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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
  • 4,470 View
  • 191 Download
  • 3 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary 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  
  • 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
COVID-19: Original Article
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
Epidemiol Health. 2022;44:e2022085.   Published online September 30, 2022
DOI: https://doi.org/10.4178/epih.e2022085
  • 4,364 View
  • 174 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
After the third wave of coronavirus disease 2019 (COVID-19), by mid-February 2021, approximately 0.16% of the Korean population was confirmed positive, which appeared to be among the lowest rates worldwide at that time. However, asymptomatic transmission is challenging for COVID-19 surveillance. Therefore, a community-based serosurvey of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was conducted to understand the effectiveness of Korea’s strong containment strategy.
METHODS
We collected 5,002 residual sera samples from January 30 to March 3, 2021, from 265 medical facilities in Seoul, 346 in Gyeonggi Province, and 57 in Incheon. Sixty samples from tertiary institutions were excluded. We defined the sub-regions according to the addresses of the medical facilities where the specimens were collected. Elecsys Anti-SARS-CoV-2 was used for screening, and positivity was confirmed using the SARS-CoV-2 sVNT Kit. Prevalence was estimated using sampling weights and the Wilson score interval for a binomial proportion with a 95% confidence interval.
RESULTS
Among the 4,942 specimens, 32 and 25 tested positive for COVID-19 in the screening and confirmatory tests, respectively. The overall crude prevalence of SARS-CoV-2 antibodies was 0.51%. The population-adjusted overall prevalence was 0.55% in women and 0.38% in men. The region-specific estimation was 0.67% and 0.30% in Gyeonggi Province and Seoul, respectively. No positive cases were detected in Incheon.
CONCLUSIONS
The proportion of undetected cases in Korea remained low as of early 2021. Therefore, an infection control strategy with exhaustive tracing and widespread pre-emptive testing appears to be effective in containing community spread of COVID-19.
Summary
Korean summary
코로나19바이러스 감염병(COVID-19)의 한국 내 3차 대유행기인 2020년 말 이후, 2021년 1월 우리나라 인구의 약 0.16%가 누적 확진되었으며, 이는 세계에서 매우 낮은 비율을 보이는 국가 중 하나였습니다. 그러나 COVID-19의 무증상 전파는 감염 확산방지와 감시체계에 문제점들을 초래할 수 있어 지역사회 기반 혈청 조사를 통해 그 현황을 파악했습니다. 2021년 1월 30일부터 3월 3일까지 서울, 경기, 인천 등 수도권 소재 1, 2차 의료기관에서 수집된 혈액검체의 잔여혈청표본 4942개에 대해 Roche사의 Elecsys Anti-SARS-CoV-2를 이용한 1차 항체검사와, GenScript의 SARS-CoV-2 sVNT Kit를 이용하여 2차 중화항체유무를 확인하였다. 4942명의 검체 중 1차 검사와 2차 중화항체검사에서 각각 32명과 25명이 항체 양성이었다. SARS-CoV-2 항체의 전체 수도권 조유병률은 0.51%였습니다. 인구의 연령보정 전체 유병률은 0.47%였으며, 성별로는 여성에서 0.55%, 남성에서 0.38%였습니다. 지역별 추정치는 경기도와 서울이 각각 0.67%와 0.30%였고, 인천에서는 양성사례가 발견되지 않았습니다. 한국의 미발견 사례 비율은 누적 확진율의 3배에 달하지만, 여전히 1% 미만으로 ​​낮습니다. 철저한 추적과 광범위한 선제적 검사를 통한 감염 관리 전략이 지역사회에서 바이러스 확산을 억제하는 데 효과적이었던 것으로 보입니다.
Key Message
Around February 2021, the SARS-CoV-2 antibody test was conducted on the residual serum of adults (≥19 years) collected from primary and secondary medical institutions in the metropolitan area in South Korea. The estimated overall prevalence was 0.60% in the electrochemiluminescence immunoassay (ECLIA) detecting IgG against the nucleocapsid protein and 0.47% for the neutralization antibody. The positivity of the confirmed test using surrogate neutralizing antibodies was only 78% of the ECLIA’s results. For prevention and control measures against the spread of SARS-CoV-2 infections and new variants emerge, serosurvey targeting community-dwelling people is needed to understand the changing status in the community.

Citations

Citations to this article as recorded by  
  • 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
  • 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-Seo
    Epidemiology and Health.2023; 45: e2023075.     CrossRef
Perspective
Measles susceptibility of marriage migrant women in Korea
Sooyeon Kim, Sun A Kim, Hanbich Hong, Seong Ryeong Choi, Hae-Young Na, Sung Un Shin, Kyung-Hwa Park, Sook In Jung, Min-Ho Shin, Sun-Seog Kweon, Seung Ji Kang
Epidemiol Health. 2022;44:e2022031.   Published online March 12, 2022
DOI: https://doi.org/10.4178/epih.e2022031
  • 6,741 View
  • 361 Download
AbstractAbstract AbstractSummary PDF
Abstract
International migrants could be considered a risk group susceptible to vaccine-preventable diseases. We conducted a measles seroprevalence study among 419 marriage migrant women living in Sinan-gun and Wando-gun, South Jeolla Province, located in the southwestern part of Korea. The overall seroimmunity was 92.8%. The seroimmunity varied considerably according to the country of origin and increased with age. Our current analysis could be valuable in the context of discussions concerning vaccination policies for immigrants in Korea.
Summary
Korean summary
전라남도 신안군과 완도군에 거주하는 결혼이주여성 419명을 대상으로 홍역항체 양성률을 조사하였다. 전체적 항체양성률은 92.8% 로 높았으나, 나이로 나누어 분석하였을 때, 30세 미만에서는 83.1% 로 30세 이상의 95.5% 에 비해 통계적으로 유의미하게 낮았다. 출신국가에 따른 분석에서는 캄보디아 출신의 경우 30세 미만에서 항체 양성률이 40.0 % 에 불과하여, 타국가 들에 비해 통계적으로 유의미하게 낮았다.
Key Message
To prevent measles resurgence, continuous monitoring of immunity in communities, including foreign-born populations who may have different serostatus, is essential.
Original Articles
The BRAIN-Q, a tool for assessing self-reported sport-related concussions for epidemiological studies
Laura James, Madeline Davies, Saba Mian, Giulia Seghezzo, Elizabeth Williamson, Simon Kemp, Nigel Arden, Damien McElvenny, Neil Pearce, Valentina Gallo
Epidemiol Health. 2021;43:e2021086.   Published online October 19, 2021
DOI: https://doi.org/10.4178/epih.e2021086
  • 7,202 View
  • 130 Download
  • 3 Web of Science
  • 4 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The BRAIN-Q is a tool aimed at maximising the accuracy and minimising measurement error for retrospectively assessing concussions. This paper reports the agreement of the BRAIN-Q tool when compared to extant questionnaire questions, and its reproducibility when compared with its telephonic version (tBRAIN-Q).
METHODS
The BRAIN-Q entails a 3-stage process: defining a concussion, creating a visual timeline with life events, and establishing detailed characteristics for each reported concussion. It was designed to be administered in-person by trained personnel, and was used in the BRAIN study. Its performance was compared with the MSK study, which previously collected a few questions in a broader self-administered questionnaire, and with the tBRAIN-Q Recall, its telephonic version.
RESULTS
In total, 101 participants were included, of whom 9 were re-assessed with the tBRAIN-Q. The agreement of the BRAIN-Q with the muscle skeletal-questionnaire for rugby-related concussion was 86.7% (κ=0.6). Rugby-related concussion with loss of consciousness showed lower agreement (82.0%; κ=0.6). The comparison between the BRAIN-Q and the tBRAIN-Q showed good reproducibility.
CONCLUSIONS
The BRAIN-Q is a relatively easy tool to administer in face-to-face assessments, and it showed optimal reproducibility. It includes a well-established definition of concussion, and is used to collect detailed information on each concussion, allowing for a number of subgroup analyses (e.g., by severity, age, or context). The BRAIN-Q is easily adaptable to other sporting settings.
Summary
Key Message
The BRAIN-Q is a new tool for assessing self-reported sport-related concussion in epidemiological studies. It is relatively easy to administer, it showed optimal reproducibility, and can be used by phone.

Citations

Citations to this article as recorded by  
  • Exposure assessment for repeated sub-concussive head impacts in soccer: The HEalth and Ageing Data IN the Game of football (HEADING) study
    Ioannis Basinas, Damien M. McElvenny, Finley Brooker, Steven Robertson, Yvonne van Hoecke, Simon Kemp, Neil Pearce, Valentina Gallo, John W. Cherrie
    International Journal of Hygiene and Environmental Health.2023; 253: 114235.     CrossRef
  • Prior exposure to concussions in patients with isolated REM sleep behavior disorder
    Mónica Roig-Uribe, Mònica Serradell, Amaia Muñoz-Lopetegi, Carles Gaig, Alex Iranzo
    Sleep Medicine.2023; 110: 254.     CrossRef
  • eHealth tools to assess the neurological function for research, in absence of the neurologist – a systematic review, part I (software)
    Vasco Ribeiro Ferreira, Esther Metting, Joshua Schauble, Hamed Seddighi, Lise Beumeler, Valentina Gallo
    Journal of Neurology.2023;[Epub]     CrossRef
  • Concussion and long‐term cognitive function among rugby players—The BRAIN Study
    Valentina Gallo, Damien M. McElvenny, Giulia Seghezzo, Simon Kemp, Elizabeth Williamson, Kirsty Lu, Saba Mian, Laura James, Catherine Hobbs, Donna Davoren, Nigel Arden, Madeline Davies, Andrea Malaspina, Michael Loosemore, Keith Stokes, Matthew Cross, Seb
    Alzheimer's & Dementia.2022; 18(6): 1164.     CrossRef
Bacillus of Calmette and Guérin (BCG) and the risk of leprosy in Ciudad del Este, Paraguay, 2016-2017
Nancy Carolina Cuevas, Victor M. Cardenas
Epidemiol Health. 2021;43:e2021060.   Published online September 8, 2021
DOI: https://doi.org/10.4178/epih.e2021060
  • 7,090 View
  • 92 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Paraguay has experienced a 35% reduction in the detected incidence of leprosy during the last ten years, as the vaccination coverage against tuberculosis (Bacillus of Calmette and Guérin [BCG] vaccine) reached ≥95% among infants. The objective of this case-control study was to evaluate the protective effect of BCG on the risk of leprosy.
METHODS
We used a population-based case-control study of 20 leprosy confirmed cases reported among residents of Ciudad del Este, Paraguay, diagnosed in 2016-2017. Three controls were selected from a random sample of households from the city. We assessed vaccine effectiveness using 1- odds ratio [OR], and confounding for age, gender, education, occupation, and marital status using stratified and exact logistic regression, and explored if there was effect modification calculating the synergy factor (SF) and relative excess risk due to interaction (RERI).
RESULTS
After controlling for age, gender, education, occupation and marital status, the OR of BCG scar on the risk of leprosy was 0.10 (95% confidence interval [CI], 0.02 to 0.45), for an estimate of vaccine effectiveness of 89.5% reduced risk of leprosy (95% CI, 55.2 to 98.1). There was evidence of heterogeneity by which the effectiveness of BCG seemed stronger among younger persons (Breslow-Day and Z-test of the SF had a p<0.05), and both the RERI and SF indicated a less then multiplicative and additive interaction of BCG and younger age.
CONCLUSIONS
BCG vaccination was associated with a decreased risk of leprosy in the study population, particularly in persons born after 1980.
Summary
Key Message
Paraguay had the second highest reported incidence in the Americas, but no previous study had investigated the topic of BCG for leprosy in Paraguay. We confirmed that BCG protected from leprosy, hence it may have contributed to the observed decline of leprosy.

Citations

Citations to this article as recorded by  
  • BCG and SARS-CoV-2—What Have We Learned?
    Jakub Kulesza, Ewelina Kulesza, Piotr Koziński, Wojciech Karpik, Marlena Broncel, Marek Fol
    Vaccines.2022; 10(10): 1641.     CrossRef
Geographic distribution of the incidence of colorectal cancer in Iran: a population-based study
Fatemeh Khosravi Shadmani, Erfan Ayubi, Salman Khazaei, Mohadeseh Sani, Shiva Mansouri Hanis, Somayeh Khazaei, Mokhtar Soheylizad, Kamyar Mansori
Epidemiol Health. 2017;39:e2017020.   Published online May 17, 2017
DOI: https://doi.org/10.4178/epih.e2017020
  • 15,944 View
  • 280 Download
  • 27 Web of Science
  • 25 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Colorectal cancer (CRC) is the third most common cancer and the fourth most common cause of cancer death in the world. The aim of this study was to investigate the provincial distribution of the incidence of CRC across Iran.
METHODS
This epidemiologic study used data from the National Cancer Registry of Iran and the Center for Disease Control and Prevention of the Ministry of Health and Medical Education of Iran. The average annual age-standardized rate (ASR) for the incidence of CRC was calculated for each province.
RESULTS
We found that adenocarcinoma (not otherwise specified) was the most common histological subtype of CRC in males and females, accounting for 81.91 and 81.95% of CRC cases, respectively. Signet ring cell carcinoma was the least prevalent subtype of CRC in males and females and accounted for 1.5 and 0.94% of CRC cases, respectively. In patients aged 45 years or older, there was a steady upward trend in the incidence of CRC, and the highest ASR of CRC incidence among both males and females was in the age group of 80-84 years, with an ASR of 144.69 per 100,000 person-years for males and 119.18 per 100,000 person-years for females. The highest incidence rates of CRC in Iran were found in the central, northern, and western provinces. Provinces in the southeast of Iran had the lowest incidence rates of CRC.
CONCLUSIONS
Wide geographical variation was found in the incidence of CRC across the 31 provinces of Iran. These variations must be considered for prevention and control programs for CRC, as well as for resource allocation purposes.
Summary

Citations

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    Mohammad Abolhosseini, Zahra Khorrami, Sare Safi, Mohammad Esmaeil Akbari, Seyed Mohamadmehdi Moshtaghion, Seyed Farzad Mohammadi, Mozhgan Rezaei Kanavi, Saeed Karimi
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    Forum of Clinical Oncology.2022; 13(1): 9.     CrossRef
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    Saeede Jafari Nasab, Matin Ghanavati, Pegah Rafiee, Alireza Bahrami, Nazanin Majidi, Cain C. T. Clark, Amir Sadeghi, Mohammad Houshyari, Ehsan Hejazi
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MERS-Epidemiologic Investigation
The first case of the 2015 Korean Middle East Respiratory Syndrome outbreak
Yong-Shik Park, Changhwan Lee, Kyung Min Kim, Seung Woo Kim, Keon-Joo Lee, Jungmo Ahn, Moran Ki
Epidemiol Health. 2015;37:e2015049.   Published online November 14, 2015
DOI: https://doi.org/10.4178/epih/e2015049
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
This study reviewed problems in the prevention of outbreak and spread of Middle East Respiratory Syndrome (MERS) and aimed to provide assistance in establishing policies to prevent and manage future outbreaks of novel infectious diseases of foreign origin via in-depth epidemiological investigation of the patient who initiated the MERS outbreak in Korea, 2015. Personal and phone interviews were conducted with the patient and his guardians, and his activities in Saudi Arabia were investigated with the help of the Saudi Arabian Ministry of Health. Clinical courses and test results were confirmed from the medical records. The patient visited 4 medical facilities and contacted 742 people between May 11, 2015, at symptom onset, and May 20, at admission to the National Medical Center; 28 people were infected and diagnosed with MERS thereafter. Valuable lessons learned included: (1) epidemiological knowledge on the MERS transmission pattern and medical knowledge on its clinical course; (2) improvement of epidemiological investigative methods via closed-circuit television, global positioning system tracking, and review of Health Insurance Review and Assessment Service records; (3) problems revealed in the existing preventive techniques, including early determination of the various people contacted; (4) experiences with preventive methods used for the first time in Korea, including cohort quarantine; (5) reconsideration of the management systems for infectious disease outbreaks across the country, such as this case, at the levels of central government, local government, and the public; (6) reconsideration of hospital infectious disease management systems, culture involving patient visitation, and emergency room environments.
Summary
Korean summary
2015년 한국 메르스 유행의 발단이 된 첫 번째 환자의 역학조사를 통해 신종감염병의 국내 유입 경위 및 유행확산을 막기 위한 대응 과정의 문제점을 되짚어 보았다. 이를 통해 향후 신종감염병의 국내유입을 막기 위한 대비, 대응 정책 수립에 도움이 되길 바라며 이번 메르스 유행이 한국의 병원감염 관리 수준이 향상되는 계기가 되어야 할 것이다.

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Original Articles
Seroprevalence of measles and mumps antibody among preschool children in Korea, according to their vaccination history.
Jung Hwa Lee, Geun Ryang Bae, Chang Sik Park, Yoon Seok Chung, Young A Kang, Hyun Woo Han, Chun Kang
Korean J Epidemiol. 2008;30(1):34-40.   Published online June 30, 2008
DOI: https://doi.org/10.4178/kje.2008.30.1.34
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AbstractAbstract PDF
Abstract
PURPOSE
To maintain measles elimination status, we evaluated the seropositivity of measles and mumps according to time interval since the first or second dose of MMR in children aged 4 to 6 years, who are starting communal life. MATERIALS AND METHOD: 2,447 children aged 4 to 6 years were enrolled at 251 public health centers over the period of March to May 2007. Subjects were verified their date of MMR vaccination and then their blood was sampled for serologic test. Measles and mumps IgG antibody was tested by ELISA at Korea CDC.
RESULTS
Vaccination coverage was 99.9% in the first dose, 64.9% in the second dose regardless of gender. Seropositivity of measles and mumps was 95.7%, 85.5% in the first dose and 98.7%, 98.1% in the second dose, respectively. The seropositivity of measles was 88.1% in 6-year-olds who did not receive the second dose of MMR. As time since receipt, seropositivity of measles tended to decrease over time and was 93.3% in vaccinees over 48 months after the first dose.
CONCLUSION
A first dose MMR at 12-15 months cannot lead to herd immunity. More public information is needed to encourage second dose vaccination before admission to day-care center or kindergarten.
Summary

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Epidemiologic Investigation into an Outbreak of Typhoid Fever Recognized by Electronic Data Interchange in Gyeongsangbuk-do, 2003.
Hyun Sul Lim, Young Sun Min, Kwan Lee, Sang Hyuk Lim
Korean J Epidemiol. 2004;26(1):59-68.
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AbstractAbstract PDF
Abstract
Epidemiologic Investigation into an Outbreak of Typhoid Fever Recognized by Electronic Data Interchange in Gyeongsangbuk-do, 2003 PURPOSE: Fourteen cases of typhoid fever occurred in Gyeongsan-si, Gyeongsangbuk-do from May 22 to July 19, 2003. Especially, 6 cases were students of Y University located in Gyeongsan-si. This investigation was carried out to study the infection source and transmission of typhoid fever and to institute an effective prevention counterplan.
METHODS
The authors conducted an epidemiologic survey from June 25, 2003 among the 14 cases, restaurants and employees of the whole neighborhood of Y University. Widal test was carried out for the restaurant employees and schoolmates of the 13-year-old case Miss Kim. The authors executed a pulsed field gel electrophoresis (PFGE) for Salmonella typhi cultured from 9 cases. The authors collected data about chloride and turbid levels of treated water from April to June in Gyeongsan-si water treatment plant and repair work records of waterworks pipe line in Gyeongsan-si city hall.
RESULTS
All cases had used restaurants of the whole neighborhood of Y University within 2 months before the typhoid fever symptoms were developed, but the restaurant that was rarely visited by any of the patients had a case to be matched. In the results of the Widal test, 9 out of 45 of subjects (20.0%) were suspicious cases or showed a value to suggest past infection. In the results of PFGE test, there were 3 subtypes, and each subtype had a similar DNA fragments array. In all cases the patients drank tap water when they visited the restaurants. The restaurants provided drinking water from filtered tap water rather than boiled water, and all patients had drunk this water. The chlorine level of the treated water was the normal value in the Gyeongsan-si water treatment plant, but in 2 times the value was the minimum standard level. There was water pipe construction work in some regions of the whole neighborhood of Y University. The number of gastrointestinal patients in 2003 was approximately 2 times that in 2002 at the health center in Y University.
CONCLUSIONS
The possibility that typhoid fever was generated in the whole neighborhood of Y University is very high. Among various possibilities, the highest possibility is the pollution of tap water intake by water leakage of a water pipe. There was no case of patient infection after strengthening of the tap water disinfection. Thorough disinfection, boiled drinking water and a periodic carrier inspection are necessary to prevent additional local occurrences of these typhoid infections.
Summary
Epidemiol Health : Epidemiology and Health
© Korean Society of Epidemiology.