Epidemiology and Health

Original Articles

Changes in the prevalence of metabolic syndrome in Korean adults after the COVID-19 outbreak: Ji-Young Kwon, Sang-Wook Song; Epidemiol Health. 2022;44:e2022101. Published online November 5, 2022; DOI: https://doi.org/10.4178/epih.e2022101

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Abstract PDF: Abstract
OBJECTIVES
This study sought to reveal changes in the prevalence of metabolic syndrome (MetS) after the start of the coronavirus disease 2019 (COVID-19) pandemic and to identify the groups showing the greatest changes.
METHODS
We compared the prevalence of MetS between 2017–2019 (i.e., the 3-year period before the COVID-19 pandemic) and soon after the initial outbreak of COVID-19 in 2020 among 24,564 adults ≥ 19 years of age using data from the Korea National Health and Nutrition Examination Survey.
RESULTS
The prevalence of MetS increased steadily between 2017 and 2020 (29.4 to 35.3%, p for trend < 0.001), with annual percent changes of 2.0%p, 2.2%p, and 1.7%p, respectively. Compared to 3 years before the COVID-19 pandemic, the prevalence of MetS significantly increased during the COVID-19 pandemic in males (6.2%p; 95% confidence interval [CI], 3.5 to 8.9) compared to females (1.5%p; 95% CI, -1.2 to 4.1). The age groups with the greatest increases in MetS prevalence after the COVID-19 pandemic were those in their 40s (4.6%p; 95% CI, 0.9 to 8.4) and 50s (5.8%p; 95% CI, 2.2 to 9.4). By educational background, the increase in MetS prevalence was greatest among those with a college degree or higher (5.1%p). The prevalence of MetS in high-income (5.3%p) and low-income (4.6%p) groups significantly increased.
CONCLUSIONS
The increasing trend in the overall prevalence of MetS continued during the COVID-19 pandemic. In particular, the prevalence of MetS among adult males in their 40s and 50s increased significantly after the COVID-19 outbreak in Korea.; Summary

Korean summary

Key Message

Predictors of COVID-19 booster vaccine hesitancy among fully vaccinated adults in Korea: a nationwide cross-sectional survey: Yunha Noh, Ju Hwan Kim, Dongwon Yoon, Young June Choe, Seung-Ah Choe, Jaehun Jung, Sang-Won Lee, Ju-Young Shin; Epidemiol Health. 2022;44:e2022061. Published online July 22, 2022; DOI: https://doi.org/10.4178/epih.e2022061

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Abstract

OBJECTIVES
This study explored predictors of coronavirus disease 2019 (COVID-19) booster hesitancy among fully vaccinated young adults and parental COVID-19 vaccine hesitancy for their children.

METHODS

This cross-sectional study administered an online survey from December 2 to December 20, 2021. We enrolled participants aged 18-49 years, for whom ≥2 weeks had passed after their initial COVID-19 vaccination. We estimated odds ratios (ORs) with 95% confidence intervals (CIs) using multivariate logistic regression to evaluate factors associated with booster/vaccine hesitancy.

RESULTS

Among the 2,993 participants, 48.8% showed hesitancy (wait and see: 40.2%; definitely not: 8.7%). Booster hesitancy was more common among women (OR, 1.25; 95% CI, 1.05 to 1.50), younger people (OR, 1.44; 95% CI, 1.17 to 1.77), those with a lower education level (OR, 2.05; 95% CI, 1.10 to 3.82), those who received the mRNA-1273 vaccine type (OR, 2.01; 95% CI, 1.65 to 2.45), and those who experienced serious adverse events following previous COVID-19 vaccination (OR, 2.03; 95% CI, 1.47 to 2.80). The main reasons for booster hesitancy were concerns about safety (54.1%) and doubts about efficacy (29.8%). Among the 1,020 respondents with children aged <18 years, 65.8% were hesitant to vaccinate their children against COVID-19; hesitancy was associated with younger parental age, education level, the type of vaccine the parent received, and a history of COVID-19 infection.

CONCLUSIONS

Concerns about the efficacy and safety of COVID-19 vaccines were the major barrier to booster acceptance. The initial COVID-19 vaccine type (mRNA-1273), young age, gender (women), a low education level, and adverse events after the first COVID-19 vaccine were key predictors of booster hesitancy.

Summary

Korean summary
본 연구는 국내 19-49세 성인을 대상으로, 코로나19 3차접종 의향과 그들의 18세 미만 자녀에 대한 코로나19 기초접종 의향을 조사하고, 코로나19 백신접종 기피와 관련된 요인을 파악하고자 하였다. 2021년 12월 2일부터 20일까지 온라인 설문조사를 통하여 자료를 수집하였으며, 연구대상자는 코로나19 기초접종을 완료한 후 2주 경과한 19-49세 성인으로, 전국 대표성을 확보하기 위해 성별, 연령, 지역별로 층화하여 모집하였다. 코로나19 3차접종 기피율은 약 48.8%로 나타났으며, 접종 기피 관련 영향요인으로는 젊은 연령층, 여성, 낮은 교육수준, 기초접종 백신 종류, 기초접종 후 중증 이상반응 경험이 포함되었으며, 18세 미만 자녀에 대한 코로나19 기초접종 기피율은 65.8%로, 관련 영향요인으로는 젊은 부모 연령, 교육수준, 부모의 기초접종 백신 종류, 코로나19 감염 과거력이 포함되었다.

Key Message
Concerns about the safety and efficacy of COVID-19 vaccines were the major barrier to booster acceptance; the initial COVID-19 vaccine type (mRNA-1273), younger age, gender (women), a low education level, and adverse events after the first COVID-19 vaccine were key predictors of booster hesitancy.

Citations

Citations to this article as recorded by

Why Some People Are Hesitant to Receive COVID-19 Boosters: A Systematic Review
Yam B. Limbu, Bruce A. Huhmann
Tropical Medicine and Infectious Disease.2023; 8(3): 159. CrossRef
COVID-19 Vaccine Booster Hesitancy in Malaysia: A Web-Based Cross-Sectional Study
Kai Wei Lee, Sook Fan Yap, Hooi Tin Ong, Myo Oo, Kye Mon Min Swe
Vaccines.2023; 11(3): 638. CrossRef

Local-level spatiotemporal dynamics of COVID-19 transmission in the Greater Seoul Area, Korea: a view from a Bayesian perspective: Youngbin Lym, Hyobin Lym, Ki-Jung Kim; Epidemiol Health. 2022;44:e2022016. Published online January 13, 2022; DOI: https://doi.org/10.4178/epih.e2022016

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Abstract Summary PDF: Abstract
OBJECTIVES
The purpose of this study was to enhance the understanding of the local-level spatiotemporal dynamics of COVID-19 transmission in the Greater Seoul Area (GSA), Korea, after its initial outbreak in January 2020.
METHODS
Using the weekly aggregates of coronavirus disease 2019 (COVID-19) cases of 77 municipalities in the GSA, we examined the relative risks of COVID-19 infection across local districts over 50 consecutive weeks in 2020. To this end, we employed a spatiotemporal generalized linear mixed model under the hierarchical Bayesian framework. This allowed us to empirically examine the random effects of spatial alignments, temporal autocorrelation, and spatiotemporal interaction, along with fixed effects. Specifically, we utilized the conditional autoregressive and the weakly informative penalized complexity priors for hyperparameters of the random effects.
RESULTS
Spatiotemporal interaction dominated the overall variability of random influences, followed by spatial correlation, whereas the temporal correlation appeared to be small. Considering these findings, we present dynamic changes in the spread of COVID-19 across local municipalities in the GSA as well as regions at elevated risk for further policy intervention.
CONCLUSIONS
The outcomes of this study can contribute to advancing our understanding of the local-level COVID-19 spread dynamics within densely populated regions in Korea throughout 2020 from a different perspective, and will contribute to the development of regional safety planning against infectious diseases.; Summary

Korean summary
본 논문은 수도권 지역에서 코로나바이러스가 처음 발생한 2020년 1월 이후 12월 말까지 총 50주 동안 수도권 내 지자체 수준에서의 코로나 19 전염병에 대한 시공간적 확산 역동성을 파악하기 위한 연구이다. 데이터 기반의 실증분석을 위한 계층적 베이지언 기법 기반의 시공간 일반화 선형 혼합모형의 결과에 따르면, 확률효과 중 시공간적 상호작용의 영향성이 가장 크게 나타났고, 다음으로는 공간자기상관에 의한 영향 순으로 나타난 반면, 시간에 의한 확률효과는 상대적으로 적게 도출되었다. 연구의 결과를 종합하여, 본 연구에서는 지도 기반의 코로나 19 위험 및 그 위험의 시공간적 변화를 제시하고, 향후 전염병에 대한 정책대응에 활용될 수 있도록 하였다.

Key Message
This study investigates the local-level spatiotemporal dynamics of COVID-19 transmission in the Greater Seoul Area, Korea, after its initial outbreak in January 2020. We adopt a flexible hierarchical Bayesian method so as to account for latent influences of space and time along with the fixed effects by covariates. The results suggest that spatiotemporal interaction dominates the overall variability of random influences, followed by spatial correlation, while the temporal effect appears to be small. Based on these findings, we present maps that depict dynamic changes of COVID-19 infection as well as regions of elevated risks for further policy consideration.

Socioeconomic inequality in compliance with precautions and health behavior changes during the COVID-19 outbreak: an analysis of the Korean Community Health Survey 2020: Ga Bin Lee, Sun Jae Jung, Yang Yiyi, Jea Won Yang, Hoang Manh Thang, Hyeon Chang Kim; Epidemiol Health. 2022;44:e2022013. Published online January 9, 2022; DOI: https://doi.org/10.4178/epih.e2022013

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Abstract

OBJECTIVES
This study examined socioeconomic inequalities in compliance with precautions and health behavior changes during the coronavirus disease 2019 (COVID-19) outbreak using a representative Korean sample.

METHODS

This exploratory study utilized around 210,000 participants aged ≥25 years in the Korean Community Health Survey 2020. Socioeconomic status was measured with educational attainment and household income. Outcomes included non-compliance with 8 precaution measures and deterioration in 6 health behaviors. The relative inequality index (RII) was calculated to quantify the degree of inequality by education and income level. RII values >1.0 indicate that deprived people have a higher frequency of health problems, and RII values <1.0 conversely indicate a higher frequency of health problems in more advantaged groups.

RESULTS

People with lower education or income levels tended to have higher rates of non-compliance with COVID-19 safety precautions (RII range, 1.20 to 3.05). Lower education and income levels were associated with an increased smoking amount (RII=2.10 and 1.67, respectively) and sleep duration changes (RII=1.21 and 1.36, respectively). On the contrary, higher education and income levels were associated with decreased physical activity (RII=0.59 and 0.77, respectively) and increased delivery food consumption (RII=0.27 and 0.37, respectively). However, increased alcohol drinking was associated with lower education and income levels in younger men (RII=1.73 and 1.31, respectively), but with higher levels in younger women (RII=0.73 and 0.68, respectively).

CONCLUSIONS

Our findings suggest the need to develop customized strategies, considering the characteristics of the target population, to decrease the burden and impact of the COVID-19 outbreak.

Summary

Korean summary
코로나19 유행기간 동안 예방지침 준수율과 건강관련 생활습관이 나빠지는 정도는 사회경제적 수준에 따라 차이가 있다. 전반적으로 코로나19 예방지침 준수율은 높았지만, 사회경제수준이 낮을수록 예방지침 준수율도 낮아지는 경향을 보였다. 하지만, 사회경제수준과 생활습관 악화의 관계는 성, 연령, 생활습관의 종류에 따라 달랐다.

Key Message
This study of a representative Korean sample found that socioeconomic inequalities existed in compliance with COVID-19 precautions and in health behavior deterioration. There is a need to develop target group-specific strategies to reduce health inequalities and the long-term health burden of the COVID-19 outbreak.

Citations

Citations to this article as recorded by

Association of Depression With Precautionary Behavior Compliance, COVID-19 Fear, and Health Behaviors in South Korea: National Cross-sectional Study
Hyerine Shin, Ji-Su Kim, HyunHae Lee
JMIR Public Health and Surveillance.2023; 9: e42677. CrossRef
Trends in socioeconomic inequalities in obesity among Korean adolescents: the Korea Youth Risk Behavior Web-based Survey (KYRBS) 2006 to 2020
Eunji Kim, Ga Bin Lee, Dong Keon Yon, Hyeon Chang Kim
Epidemiology and Health.2023;[Epub] CrossRef
Factors associating to the increased smoking time among South Korean male workers during COVID-19 pandemic
Mi Young Kwon, Myong Sun Cho
Korean Journal of Health Education and Promotion.2022; 39(2): 53. CrossRef
Trust and compliance: Milieu-specific differences in social cohesion during the COVID-19 pandemic in Germany
Tim Schröder, Anne Speer, Patrick Sachweh, Olaf Groh-Samberg
Frontiers in Sociology.2022;[Epub] CrossRef

Does having various types of fear related to COVID-19 disrupt individuals’ daily life?: Findings from a nationwide survey in Korea: Woorim Kim, Yeong Jun Ju, Soon Young Lee; Epidemiol Health. 2022;44:e2022004. Published online January 3, 2022; DOI: https://doi.org/10.4178/epih.e2022004

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Abstract

OBJECTIVES
Unexpected changes in daily routines caused by the coronavirus disease 2019 (COVID-19) pandemic may affect psychological health. This study investigated the association between various types of COVID-19-related fear and the subjective level of disturbance in daily activities experienced by individuals.

METHODS

This cross-sectional study used the Korea Community Health Survey conducted from August through November 2020. COVID-19-related fear included fear of infection, death, public criticism, family members getting infected, and economic loss. The subjective level of disruption in daily activities was measured using a 0-100 numeric rating scale developed by the Korea Disease Control and Prevention Agency. Multivariable linear regression was used to analyze the associations between the independent and dependent variables. A subgroup analysis was performed based on income level.

RESULTS

Participants who reported fear of infection (β=-3.37, p<0.001), death (β=-0.33, p=0.030), public criticism (β=-1.63, p<0.001), a family member getting infected (β=-1.03, p<0.001), and economic loss (β=-3.52, p<0.001) experienced more disturbances in daily activities. The magnitude of this association was most significant in the lowest-income group.

CONCLUSIONS

Individuals reporting COVID-19-related fear experienced higher levels of subjective disruption in daily activities.

Summary

Korean summary
이 연구는 COVID-19 팬데믹과 관련된 심리적염려가 일상생활 활동에 부정적인 영향을 줄 수 있음을 관찰하였다. COVID-19 감염으로 인한 감염, 사망, 대중의 비판, 가족 중 건강취약자의 감염, 경제적 손실에 대해 염려하는 사람은 그렇지 않은 사람에 비해 일상생활에 더 부정적인 영향을 받고 있는 것으로 관찰되었다. 특히 다양한 유형의 감염염려를 동시에 경험하고 있을수록 일상생활 지장 정도가 더 증가하는 경향이 관찰되었으며 소득수준이 낮을수록 부정적인 영향정도가 더 두드러졌다.

Key Message
Our results revealed that fear related to the COVID-19 pandemic was associated with increased levels of subjective disruptions in daily activities. Compared to individuals without fear, those with fears of COVID-19 infection, dying from infection, public criticism, a family member getting infected, and economic loss reported higher levels of disruption in daily activities. Those who reported fear of COVID-19 infection and economic loss due to infection had particularly higher levels of disturbances. Considering the various types of fear concurrently, the level of disruption experienced tended to increase with the number of reported fears.

Citations

Citations to this article as recorded by

Association Between Changes in Family Life Due to COVID-19 and Depressive Mood and Stress Perception
Min-Su Kim, Mi Ah Han, Jong Park, So Yeon Ryu
Asia Pacific Journal of Public Health.2023; 35(1): 14. CrossRef
Is fear of COVID-19 higher in individuals residing in more deprived areas? A nationwide study
Woorim Kim, Soon Young Lee, Yeong Jun Ju
Journal of Public Health.2022;[Epub] CrossRef

COVID-19: Epidemiologic Investigation

Experience of a COVID-19 outbreak response in a general hospital in Gyeonggi Province, Korea: Chanhee Kim, Gawon Choi, Shin Young Park, Jieun Kim, Young Joon Park, Kyungnam Kim; Epidemiol Health. 2021;43:e2021083. Published online October 18, 2021; DOI: https://doi.org/10.4178/epih.e2021083

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Abstract Summary PDF: Abstract
OBJECTIVES
Coronavirus disease 2019 (COVID-19) outbreaks in general hospitals are particularly risky because they not only overburden the regional healthcare delivery system, but also increase the possibility of community transmission. This study shares an experience of a COVID-19 outbreak response in a general hospital in Gyeonggi Province, Korea.
METHODS
Since the first COVID-19 confirmed case was recognized in Hospital A on March 29, 2020, the Immediate Response Team of Gyeonggi Province and Korea Disease Control and Prevention Agency devised a plan to conduct an epidemiological investigation and minimize the paralysis of hospital functions. Apart from the epidemiological investigation, a risk assessment of the hospital and management of contacts, including patients and workers, were also undertaken.
RESULTS
In total, 72 confirmed cases were identified, including 26 hospitalized patients, 16 healthcare personnel, 7 visitors, and 22 cases identified externally. The majority of the confirmed cases were exposed in Ward B or were contacts of people exposed in Ward A (58.3% of 72 cases). Among healthcare personnel, caregivers were found to be the most vulnerable to COVID-19 in this outbreak.
CONCLUSIONS
Preparation for all possible situations in medical facilities is important because it is difficult to find alternative resources. The findings of this study provide information on controlling the further transmission of COVID-19 and furnish evidence of the importance of ordinary management skills to be prepared for COVID-19.; Summary

Korean summary
본 연구에서는 2020년 경기도 소재 한 종합병원에서 발생한 코로나19 유행 대응 사례 경험을 공유한다. 병원 외 지역사회 전파 사례를 포함하여 총 72명의 확진자가 이 유행에서 확인되었다. 종합병원은 지역 의료전달체계에서 중요한 역할을 하고 있기 때문에 코로나19로 인해 그 기능이 마비되지 않도록 예방하는 것이 가장 바람직하며, 이를 위해서는 평상 시에 적절한 대비 체계를 갖추어 두어야 한다.

Key Message
This study shares the experience of responding to the COVID-19 outbreak at a general hospital in Gyeonggi-do, 2020. A total of 72 confirmed cases were identified, including cases of community based transmission outside the hospital. Since general hospitals play an important role in the medical delivery system, it is most desirable to prevent the function from being paralyzed by COVID-19 situation, and for this, and appropriate preparedness should be established.

COVID-19: Perspective

Maternal mental health in Africa during the COVID-19 pandemic: a neglected global health issue: Kobi V. Ajayi, Elizabeth Wachira, Obasanjo Afolabi Bolarinwa, Beulah D. Suleman; Epidemiol Health. 2021;43:e2021078. Published online October 6, 2021; DOI: https://doi.org/10.4178/epih.e2021078

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Abstract

The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted mental health and well-being around the globe. Public health measures to control the virus’s rapid spread, such as physical distancing, social isolation, lockdown, restricted movements, and quarantine, caused fear and panic in the general population. Although pandemic-related stressors have been reported, changes that occur during the perinatal period compounded by those made to obstetric care guidelines may put pregnant and postpartum mothers at an increased risk of poor mental health. While an abundance of research has examined the impact of the pandemic on maternal mental health in developed nations such as Europe and America, very few studies have done so in the African continent. Considering that Africa has prominently weak health systems, poor mental health policies and infrastructure, high poverty rates, and unreliable maternal care, the pandemic is expected to have dire consequences on maternal mental health in the region. As such, multipronged mental health interventions and strategies that consider the heterogeneity within and between African regions must be developed. Doing so will close existing and widening global health disparities to achieve the United Nations Sustainable Development Goals by 2030.

Summary

Korean summary

Key Message
Despite the adverse psychological impact of the COVID-19 pandemic on maternal mental health globally, little is known about its effect in Africa. As of the time of this study, only four research studies have been conducted in Nigeria, Ethiopia, and Ghana, investigating the psychological sequelae of the pandemic among pregnant and postpartum women in Africa. This study calls for urgent multipronged maternal mental health interventions and psychosocial support that consider the heterogeneity within and between African regions.

Citations

Citations to this article as recorded by

Experiences of Perinatal Mental Health Care among Minority Ethnic Women during the COVID-19 Pandemic in London: A Qualitative Study
Sabrina Pilav, Abigail Easter, Sergio A. Silverio, Kaat De Backer, Sushma Sundaresh, Sara Roberts, Louise M. Howard
International Journal of Environmental Research and Public Health.2022; 19(4): 1975. CrossRef
Generalized Anxiety Disorder and Its Associated Factors Among Pregnant Women During COVID-19 at Public Health Facilities of East Gojjam Zone, 2020: A Multi-Center Cross-Sectional Study
Keralem Anteneh Bishaw, Addisu Andalem, Haile Amha, Tirusew wondie
Frontiers in Global Women's Health.2022;[Epub] CrossRef

COVID-19: Original Article

Epidemiological characteristics of a COVID-19 outbreak caused by religious activities in Daegu, Korea: Jong-Yeon Kim, Yu-Mi Lee, Hwajin Lee, Jung-Whan Kim, Shin-Woo Kim; Epidemiol Health. 2021;43:e2021024. Published online April 14, 2021; DOI: https://doi.org/10.4178/epih.e2021024

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Abstract

OBJECTIVES
A coronavirus disease 2019 (COVID-19) outbreak triggered by religious activities occurred in Daegu, Korea in February 2020. This outbreak spread rapidly to the community through high-risk groups. This study describes the characteristics of COVID-19 cases based on S religious group membership and summarizes the Daegu municipal government’s processes and responses to control the outbreak.

METHODS

The epidemiological characteristics of confirmed cases were obtained through basic and in-depth epidemiological surveys. General characteristics, the proportion of asymptomatic cases, the case-fatality rate, and the time-to-event within each group were presented after stratifying confirmed cases according to S religious group membership.

RESULTS

Overall, 7,008 COVID-19 cases were confirmed in Daegu from February 18, 2020 to June 30, 2020, and 61.5% (n= 4,309) were S religious group members. Compared with non-members, members had a higher proportion of female (p< 0.001) and younger age (p< 0.001), as well as lower disease prevalence. At the time of the investigation, 38.4% of cases in members were asymptomatic versus 23.7% of cases in non-members (p< 0.001). The case-fatality rate of non-members aged ≥ 60 years was significantly higher than that of members (p< 0.001). Compared with non-members, members had longer intervals from symptom onset to diagnosis (p< 0.001) and from diagnosis to admission (p< 0.001), and a shorter interval from admission to discharge (p< 0.001).

CONCLUSIONS

The epidemiological features of S religious group members, including the proportion of asymptomatic cases, case-fatality rate, and time-to-event, differed from non-members. The Daegu authorities prevented further COVID-19 spread through immediate isolation and active screening tests of all S religious group members.

Summary

Korean summary
2020년 2월 대구에서는 종교활동에 의한 코로나바이러스감염증-19(COVID-19) 유행이 발생하였다. 2020년 2월 18일부터 6월 30일까지 대구에서 7,008명이 확진되었으며, 이 중 약 61.5%가 S 종교집단의 신도였다. 비신도인 확진자에 비하여 S 종교집단의 신도인 확진자는 높은 여성 비율, 낮은 연령, 낮은 기저질환 유병률, 높은 무증상 감염율, 동일 연령대에 비하여 낮은 치명률을 보였다. 대구시 보건당국은 S 종교집단의 모든 회원에 대한 즉각적인 격리와 적극적인 선별검사를 통해 지역사회 내 더욱 광범위한 COVID-19 확산을 막을 수 있었다.

Key Message
A coronavirus disease 2019 (COVID-19) outbreak triggered by religious activities occurred in Daegu, Korea in February 2020. Overall, 7,008 COVID-19 cases were confirmed in Daegu from February 18, 2020 to June 30, 2020, and approximately 61.5% were S religious group members. Compared with non-members, members had a higher proportion of women, younger age, and lower disease prevalence, higher proportion of asymptomatic cases and lower case-fatality rate within the same age group. The Daegu authorities prevented further COVID-19 spread through immediate isolation and active screening tests of all S religious group members.

Citations

Citations to this article as recorded by

Estimation of the Effectiveness of a Tighter, Reinforced Quarantine for the Coronavirus Disease 2019 (COVID-19) Outbreak: Analysis of the Third Wave in South Korea
Marn Joon Park, Ji Ho Choi, Jae Hoon Cho
Journal of Personalized Medicine.2023; 13(3): 402. CrossRef
COVID-19 outbreak in a religious village community in Republic of Korea and risk factors for transmission
Jiae Shim, Eunju Lee, Eunyoung Kim, Yeonhwa Choi, Giseok Kang, Bryan Inho Kim
Osong Public Health and Research Perspectives.2023; 14(2): 110. CrossRef
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COVID-19: Perspective

COVID-19 herd immunity in the absence of a vaccine: an irresponsible approach: Jade Khalife, Derrick VanGennep; Epidemiol Health. 2021;43:e2021012. Published online February 3, 2021; DOI: https://doi.org/10.4178/epih.e2021012

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Abstract

As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread rapidly throughout the human population, the concept of “herd immunity” has attracted the attention of both decision-makers and the general public. In the absence of a vaccine, this entails that a large proportion of the population will be infected to develop immunity that would limit the severity and/or extent of subsequent outbreaks. We argue that adopting such an approach should be avoided for several reasons. There are significant uncertainties about whether achieving herd immunity is possible. If possible, achieving herd immunity would impose a large burden on society. There are gaps in protection, making it difficult to shield the vulnerable. It would defeat the purpose of avoiding harm caused by the virus. Lastly, dozens of countries are showing that containment is possible.

Summary

Korean summary

Key Message
Pursuing herd immunity without a vaccine involves numerous uncertainties, is costly in terms of lives and disease, is ineﬀective, and - being unethical and uncompassionate - is not compatible with human dignity and development.

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Marco Zenone, Jeremy Snyder, Alessandro Marcon, Timothy Caulfield, Veena Sriram
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Nele Brusselaers, David Steadson, Kelly Bjorklund, Sofia Breland, Jens Stilhoff Sörensen, Andrew Ewing, Sigurd Bergmann, Gunnar Steineck
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COVID-19: Brief Communication

Analyzing the effects of social distancing on the COVID-19 pandemic in Korea using mathematical modeling: Sunhwa Choi, Moran Ki; Epidemiol Health. 2020;42:e2020064. Published online September 7, 2020; DOI: https://doi.org/10.4178/epih.e2020064

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Abstract

OBJECTIVES
During the 6 months since the first coronavirus disease 2019 (COVID-19) patient was diagnosed in Korea on January 20, 2020, various prevention and control measures have been implemented according to the COVID-19 epidemic pattern. Therefore, this study aimed to estimate the reproductive numbers (R) for each epidemic stage to analyze the effects of the preventive measures and to predict the COVID-19 transmission trends.

METHODS

We estimated the transmission rates for each epidemic stage by fitting a COVID-19 transmission model, based on a deterministic mathematical model, to the data on confirmed cases. The effects of preventive measures such as social distancing by time period were analyzed, and the size and trends of future COVID-19 outbreaks were estimated.

RESULTS

The value of R was 3.53 from February18, 2020 to February 28, 2020, and the mean R reduced to 0.45 from March 14, 2020 to April 29, 2020, but it significantly increased to 2.69 from April 30, 2020 to May13, 2020 and it was maintained at 1.03 from May 14, 2020 to July 23, 2020.

CONCLUSIONS

According to the estimated R, it had fallen to below 1 and was maintained at that level owing to the isolation of infected persons by the public health authorities and social distancing measures followed by the general public. Then, the estimated R increased rapidly as the contact among individuals increased during the long holiday period from April 30, 2020 to May 5, 2020. Thereafter, the value of R dropped, with the continued use of preventive measures but remained higher than 1.00, indicating that the COVID-19 outbreak can be prolonged and develop into a severe outbreak at any time.

Summary

Korean summary
수학적 모델링을 통하여 코로나-19 유행양상에 따른 시기별 감염재생산수(reproductive number)를 추정하고, 시기별 방역정책의 효과를 분석하여 향후 유행의 규모와 유행 종료 시점 등을 예측하였다. 그 결과, 4월30일부터 5월5일까지의 긴 연휴 기간을 통해 사람들 간의 접촉이 증가하면서 감염재생산수가 급격히 증가하였고(4월 30일 - 5월 13일까지 평균 R=2.69), 그 후, 지속적인 방역조치로 인해 5월 14일-7월 23일까지 평균 R=1.03로 감소하였으나, 여전히 1보다 큰 값으로 나타나, 코로나-19유행이 지속되고 있으며 언제라도 다시 큰 유행으로 커질 수 있다고 예측되었다.

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COVID-19: Perspective

Air filtration and SARS-CoV-2: Yevgen Nazarenko; Epidemiol Health. 2020;42:e2020049. Published online July 4, 2020; DOI: https://doi.org/10.4178/epih.e2020049

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Abstract

Air filtration in various implementations has become a critical intervention in managing the spread of coronavirus disease 2019 (COVID-19). However, the proper deployment of air filtration has been hampered by an insufficient understanding of its principles. These misconceptions have led to uncertainty about the effectiveness of air filtration at arresting potentially infectious aerosol particles. A correct understanding of how air filtration works is critical for further decision-making regarding its use in managing the spread of COVID-19. The issue is significant because recent evidence has shown that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can remain airborne longer and travel farther than anticipated earlier in the COVID-19 pandemic, albeit with diminishing concentrations and viability. While SARS-CoV-2 virions are around 60-140 nm in diameter, larger respiratory droplets and air pollution particles (>1 µm) have been found to harbor the virions. Removing particles that could carry SARS-CoV-2 from the air is possible using air filtration, which relies on the natural or mechanical movement of air. Among various types of air filters, high-efficiency particle arrestance (HEPA) filters have been recommended. Other types of filters are less or more effective and, correspondingly, are easier or harder to move air through. The use of masks, respirators, air filtration modules, and other dedicated equipment is an essential intervention in the management of COVID-19 spread. It is critical to consider the mechanisms of air filtration and to understand how aerosol particles containing SARS-CoV-2 virions interact with filter materials to determine the best practices for the use of air filtration to reduce the spread of COVID-19.

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COVID-19: Brief Communication

An interim review of the epidemiological characteristics of 2019 novel coronavirus: Sukhyun Ryu, Byung Chul Chun; Epidemiol Health. 2020;42:e2020006. Published online February 6, 2020; DOI: https://doi.org/10.4178/epih.e2020006

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The 2019 novel coronavirus (2019-nCoV) from Wuhan, China is currently recognized as a public health emergency of global concern.

METHODS

We reviewed the currently available literature to provide up-to-date guidance on control measures to be implemented by public health authorities.

RESULTS

Some of the epidemiological characteristics of 2019-nCoV have been identified. However, there remain considerable uncertainties, which should be considered when providing guidance to public health authorities on control measures.

CONCLUSIONS

Additional studies incorporating more detailed information from confirmed cases would be valuable.

Summary

Korean summary
여러 국외 연구를 통해 2019 신종 코로나바이러스에 대한 역학적 특성이 보고되고 있다. 아직까지 지역사회 전파 예방 및 관리방안을 제시하기 위한 역학적 근거가 아직까지 밝혀지지 않은 부분이 많아 지속적인 추가 연구가 필요하다.

Key Message

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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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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.

Key Message

Citations

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MERS-Original Articles

Preventive behaviors by the level of perceived infection sensitivity during the Korea outbreak of Middle East Respiratory Syndrome in 2015: Soon Young Lee, Hee Jeong Yang, Gawon Kim, Hae-Kwan Cheong, Bo Youl Choi; Epidemiol Health. 2016;38:e2016051. Published online November 16, 2016; DOI: https://doi.org/10.4178/epih.e2016051

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study was performed to investigate the relationship between community residents’ infection sensitivity and their levels of preventive behaviors during the 2015 Middle East Respiratory Syndrome (MERS) outbreak in Korea.

METHODS

Seven thousands two hundreds eighty one participants from nine areas in Gyeonggi-do including Pyeongtaek, the origin of the outbreak in 2015 agreed to participate in the survey and the data from 6,739 participants were included in the final analysis. The data on the perceived infection sensitivity were subjected to cluster analysis. The levels of stress, reliability/practice of preventive behaviors, hand washing practice and policy credibility during the outbreak period were analyzed for each cluster.

RESULTS

Cluster analysis of infection sensitivity due to the MERS outbreak resulted in classification of participants into four groups: the non-sensitive group (14.5%), social concern group (17.4%), neutral group (29.1%), and overall sensitive group (39.0%). A logistic regression analysis found that the overall sensitive group with high sensitivity had higher stress levels (17.80; 95% confidence interval [CI], 13.77 to 23.00), higher reliability on preventive behaviors (5.81; 95% CI, 4.84 to 6.98), higher practice of preventive behaviors (4.53; 95% CI, 3.83 to 5.37) and higher practice of hand washing (2.71; 95% CI, 2.13 to 3.43) during the outbreak period, compared to the non-sensitive group.

CONCLUSIONS

Infection sensitivity of community residents during the MERS outbreak correlated with gender, age, occupation, and health behaviors. When there is an outbreak in the community, there is need to maintain a certain level of sensitivity while reducing excessive stress, as well as promote the practice of preventive behaviors among local residents. In particular, target groups need to be notified and policies need to be established with a consideration of the socio-demographic characteristics of the community.

Summary

Korean summary
2015년 한국에서 발생한 메르스 유행 시 지역 주민이 인식하는 민감도와 예방행위 수준을 파악하고 연관성을 밝히고자 2015년 경기도 9개 시의 지역사회건강조사 대상자 6,739명을 대상으로 감염 민감도와 예방행위 등을 조사 분석하였다. 감염 민감도는 성별, 연령, 직업, 건강행위와 연관성이 있었으며, 감염에 대한 민감도가 높을수록 스트레스를 많이 받는 한편, 예방행위 실천에 긍정적인 영향을 미침을 알 수 있었다. 따라서 감염병 유행 시 지나친 스트레스는 줄이되 공중보건 위기에 대한 적정 수준의 민감도를 유지하고, 인구사회학적 특성을 고려한 관리정책이 요구된다.

Key Message

Citations

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Ronel Sewpaul, Musawenkosi Mabaso, Allanise Cloete, Natisha Dukhi, Inbarani Naidoo, Adlai S Davids, Tholang Mokhele, Khangelani Zuma, Sasiragha Priscilla Reddy
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Frontiers in Public Health.2021;[Epub] CrossRef
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Mental health status of people isolated due to Middle East Respiratory Syndrome: Hyunsuk Jeong, Hyeon Woo Yim, Yeong-Jun Song, Moran Ki, Jung-Ah Min, Juhee Cho, Jeong-Ho Chae; Epidemiol Health. 2016;38:e2016048. Published online November 5, 2016; DOI: https://doi.org/10.4178/epih.e2016048

36,111 View
1,116 Download
624 Citations

Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Isolation due to the management of infectious diseases is thought to affect mental health, but the effects are still unknown. We examined the prevalence of anxiety symptoms and anger in persons isolated during the Middle East Respiratory Syndrome (MERS) epidemic both at isolation period and at four to six months after release from isolation. We also determined risk factors associated with these symptoms at four to six months.

METHODS

Of 14,992 individuals isolated for 2-week due to having contact with MERS patients in 2015, when MERS was introduced to Korea, 1,692 individuals were included in this study. Anxiety symptoms were evaluated with the Generalized Anxiety Disorder 7-item scale and anger was assessed with the State-Trait Anger Expression Inventory at four to six months after release from isolation for MERS.

RESULTS

Of 1,692 who came in contact with MERS patients, 1,656 were not diagnosed with MERS. Among 1,656, anxiety symptoms showed 7.6% (95% confidence interval [CI], 6.3 to 8.9%) and feelings of anger were present in 16.6% (95% CI, 14.8 to 18.4%) during the isolation period. At four to six months after release from isolation, anxiety symptoms were observed in 3.0% (95%CI, 2.2 to 3.9%). Feelings of anger were present in 6.4% (95% CI, 5.2 to 7.6%). Risk factors for experiencing anxiety symptoms and anger at four to six months after release included symptoms related to MERS during isolation, inadequate supplies (food, clothes, accommodation), social networking activities (email, text, Internet), history of psychiatric illnesses, and financial loss.

CONCLUSIONS

Mental health problems at four to six month after release from isolation might be prevented by providing mental health support to individuals with vulnerable mental health, and providing accurate information as well as appropriate supplies, including food, clothes, and accommodation.

Summary

Korean summary
메르스 환자와의 밀착접촉으로 격리되었던 1,692명을 대상으로 격리 당시와 격리해제 후 4-6개월 시점의 불안증상과 분노감 유병율을 파악하고 격리 해제 후 4-6개월 시점에 불안증상과 분노감 유병과 연관된 격리기간 동안의 위험요인을 알아보고자 하였다. 메르스 격리자에서 격리시점의 불안증상 유병율은 7.6% (95%CI: 6.3-8.9%), 분노감 유병율은 16.6% (95%CI: 14.8-18.4%) 였고, 4-6개월 시점이 불안증상 유병율은 3.0% (95%CI: 2.2-3.9%), 분노감 유병율은 6.4% (95%CI: 5.2-7.6%) 이였다. 성별과 연령을 보정한 후 격리해제 4-6개월 지난 시점에서 불안증상 및 분노감 유병의 위험요인은 격리 당시 메르스 증상이 있었거나 구호품 보급이 충분하지 않았거나, 정신과 질환의 과거력이 있었던 경우, 재정 손실이 있었던 사람이었다.

Key Message

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