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Epidemiologic Investigation
An outbreak of neurologic symptoms among patients exposed to an unknown stench in a high school near an industrial complex: an epidemiological investigation
Kiook Baek, Seongmin Jo, Chulyong Park, Joon Sakong
Epidemiol Health. 2022;44:e2022105.   Published online November 9, 2022
DOI: https://doi.org/10.4178/epih.e2022105
  • 4,128 View
  • 98 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Seven students at a high school in Korea visited the emergency room with non-specific neurological symptoms after a stench was noticed during a school entrance ceremony. In relation to this incident, 105 patients visited medical institutions over 5 days. A team of environmental and epidemiological experts was assembled to investigate the incident.
METHODS
Our team of experts participated in the investigation 1 month post-incident. Previously, only air samples had been analyzed. We received results of air samples analyzed by other investigators, medical records of some students, and data from police interviews of patients. Additional investigation and interviews were conducted, and the events were reconstructed in spatial and temporal order.
RESULTS
A cluster of patients was observed on the south side and parts of the north side of the upper floor. A stench like that reported during the incident had been noticed for about 2 years near the school. Students consistently described a similar stench occurring frequently in the vicinity of the school. According to student statements, the odor mainly resembled something burning. The carboxyhemoglobin levels of some students were observed to be >1.5%.
CONCLUSIONS
In the investigation, 2 suspected sources were identified: a science room storing chemicals downstairs from the auditorium and various industrial facilities near the school. Combining the scattered evidence, we considered a toxic puff of gas, perhaps from brief incineration or leakage in a specific area, to be the likely cause of the incident. We describe our approach and the limitations encountered during the investigation.
Summary
Korean summary
본 논문은 일개 고등학교에서 원인미상의 악취와 함께 100명 이상의 환자가 발생한 사건에 대한 조사과정을 담은 문헌이다. 본 연구진은 사건 발생 후 약 1달 후에 조사진에 합류하였으며, 발생 당시 환자 분포 점지도 작성, 인근 지역 사업장 및 악취발생 장소 점지도 작성, 사건 전후 시계열적 사건분석, 기상자료, 관계자 인터뷰 자료 분석 등의 역학적 기법을 동원하여 원인을 인근 지역에서 발생한 퍼프 가스의 유입으로 추정하였다. 본 사건의 원인은 결국 미제로 종결되었지만 추후 유사 사례 발생시 본 조사의 방법론을 참고할 수 있을 것이며, 의료진의 조기 개입을 수행하지 못함으로 인한 초기 상세 인터뷰 자료 확보, 생체 시료 수집 등이 이루어지지 못한 본 조사 과정의 한계점을 반면교사로 삼을 수 있을 것이다.
Key Message
This paper presents an investigation of an outbreak of over 100 patients experiencing an unexplained odor in a high school. The research team utilized epidemiological methods, including dot mapping, temporal analysis of events, and interview data analysis. The source of the odor was estimated to be the inflow of puff gas from surrounding areas. Although the toxic puff gas discharge facility was not identified, sharing the experience from this investigation could help with future investigations of similar incidents.
MERS-Perspective
Strengthening epidemiologic investigation of infectious diseases in Korea: lessons from the Middle East Respiratory Syndrome outbreak
Changhwan Lee, Moran Ki
Epidemiol Health. 2015;37:e2015040.   Published online September 16, 2015
DOI: https://doi.org/10.4178/epih/e2015040
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  • 6 Web of Science
  • 14 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The recent outbreak of Middle East Respiratory Syndrome (MERS) coronavirus infection in Korea resulted in large socioeconomic losses. This provoked the Korean government and the general public to recognize the importance of having a well-established system against infectious diseases. Although epidemiologic investigation is one of the most important aspects of prevention, it has been pointed out that much needs to be improved in Korea. We review here the current status of the Korean epidemiologic service and suggest possible supplementation measures. We examine the current national preventive infrastructure, including human resources such as Epidemic Intelligence Service officers, its governmental management, and related policies. In addition, we describe the practical application of these resources to the recent MERS outbreak and the progress in preventive measures. The spread of MERS demonstrated that the general readiness for emerging infectious diseases in Korea is considerably low. We believe that it is essential to increase society’s investment in disease prevention. Fostering public health personnel, legislating management policies, and establishing research centers for emerging infectious diseases are potential solutions. Evaluating international preventive systems, developing cooperative measures, and initiating improvements are necessary. We evaluated the Korean epidemiologic investigation system and the public preventive measures against infectious diseases in light of the recent MERS outbreak. We suggest that governmental authorities in Korea enforce preventive policies, foster the development of highly qualified personnel, and increase investment in the public health domain of infectious disease prevention.
Summary
Korean summary
2015년 한국의 메르스 유행시 실제 시행되었던 역학조사 내용을 기술하고, 단계별로 문제점을 검토하였다. 또한 향후 역학조사 강화방안으로 1)관련 법령 수정, 2)역학조사 전문인력 강화, 3) 신종 감염병 연구센터 필요성 등을 제시하였다. 이번 메르스 위기를 기회로 삼아 한국 감염병 대비대응체계를 굳건히 하여야 할 것이다.

Citations

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  • Socioeconomic impacts of airborne and droplet-borne infectious diseases on industries: a systematic review
    Ely Zarina Samsudin, Siti Munira Yasin, Nur-Hasanah Ruslan, Nik Nairan Abdullah, Ahmad Faiz Azhari Noor, Ahmad Fitri Abdullah Hair
    BMC Infectious Diseases.2024;[Epub]     CrossRef
  • Epidemiology and Characteristics of Pediatric Respiratory Virus Infection From 2017 to 2019 Focusing on Human Coronavirus: A Retrospective Study of a Single Center in Northwestern Gyeonggi-do
    Hyoungsuk Park, Kyoung Won Cho, Lindsey Yoojin Chung, Jong Min Kim, Jun Hyuk Song, Kwang Nam Kim
    Pediatric Infection & Vaccine.2023; 30(2): 62.     CrossRef
  • How has Guinea learnt from the response to outbreaks? A learning health system analysis
    Tamba Mina Millimouno, Bruno Meessen, Willem Van De Put, Marlon Garcia, Bienvenu Salim Camara, Aliki Christou, Therese Delvaux, Sidikiba Sidibé, Abdoul Habib Beavogui, Alexandre Delamou
    BMJ Global Health.2023; 8(2): e010996.     CrossRef
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    Younsik Kim
    Cogent Social Sciences.2022;[Epub]     CrossRef
  • The impact of the Middle East Respiratory Syndrome coronavirus on inbound tourism in South Korea toward sustainable tourism
    Yunseon Choe, Junhui Wang, HakJun Song
    Journal of Sustainable Tourism.2021; 29(7): 1117.     CrossRef
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    Katelyn J. Yoo, Soonman Kwon, Yoonjung Choi, David M. Bishai
    Health Policy.2021; 125(5): 568.     CrossRef
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    Sangjoon Shin, Jimin Gim
    Asian Social Work and Policy Review.2021; 15(3): 267.     CrossRef
  • Infectious disease and economics: The case for considering multi-sectoral impacts
    Kristine M. Smith, Catherine C. Machalaba, Richard Seifman, Yasha Feferholtz, William B. Karesh
    One Health.2019; 7: 100080.     CrossRef
  • Working experiences of nurses during the Middle East respiratory syndrome outbreak
    Hee Sun Kang, Ye Dong Son, Sun‐Mi Chae, Colleen Corte
    International Journal of Nursing Practice.2018;[Epub]     CrossRef
  • 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
    Epidemiology and Health.2018; 40: e2018014.     CrossRef
  • Airflow as a Possible Transmission Route of Middle East Respiratory Syndrome at an Initial Outbreak Hospital in Korea
    Minki Sung, Seongmin Jo, Sang-Eun Lee, Moran Ki, Bo Youl Choi, JinKwan Hong
    International Journal of Environmental Research and Public Health.2018; 15(12): 2757.     CrossRef
  • Surveillance and epidemiologic investigation in public health emergencies caused by infectious diseases
    Moran Ki
    Journal of the Korean Medical Association.2017; 60(4): 292.     CrossRef
  • Identifying determinants of heterogeneous transmission dynamics of the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea, 2015: a retrospective epidemiological analysis
    Hiroshi Nishiura, Akira Endo, Masaya Saitoh, Ryo Kinoshita, Ryo Ueno, Shinji Nakaoka, Yuichiro Miyamatsu, Yueping Dong, Gerardo Chowell, Kenji Mizumoto
    BMJ Open.2016; 6(2): e009936.     CrossRef
  • Epidemiologic Parameters of the Middle East Respiratory Syndrome Outbreak in Korea, 2015
    Sun Hee Park, Woo Joo Kim, Jin-Hong Yoo, Jung-Hyun Choi
    Infection & Chemotherapy.2016; 48(2): 108.     CrossRef
MERS-Epidemiologic Investigation
MERS epidemiological investigation to detect potential mode of transmission in the 178th MERS confirmed case in Pyeongtaek, Korea
Kyujin Chang, Moran Ki, Eun Gyu Lee, Soon Young Lee, Byoungin Yoo, Jong Hyuk Choi
Epidemiol Health. 2015;37:e2015036.   Published online August 15, 2015
DOI: https://doi.org/10.4178/epih/e2015036
  • 20,038 View
  • 166 Download
  • 10 Web of Science
  • 7 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
Most cases of Middle East Respiratory Syndrome (MERS) infection in Korea (outbreak: May 11-July 4, 2015) occurred in hospital settings, with uncertain transmission modes in some cases. We performed an in-depth investigation epidemiological survey on the 178th case to determine the precise mode of transmission. A 29- year-old man living in Pyeongtaek presented on June 16 with a febrile sensation, chills, and myalgia. Upon confirmatory diagnosis on June 23, he was treated in an isolation room and discharged on July 2 after cure. An epidemiological investigation of all possible infection routes indicated two likely modes of transmission: exposure to MERS in Pyeongtaek St. Mary’s Hospital during a visit to his hospitalized father (May 18-29), and infection through frequent contact with his father between the latter’s referral to Pyeongtaek Good Samaritan Bagae Hospital for treatment without confirmatory diagnosis until his death (May 29-June 6). Although lack of clear proof or evidence to the contrary does not allow a definitive conclusion, all other possibilities could be excluded by epidemiological inferences. While it is impossible to trace back the modes of transmission of all cases in a large-scale outbreak, case-by-case tracking and isolation of infected individuals and those in close contact with them is important in preventing the spread. Efforts should be made to establish a methodology for rapid tracking of all possible contacts and elimination-based identification of the precise modes of transmission.
Summary
Korean summary
이 논문은 2015년 한국에서 새롭게 발생한 감염병인 메르스 유행 중, 감염경로가 불분명하였던 178번째 환자에 대한 심층 역학조사 과정과 결과를 기술한 것이며, 조사를 통해 얻은 교훈을 학계 및 관계자들과 공유하고자 한다. 조사 결과, 다른 사례들과 마찬가지로 병원감염으로 볼 수 있음을 밝힌다.

Citations

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  • Constructing big data prevention and control model for public health emergencies in China: A grounded theory study
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    Hiroshi Nishiura, Akira Endo, Masaya Saitoh, Ryo Kinoshita, Ryo Ueno, Shinji Nakaoka, Yuichiro Miyamatsu, Yueping Dong, Gerardo Chowell, Kenji Mizumoto
    BMJ Open.2016; 6(2): e009936.     CrossRef
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    Sun Hee Park, Woo Joo Kim, Jin-Hong Yoo, Jung-Hyun Choi
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Original Article
An Epidemiological Investigation of Bacterial Dysentery Outbreak in Busan(Pusan), 1999.
Hai Rim Shin, Duk Hee Lee, Heung Man Sul, Sang Won Lee, Young Ju Huh
Korean J Epidemiol. 2000;22(2):93-100.
  • 5,644 View
  • 9 Download
AbstractAbstract PDF
Abstract
BACKGROUND
In March 1999, six children who attended a nursery school became ill with acute gastroenteritis by Shigella sonnei. The majority of the children became sick one day after sharing a snack which was served from one of the children's home. By the time the outbreak of dysentery was recognized, the rest of family members of the children became also sick. The nursery school was located in a crowded residential area. EPIDEMIOLOGIC INVESTIGATION: After active and passive surveillance was established on patients with diarrhea, 438 patients were registered. Among them, 252 patients were considered to have simple diarrhea, but the rest (186 patients) suffered from more than three consecutive diarrheas. Shigella sonnei was isolated from 75 patients. The first attack rate was estimated at 50.0%, the second, 25.6%-34.3% and the third, 13.5%. The epidemic lasted for two months spreading further from person to person in the highly populous area. The active surveillance was implemented after the occurrence of the secondary attack of dysentery among the residents, who had no obvious direct contact with people associated with the nursery school.
CONCLUSION
This investigation demonstrates the need for prompt implementation of active surveillance when Shigella infection is recognized in a highly populous city.
Summary

Epidemiol Health : Epidemiology and Health