutic method which may kill only the tumor cells leaving the normal cells alive. Efforts must be focused on the search and development of new agents. This may be the primary task in cancer control today. Because the development of new agents includes not only the new source of chemeotherapeutics but also the agents which can provide a certain complementary fuctions to the defects found in chemotherapy, radiotherapy, immunotherapy, and hyperthermia to maximize the efficiency of the therapy.; Summary

An epidemiological investigation of typhoid fever outbreaks in a hot spring resort town and its satellite rural villages: Joung Soon Kim, Yong Heo, Sung Soo Lee, Duk Hyoung Lee, Kun Young Shon, Sung Woo Lee; Korean J Epidemiol. 1988;10(1):92-101.

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An epidemiological investigation was carried out to identify source of infection and mode of transmission of typhoid fever outbreak, which has occurred in a hot spring resort town and its satellite rural villages from the begining of the march 1988. The investigation was carried out for two days, April 16th and 17th, on hospitalized patients and the villages where confirmed cases had been reported. The results obtained are as followings： 1. The S. Typhi isolated from 47 patients were all the same phage type that was untypable phage Type. 2. The incidence rate of typhoid fever among surveyed population, the populations belong to the same Ban (about 20-50 households) of the patients re¬ported, was 13.2% in hot spring resort town and 9.8% for the satellite villagers. 3. The incidence showed no difference between male and female population as a whole although for the age groups of 0-9 years old and 10-19 years old the incindence rates were much higher among males, and for the age groups of 20-29 years old, 30-39 years, and 40-49 years the rates were higher among females; for the age group of 20-29 years, female’s rate was as high as 5 times of males. The lowest rate was found among older ages. 4. The study results suggested that the source of infection was primarily water supply contaminated by sewage; the central water supply has been under repair for replacement of broken pipes almost for a month, from the end of February and the begining of April, in on and off fashion. Supportive data are presented in the text.; Summary

Special edition

Epidemiologic characteristics of cancer mortality and morbidity among Koreans: Joung Soon Kim; Korean J Epidemiol. 1988;10(1):1-29.

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Cancer has been a major cause of death among Koreans since 1970’s. This study was carried out to characterize the cancer occurrence among Koreans by analyzing mortality and morbidity data. The source of data on cancer mortality is annual reports on the cause of death statistics produced by National Bureau of Statistics, EPB Korea and annual World Health Statistics; on morbidity of cancer is prevalence survey of 1987 for the populations of six health insurance demonstration project areas. Mortality rate and prevalence rate per 100,000 population were plotted on the semi-logarithmic paper by cancer site, sex and age groups for comparison. Observed results are as followings: 1. Mortality rates per 100,000 caused by all sites cancer among Koreans in 1985 were 95.0 for males and 54.7 for females which were much lower than that of Japanese males(191.1)and females(126.9). 2. The most frequent cancer site causing death was in order of stomach, lung, esophagus, leukemia and larynx for male, and in order of stomach, uterus(part unspecified), lung, leukemia and breast for female; malignant neoplasms of rectum and rectosigmoid, liver(primary), bladder, lung, prostate, female breast and uterine cervix were much lower among Koreans when compared with Japanese and USA populations. 3. The mortality age curves of various cancer for Koreans, in which the mortality rates were higher among younger age groups and much lower among older age groups(over 65-year of age)than those of Japanese and USA populations, suggested that the effort to make valid diagnosis for older ages was lacking. 4. Age adjusted prevalence rate of all site cancer per 100,000 was 225 for male and 189 for female; the prevalence of cancer strikingly increased from 35-44 years old age group up to 65-74 years group tappering off after the age 75-year. 5. The four major cancer site in the prevalence study data were stomach(33.3%), lung(13.1%), liver and intrahepatic bile duct(12.5%) and lymphatic & hematopoietic tissue(6.8%)for male; stomach(19.8%), uterine cervix(15.9%), breast(7.2%) and liver(6.7%) for female. The frequency distribution of the cancer by site was quite similar to other studies such as Kang-wha cancer registry and hospital admission study on cancer patients among policy holders of Korean Medical Insurance Corporation. 6. The prevalence rates of cancer occurred almost every site were higher among males than females, and the age curves of the prevalence were almost identical to that of mortality data.; Summary

Editorial

Global density of AIDS patient per one million population by continent and country as of August 31, 1988: Joung Soon Kim; Korean J Epidemiol. 1988;10(2):157-163.

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AIDS has become a pandemic ever since the initial recognition in 1981, and experts state the pandemic is still in its early stages difficult to gauge, but appearently threateming global health. This paper is prepared in order to provide with correct information on the global distribution of AIDS patient by means of AIDS patient density (cumulative AIDS pts per unit of population) in determining global rank of AIDS occurrence. The conventional way of expressing rank with the absolute number of AIDS patients would not be as useful as the density presentation in terms of epidemiological understanding of the pandemic. The materials utilized are WHO Weekly Epidemiological Record: AIDS Data As At August 31, 1988 and 1986 population data in WHO Annual Statistics, 1987. Summarized results are as followings: 1. One hundred forty countries(78.7%) out of 178 countries, which informed the presence or absence of AIDS patient to WHO reported to have AIDS patients; the percent of countries having AIDS patients among countries informed to the WHO was 93.3% in European continent, 90.9% in American continent, 86.5% in African, 57.9% in Asian and 35.7% in Oceanian. Number of total AIDS patient per million of the population for each continent were 119 patients in American, 41 in Oceanian, 26 in African, 19 in European and 0.1 in Asian continent. Geobal average/million was 23 patients. 2. AIDS patient Density(per million population) by country ranged from 0 to 1345 pateints; in African continent there were six countries where the number of AIDS patient per million was over one hundred-Congo(700), Brundi(290), Uganda(250), Central African Republic(164), Rwanda(157) and Zambia(144); in American continent smaller resort areas with fewer population had higher AIDS density, and there were 9 countries with more than 100 AIDS patients/million population-French Quiana(1345), Bahamas(803), Bermuda(339), U.S.A. (297), Guadeloupe(220), Barbados(217), Haiti(203), Trinidad & Tobago(189) and Mortinigue(116); in Asian continent only one country, Qatar of which population is 335 thousands had 100 patients/105; in Europe continent, there was no single country with more the 100 AIDS patients/million population and the density was rather homogeneous ranging from 13~79 AIDS patients/106; in Oceaneon countries, 25~59 patients/million. 3. Global rank for AIDS density was entirely different from the rank based on absolute number of AIDS patients. The rank for first top ten is in order of Congo, U.S., Brundi, Uganda, Haiti, Trimidad & Tobago, Central African Republic, Rwanda and Kenya among countris with more than one million population. On the other hand the top ten country by the absolute number of AIDS patient was U.S., France, Uganda, Bragil, Germany F.R., Italy, Kenya, Canada, U.K., and Tanzania. 4. In Korea six AIDS patients and 30 HIV infected persons have been officially reported currently. When the 1(AIDS patient): 50~100(HIV infected) ratio is projected, 300~600 HIV infected persons are estimated, implying that only one tenth of them has been detected and reported.; Summary

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