Epidemiology and Health

COVID-19: Original Article

Korea Seroprevalence Study of Monitoring of SARS-COV-2 Antibody Retention and Transmission (K-SEROSMART): findings from national representative sample: Jina Han, Hye Jin Baek, Eunbi Noh, Kyuhyun Yoon, Jung Ae Kim, Sukhyun Ryu, Kay O Lee, No Yai Park, Eunok Jung, Sangil Kim, Hyukmin Lee, Yoo-Sung Hwang, Jaehun Jung, Hun Jae Lee, Sung-il Cho, Sangcheol Oh, Migyeong Kim, Chang-Mo Oh, Byengchul Yu, Young-Seoub Hong, Keonyeop Kim, Sun Jae Jung, Mi Ah Han, Moo-Sik Lee, Jung-Jeung Lee, Young Hwangbo, Hyeon Woo Yim, Yu-Mi Kim, Joongyub Lee, Weon-Young Lee, Jae-Hyun Park, Sungsoo Oh, Heui Sug Jo, Hyeongsu Kim, Gilwon Kang, Hae-Sung Nam, Ju-Hyung Lee, Gyung-Jae Oh, Min-Ho Shin, Soyeon Ryu, Tae-Yoon Hwang, Soon-Woo Park, Sang Kyu Kim, Roma Seol, Ki-Soo Park, Su Young Kim, Jun-wook Kwon, Sung Soon Kim, Byoungguk Kim, June-Woo Lee, Eun Young Jang, Ah-Ra Kim, Jeonghyun Nam, The Korea Community Health Survey Group, Soon Young Lee, Dong-Hyun Kim; Epidemiol Health. 2023;45:e2023075. Published online August 17, 2023; DOI: https://doi.org/10.4178/epih.e2023075

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We estimated the population prevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including unreported infections, through a Korea Seroprevalence Study of Monitoring of SARS-CoV-2 Antibody Retention and Transmission (K-SEROSMART) in 258 communities throughout Korea.

METHODS

In August 2022, a survey was conducted among 10,000 household members aged 5 years and older, in households selected through two stage probability random sampling. During face-to-face household interviews, participants self-reported their health status, COVID-19 diagnosis and vaccination history, and general characteristics. Subsequently, participants visited a community health center or medical clinic for blood sampling. Blood samples were analyzed for the presence of antibodies to spike proteins (anti-S) and antibodies to nucleocapsid proteins (anti-N) SARS-CoV-2 proteins using an electrochemiluminescence immunoassay. To estimate the population prevalence, the PROC SURVEYMEANS statistical procedure was employed, with weighting to reflect demographic data from July 2022.

RESULTS

In total, 9,945 individuals from 5,041 households were surveyed across 258 communities, representing all basic local governments in Korea. The overall population-adjusted prevalence rates of anti-S and anti-N were 97.6% and 57.1%, respectively. Since the Korea Disease Control and Prevention Agency has reported a cumulative incidence of confirmed cases of 37.8% through July 31, 2022, the proportion of unreported infections among all COVID-19 infection was suggested to be 33.9%.

CONCLUSIONS

The K-SEROSMART represents the first nationwide, community-based seroepidemiologic survey of COVID-19, confirming that most individuals possess antibodies to SARS-CoV-2 and that a significant number of unreported cases existed. Furthermore, this study lays the foundation for a surveillance system to continuously monitor transmission at the community level and the response to COVID-19.

Summary

Korean summary
인구집단을 기반으로 하여 대표성 있는 표본을 추출하여 COVID-19 항체유병률 조사를 전국적으로 수행함으로 지역사회 단위에서 지속적으로 모니터링할 수 있는 COVID-19 감시체계 구축의 기반을 마련하였다. 2022년 8월 우리나라 국민의 대부분이 COVID-19에 대한 항체를 보유하고 있었고 인구 3명 중 1명은 미확진 감염자로 추정되었다.

Key Message
The K-SEROSMART represents the first nationwide, community-based seroepidemiologic survey of COVID-19. In August 2022, most of the Korean people had antibodies to COVID-19, and one in three people was estimated to have an unreported infection. This study lays the foundation for a surveillance system to continuously monitor transmission at the community level and the response to COVID-19.

Citations

Citations to this article as recorded by

Modeling vaccination prioritization strategies for post-pandemic COVID-19 in the Republic of Korea accounting for under-reporting and age-structure
Geunsoo Jang, Jihyeon Kim, Robin N. Thompson, Hyojung Lee
Journal of Infection and Public Health.2025; 18(4): 102688. CrossRef
Limitations of neutralizing antibody titers in COVID-19 vaccine efficacy trials and a call for additional correlates of protection
Young Hoon Hwang, Dal-Hee Min, Wan Beom Park
Human Vaccines & Immunotherapeutics.2025;[Epub] CrossRef
Evaluating the Effect of Public Health and Social Measures Under Rapid Changes in Population-level Immunity Against SARS-CoV-2: A Mathematical Modeling Study
Sung-mok Jung, Jaehun Jung, Justin Lessler
Epidemiology.2025; 36(3): 334. CrossRef
Infection-mediated immune response in SARS-CoV-2 breakthrough infection and implications for next-generation COVID-19 vaccine development
Sho Miyamoto, Tadaki Suzuki
Vaccine.2024; 42(6): 1401. CrossRef
Changes in the intrinsic severity of severe acute respiratory syndrome coronavirus 2 according to the emerging variant: a nationwide study from February 2020 to June 2022, including comparison with vaccinated populations
Boyeong Ryu, Eunjeong Shin, Dong Hwi Kim, HyunJu Lee, So Young Choi, Seong-Sun Kim, Il-Hwan Kim, Eun-Jin Kim, Sangwon Lee, Jaehyun Jeon, Donghyok Kwon, Sungil Cho
BMC Infectious Diseases.2024;[Epub] CrossRef
Seroprevalence of SARS-CoV-2 infection in pediatric patients in a tertiary care hospital setting
Ploy Pattanakitsakul, Chanya Pongpatipat, Chavachol Setthaudom, Mongkol Kunakorn, Thiantip Sahakijpicharn, Anannit Visudtibhan, Nopporn Apiwattanakul, Surapat Assawawiroonhakarn, Uthen Pandee, Chonnamet Techasaensiri, Sophida Boonsathorn, Sujittra Chaisav
PLOS ONE.2024; 19(9): e0310860. CrossRef
Realistic Estimation of COVID-19 Infection by Seroprevalence Surveillance of SARS-CoV-2 Antibodies: An Experience From Korea Metropolitan Area From January to May 2022
In Hwa Jeong, Jong-Hun Kim, Min-Jung Kwon, Jayoung Kim, Hee Jin Huh, Byoungguk Kim, Junewoo Lee, Jeong-hyun Nam, Eun-Suk Kang
Journal of Korean Medical Science.2024;[Epub] CrossRef
COVID-19 Vaccination Recommendations for 2024–2025 in Korea
Wan Beom Park, Young Hoon Hwang, Ki Tae Kwon, Ji Yun Noh, Sun Hee Park, Joon Young Song, Eun Ju Choo, Min Joo Choi, Jun Yong Choi, Jung Yeon Heo, Won Suk Choi
Infection & Chemotherapy.2024; 56(4): 453. CrossRef

COVID-19: Original Article

Seroprevalence of SARS-CoV-2 antibodies in the community based on participants in the 2020 Korea National Health and Nutrition Examination Survey: Ah-Ra Kim, Dohsik Minn, Su Hwan Kim, Hyeon Nam Do, Byoungguk Kim, Young Sill Choi, Dong-Hyun Kim, Eun-Jee Oh, Kyungwon Oh, Donghyok Kwon, Jun-Wook Kwon, Sung Soon Kim, June-Woo Lee; Epidemiol Health. 2022;44:e2022028. Published online February 21, 2022; DOI: https://doi.org/10.4178/epih.e2022028

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Abstract Summary PDF

Abstract

OBJECTIVES
The Korea National Health and Nutrition Examination Survey (KNHANES) is a nationwide cross-sectional surveillance system that assesses the health and nutritional status of the Korean population. To evaluate the occurrence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the community, we investigated the prevalence of anti-SARS-CoV-2 antibodies in the sera of KNHANES participants.

METHODS

Subjects were recruited between April 24 and December 12, 2020. In total, 5,284 subjects aged 10-90 years from 17 regions participated. SARS-CoV-2 antibodies were screened using the Elecsys Anti-SARS-CoV-2 assay. Positive samples were verified using 4 different SARS-CoV-2 antibody assays and the plaque reduction neutralizing test. The final seropositivity criteria were a positive screening test and at least 1 positive result from the 5 additional tests.

RESULTS

Almost half (49.2%; 2,600/5,284) of participants were from metropolitan areas, 48.9% were middle-aged (40-69 years), and 20.5% were in their 20s or younger. The seropositivity rate was 0.09% (5/5,284). Three of the 5 antibody-positive subjects had a history of infection, of whom 2 were infected abroad and 1 was infected in a local cluster outbreak.

CONCLUSIONS

The low SARS-CoV-2 antibody seroprevalence in Korea indicates that there have been few coronavirus disease 2019 (COVID-19) cases due to successful COVID-19 management measures (e.g., diagnostic tests for overseas arrivals, national social distancing, and strict quarantine measures). Moreover, asymptomatic infections were uncommon due to active polymerase chain reaction testing. However, hidden infections may exist in the community, requiring the continuation of quarantine and vaccination measures.

Summary

Korean summary
코로나19에 대한 방역대책 및 예방접종 정책 수립을 위한 과학적 근거를 확보하기 위하여 2020년도 국민건강영양조사(이하 국건영) 참여자 5,284명에 대해 코로나19 항체보유율을 조사함. 그 결과 2020년도 국건영 참여자의 항체양성률은 0.09%(5/5,284)였으며, 이중 확진 이력이 있는 사람은 3명이었음. 따라서 지역사회 미진단 감염자는 2명으로 확인됨. 국내 항체보유율은 해외 사례에 비해 낮으며, 이는 적극적인 방역관리에 따른 것으로 사료되며, 지역사회에 미진단 감염자가 존재함이 확인되어 이들에 대한 철저한 관리가 요구됨.

Key Message
The low SARS-CoV-2 antibody seroprevalence in Korea indicates that there have been few COVID-19 cases due to successful management measures, however, hidden infections may exist in the community, requiring the continuation of quarantine and vaccination measures.

Citations

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Protective effect of vaccination on the risk of cardiovascular disease after SARS-CoV-2 infection
Jihun Song, Seulggie Choi, Seogsong Jeong, Joo young Chang, Sun Jae Park, Yun Hwan Oh, Ji Soo Kim, Yoosun Cho, Kyeonghyang Byeon, Jun Yong Choi, Seju Lee, Sang Min Park
Clinical Research in Cardiology.2024; 113(2): 235. CrossRef
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In Hwa Jeong, Jong-Hun Kim, Min-Jung Kwon, Jayoung Kim, Hee Jin Huh, Byoungguk Kim, Junewoo Lee, Jeong-hyun Nam, Eun-Suk Kang
Journal of Korean Medical Science.2024;[Epub] CrossRef
Accelerated Cognitive Function Decline in Community-Dwelling Older Adults during COVID-19 Pandemic: The Korean Frailty and Aging Cohort Study (KFACS)
Jaehoon Jung, Sunyoung Kim, Byungsung Kim, Miji Kim, Jisoo Yang, Dongmin Chung, Changwon Won
International Journal of Environmental Research and Public Health.2022; 19(17): 10666. CrossRef
Seroprevalence of SARS-CoV-2 antibodies during the third wave of COVID-19 in the Seoul metropolitan area of Korea
Kyuhyun Yoon, Jayeun Kim, Kyong Ran Peck, Hyun Soo Kim, Hyukmin Lee, Yoo-Sung Hwang, Soon Young Lee, Sung-il Cho, Hun Jae Lee, Yeong-gyeong Kim, Byoungguk Kim, June-Woo Lee, Ah-Ra Kim, Hyeon Nam Do, Dong-Hyun Kim
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Cohort Profile

Korea HIV/AIDS Cohort Study: study design and baseline characteristics: Bo Youl Choi, Jun Yong Choi, Sang Hoon Han, Sang Il Kim, Mee-Kyung Kee, Min Ja Kim, Shin-Woo Kim, Sung Soon Kim, Yu-Mi Kim, Nam Su Ku, Jin-Soo Lee, Joo-Shil Lee, Yunsu Choi, Kyong Sil Park, Joon Young Song, Jun Hee Woo, Moon Won Kang, June Kim; Epidemiol Health. 2018;40:e2018023. Published online June 6, 2018; DOI: https://doi.org/10.4178/epih.e2018023

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Abstract Summary PDF Supplementary Material

Abstract

The number of persons infected by HIV/AIDS has consistently increased in Korea since the first case of HIV/AIDS infection in 1985 and reached 15,208 by 2016. About 1,100 new patients with HIV/ AIDS infections have emerged every year since 2013. In Korea, the Korea HIV/AIDS Cohort Study was established for the evidenced-based prevention, treatment, and effective management of patients infected with human immunodeficiency virus (HIV) in December 2006. This study monitored 1,438 patients, who accounted for about 10% of all patients with HIV/AIDS in Korea, for 10 years with the following aims: (1) to develop an administrative system for the establishment of a HIV/AIDS cohort-based study; (2) to standardize methodologies and the case report forms; and (3) to standardize multi-cohort data and develop a data cleaning method. This study aims to monitor at least 1,000 patients (excluding those for whom investigation had been completed) per year (estimated number of patients who can be monitored by January 2018: 939). By December 2016, the sex distribution was 93.3% for men, and 6.7% for women (gender ratio, 13.9:1.0), and 98.9% of all participants were Korean. More than 50.0% of the participants were confirmed as HIV positive after 2006. This study reports competitive, long-term research that aimed to develop policies for the prevention of chronic infectious diseases for patients with HIV. The data collected over the last decade will be used to develop indices for HIV treatment and health promotion.

Summary

Korean summary
세계적으로 HIV 감염인은 감소하고 있으나, 한국의 HIV 감염은 증가하여 2013년 이후 매년 1,000명이 넘는 신규 감염인이 보고되고 있다. HIV/AIDS 코호트 연구진은 2006년부터 HIV 감염인과 AIDS 환자를 대상으로 6개월 간격의 반복 조사를 시행하여 역학과 임상 자료를 수집하여 데이터베이스를 구축하고, 생물검체를 채취하여 인체자원은행에 보관하여, HIV/AIDS의 발생 기전을 구명하고, 자연사를 파악하며, 예방과 진단, 치료, 관리 방법을 개발하기 위한 기초와 임상, 역학 연구에 활용하고 있다.

Citations

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Cohort profile: a nationwide retrospective cohort of mortality in people living with HIV in Korea, 1985-2020
Taeyoung Kim, Yoonhee Jung, Koun Kim, Jung Wan Park, Jeonghee Yu, Sung-il Cho
Epidemiology and Health.2025; 47: e2025002. CrossRef
Smoothed quantile residual life regression analysis with application to the Korea HIV/AIDS cohort study
Soo Min Kim, Yunsu Choi, Sangwook Kang, Korea HIV/AIDS cohort study
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Hye Seong, Yunsu Choi, Minjeong Kim, Jung Ho Kim, Joon Young Song, Shin-Woo Kim, Sang Il Kim, Youn Jeong Kim, Dae Won Park, Boyoung Park, Bo Youl Choi, Jun-Yong Choi
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Kyungmin Kim, Seoyoung Jang, Hyo-Deog Rim, Shin-Woo Kim, Hyun-ha Chang, Jungmin Woo
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Kyung Sun Oh, Jin-soo Lee, Euna Han
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Original Article

Asymptomatic Middle East Respiratory Syndrome coronavirus infection using a serologic survey in Korea: Yeong-jun Song, Jeong-Sun Yang, Hee Jung Yoon, Hae-Sung Nam, Soon Young Lee, Hae-Kwan Cheong, Woo-Jung Park, Sung Han Park, Bo Youl Choi, Sung Soon Kim, Moran Ki; Epidemiol Health. 2018;40:e2018014. Published online April 15, 2018; DOI: https://doi.org/10.4178/epih.e2018014

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307 Download
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Abstract Summary PDF

Abstract

OBJECTIVES
The rates of asymptomatic infection with Middle East Respiratory Syndrome (MERS) coronavirus vary. A serologic study was conducted to determine the asymptomatic MERS infection rate in healthcare workers and non-healthcare workers by exposure status.

METHODS

Study participants were selected from contacts of MERS patients based on a priority system in 4 regions strongly affected by the 2015 MERS outbreak. A sero-epidemiological survey was performed in 1,610 contacts (average duration from exposure to test, 4.8 months), and the collected sera were tested using an enzyme-linked immunespecific assay (ELISA), immunofluorescence assay (IFA), and plaque reduction neutralization antibody test (PRNT). Among the 1,610 contacts, there were 7 ELISA-positive cases, of which 1 exhibited positive IFA and PRNT results.

RESULTS

The asymptomatic infection rate was 0.060% (95% confidence interval, 0.002 to 0.346). The asymptomatic MERS case was a patient who had been hospitalized with patient zero on the same floor of the hospital at the same time. The case was quarantined at home for 2 weeks after discharge, and had underlying diseases, including hypertension, angina, and degenerative arthritis.

CONCLUSIONS

The asymptomatic infection was acquired via healthcare-associated transmission. Thus, it is necessary to extend serologic studies to include inpatient contacts who have no symptoms.

Summary

Korean summary
2015년 국내 MERS 유행시에 자가격리를 시행하였던 접촉자 약 15,000명 (의료인과 비의료인 포함) 중에서 주요 유행지역, 노출 강도 등을 고려하여 선별된 3,291명을 대상으로 무증상 감염여부를 확인하기 위한 혈청 역학조사를 수행하였다. 최종 검사에 참여한 1,610명 중에서 7명이 ELISA 양성 반응을 보였고, 그 중 1명이 IFA와 PRNT에서도 양성 반응을 보여 무증상 감염률은 0.060%(95% CI: 0.002-0.346)로 기존 연구에 비하여 낮았다. 최종 양성을 보인 1명은 노출 당시 1번환자와 가까운 병실에 입원하였던 환자였다.

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Airflow as a Possible Transmission Route of Middle East Respiratory Syndrome at an Initial Outbreak Hospital in Korea
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CD8+ T Cells Responding to the Middle East Respiratory Syndrome Coronavirus Nucleocapsid Protein Delivered by Vaccinia Virus MVA in Mice
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Mi-Na Kim, Eui-Chong Kim
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