Epidemiology and Health

Epidemiologic Investigation

Detecting mpox infection in the early epidemic: an epidemiologic investigation of the third and fourth cases in Korea: Taeyoung Kim, Eonjoo Park, Jun Suk Eun, Eun-young Lee, Ji Won Mun, Yunsang Choi, Shinyoung Lee, Hansol Yeom, Eunkyoung Kim, Jongmu Kim, Jihyun Choi, Jinho Ha, Sookkyung Park; Epidemiol Health. 2023;45:e2023040. Published online March 23, 2023; DOI: https://doi.org/10.4178/epih.e2023040

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Abstract

OBJECTIVES
As few mpox cases have been reported in Korea, we aimed to identify the characteristics of mpox infection by describing our epidemiologic investigation of a woman patient (index patient, the third case in Korea) and a physician who was infected by a needlestick injury (the fourth case).

METHODS

We conducted contact tracing and exposure risk evaluation through interviews with these 2 patients and their physicians and contacts, as well as field investigations at each facility visited by the patients during their symptomatic periods. We then classified contacts into 3 levels according to their exposure risk and managed them to minimize further transmission by recommending quarantine and vaccination for post-exposure prophylaxis and monitoring their symptoms.

RESULTS

The index patient had sexual contact with a man foreigner during a trip to Dubai, which was considered the probable route of transmission. In total, 27 healthcare-associated contacts across 7 healthcare facilities and 9 community contacts were identified. These contacts were classified into high (7 contacts), medium (9 contacts), and low (20 contacts) exposure risk groups. One high-risk contact was identified as a secondary patient: a physician who was injured while collecting specimens from the index patient.

CONCLUSIONS

The index patient visited several medical facilities due to progressive symptoms prior to isolation. Although the 2022 mpox epidemic mainly affected young men, especially men who have sex with men, physicians should also consider mpox transmission in the general population for the timely detection of mpox-infected patients.

Summary

Korean summary
국내 엠폭스 3번환자는 전파 가능 시기에 7곳의 의료기관을 방문했으며, 접촉자로 분류된 27명의 의료기관 접촉자와 9명의 지역사회 접촉자 중 주사침 자상을 입은 의료인 1명이 추가 확진되었다. 적시에 엠폭스 환자를 발견하기 위하여 의료인들은 전파위험이 낮은 일반 인구의 감염 가능성에 대한 고려가 필요하다.

Key Message
As a result of contact tracing of a mpox patient in the early phase of epidemic, she visited 7 healthcare facilities to be diagnosed which infers diagnosing those who are statistically not at high risk is challenging. Yet the risk of contracting mpox seems relatively low as only one of 36 contacts was infected; a healthcare personnel who sustained a needlestick injury.

Citations

Citations to this article as recorded by

Clinical Features of Mpox Patients in Korea: A Multicenter Retrospective Study
So Yun Lim, Hyeon Jae Jo, Su-Yeon Lee, Miyoung Ahn, Yeonjae Kim, Jaehyun Jeon, Eu Suk Kim, BumSik Chin, Jae-Phil Choi, Nam Joong Kim
Journal of Korean Medical Science.2024;[Epub] CrossRef
Transmission potential of mpox in mainland China, June-July 2023: estimating reproduction number during the initial phase of the epidemic
Andrei R. Akhmetzhanov, Pei-Hsuan Wu
PeerJ.2024; 12: e16908. CrossRef
Mpox exposure and transmission in healthcare settings during the 2022 global outbreak
Kimon C Zachary, Lisa L Philpotts, Erica S Shenoy
Current Opinion in Infectious Diseases.2023; 36(4): 257. CrossRef

COVID-19: Original Article

Perceived usefulness of COVID-19 tools for contact tracing among contact tracers in Korea: Seonyeong Gong, Jong Youn Moon, Jaehun Jung; Epidemiol Health. 2022;44:e2022106. Published online November 15, 2022; DOI: https://doi.org/10.4178/epih.e2022106

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
In Korea, contact tracing for coronavirus disease 2019 is conducted using information from credit card records, handwritten visitor logs, KI-Pass (QR code), and the Safe Call system after an interview. We investigated the usefulness of these tools for contact tracing.
METHODS
An anonymous survey was conducted for 2 months (July to September 2021) among contact tracers throughout Korea. The questionnaire consisted of 4 parts: (1) demographic characteristics; (2) the usefulness of each tool for contact tracing; (3) the order in which information was checked during contact tracing; and (4) the match rate between tools for contact tracing, screening test rate, response rate, and helpfulness (rated on a Likert scale).
RESULTS
In total, 190 individuals completed the survey. When asked to rate the usefulness of each tool for contact tracing on a Likert scale, most respondents (86.3%) provided positive responses for credit card records, while the most common responses for handwritten visitor logs were negative. The highest percentage of positive responses for helpfulness was found for KI-Pass (91.1%), followed in descending order by credit card records (82.6%), Safe Call (78.2%), and handwritten visitor logs (22.1%).
CONCLUSIONS
Over 80% of participants provided positive responses for credit card records, KI-Pass, and Safe Call data, while approximately 50% provided negative responses regarding the usefulness of handwritten visitor logs. Our findings highlight the need to unify systems for post-interview contact tracing to increase their convenience for contact tracers, as well as the need to improve tools utilizing handwritten visitor logs for digitally vulnerable groups.; Summary

Korean summary
본 연구는 국내 역학조사 담당자들을 대상으로 시행한 설문조사를 중심으로 면담조사 후 추가적으로 실시하는 다양한 접촉자 추적 방법의 유용성에 대한 분석을 목표로 한다. 응답자 중 약 80% 이상이 카드결제기록, KI-Pass, GPS 및 CCTV 정보의 유용성에 대해 긍정적으로 응답하였다. 반면 약 50%는 수기명부의 유용성에 대해 부정적으로 응답하였다. 본 연구의 결과는 역학조사관과 사용자 모두의 편의를 위해 역학조사 방법의 일원화가 필요할 뿐만 아니라 디지털 취약 계층을 위해 수기명부를 대체할 수 있는 시스템의 필요성을 시사한다.

Key Message
We conducted an anonymous online survey to assess the usefulness of tools for contact tracing for COVID-19 in Korea. Over 80% of participants provided positive responses regarding the usefulness of credit card records, KI-Pass, and Safe Call data, while approximately 50% provided negative responses regarding the usefulness of handwritten visitor logs. Our findings highlight the need to unify contact tracing systems to increase their convenience for contact tracers.

COVID-19: Original Article

Evidence of the importance of contact tracing in fighting COVID-19: Okyu Kwon; Epidemiol Health. 2022;44:e2022006. Published online January 3, 2022; DOI: https://doi.org/10.4178/epih.e2022006

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Abstract Summary PDF

Abstract

OBJECTIVES
We analyzed data to determine whether there are distinguishing characteristics depending on the success or failure of control for coronavirus disease 2019 (COVID-19) by country in the trend of the daily number of confirmed cases and the number of tests.

METHODS

We obtained the number of confirmed cases and tests per day for almost every country in the world from Our World in Data. The Pearson correlation between the two time series was calculated according to the time delay to analyze the relationship between the number of tests and the number of cases with a lag.

RESULTS

For each country, we obtained the time lag that makes the maximum correlation between the number of confirmed cases and the number of tests for COVID-19. It can be seen that countries whose time lag making maximum correlation lies in a special section between about 15 days and 20 days are generally been successful in controlling COVID-19. That section looks like a trench on the battlefield.

CONCLUSIONS

We have seen the possibility that the success in mitigating COVID-19 can be expressed as a simple indicator of the time lag of the correlation between confirmed cases and tests. This time lag indicator is presumably reflected by efforts to actively trace the infected persons.

Summary

Korean summary
일일 신규 확진자 수와 검사자 수 시계열의 상관관계에서의 시간지연 값은 방역의 성공을 평가할 수 있는 지표가 될 수 있음을 여러 국가의 실제 데이터로부터 확인할 수 있었다. 이 시간 지연은 역학 조사에 따른 감염자 발굴의 노력의 결과로 이해할 수 있을 것이다.

Key Message
It was confirmed from actual data from several countries that the time delay value in the correlation between the number of daily new confirmed cases and the number of tests can be an indicator to evaluate the success of quarantine. This time delay can be understood as a result of efforts to discover infected persons according to epidemiological investigations.

Citations

Citations to this article as recorded by

Looking under the lamp-post: quantifying the performance of contact tracing in the United States during the SARS-CoV-2 pandemic
Henry Bayly, Madison Stoddard, Debra Van Egeren, Eleanor J Murray, Julia Raifman, Arijit Chakravarty, Laura F White
BMC Public Health.2024;[Epub] CrossRef
From Crisis to Control: Amidst and Postpandemic Data Protection Concerns in Singapore and Vietnam through the Lens of Techno-Solutionism and Efficient Violation of Privacy Rights
Vy Ngo Nguyen Thao
Law and Development Review.2024;[Epub] CrossRef
Global transmission of COVID-19 — A gravity model approach
Hyungsoo Woo, Okyu Kwon, Jae-Suk Yang
International Journal of Modern Physics C.2023;[Epub] CrossRef

Original Articles

Hand-to-face contact behaviors during indoor activities in daily life among Korean adults: an observational pilot study using videotaping: Hyang Soon Oh, Mikyung Ryu, Youngran Yang; Epidemiol Health. 2021;43:e2021030. Published online April 22, 2021; DOI: https://doi.org/10.4178/epih.e2021030

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Abstract Summary PDF

Abstract

OBJECTIVES
Hand-to-face contact (HFC) is the major route for the self-inoculation of pathogens. This study aimed to describe the characteristics of HFC behaviors among Korean adults during indoor activities.

METHODS

Thirty participants were enrolled in the study, and 2 hours of videotaped data were collected from each participant. Contact data were recorded by examining the frequency and duration of HFC on the videos. Three training sessions were conducted for 2 readers to ensure the accuracy and reliability of videotape reading. Re-reading and verification of selected video data were performed to confirm intrapersonal and interpersonal validity. Contact exposure (CE) was determined by multiplying the contact frequency (CF) by the contact duration (CD) to quantify the intensity of contact during the observation time (2 hours).

RESULTS

A total of 3,007 HFCs (1,305 mucous membrane contacts and 1,702 non-mucous membrane contacts) were observed for 60 person-hours. The median CF (person/2 hr) of the mucous membranes (eye; 4.0, nose; 15.5, mouth; 16.5) was 39.5/person and the median total CD was 177.0 sec/person. The median CE (frequency-duration/sec/person) was 5,795.0 (mouth: 1,356.0, nose: 600.0, eye: 57.5).

CONCLUSIONS

This study showed that the mouth and nose were the most frequent exposure sites for HFC. Avoiding habitual HFC, awareness of self-inoculation by HFC, and vigorous hand hygiene should be strengthened to prevent the spread of infections.

Summary

Korean summary
· 얼굴의 가장 빈번한 직접 자가 손접촉 노출은 입과 코에서 발생했습니다. · 접촉 노출량 지표 (contact exposure)는 입과 코에 자가 손접촉을 보다 잘 구별할 수 있습니다. · 습관적인 손-얼굴 접촉을 피하고, 마스크 사용 및 철저한 손위생으로 감염성 질환의 전파를 예방해야 합니다.

Key Message
• Average contact frequency (no./person) and contact duration (sec/person) of hand-to-face contact to the mucous membranes were high on the mouth, nose and then nose. • Contact exposure could differentiate more distinguished the hand contacts to mouth and to nose than contact frequency. • Hand-to face contacts, especially to mouth and then to nose can be the most frequent route of self-inoculation among Korean adults. • Avoiding habitual hand-to-face contacts, mask use, and vigorous hand hygiene should be strengthened as we counter epidemics of transmitting infectious diseases.

Citations

Citations to this article as recorded by

Impact of a Serious Game (#RedPingüiNO) to Reduce Facial Self-Touches and Prevent Exposure to Pathogens Transmitted via Hands: Quasi-Experimental Intervention
Marta Arévalo-Baeza, Alejandro Viuda-Serrano, Carmen Juan-Llamas, Pablo Sotoca-Orgaz, Iván Asín-Izquierdo
JMIR Serious Games.2023; 11: e45600. CrossRef
Hemşirelik Öğrencilerine Eğitimleri Sırasında Öğretilen Asepsi Uygulamalarının Covid -19 Pandemi Dönemindeki Bireysel Uygulamalarına Etkisi
Ayşe SERPİCİ, Neriman AKANSEL, Nursel VATANSEVER, Vahit DALKIZAN
Uludağ Üniversitesi Tıp Fakültesi Dergisi.2023; 49(2): 245. CrossRef
Hand-to-Face Contact of Preschoolers during Indoor Activities in Childcare Facilities in the Republic of Korea
Hyang Soon Oh, Mikyung Ryu
International Journal of Environmental Research and Public Health.2022; 19(20): 13282. CrossRef

Outbreak investigation: transmission of COVID-19 started from a spa facility in a local community in Korea: Taewon Han; Epidemiol Health. 2020;42:e2020056. Published online July 29, 2020; DOI: https://doi.org/10.4178/epih.e2020056

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
In Korea, there have been 10,480 confirmed cases of coronavirus disease 2019 (COVID-19) as of April 11, 2020. We investigated the transmission of COVID-19 in a cluster of cases.

METHODS

We analyzed the epidemiological characteristics of 10 confirmed COVID-19 patients in an outbreak that started at Spa facility A in a local community in Korea on March 28, 2020 and traced them through April 8, 2020. Epidemiological surveys and diagnostic tests were conducted for each contact, and the secondary attack rate was estimated.

RESULTS

There were 3 male confirmed patients (30.0%) and 7 female confirmed patients (70.0%), and their mean age was 53.5 years (range, 2.0 to 73.0). Two patients (20.0%) were asymptomatic. The incubation period was between 3 days and 12 days. Three confirmed patients were infected at female’s Spa facility A and 7 confirmed patients were second, third, and fourth generations of transmission. Seven confirmed patients contracted COVID-19 through presymptomatic contact. In total, 192 contacts were identified, with a secondary attack rate of 3.6%. Eighty-three contacts (43.2%) were aged 40-59 years, and the secondary attack rate was the highest (12.1%) in those aged ≥60 years. Most exposures (n=156, 81.3%) involved casual contact. The number of visitors using the female’s spa facility was 58, including 3 confirmed patients, resulting in a secondary outbreak rate of 5.9%.

CONCLUSIONS

This study presents a cluster of cases occurring in a setting with high temperature and humidity. The second, third, and fourth generations were transmitted through presymptomatic contact.

Summary

Korean summary
본 연구는 목욕탕에서 시작된 지역사회로 전파된 코로나19의 유행조사를 통해 전증상전파와 그 영향에 대해서 알아보고자 하였다. 유행조절과 감염원파악을 위해 목욕탕 방문자와 각 확진자들의 접촉자에 대해서 역학조사 및 검사를 진행하였으며 이에 기반하여 이차감염률을 추정하였고, 이를 통해 전증상 전파 역시도 코로나19 유행에 큰 영향을 미친다는 것을 알 수 있었다. 이러한 전증상전파가 특징인 코로나19 유행을 조절하기 위해선 보건당국의 빠른 접촉자 파악과 격리, 검사 뿐만 아니라 국민들의 개인위생 및 사회적 거리두기가 필수적이다.

Citations

Citations to this article as recorded by

Assessing changes in incubation period, serial interval, and generation time of SARS-CoV-2 variants of concern: a systematic review and meta-analysis
Xiangyanyu Xu, Yanpeng Wu, Allisandra G. Kummer, Yuchen Zhao, Zexin Hu, Yan Wang, Hengcong Liu, Marco Ajelli, Hongjie Yu
BMC Medicine.2023;[Epub] CrossRef
Incubation Period of COVID-19 Caused by Unique SARS-CoV-2 Strains
Yu Wu, Liangyu Kang, Zirui Guo, Jue Liu, Min Liu, Wannian Liang
JAMA Network Open.2022; 5(8): e2228008. CrossRef
Relative infectiousness of asymptomatic SARS-CoV-2 infected persons compared with symptomatic individuals: a rapid scoping review
David McEvoy, Conor McAloon, Aine Collins, Kevin Hunt, Francis Butler, Andrew Byrne, Miriam Casey-Bryars, Ann Barber, John Griffin, Elizabeth Ann Lane, Patrick Wall, Simon John More
BMJ Open.2021; 11(5): e042354. CrossRef
Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis
Pratha Sah, Meagan C. Fitzpatrick, Charlotte F. Zimmer, Elaheh Abdollahi, Lyndon Juden-Kelly, Seyed M. Moghadas, Burton H. Singer, Alison P. Galvani
Proceedings of the National Academy of Sciences.2021;[Epub] CrossRef
Household Transmission of SARS-CoV-2
Zachary J. Madewell, Yang Yang, Ira M. Longini, M. Elizabeth Halloran, Natalie E. Dean
JAMA Network Open.2020; 3(12): e2031756. CrossRef

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