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Original article
Korea Seroprevalence Study of Monitoring of SARS-COV-2 Antibody Retention and Transmission (K-Sero SMART): 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, Sunjae 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, Soon Young Lee, Dong-Hyun Kim
Epidemiol Health. 2023;e2023075.   Published online August 17, 2023
DOI: https://doi.org/10.4178/epih.e2023075    [Accepted]
  • 579 View
  • 48 Download
AbstractAbstract PDF
Abstract
OBJECTIVES
We estimated the population prevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including unreported infections, through a Seroprevalence Study of Monitoring of SARS-CoV-2 Antibody Retention and Transmission (K-SMART) 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 anti-spike (anti-S) and anti-nucleocapsid (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 South 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-SMART 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
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
  • 6,571 View
  • 363 Download
  • 3 Citations
AbstractAbstract AbstractSummary 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

Citations to this article as recorded by  
  • 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.2023;[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
    Epidemiology and Health.2022; 44: e2022085.     CrossRef
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
  • 13,838 View
  • 354 Download
  • 11 Citations
AbstractAbstract AbstractSummary PDFSupplementary 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

Citations to this article as recorded by  
  • Rate of and Risk Factors for Loss to Follow Up in HIV-Infected Patients in Korea: The Korea HIV/AIDS Cohort Study
    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
    Infection & Chemotherapy.2023; 55(1): 69.     CrossRef
  • Effect of characteristics on the clinical course at the initiation of treatment for human immunodeficiency virus infection using dimensionality reduction
    Yunsu Choi, Bo Youl Choi, Sang Il Kim, Jungsoon Choi, Jieun Kim, Bo Young Park, Soo Min Kim, Shin-Woo Kim, Jun Yong Choi, Joon Young Song, Youn Jeong Kim, Hyo Youl Kim, Jin-Soo Lee, Jung Ho Kim, Yoon Hee Jun, Myungsun Lee, Jaehyun Seong
    Scientific Reports.2023;[Epub]     CrossRef
  • Attachment Insecurity and Stigma as Predictors of Depression and Anxiety in People Living With HIV
    Kyungmin Kim, Seoyoung Jang, Hyo-Deog Rim, Shin-Woo Kim, Hyun-ha Chang, Jungmin Woo
    Psychiatry Investigation.2023; 20(5): 418.     CrossRef
  • Effect of single tablet regimen on prescription trends for treatment-naïve patients with HIV/AIDS in Korea
    Kyung Sun Oh, Gi Hyeon Seo, Hee Kyoung Choi, Euna Han
    Scientific Reports.2022;[Epub]     CrossRef
  • Predictors Associated With HIV Status Non-Disclosure in Korea
    Kyungmin Kim, Jungmin Woo
    Journal of Korean Medical Science.2022;[Epub]     CrossRef
  • Comparison of Three Cardiovascular Risk Scores among HIV-Infected Patients in Korea: The Korea HIV/AIDS Cohort Study
    Ji Yun Bae, Soo Min Kim, Yunsu Choi, Jun Yong Choi, Sang Il Kim, Shin-Woo Kim, Bo Young Park, Bo Youl Choi, Hee Jung Choi
    Infection & Chemotherapy.2022; 54(3): 409.     CrossRef
  • The Incidence and Risk Factors of Renal Insufficiency among Korean HIV infected Patients: The Korea HIV/AIDS Cohort Study
    Jun Hyoung Kim, Heeseon Jang, Jung Ho Kim, Joon Young Song, Shin-Woo Kim, Sang Il Kim, Bo Youl Choi, Jun Yong Choi
    Infection & Chemotherapy.2022; 54(3): 534.     CrossRef
  • Estimation of the Number of HIV Infections and Time to Diagnosis in the Korea
    Eunyoung Lee, Jungmee Kim, Jin Yong Lee, Ji Hwan Bang
    Journal of Korean Medical Science.2020;[Epub]     CrossRef
  • Human Immunodeficiency Virus-Associated Gastrointestinal Kaposi's Sarcoma: A Case Report
    Hee Joong Lim, So Hyun Park, Seung Joon Choi, Suyoung Park, Hee Young Lee, Jun Won Chung, Dong Hae Chung
    Journal of the Korean Society of Radiology.2020; 81(5): 1260.     CrossRef
  • Epidemiological characteristics of HIV infected Korean: Korea HIV/AIDS Cohort Study
    Yunsu Choi, Bo Youl Choi, Soo Min Kim, Sang Il Kim, June Kim, Jun Young Choi, Shin-Woo Kim, Joon Young Song, Youn Jeong Kim, Dae Won Park, Hyo Youl Kim, Hee-Jung Choi, Mee-Kyung Kee, Young Hyun Shin, Myeongsu Yoo
    Epidemiology and Health.2019; 41: e2019037.     CrossRef
  • Comparison of Characteristics and Survival between Prospective and Retrospective Korea Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Cohort Studies
    Jun Hyoung Kim, Yunsu Choi, Joon Young Song, Shin-Woo Kim, Sang Il Kim, Mee-Kyung Kee, Bo Youl Choi, Jun Yong Choi
    Infection & Chemotherapy.2019; 51(4): 393.     CrossRef
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
  • 14,317 View
  • 290 Download
  • 16 Citations
AbstractAbstract AbstractSummary 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.

Citations

Citations to this article as recorded by  
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    Jefree Johari, Robert D. Hontz, Brian L. Pike, Tupur Husain, Norhayati Rusli, Rozainanee Mohd-Zain, Vunjia Tiong, Hai-Yen Lee, Boon-Teong Teoh, Sing-Sin Sam, Chee-Sieng Khor, Shih-Keng Loong, Juraina Abd-Jamil, Siti-Sarah Nor'e, Hasmawati Yahaya, Naim Che
    Emerging Microbes & Infections.2023;[Epub]     CrossRef
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    Majid Sharifi, Anwarul Hasan, Setareh Haghighat, Akbar Taghizadeh, Farnoosh Attar, Samir Haj Bloukh, Zehra Edis, Mengzhou Xue, Suliman Khan, Mojtaba Falahati
    Talanta.2021; 223: 121704.     CrossRef
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    Hanjie Jonathan Gan, Amaravadhi Harikishore, Jihye Lee, Sangeun Jeon, Sreekanth Rajan, Ming Wei Chen, Jun Long Neo, Seungtaek Kim, Ho Sup Yoon
    Antiviral Research.2021; 185: 104996.     CrossRef
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    Nash Rochman, Yuri Wolf, Eugene V. Koonin
    F1000Research.2021; 10: 447.     CrossRef
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    Nash Rochman, Yuri Wolf, Eugene V. Koonin
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    Afnan A. Degnah, Sawsan S. Al-amri, Ahmed M. Hassan, Abdulrahman S. Almasoud, Manar Mousa, Sarah A. Almahboub, Rowa Y. Alhabbab, Ahmed A. Mirza, Salwa I. Hindawi, Naif Khalaf Alharbi, Esam I. Azhar, Anwar M. Hashem
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    PLOS ONE.2020; 15(5): e0232757.     CrossRef
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