Epidemiology and Health

Systematic Review

Probiotics for preventing neonatal sepsis in preterm neonates: a systematic review and meta-analysis for clinical practice: Rizka Maulida, Radhian Amandito, Rinawati Rohsiswatmo, Amarila Malik; Epidemiol Health. 2025;47:e2025051. Published online September 3, 2025; DOI: https://doi.org/10.4178/epih.e2025051

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Abstract Summary PDF Supplementary Material: Abstract
Late-onset sepsis (LOS), occurring after 72 hours of birth, is a significant cause of morbidity and mortality especially in preterm neonates. Probiotics have been proposed as a preventive strategy to enhance gut health, modulate immune responses, and reduce the incidence of neonatal sepsis. We aimed to evaluate the effectiveness of probiotics in preventing neonatal sepsis in preterm neonates, with particular attention to the impact of different strains and dosage regimens. Eligible studies included preterm neonates (≤36 weeks gestational age) with culture-proven LOS and focused on probiotic supplementation. Comprehensive searches were conducted in MEDLINE via PubMed, Cochrane CENTRAL, Scopus, and ProQuest up to July 28, 2024. The Revised Cochrane Risk of Bias Tool (RoB 2.0) was applied to assess study quality, and a random-effects meta-analysis was performed using Review Manager version 5.4. Additionally, the certainty of the body of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Thirty-one studies including 8,040 preterm neonates were reviewed. Meta-analysis demonstrated that probiotics significantly reduced the incidence of LOS (pooled risk ratio [RR], 0.83; 95% confidence interval [CI], 0.72 to 0.95). Greater efficacy was observed with multistrain formulations (RR, 0.76; 95% CI, 0.72 to 0.95) and low-dose regimens (RR, 0.72; 95% CI, 0.56 to 0.91). Probiotic supplementation was also associated with shorter hospital stays and a trend toward lower mortality, although the latter did not reach statistical significance. To effectively reduce LOS in preterm neonates, specific combinations of multistrain probiotics and optimized dosing strategies may provide the most benefit.; Summary

Key Message
• Late-onset sepsis (LOS) is a major cause of morbidity and mortality in preterm neonates, and the optimal approach for using probiotics to prevent LOS remains uncertain. • Probiotics significantly reduce LOS risk (RR, 0.83; 95% CI, 0.72 to 0.95), with multistrain (RR, 0.76; 95% CI, 0.72 to 0.95) and low-dose formulations (RR, 0.72; 95% CI, 0.56 to 0.91) showing greater efficacy. Supplementation shortens hospital stays. • These findings support the use in probiotics in neonatal care, as they enhance immune defense and reduce infection burden. • This study informs clinical guidelines and highlights probiotics’ potential to improve neonatal outcomes and reduce healthcare costs.

Original Articles

Palivizumab coverage rates among moderate-to-late preterm infants in Korea: a nationwide cross-sectional study: Seungyeon Kim, Saram Lee, Young June Choe, Ju Sun Heo; Epidemiol Health. 2025;47:e2025015. Published online April 1, 2025; DOI: https://doi.org/10.4178/epih.e2025015

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Since October 2016, Korea has implemented a national reimbursement program for palivizumab aimed at moderate-to-late preterm (MLPT) infants born between 32 0/7 weels and 35 6/7 weeks of gestation during the respiratory syncytial virus (RSV) season (October–March). However, large-scale data on coverage rates and associated factors remain limited. This study evaluated palivizumab coverage rates and identified predictive factors influencing its administration in MLPT infants.
METHODS
This nationwide, population-based cross-sectional study utilized data from the Korean National Health Insurance Service collected between October 2016 and March 2019. MLPT infants eligible for palivizumab reimbursement were divided into administration and non-administration groups. Seasonal and overall coverage rates were assessed. A multivariate logistic regression analysis examined factors associated with palivizumab administration, with a focus on infant and maternal characteristics.
RESULTS
Among 2,843 eligible MLPT infants, 1,201 (42.2%) received palivizumab, while 1,642 (57.8%) did not. Although coverage rates increased annually, they remained suboptimal. Lower palivizumab prophylaxis coverage was observed in infants with higher gestational ages, female sex, absence of low birth weight, those born in March, residents of non-capital areas, infants not admitted to a neonatal intensive care unit at birth, and infants of mothers aged <35 years.
CONCLUSIONS
In the initial 3 RSV seasons following the introduction of palivizumab reimbursement for MLPT infants in Korea, the overall coverage rate was low (42.2%). National policies targeting infants with higher gestational ages, those born in March, and those residing in non-capital areas are necessary to improve coverage and ensure equitable RSV prophylaxis.; Summary

Korean summary
- 한국에서 중후기 미숙아를 대상으로 팔리비주맙 예방접종이 도입된 이후, 초기 3개 RSV 유행 시즌 동안 전체 예방접종률은 42.2%로 낮은 수준에 머물렀다. - 재태주수가 높은 영아, 3월 출생 영아, 그리고 비수도권 거주 영아에서 예방접종률이 유의하게 낮았다.

Key Message
- In Korea, following the introduction of palivizumab for MLPT infants, the overall coverage rate during the initial 3 RSV seasons was low (42.2%). - Infants with higher gestational ages, those born in March, and residents of non-capital areas exhibited significantly lower coverage rates.

Effect of the human papillomavirus vaccine on the risk of genital warts: a nationwide cohort study of Korean adolescent girls: Jaeyoung Cho, Eun Mi Kim, Jihye Kim, Ju-Young Shin, Eui Hyeok Kim, Jong Heon Park, Seunghyun Lewis Kwon, Geun-Yong Kwon, Soon-Ae Shin, Jaiyong Kim; Epidemiol Health. 2024;46:e2024040. Published online March 18, 2024; DOI: https://doi.org/10.4178/epih.e2024040

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The purpose of this study was to assess the effectiveness of human papillomavirus (HPV) vaccination administered to adolescent girls through Korea’s National Immunization Program.

METHODS

This retrospective cohort study included patients who were 12-13 years old, whether vaccinated or unvaccinated, between July 2016 and December 2017. The incidence of genital warts (GWs) was monitored through 2021. Time-stratified hazard ratios (HRs) were estimated, adjusting for birth year, socioeconomic status, and the level of urbanization of the region, and were presented with 95% confidence intervals (CIs). Data were sourced from the Immunization Registry Integration System, linked with the National Health Information Database.

RESULTS

The study included 332,062 adolescent girls, with an average follow-up period of approximately 4.6 years. Except for the first year, the HRs for the vaccinated group were lower than those for the unvaccinated group. The HRs for specific cut-off years were as follows: year 2, 0.62 (95% CI, 0.31 to 1.13); year 3, 0.58 (95% CI, 0.35 to 0.96); and year 4 and beyond, 0.39 (95% CI, 0.28 to 0.52).

CONCLUSIONS

Our findings indicate that HPV vaccination was associated with a reduction in the risk of GWs among adolescent girls. Notably, this reduction became significant as the incidence of GWs increased with age.

Summary

Korean summary
이 연구는 후향적 코호트 연구로써, HPV 예방접종이 한국의 여자 청소년에서 생식기사마귀 질환의 위험을 감소시키는 것과 연관성이 있다는 것을 보여주었다. 따라서 단기적으로 한국의 국가예방접종 사업은 생식기사마귀 질환에 있어 효과가 있었다고 볼 수 있다. 향후에는 전암성 병변 또는 암 등과 같은 심각한 질환에 대한 백신의 영향을 확인할 필요가 있다.

Key Message
In this retrospective cohort study, our results demonstrated that HPV vaccination is associated with a reduction in the risk of GWs among adolescent girls. In the short term, the NIP of Korea can be considered effective in providing protection against GWs. Future studies need to analyze the impact of vaccines on more serious diseases such as precancerous lesions or cancer.

Citations

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Global status of HPV vaccination two decades in: effective, safe and preventing cancer
Julia M. L. Brotherton, D. Scott LaMontagne, Paul J. N. Bloem
Expert Review of Vaccines.2026;[Epub] CrossRef
Human papillomavirus vaccine for the prevention and treatment of warts: A clinical review
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Effects of human papillomavirus (HPV) vaccination programmes on community rates of HPV-related disease and harms from vaccination
Nicholas Henschke, Hanna Bergman, Brian S Buckley, Emma J Crosbie, Kerry Dwan, Su P Golder, Maria Kyrgiou, Yoon Kong Loke, Heather M McIntosh, Katrin Probyn, Gemma Villanueva, Jo Morrison
Cochrane Database of Systematic Reviews.2025;[Epub] CrossRef
Effect of human papillomavirus (HPV) vaccination on HPV infection and recurrence of HPV related disease after local surgical treatment: A systematic review and meta-analysis
Qinxue Cao, Yantao Hou, Chaoyang Wang, Juntao Yin, Mehmet Demirci
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Outbreak of carbapenem-resistant Enterobacterales at a long-term care facility in Seoul, Korea: surveillance and intervention mitigation strategies: Yoojin Park, Euncheol Son, Young June Choe, Cho Ryok Kang, Sangmi Roh, Young Ok Hwang, Sung-il Cho, Jihwan Bang; Epidemiol Health. 2023;45:e2023057. Published online June 9, 2023; DOI: https://doi.org/10.4178/epih.e2023057

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Abstract Summary PDF

Abstract

OBJECTIVES
Because effective decolonization options are not available, and treatment options are limited, carbapenem-resistant Enterobacterales (CRE) constitute increasingly threatening nosocomial pathogens. To prevent CRE-associated transmission and ensure patient safety, healthcare personnel and everyone in contact with CRE-infected patients must implement stringent infection control practices. This report describes a CRE outbreak, possibly related to a caregiver at a long-term care facility (LTCF), and presents a new surveillance model to improve the infection control of CRE in Seoul, Korea.

METHODS

The Seoul Metropolitan Government surveillance system identified an outbreak of CRE in an LTCF in 2022. We obtained data on the demographic characteristics and contact histories of the inpatients, medical staff, and caregivers. To isolate the inpatients and employees exposed to CRE, we used rectal swab samples and environmental sampling during the study period (May-December 2022).

RESULTS

We identified 18 cluster cases (1 caregiver and 17 inpatients) and 12 sporadic cases with CRE, and conducted a complete 197-day follow-up of all cases in the LTCF’s isolation wards.

CONCLUSIONS

This investigation demonstrated that our surveillance model and targeted intervention, based on the cooperation of the municipal government, public health center, and infection control advisory committee, effectively contained the epidemic at the LTCF. Measures to improve the compliance of all employees in LTCFs with infection control guidelines should also be adopted.

Summary

Korean summary
서울시 CRE 감시체계를 통해 2022년 한 요양병원의 집단발생을 인지하였다. 현장역학조사를 실시하여 18명의 집단발생 사례(1명 간병인, 17명 입원환자)와 12명의 산발적인 사례를 확인하였고 감염관리 컨설팅을 통해 유행을 확산을 방지하는 중재를 시행하였다.

Key Message
The Seoul Metropolitan Government surveillance system identified an outbreak of carbapenem-resistant Enterobacterales (CRE) in a long-term care facility (LTCF) in 2022. We identified 18 cluster cases (1 caregiver and 17 inpatients) and 12 sporadic cases with CRE. In the current study, we could demonstrate that our surveillance model and targeted intervention, based on the cooperation of the municipal government, public health center, and infection control advisory committee, effectively contained the epidemic at the LTCF. Measures to improve the compliance of all employees in LTCFs with infection control guidelines should also be adopted.

Citations

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Significant reduction in norovirus outbreaks and secondary transmission of acute gastroenteritis in Seoul schools following the COVID-19 pandemic: a retrospective epidemiological study
Euncheol Son, Young-Hoon Kim
Journal of Yeungnam Medical Science.2025; 42: 65. CrossRef
Combating Antimicrobial Resistance Through a Data-Driven Approach to Optimize Antibiotic Use and Improve Patient Outcomes: Protocol for a Mixed Methods Study
Jonathan Mayito, Conrad Tumwine, Ronald Galiwango, Elly Nuwamanya, Suzan Nakasendwa, Mackline Hope, Reuben Kiggundu, Dathan M Byonanebye, Flavia Dhikusooka, Vivian Twemanye, Andrew Kambugu, Francis Kakooza
JMIR Research Protocols.2024; 13: e58116. CrossRef
The prevention and response to infectious diseases in long-term care facilities in Korea: a nationwide survey
Sun Hee Na, Joong Sik Eom, Sun Bean Kim, Hyung Jin Yoon, So Yeon Yoo, Kyeong Sook Cha, Jong Rim Choi, Ji Youn Choi, Si Hyeon Han, Jin Ju Park, Tark Kim, Jacob Lee
Epidemiology and Health.2024; 46: e2024084. CrossRef
Role of Probiotics in Preventing Carbapenem-Resistant Enterobacteriaceae Colonization in the Intensive Care Unit: Risk Factors and Microbiome Analysis Study
Jung-Hwan Lee, Jongbeom Shin, Soo-Hyun Park, Boram Cha, Ji-Taek Hong, Don-Haeng Lee, Kye Sook Kwon
Microorganisms.2023; 11(12): 2970. CrossRef

Epidemiologic Investigation

Epidemiological investigation of a food-borne outbreak in a kindergarten, Jeju Province, Korea: Kyoung Mi Kim, Eun Suk Cho, Seong Bae Ahn, Eun Ok Kang, Jong-Myon Bae; Epidemiol Health. 2023;45:e2023047. Published online April 17, 2023; DOI: https://doi.org/10.4178/epih.e2023047

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
On Monday, September 6, 2021, at a kindergarten in Jeju Province, a large number of children vomited and developed food poisoning symptoms, and this necessitated an epidemiological investigation.

METHODS

The team surveyed symptoms and food intake history of kindergarten children, teachers, and workers who ate lunch between September 2 (Thursday) and September 6 (Monday), excluding weekends. In addition to rectal swabs, environmental samples from preserved foods, cooking utensils, drinking water, and refrigerator handles were collected. Pulsed field gel electrophoresis (PFGE) for genetic fingerprint analysis was also performed.

RESULTS

There were 19 cases among 176 subjects, which indicated an attack rate of 10.8%. The epidemic curve showed a unimodal shape, and the average incubation period was 2.6 hours. While no food was statistically significant in food intake history, the analysis of 35 rectal smear samples detected Bacillus cereus in 7 children, 4 teachers, and 1 cooking staff. Enterotoxins were also detected in 12 samples. Out of 38 environmental samples, B. cereus and enterotoxins were detected in the morning snack cereal, lunch bean sprouts, and afternoon snack steamed potatoes on Monday, September 6th. The result of the PFGE test on 10 isolates of B. cereus showed that there was no genetic homology.

CONCLUSIONS

Our results indicated that this outbreak was simultaneously caused by various strains of B. cereus from the environment.

Summary

Korean summary
모 유치원에서 제공한 급식 취식아동에서 발열이 없고 구토형의 주증상인 식중독이 발생되었다. 평균 잠복기 2.6시간 (최소 0.8, 최대 4.5시간)이며, 인체 및 환경 검체에서 바실러스 세레우스 균이 분리되었다. 이에 해당 집단발생은 구토형 바실러스 세레우스 감염증에 의한 식중독을 결론지었다.

Key Message
A large number of children in a kindergarten vomited suddenly. The average incubation period was 2.6 hours (min 0.8, max 4.5 hours) with uni-modal shape in the epidemic curve. Bacillus cereus and entertoxin were detected in rectal smear and environmental samples.

Citations

Citations to this article as recorded by

Surge of acute gastroenteritis outbreaks due to rising norovirus GII.4 transmission in Seoul childcare centers and kindergartens in 2022 compared to 2019–2021
Euncheol Son, Young-Hoon Kim
Archives of Virology.2024;[Epub] CrossRef

COVID-19: Brief Communication

Clinical severity according to the primary infection variant in patients with suspected SARS-CoV-2 reinfection in Korea: Myung-Jae Hwang, Insob Hwang, Chungmin Park, Hanul Park, Taejong Son, Jong-Hun Kim; Epidemiol Health. 2023;45:e2023007. Published online December 21, 2022; DOI: https://doi.org/10.4178/epih.e2023007

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Abstract

OBJECTIVES
We aimed to evaluate the severity of suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection according to variants of concern in Gyeongsangbuk-do and Daegu, Korea.

METHODS

The database of coronavirus disease 2019 (COVID-19) cases reported from epidemiological investigations through the integrated system operated by the Korea Disease Control and Prevention Agency, from January 20, 2020 to May 7, 2022 was combined with data from the Health Insurance Review and Assessment Service system. The severity odds ratio (SOR) in secondary infection episodes compared with primary infection was estimated using a generalized linear model with a binomial distribution.

RESULTS

In all patients, the SOR of SARS-CoV-2 reinfection was 0.89 (95% confidence interval [CI], 0.82 to 0.95), and the severity was lower than in the first infection. Patients who had been vaccinated within 91 days showed a more attenuated SOR (0.85; 95% CI, 0.74 to 0.98). However, despite vaccination, in patients with both primary and secondary infections caused by the Omicron variant, the severity was reduced to a lesser extent than in patients primarily infected with other variants.

CONCLUSIONS

We could make efforts to relieve the severity of COVID-19 in vulnerable populations, in which death is more likely, by recommending booster vaccinations in case of a resurgence.

Summary

Korean summary
국내 COVID-19 확진자들의 중증도 증가 위험은 재감염(2차감염) 시 감소하였지만, 1차감염과 재감염 모두 오미크론론 변이가 우세하였던 시기인 경우에는 오히려 증가하였다. 특히 마지막 예방접종일로부터 91일 이상인 확진자들과 60세이상 인구에서는 중증도 증가 위험이 더 높았다. 우리는 COVID-19가 장기화됨에 따라 취약인구집단에 대해 추가 예방접종을 권고함으로써 재감염시 중증도가 증가하는 것을 예방해야 할 필요가 있다.

Key Message
As COVID-19 prolongs, there is a need to recommend booster vaccinations for vulnerable populations to prevent the potential for increased severity in the event of reinfection.

Citations

Citations to this article as recorded by

Changes in the intrinsic severity of severe acute respiratory syndrome coronavirus 2 according to the emerging variant: a nationwide study from February 2020 to June 2022, including comparison with vaccinated populations
Boyeong Ryu, Eunjeong Shin, Dong Hwi Kim, HyunJu Lee, So Young Choi, Seong-Sun Kim, Il-Hwan Kim, Eun-Jin Kim, Sangwon Lee, Jaehyun Jeon, Donghyok Kwon, Sungil Cho
BMC Infectious Diseases.2024;[Epub] CrossRef
The effect of shortening the quarantine period and lifting the indoor mask mandate on the spread of COVID-19: a mathematical modeling approach
Jung Eun Kim, Heejin Choi, Minji Lee, Chang Hyeong Lee
Frontiers in Public Health.2023;[Epub] CrossRef
Previous infection with seasonal coronaviruses does not protect male Syrian hamsters from challenge with SARS-CoV-2
Magen E. Francis, Ethan B. Jansen, Anthony Yourkowski, Alaa Selim, Cynthia L. Swan, Brian K. MacPhee, Brittany Thivierge, Rachelle Buchanan, Kerry J. Lavender, Joseph Darbellay, Matthew B. Rogers, Jocelyne Lew, Volker Gerdts, Darryl Falzarano, Danuta M. S
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COVID-19: Original Article

The association between tobacco or nicotine product use behaviors and non-compliance with mask-wearing during the COVID-19 pandemic: a cross-sectional study in Korea: Da-eun Lee, Heewon Kang, Sung-il Cho; Epidemiol Health. 2022;44:e2022087. Published online October 7, 2022; DOI: https://doi.org/10.4178/epih.e2022087

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
It is necessary to investigate tobacco or nicotine product (TNP) use which acts as a risk factor for coronavirus disease 2019 (COVID-19) infection. Especially, wearing a mask is difficult to practice while using TNP. Therefore, this study aimed to examine the association between TNP use behaviors and non-compliance with mask-wearing during the COVID-19 pandemic.
METHODS
The samples of 208,618 Korean adults from 2020 Community Health Survey in Korea were used. As an independent variable, TNP use behaviors such as TNP use status, changes in TNP use after the COVID-19 outbreak, TNP types, and attempt to quit were analyzed. Logistic regression was performed on gender-stratified participants.
RESULTS
Among men, the odds ratio (OR) of current and former TNP users were 2.00 (95% confidence interval [CI], 1.66 to 2.40) and 1.32 (95% CI, 1.09 to 1.60), respectively, compared to never users. In women, OR was 1.50 (95% CI, 1.00 to 2.26) for former users. Cigarette use was more associated with not wearing a mask than non-cigarette tobacco or nicotine product (NCTNP) use (OR, 1.53; 95% CI, 1.12 to 2.08). Men whose TNP use decreased had lower non-compliance (OR, 0.52; 95% CI, 0.36 to 0.74); while women whose TNP use increased had lower non-compliance (OR, 0.13; 95% CI, 0.07 to 0.26).
CONCLUSIONS
Current and former users were less likely to wear masks. Cigarette use was more associated with not wearing a mask than NCTNP use. Changes in TNP use showed association for men and women; however, in the opposite direction. Therefore, more attention should be paid to TNP use prevention and cessation support during the epidemic of respiratory infectious diseases. Moreover, it is necessary to identify risk factors of cigarette users in compliance with mask-wearing.; Summary

Korean summary
담배 또는 니코틴 제품 (Tobacco or Nicotine Products, TNPs) 현재사용자와 과거사용자는 비사용자 대비 마스크 미착용 연관성이 높고, 비궐련 담배 또는 니코틴 제품 (Non-Cigarette Tobacco or Nicotine Products, NCTNPs) 사용자보다는 일반담배 사용자의 마스크 미착용 연관성이 높다. 남성에서는 코로나19 유행 이전 대비 TNPs 사용이 감소했을 때, 여성에서는 증가했을 때 마스크 미착용 연관성이 낮았다. 따라서 호흡기 감염병 유행 시기에는 더욱 TNPs 사용 예방과 금연 지원에 관심을 가질 것을 제안한다.

Key Message
During the epidemic of respiratory infectious diseases, more attention should be paid to tobacco or nicotine products (TNPs) use prevention and cessation support.

COVID-19: Perspective

Dengue and COVID-19 infections in the ASEAN region: a concurrent outbreak of viral diseases: Lowilius Wiyono, Ian Christoper N. Rocha, Trisha Denise D. Cedeño, Adriana Viola Miranda, Don Eliseo Lucero-Prisno III; Epidemiol Health. 2021;43:e2021070. Published online September 16, 2021; DOI: https://doi.org/10.4178/epih.e2021070

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Abstract

Member countries of the Association of Southeast Asian Nations (ASEAN) have faced dengue outbreaks for decades, and the region has one of the highest rates of dengue globally. Outbreaks continue to occur concurrently with the coronavirus disease 2019 (COVID-19) pandemic in the 10 ASEAN countries. Both infectious diseases pose a tremendous burden in these countries related to both infection control and the economy. Increases in the number of dengue cases occurred in part due to disruptions in the pathogen-host-vector relationship caused by changes in human behaviour in response to the COVID-19 pandemic. The spread of dengue was further aggravated by the implementation of lockdowns and social distancing policies. These measures limited the coverage of dengue preventive programs and delayed the medical management of both diseases due to co-infection and misdiagnosis. It is of the utmost importance for the population to remain aware of both diseases, and dengue vector control strategies must be devised to properly address outbreaks using digitalization and remote surveillance. Similarly, critical triage algorithms and further research are also needed to combat co-infection and misdiagnosis. Controlling the spread of COVID-19 though vaccination should also be undertaken to reduce the impact of the pandemic.

Summary

Key Message
The rising dengue infection amidst the COVID-19 pandemic has indicated the need of response to mitigate the dangers of both dengue and COVID-19. Appropriate measurement from all ASEAN countries are needed to lower the number of cases and ease the burden of both dengue and COVID-19 management."

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Infection and Drug Resistance.2023; Volume 16: 1081. CrossRef
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COVID-19: Original Article

The age-standardized incidence, mortality, and case fatality rates of COVID-19 in 79 countries: a cross-sectional comparison and their correlations with associated factors: Dongui Hong, Sohyae Lee, Yoon-Jung Choi, Sungji Moon, Yoonyoung Jang, Yoon-Min Cho, Hyojung Lee, Sukhong Min, Hyeree Park, Seokyung Hahn, Ji-Yeob Choi, Aesun Shin, Daehee Kang; Epidemiol Health. 2021;43:e2021061. Published online September 8, 2021; DOI: https://doi.org/10.4178/epih.e2021061

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
During the coronavirus disease 2019 (COVID-19) pandemic, crude incidence and mortality rates have been widely reported; however, age-standardized rates are more suitable for comparisons. In this study, we estimated and compared the age-standardized incidence, mortality, and case fatality rates (CFRs) among countries and investigated the relationship between these rates and factors associated with healthcare resources: gross domestic product per capita, number of hospital beds per population, and number of doctors per population.

METHODS

The incidence, mortality, and CFRs of 79 countries were age-standardized using the World Health Organization standard population. The rates for persons 60 years or older were also calculated. The relationships among the rates were analysed using trend lines and coefficients of determination (R2). Pearson correlation coefficients between the rates and the healthcare resource-related factors were calculated.

RESULTS

The countries with the highest age-standardized incidence, mortality, and CFRs were Czechia (14,253 cases/100,000), Mexico (182 deaths/100,000), and Mexico (6.7%), respectively. The R2 between the incidence and mortality rates was 0.852 for all ages and 0.945 for those 60 years or older. The healthcare resources-related factors were associated positively with incidence rates and negatively with CFRs, with weaker correlations among the elderly.

CONCLUSIONS

Compared to age-standardized rates, crude rates showed greater variation among countries. Medical resources may be important in preventing COVID-19-related deaths; however, considering the small variation in fatality among the elderly, preventive measures such as vaccination are more important, especially for the elderly population, to minimize the mortality rates.

Summary

Korean summary
국가별 발생률, 사망률, 치명률을 WHO 표준 인구로 연령표준화하였고, 의료자원과 관계된 지표와의 상관관계를 파악하였다. 2021년 4월 6일 기준, 연령표준화 발생률, 사망률, 치명률이 가장 높은 나라는 각각 체코 (10만명당 14,253명), 멕시코 (10만명당 182명), 멕시코 (6.7%)이며, 60세 이상 노인은 사망률과 치명률이 더 높은 것으로 나타났다. 1인당GDP, 인구당 의사 수, 인구당 병상 수는 발생률과 양의 상관관계가, 치명률과는 음의 상관관계가 있었고 노인에게서는 상관관계가 약하게 나타났다. 코로나바이러스감염증-19로 인한 피해를 최소화하기 위해서 의료자원의 투입과 더불어 노인의 감염예방이 중요할 것이다.

Key Message
The incidence, mortality, and case fatality rates of 79 countries were age-standardized using the WHO standard population. The correlations between the rates and the healthcare resource-related factors were investigated. As of April 6, 2021, the countries with the highest age-standardized incidence, mortality, and case fatality rates were Czechia (14,253 cases/100,000), Mexico (182 deaths/100,000), and Mexico (6.7%), respectively; the mortality and case fatality rates were higher among the elderly. GDP per capita, number of hospital beds per population, and number of doctors per population were associated positively with incidence rate, and negatively with case fatality rates: the correlations were weaker among the elderly. To minimize the burden caused by COVID-19, preventing the elderly from infection is important as well as supply of medical resources.

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Y. Bodryzlova, A. J. Lemieux, A. Crocker
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Age-standardization and Standard Population
Dongui Hong, Sohyae Lee, Kyu-Won Jung, Aesun Shin
Journal of Health Informatics and Statistics.2023; 48(Suppl 1): S15. CrossRef
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Roberto Tapia-Conyer, Rafael Ricardo Valdez-Vázquez, Julieta Lomelín-Gascón, Rodrigo Saucedo-Martínez, Luis Alberto Martinez-Juarez, Héctor Gallardo-Rincón
Hospital Practice.2022; 50(3): 183. CrossRef
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Iván de Jesús Ascencio-Montiel, Oscar David Ovalle-Luna, Ramón Alberto Rascón-Pacheco, Victor Hugo Borja-Aburto, Gerardo Chowell
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Time-series comparison of COVID-19 case fatality rates across 21 countries with adjustment for multiple covariates
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COVID-19: Systematic Review

Clinical outcomes of COVID-19 amongst HIV patients: a systematic literature review: Thomas Massarvva; Epidemiol Health. 2021;43:e2021036. Published online May 17, 2021; DOI: https://doi.org/10.4178/epih.e2021036

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420 Download
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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The global pandemic coronavirus disease 2019 (COVID-19) emerged in the city of Wuhan, China around December 2019. Since then, the virus has caused severe morbidity and mortality worldwide and has put pressure on the global medical system. Still, there are limited data regarding the clinical impact of COVID-19 on people living with human immunodeficiency virus (HIV). The primary aim of this study was, therefore, to systematically review up-to-date studies reporting the clinical outcomes of COVID-19 amongst HIV patients.

METHODS

A thorough literature search was carried out using MEDLINE, Embase, Scopus, and the Cochrane Library Databases in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

A total of 22 studies were identified. Amongst 730 HIV/COVID-19-coinfected patients, 79.4% were males, the median age was 51.5 years, and the number of reported patients receiving antiretroviral drugs was 708 (97.2%). Most coinfected patients had mild to moderate symptoms, including cough (37.7%), fever (37.5%), and dyspnoea (24.7%). Among pre-existing comorbidities, hypertension (26.3%) was the most prevalent in HIV/COVID-19 coinfected patients, and 87% of coinfected patients recovered.

CONCLUSIONS

Based on the existing data in this systematic literature review, HIV patients with pre-existing comorbidities, obesity, and older age should be considered as a high-risk group for COVID-19. Furthermore, coinfected patients appear to have marginally comparable clinical outcomes with the general population. The study’s findings highlight the need for further investigation to elucidate the impact of COVID-19 infection on HIV patients.

Summary

Key Message
In this systematic literature review, various aspects of COVID-19 outcomes amongst HIV patients are identified and quantified, including the proportion of different symptoms, severity, pre-existing comorbidities, recovery, death, and the most commonly prescribed antiretroviral drugs in HIV patients with COVID-19 coinfection.

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A study in a tertiary level hospital in Bangladesh shows no age dependent variations in COVID-19 antibody level among school-aged children and healthy adults
Sabira Rahman, Shaifa Lubna Mili, M. Raqibul Islam, Nayeema Ferdous Shanta, Mashura Musharraf, Sumon Shahrior Morshed
International Journal of Contemporary Pediatrics.2025; 12(8): 1283. CrossRef
Exit Meta-Analysis on the Effect of HIV on COVID-19 Mortality, Hospitalization, and ICU Admission
Lubna A. Zar, Shahd Hamran, Izzaldin Alremawi, Mohamed Elahtam, Asmaa Abdelmaksoud, Rida Arif, Tawanda Chivese
Medical Sciences.2025; 13(4): 261. CrossRef
Double Trouble Co-Infections: Understanding the Correlation Between COVID-19 and HIV Viruses
Sassi Ashraf Ali Abbasi, Tarika Noor, Maneeth Mylavarapu, Monika Sahotra, Hunmble A Bashir, Rakshita Ramesh Bhat, Urmi Jindal, Uzma Amin, Anushree V, Humza F Siddiqui
Cureus.2023;[Epub] CrossRef
HIV and COVID-19: review of clinical course and outcomes
Lauren K. Barbera, Kevin F. Kamis, Sarah E. Rowan, Amelia J. Davis, Soraya Shehata, Jesse J. Carlson, Steven C. Johnson, Kristine M. Erlandson
HIV Research & Clinical Practice.2021; 22(4): 102. 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.

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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
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International Journal of Environmental Research and Public Health.2022; 19(20): 13282. CrossRef

Impact of early-life weight status on urinary tract infections in children: a nationwide population-based study in Korea: Hyung Eun Yim, Kyung Do Han, Bongseong Kim, Kee Hwan Yoo; Epidemiol Health. 2021;43:e2021005. Published online December 29, 2020; DOI: https://doi.org/10.4178/epih.e2021005

22,070 View
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Abstract Summary PDF

Abstract

OBJECTIVES
We aimed to evaluate the association between early-life weight status and urinary tract infection (UTI) risk in children.

METHODS

A nationwide study was conducted using Korean National Health Screening (NHS) data and National Health Insurance Service data. A sample cohort was selected using data from the 2014 and 2015 NHS for infants and children (4-71 months) and followed up until the end of 2017. Participants were divided into 4 groups (underweight, normal weight, overweight, and obese) based on the weight-for-age (< 2 years) or body mass index (≥ 2 years). Hazard ratios (HRs) with 95% confidence intervals (CIs) for developing UTIs, cystitis, and acute pyelonephritis (APN) were calculated using a Cox proportional hazard model.

RESULTS

Of 1,653,106 enrolled children, 120,142 (7.3%) developed UTIs, cystitis, and APN during follow-up. The underweight, overweight, and obese groups had higher risks of UTIs than the reference group after adjusting for age, sex, birth weight, and preterm birth. Between 2 years and 6 years of age, boys with underweight had a high risk of UTI and APN, while girls with overweight and obesity revealed elevated risks of UTIs, cystitis, and APN. The HRs for APN in boys with underweight and in girls with obesity were 1.46 (95% CI, 1.03 to 2.07) and 1.41 (95% CI, 1.13 to 1.75), respectively, after adjusting for age, sex, birth weight, and preterm birth. The incidence of APN did not decrease with age in underweight and obese children aged 2-6 years.

CONCLUSIONS

Children with underweight, overweight, and obesity may be at high risk for UTIs.

Summary

Korean summary
1. 영유아 및 소아에서 과소체중, 과체중 및 비만은 요로감염 발생 증가와 관련이 있다. 2. 본 전국적인 인구 기반 연구에서 2-6세 남아에서 과소체중을 보인 경우 요로감염과 신우신염 발생빈도가 증가하였으며, 2-6세 여아에서 과체중 및 비만을 보이는 경우 요로감염, 방광염, 신우신염 발생이 증가하였다. 3. 소아에서 적정체중을 유지하는 것이 요로감염, 방광염, 신우신염의 발생을 예방함에 있어서 중요하다.

Key Message
1. Being underweight, overweight, or obese can be associated with an increased risk of urinary tract infection in infants and children. 2. The underweight boys aged 2–6 years had a high risk of urinary tract infection and acute pyelonephritis, while the overweight and obese girls aged 2–6 years revealed increased risks of urinary tract infection, cystitis, and acute pyelonephritis in our nationwide population-based study on urinary tract infections. 3. Body weight control would be significant for the primary prevention of urinary tract infections, cystitis, and acute pyelonephritis in children.

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Risk factors for recurrent urinary tract infections in young infants under the age of 24 months
Min Hwa Son, Hyung Eun Yim
Childhood Kidney Diseases.2024; 28(1): 35. CrossRef
Childhood Body Mass Index (BMI) and the Risk of Infection: A Narrative Review
Houman Hashemian, Mohammad Ali Esfandiari, Setila Dalili
Journal of Comprehensive Pediatrics.2023;[Epub] CrossRef
Kidney Considerations in Pediatric Obesity
Alexandra Sawyer, Evan Zeitler, Howard Trachtman, Petter Bjornstad
Current Obesity Reports.2023; 12(3): 332. CrossRef
Association of body weight and urinary tract infections during infancy: a nationwide comparative matched cohort study
Peong Gang Park, Ji Hyun Kim, Yo Han Ahn, Hee Gyung Kang
Childhood Kidney Diseases.2023; 27(2): 111. CrossRef
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Estimation of the number of working population at high-risk of COVID-19 infection in Korea: Juyeon Lee, Myounghee Kim; Epidemiol Health. 2020;42:e2020051. Published online July 9, 2020; DOI: https://doi.org/10.4178/epih.e2020051

25,776 View
421 Download
21 Web of Science
16 Crossref

Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We aimed to identify occupational groups at high-risk of coronavirus disease 2019 (COVID-19) infection in Korea, to estimate the number of such workers, and to examine the prevalence of protective resources by employment status.

METHODS

Based on the sixth Standard Occupational Classification codes, 2015 census data were linked with data from the fifth Korean Working Conditions Survey, which measured how frequently workers directly come into contact with people other than fellow employees in the workplace.

RESULTS

A total of 30 occupational groups, including 7 occupations from the healthcare and welfare sectors and 23 from other sectors, were classified as high-risk occupational groups involving frequent contact with people other than fellow employees in the workplace (more than half of the working hours). Approximately 1.4 million (women, 79.1%) and 10.7 million workers (46.3%) are employed in high-risk occupations. Occupations with a larger proportion of women are more likely to be at a high-risk of infection and are paid less. For wage-earners in high-risk occupations, protective resources to deal with COVID-19 (e.g., trade unions and health and safety committees) are less prevalent among temporary or daily workers than among those with permanent employment.

CONCLUSIONS

Given the large number of Koreans employed in high-risk occupations and inequalities within the working population, the workplace needs to be the key locus for governmental actions to control COVID-19, and special consideration for vulnerable workers is warranted.

Summary

Korean summary
코로나바이러스감염증-19 (코로나19) 유행 상황에서 감염 고위험 직업군 종사자는 보건의료복지 업종에서 총 140만 명, 그 외 업종에서 총 1,073만 명으로 추정된다. 고위험 사업장에 대해 정부가 안전보건 관리·감독·규제 및 지원 체계를 수립하고, 방역대책의 중심에 노동자의 안전과 건강 보호를 두는 관점의 전환이 필요하다. 우선 당장 역학조사 과정에서 직업관련 요소를 자세히 확인하고, 직업관련 감염에 대한 모니터링과 그에 걸맞는 대책을 마련해야 한다.

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COVID-19: Brief Communication

Follow-up investigation of asymptomatic COVID-19 cases at diagnosis in Busan, Korea: Miyoung Lee, Youngduck Eun, Kyounghee Park, Jeonghun Heo, Hyunjin Son; Epidemiol Health. 2020;42:e2020046. Published online June 23, 2020; DOI: https://doi.org/10.4178/epih.e2020046

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The objective of the study was to conduct a follow-up investigation of 10 asymptomatic patients at diagnosis among the 98 confirmed coronavirus disease 2019 (COVID-19) cases reported in Busan between February 21, 2020 and March 13, 2020 to determine whether asymptomatic infection and transmission during asymptomatic period are possible.

METHODS

The study analyzed 10 asymptomatic, confirmed COVID-19 cases to determine whether asymptomatic infection is possible. We conducted in-depth interviews with patients and guardians; interviews with primary physicians; review of medical records and drug utilization review (DUR) reports; and base station-based location tracking.

RESULTS

Among the 98, confirmed COVID-19 cases reported in Busan, the study analyzed 10 (10.2%) asymptomatic patients at diagnosis. The results confirmed that two (2.0%) patients reported to be asymptomatic during the initial epidemiological investigation, but turned symptomatic before diagnosis as per the in-depth interview results. Four cases (4.0%) of early detection led to confirmed diagnosis during the incubation period and presentation of symptoms after diagnosis. In addition, the remaining four patients (4.0%), having no subjective symptoms nor specific findings on chest radiography and computed tomography, remained asymptomatic until the isolation order was lifted. With regard to whether transmission during the asymptomatic period is possible, it was found that one out of 23 household contacts of the confirmed patients was identified as an additional confirmed case after coming in close contact with an index patient during the presymptomatic period.

CONCLUSIONS

Among the 98 confirmed cases, asymptomatic infection was confirmed in four cases (4.0%). In addition, there was one additional confirmed case in which the patient was a family member who came in close contact with an index patient during the incubation period, thereby confirming that transmission during the asymptomatic period is possible. The possibility of transmission during the asymptomatic period has been confirmed; therefore, it is necessary to review the measures for expanding contact tracing that is currently being applied starting one day prior to the onset of symptoms.

Summary

Korean summary
본 연구는 부산광역시에서 무증상으로 COVID-19에 진단된 10명의 환자를 추적조사하여 무증상 감염이 가능한가, 무증상기에 전파가 가능한가에 대해 확인하였다. 조사결과 4명(4.0%)의 무증상 감염환자를 확인하였고, 환자의 무증상기에 밀접 접촉한 가족 중 1명의 추가 환자를 확인하여 무증상기 전파가 가능하다는 것을 확인하였다.

Citations

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Characterization of COVID-19 cases in the early phase (March to July 2020) of the pandemic in Kenya
Philip Ngere, Joyce Onsongo, Daniel Langat, Elizabeth Nzioka, Faith Mudachi, Samuel Kadivane, Bernard Chege, Elvis Kirui, Ian Were, Stephen Mutiso, Amos Kibisu, Josephine Ihahi, Gladys Mutethya, Trufosa Mochache, Peter Lokamar, Waqo Boru, Lyndah Makayotto
Journal of Global Health.2022;[Epub] CrossRef
Asymptomatic Cases, the Hidden Challenge in Predicting COVID-19 Caseload Increases
Brett Snider, Bhumi Patel, Edward McBean
Infectious Disease Reports.2021; 13(2): 340. CrossRef
Efficacy and safety of traditional Chinese medicine combined with routine western medicine for the asymptomatic novel coronavirus disease (COVID–19)
Jiahao Wang, Xue Zhu, Yuying Sun, Xingcai Zhang, Wei Zhang
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COVID-19: Methods

Individual-based simulation model for COVID-19 transmission in Daegu, Korea: Woo-Sik Son, RISEWIDs Team; Epidemiol Health. 2020;42:e2020042. Published online June 15, 2020; DOI: https://doi.org/10.4178/epih.e2020042

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The aims of this study were to obtain insights into the current coronavirus disease 2019 (COVID-19) epidemic in the city of Daegu, which accounted for 6,482 of the 9,241 confirmed cases in Korea as of March 26, 2020, to predict the future spread, and to analyze the impact of school opening.

METHODS

Using an individual-based model, we simulated the spread of COVID-19 in Daegu. An individual can be infected through close contact with infected people in a household, at work/school, and at religious and social gatherings. We created a synthetic population from census sample data. Then, 9,000 people were randomly selected from the entire population of Daegu and set as members of the Shincheonji Church. We did not take into account population movements to and from other regions in Korea.

RESULTS

Using the individual-based model, the cumulative confirmed cases in Daegu through March 26, 2020, were reproduced, and it was confirmed that the hotspot, i.e., the Shincheonji Church had a different probability of infection than non-hotspot, i.e., the Daegu community. For 3 scenarios (I: school closing, II: school opening after April 6, III: school opening after April 6 and the mean period from symptom onset to hospitalization increasing to 4.3 days), we predicted future changes in the pattern of COVID-19 spread in Daegu.

CONCLUSIONS

Compared to scenario I, it was found that in scenario III, the cumulative number of patients would increase by 107 and the date of occurrence of the last patient would be delayed by 92 days.

Summary

Korean summary
신천지 교인 집단이 hotspot이 되어 지역사회로 전파된 대구의 COVID-19 확산을 시뮬레이션하였다. Individual based model을 이용하여 신천지 교인 집단, 즉 hotspot과 non-hotspot이 서로 다른 감염 확률을 갖고 있음을 확인하였으며, 4월 6일로 예정된 개학이 대구 지역 COVID-19 확산에 어떤 영향을 미칠지 분석하였다.

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Epidemiological Analysis of the COVID-19 Clusters in the Early Stages of the Epidemic in Shanghai, China: Pandemic-to-Epidemic Response Shift
Dechuan Kong, Qiwen Fang, Jian Chen, Linjie Hu, Yihan Lu, Yaxu Zheng, Yiyi Zhu, Bihong Jin, Wenjia Xiao, Shenghua Mao, Chenyan Jiang, Xiaohuan Gong, Sheng Lin, Ruobing Han, Xiao Yu, Qi Qiu, Xiaodong Sun, Hao Pan, Huanyu Wu
Tropical Medicine and Infectious Disease.2025; 10(6): 170. CrossRef
Using simulation modelling and systems science to help contain COVID‐19: A systematic review
Weiwei Zhang, Shiyong Liu, Nathaniel Osgood, Hongli Zhu, Ying Qian, Peng Jia
Systems Research and Behavioral Science.2023; 40(1): 207. CrossRef
Mathematical Modeling of COVID-19 Transmission and Intervention in South Korea: A Review of Literature
Hyojung Lee, Sol Kim, Minyoung Jeong, Eunseo Choi, Hyeonjeong Ahn, Jeehyun Lee
Yonsei Medical Journal.2023; 64(1): 1. CrossRef
Transition from growth to decay of an epidemic due to lockdown
Hamid Khataee, Jack Kibble, Istvan Scheuring, Andras Czirok, Zoltan Neufeld
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A Full-Scale Agent-Based Model to Hypothetically Explore the Impact of Lockdown, Social Distancing, and Vaccination During the COVID-19 Pandemic in Lombardy, Italy: Model Development
Giuseppe Giacopelli
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Comparison of Psychosocial Distress in Areas With Different COVID-19 Prevalence in Korea
Mina Kim, In-Hoo Park, Young-Shin Kang, Honey Kim, Min Jhon, Ju-Wan Kim, Seunghyong Ryu, Ju-Yeon Lee, Jae-Min Kim, Jonghun Lee, Sung-Wan Kim
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Original Articles

Factors associated with in-hospital death in patients with nosocomial infections: a registry-based study using community data in western Iran: Salman Khazaei, Erfan Ayubi, Ensiyeh Jenabi, Saeid Bashirian, Masud Shojaeian, Leili Tapak; Epidemiol Health. 2020;42:e2020037. Published online June 1, 2020; DOI: https://doi.org/10.4178/epih.e2020037

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Abstract PDF Supplementary Material

Abstract

Objectives
Determining the predictors of in-hospital death related to nosocomial infections is an essential part of efforts made in the overall health system to improve the delivery of health care to patients. Therefore, this study investigated the predictors of in-hospital death related to nosocomial infections.

Methods

This registry-based, longitudinal study analyzed data on 8,895 hospital-acquired infections (HAIs) in Hamadan Province, Iran from March 2017 to December 2019. The medical records of all patients who had been admitted to the hospitals were extracted from the Iranian Nosocomial Infections Surveillance Software. The effects of the type and site of infection, as well as age group, on in-hospital death were estimated using univariate and multivariable Cox regression models.

Results

In total, 4,232 (47.8%) patients with HAIs were males, and their mean age was 48.25±26.22 years. In both sexes, most nosocomial infections involved Gram-negative bacteria and the most common site of infection was the urinary tract. Older patients had a higher risk of in-hospital death (adjusted hazard ratio [aHR], 2.26; 95% confidence interval [CI], 1.38 to 3.69 for males; aHR, 2.44; 95% CI, 1.29 to 4.62 for females). In both sexes, compared with urinary tract infections, an increased risk of in-hospital death was found for ventilator-associated events (VAEs) (by 95% for males and 93% for females) and bloodstream infections (BSIs) (by 67% for males and 82% for females).

Conclusion

We found that VAEs, BSIs, and fungal infections were independently and strongly associated with increased mortality.

Summary

Citations

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Predictors of In-ICU Mortality Among Older Patients with Healthcare-Associated Infection: A Cohort Study
Fereshteh Rezaie, Farahnaz Mohammadi-Shahboulaghi, Reza Fadayevatan, Mohsen Shati, Gholamreza Ghaedamini Harouni
Journal of Kermanshah University of Medical Sciences.2023;[Epub] CrossRef
Barriers to hand hygiene compliance in intensive care units to prevent the spread of healthcare-associated infections
Gurjeet Singh, Raksha Singh, Ranga Reddy Burri
MGM Journal of Medical Sciences.2023; 10(4): 667. CrossRef
Prevalence of Nosocomial Infections During the COVID-19 Pandemic: A Systematic Review and Meta-analysis
Sima Rafiei, Zahra Nejatifar, Rana Soheylirad, Samira Raoofi, Fatemeh Pashazadeh Kan, Ahmad Ghashghaee
Journal of Health Reports and Technology.2022;[Epub] CrossRef
Prevalence of Nosocomial Infections During the COVID-19 Pandemic: A Systematic Review and Meta-analysis
Sima Rafiei, Zahra Nejatifar, Rana Soheylirad, Samira Raoofi, Fatemeh Pashazadeh Kan, Ahmad Ghashghaee
Journal of Health Reports and Technology.2022;[Epub] CrossRef
The Impact of COVID-19 Outbreak on Nosocomial Infection Rate: A Case of Iran
Maryam Jabarpour, Mahlagha Dehghan, Giti Afsharipour, Elham Hajipour Abaee, Parvin Mangolian Shahrbabaki, Mehdi Ahmadinejad, Mahboobeh Maazallahi, Aseer Manilal
Canadian Journal of Infectious Diseases and Medical Microbiology.2021; 2021: 1. CrossRef
Survival rate in patients with ICU-acquired infections and its related factors in Iran’s hospitals
MEDSKorosh Etemad, Yousef Khani, Seyed-Saeed Hashemi-Nazari, Neda Izadi, Babak Eshrati, Yadollah Mehrabi
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Major enteropathogens in humans, domestic animals, and environmental soil samples from the same locality: prevalence and transmission considerations in coastal Odisha, India: Arpit Kumar Shrivastava, Nirmal Kumar Mohakud, Swagatika Panda, Saumya Darshana Patra, Subrat Kumar, Priyadarshi Soumyaranjan Sahu; Epidemiol Health. 2020;42:e2020034. Published online May 26, 2020; DOI: https://doi.org/10.4178/epih.e2020034

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Abstract PDF Supplementary Material

Abstract

Objectives
Regions with limited sanitation facilities have higher rates of infections with various enteric pathogens. It is therefore important to identify different hosts and their relative contribution to pathogen shedding into the environment, and to assess the subsequent health risks to humans.

Methods

In this study, human faecal (n=310), animal faecal (n=150), and environmental (soil) samples (n=40) were collected from the same locality and screened for selected enteric pathogens by immunochromatography and/or polymerase chain reaction.

Results

At least 1 microbial agent was detected in 49.0%, 44.7%, and 40.0% of the samples from human, animals, and soil, respectively. Among humans, rotavirus was predominantly detected (17.4%) followed by enteropathogenic Escherichia coli (EPEC) (15.4%), Shigella (13.8), and Shiga toxin-producing E. coli (STEC) (9.7%). Among animals, STEC was detected most frequently (28.0%), and EPEC was the major enteric pathogen detected in soil (30.0%). The detection rate of rotavirus was higher among younger children (≤2 years) than among older children. Single infections were more commonly detected than multiple infections in humans (p<0.01), unlike the observations in animal and soil samples. For diarrhoeagenic E. coli and Shigella, most of the human and animal isolates showed close relatedness, suggesting possible cross-infection between humans and domesticated animals in the area studied.

Conclusions

The present study provides an improved understanding of the distribution of major enteric pathogens coexisting in humans and animals in the region, thereby suggesting a high potential for possible transmission among livestock and communities residing in the studied locality.

Summary

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COVID-19: Perspective

Prevention of exposure to and spread of COVID-19 using air purifiers: challenges and concerns: Seunghon Ham; Epidemiol Health. 2020;42:e2020027. Published online April 17, 2020; DOI: https://doi.org/10.4178/epih.e2020027

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Abstract

Coronavirus disease 2019 (COVID-19) is now a pandemic. The Korean government has declared a red alert, which is the highest level of the national infectious disease alert system, and the World Health Organization has similarly declared its highest-level pandemic alert (phase 6). The spread of COVID-19 is an unprecedented worldwide public health problem that governments and individuals must work to overcome. Recently, an infection cluster arose in a call center in Seoul. To support call center companies, the Korean Ministry of Employment and Labor has proposed covering the costs of installing partitions and air purifiers, providing hand sanitizers, and supplying masks to prevent droplet and aerosol infections. Air purifiers are expected to be installed on the floor with the exhaust outlets at a higher level, such as the level of the desks or breathing zones of workers. When a worker coughs or releases droplets near a colleague’s respiratory system, the droplets may spread throughout the call center via air flow from air purifier. In this fashion, a single infected person can give rise to an infection cluster. Attempts to prevent infection must not lead to new infections, and the installation of air purifiers may cause new problems. Therefore, using air purifiers to control the spread of COVID-19 should be approached with caution.

Summary

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Original Article

Epidemiological characteristics of HIV infected Korean: Korea HIV/AIDS Cohort Study: Yunsu Choi, Bo Youl Choi, Soo Min Kim, Sang Il Kim, June Kim, Jun Young Choi, Shin-Woo Kim, Joon Young Song, Youn Jeong Kim, Dae Won Park, Hyo Youl Kim, Hee-Jung Choi, Mee-Kyung Kee, Young Hyun Shin, Myeongsu Yoo; Epidemiol Health. 2019;41:e2019037. Published online September 3, 2019; DOI: https://doi.org/10.4178/epih.e2019037

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
To manage evidence-based diseases, it is important to identify the characteristics of patients in each country.

METHODS

The Korea HIV/AIDS Cohort Study seeks to identify the epidemiological characteristics of 1,442 Korean individuals with human immunodeficiency virus (HIV) infection (12% of Korean individuals with HIV infection in 2017) who visited 21 university hospitals nationwide. The descriptive statistics were presented using the Korea HIV/AIDS cohort data (2006-2016).

RESULTS

Men accounted for 93.3% of the total number of respondents, and approximately 55.8% of respondents reported having an acute infection symptom. According to the transmission route, infection caused by sexual contact accounted for 94.4%, of which 60.4% were caused by sexual contact with the same sex or both males and females. Participants repeatedly answered the survey to decrease depression and anxiety scores. Of the total participants, 89.1% received antiretroviral therapy (ART). In the initial ART, 95.3% of patients were treated based on the recommendation. The median CD4 T-cell count at the time of diagnosis was 229.5 and improved to 331 after the initial ART. Of the patients, 16.6% and 9.4% had tuberculosis and syphilis, respectively, and 26.7% had pneumocystis pneumonia. In the medical history, sexually transmitted infectious diseases showed the highest prevalence, followed by endocrine diseases. The main reasons for termination were loss to follow-up (29.9%) and withdrawal of consent (18.7%).

CONCLUSIONS

Early diagnosis and ART should be performed at an appropriate time to prevent the development of new infection.

Summary

Korean summary
국내 감염인은 대부분 성 접촉으로 인해 감염되었고, 감염인의 약 90%가 치료를 경험하였다. 하지만 여전히 결핵, 매독, 주폐포자충 폐렴 등과 같은 HIV 관련 질환의 유병률이 높았고, 치료를 통해 수명이 연장되어 노화 혹은 치료 약제 부작용과 관련된 HIV 비 관련 만성 질환의 유병률도 높았다. 향후 감염인의 HIV/AIDS 비 관련 질환에 대한 연구 및 사망 원인 등에 대한 후속 연구가 필요하겠다.

Citations

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Case Report

Two cases of cholera O1 in South Batinah, Oman, April 2019: lessons learned: Zayid K. Al Mayahi, Nasser Al-Shaqsi, Hamid A. Elmutashi, Ali Al-Dhoyani, Azza Al Hattali, Khalid Salim, Issa S. Al Fulaiti, Mahmood S. Al Subhi; Epidemiol Health. 2019;41:e2019033. Published online July 12, 2019; DOI: https://doi.org/10.4178/epih.e2019033

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Abstract PDF

Abstract

Cholera represents an ongoing threat to many low-income and middle-income countries, but some cases of cholera even occur in high-income countries. Therefore, to prevent or combat cholera outbreaks, it is necessary to maintain the capacity to rapidly detect cholera cases, implement infection control measures, and improve general hygiene in terms of the environment, water, and food. The 2 cases, 1 imported and 1 secondary, described herein are broadly indicative of areas that require improvement. These cases were missed at the primary health care stage, which should be the first detection point even for unusual diseases such as cholera, and the absence of strict infection control practices at the primary care level is believed to contribute to secondary cases of infection. This report also encourages countries to ensure that rapid diagnostic stool tests are available to enable quick detection, as well as to provide information to people travelling to areas where cholera is endemic.

Summary

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Original Articles

A large outbreak of Salmonella enterica serovar Thompson infections associated with chocolate cake in Busan, Korea: Youngduck Eun, Hyesun Jeong, Seungjin Kim, Wonseo Park, Byoungseon Ahn, Dongkeun Kim, Eunhee Kim, Eunhee Park, Sunhee Park, Inyeong Hwang, Hyunjin Son; Epidemiol Health. 2019;41:e2019002. Published online January 9, 2019; DOI: https://doi.org/10.4178/epih.e2019002

27,814 View
442 Download
43 Web of Science
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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to reveal the epidemiologic characteristics of the outbreak of gastroenteritis caused by Salmonella enterica serovar Thompson in Busan Metropolitan City and to identify points for improvement to prevent of food-borne disease outbreak.

METHODS

This was a case-control study. The control group comprised asymptomatic students in the same classes of the cases. The presence or absence of symptoms, ingestion of each food provided by school meal service, and commonly ingested foods in addition to those foods in meal service were investigated. Moreover, specimens collected from rectal swab, preserved foods, and environmental surface were tested.

RESULTS

Of the 6,092 subjects, 1,111 (1,083 students, 22 school personnel, and 6 foodservice employees) were included in the case group; this corresponded to an 18.4% attack rate. Symptoms included diarrhea (n=1,051, 94.6%), abdominal pain (n=931, 83.8%), febrile sensation (n=502, 45.2%), and vomiting (n=275, 24.8%). The epidemic curves of each 10 schools were unimodal. Investigation of food intake showed a significantly high odds ratio for chocolate cake in 5 out of the 10 schools. Laboratory test detected Salmonella enterica serovar Thompson both in rectal swab specimens of 9 schools and in collected preserved chocolate cakes of 9 schools. Pulsed-field gel electrophoresis test result showed that Salmonella enterica seorvar Thompson isolated from human and foods were the same.

CONCLUSIONS

The source of infection for the Salmonella enterica serovar Thompson outbreak in the 10 schools of Busan Metropolitan City is chocolate cake. Traceback investigation for origin of contaminated food in food-borne disease outbreak and safety control during food production should be more enhanced.

Summary

Korean summary
이 연구는 2018년 9월 부산광역시 10개 학교에서 급식으로 제공된 초콜릿 케익으로 인해 발생한 살모넬라 톰슨 감염증 대규모 유행의 역학 조사 결과이다. 학교 급식과 같은 대규모 집단급식은 원재료에서 급식 제공까지 안전하게 관리되어야 하며 식품매개감염병 집단 발생 역학조사에 있어 오염원에 대한 체계적 역추적 조사와 기관 간 협업의 중요성을 강조하였다.

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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.

Citations

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Review

The current status of Zika virus in Southeast Asia: Viroj Wiwanitkit; Epidemiol Health. 2016;38:e2016026. Published online June 16, 2016; DOI: https://doi.org/10.4178/epih.e2016026

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Abstract PDF

Abstract

OBJECTIVES
Zika virus currently poses a global threat and is a major public health issue throughout Latin America and the Caribbean. However, Zika virus infections in humans have also been observed in other regions, including Southeast Asia, where arboviral diseases are very common. In this study, we summarize the current status of Zika virus in Southeast Asia. This review aims to provide an overview of the current situation and also to suggest ways of adequately managing the emergence of Zika virus in Southeast Asia.

METHODS

The literature searching for the reports on Zika virus in Southeast Asia was done using standard database PubMed and the re-analysis and summarization on the reports was done.

RESULTS

A limited number of reports have addressed Zika virus disease in Southeast Asia, but it is has been confirmed that a problem already exists. Individual case reports and outbreaks of Zika virus have been confirmed in Southeast Asia. Several reports have also described patients becoming infected after visiting Southeast Asia. In addition, the concurrent circulation of Zika virus with other arboviruses has been confirmed.

CONCLUSIONS

As a tropical region with a high prevalence of arboviral diseases, the emergence of Zika virus in Southeast Asia is a major concern. It is essential for local medical personnel to recognize this disease. Given the status of Southeast Asia as a globally important tourist destination, continuous updates on the status of Zika virus in Southeast Asia are required and should be incorporated into global health advisories regarding travel.

Summary

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MERS-Epidemiologic Investigation

Epidemiological investigation of the 119th confirmed Middle East Respiratory Syndrome coronavirus case with an indefinite mode of transmission during the Pyeongtaek outbreak in Korea: Jong Hyuk Choi, Byoungin Yoo, Soon Young Lee, Eun Gyu Lee, Moran Ki, Woncheol Lee, Jong Rak Jung, Kyujin Chang; Epidemiol Health. 2015;37:e2015054. Published online December 10, 2015; DOI: https://doi.org/10.4178/epih/e2015054

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Abstract Summary PDF Supplementary Material

Abstract

Since the first case was diagnosed on May 20, 2015, there were 186 confirmed cases of Middle East Respiratory Syndrome (MERS) until the end of outbreak in South Korea. Although medical institutions were the most identifiable sources of MERS transmission in South Korea, similar to other countries, in-depth epidemiological investigation was required for some confirmed cases with indefinite contact history or hospital visit records. The subject of epidemiological investigation in the present study was a 35 year-old male patient diagnosed with MERS (#119) who lived in Asan-city and worked in Pyeongtaek-city. Various potential sources of transmission were carefully investigated. While he could have been exposed to MERS through a friend from Saudi Arabia or confirmed MERS cases in his workplace, neighboring areas, and medical institutions, as well as contacts in his home, the chances of transmission were low; however, the potential for transmission through his local community could not be excluded. Practically, it was difficult to determine the modes of transmission for all outbreak cases in communicable disease that occurred in this short period of time. The investigation to identify the mode of transmission in this case was ultimately unsuccessful. However, the various data collected and analyzed to reveal modes of transmission provided detailed information that could not be collected using only interview surveys.

Summary

Korean summary
2015년 한국에서 유행한 메르스 환자들 중, 감염 경로가 불분명한 119번째 환자에 대한 심층 역학조사를 통해 다양한 감염경로의 가능성을 검토하였다. 감염경로를 명확하게 밝혀내지 못한 한계점이 있지만, 지역사회 전파에 대한 가능성을 제시하였다. 감염병 대유행시 효율적인 감염경로 파악을 위해서는 다방면의 자료에 대한 확보체계와 이를 신속히 분석하고 판단할 수 있는 전문 인력 확충이 필요하다.

Citations

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A database of geopositioned Middle East Respiratory Syndrome Coronavirus occurrences
Rebecca E. Ramshaw, Ian D. Letourneau, Amy Y. Hong, Julia Hon, Julia D. Morgan, Joshua C. P. Osborne, Shreya Shirude, Maria D. Van Kerkhove, Simon I. Hay, David M. Pigott
Scientific Data.2019;[Epub] CrossRef

MERS-Original Article

Epidemiologic features of the first MERS outbreak in Korea: focus on Pyeongtaek St. Mary’s Hospital: Kyung Min Kim, Moran Ki, Sung-il Cho, Minki Sung, Jin Kwan Hong, Hae-Kwan Cheong, Jong-Hun Kim, Sang-Eun Lee, Changhwan Lee, Keon-Joo Lee, Yong-Shik Park, Seung Woo Kim, Bo Youl Choi; Epidemiol Health. 2015;37:e2015041. Published online September 17, 2015; DOI: https://doi.org/10.4178/epih/e2015041

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study investigated the epidemiologic features of the confirmed cases of Middle East Respiratory Syndrome (MERS) in Pyeongtaek St. Mary’s Hospital, where the outbreak first began, in order to identify lessons relevant for the prevention and control of future outbreaks.

METHODS

The patients’ clinical symptoms and test results were collected from their medical records. The caregivers of patients were identified by phone calls.

RESULTS

After patient zero (case #1) was admitted to Pyeongtaek St. Mary’s Hospital (May 15-May 17), an outbreak occurred, with 36 cases between May 18 and June 4, 2015. Six patients died (fatality rate, 16.7%). Twenty-six cases occurred in the first-generation, and 10 in the second-generation. The median incubation period was five days, while the median period from symptom onset to death was 12.5 days. While the total attack rate was 3.9%, the attack rate among inpatients was 7.6%, and the inpatients on the eighth floor, where patient zero was hospitalized, had an 18.6% attack rate. In contrast, caregivers and medical staff showed attack rates of 3.3% and 1.1%, respectively.

CONCLUSIONS

The attack rates were higher than those of the previous outbreaks in other countries. The outbreak spread beyond Pyeongtaek St. Mary’s Hospital when four of the patients were moved to other hospitals without appropriate quarantine. The best method of preventing future outbreaks is to overcome the vulnerabilities observed in this outbreak, such as ward crowding, patient migration without appropriate data sharing, and the lack of an initial broad quarantine.

Summary

Korean summary
평택성모병원에서는 총 36명의 메르스 환자가 발생하여 이중 6명이 사망하였다. 또한 평택성모병원 유행의 발병률은 기존에 알려진 것보다 높았다. 한국의 메르스 유행이 시작된 평택성모병원에서 나타난 초기 방역 부족, 적절한 정보공유 없이 환자들이 병원간에 이동하는 것, 혼잡한 병동 문제 등의 감염병 전파 취약점을 극복하는 것이 향후 새로운 감염병 유행을 막을 수 있는 최선의 방법이 될 것이다.

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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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Abstract Summary PDF Supplementary 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.

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MERS-Editorial

2015 MERS outbreak in Korea: hospital-to-hospital transmission: Moran Ki; Epidemiol Health. 2015;37:e2015033. Published online July 21, 2015; DOI: https://doi.org/10.4178/epih/e2015033

57,286 View
447 Download
52 Web of Science
166 Crossref

Abstract Summary PDF Supplementary Material

Abstract

The distinct characteristic of the Middle East Respiratory Syndrome (MERS) outbreak in South Korea is that it not only involves intra-hospital transmission, but it also involves hospital-to-hospital transmission. It has been the largest MERS outbreak outside the Middle East, with 186 confirmed cases and, among them, 36 fatal cases as of July 26, 2015. All confirmed cases are suspected to be hospital-acquired infections except one case of household transmission and two cases still undergoing examination. The Korean health care system has been the major factor shaping the unique characteristics of the outbreak. Taking this as an opportunity, the Korean government should carefully assess the fundamental problems of the vulnerability to hospital infection and make short- as well as long-term plans for countermeasures. In addition, it is hoped that this journal, Epidemiology and Health, becomes a place where various topics regarding MERS can be discussed and shared.

Summary

Korean summary
한국의 메르스 유행은 병원내 감염뿐 아니라 병원에서 병원으로 전파되는 양상을 보인 것이 특징이다. 사우디아라비아 다음으로 가장 많은 환자가 발생하였는데 전체 확진자는 186명이고, 이중에 사망자는 36명이다. 확진자 대부분이 병원에서 감염된 것으로 추정된다. 가족간 감염이 의심되는 경우는 1명정도이며, 2명은 경로를 조사중인데 이중에 한명은 지역사회 감염이 의심된다. 한국의 의료체계 특성이 이번 유행에 중요한 요인이 되었다. 이 기회에 한국은 병원감염관리에 취약한 우리의 근본적인 문제점을 살펴서 장단기적인 대책을 마련하여야 할 것이다. 또한 역학회지가 메르스와 관련된 다양한 주제가 논의되는 장이 되기를 바란다.

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International Journal of Environmental Research and Public Health.2021; 18(7): 3530. CrossRef
Avoidance of Healthcare Utilization in South Korea during the Coronavirus Disease 2019 (COVID-19) Pandemic
Minjung Lee, Myoungsoon You
International Journal of Environmental Research and Public Health.2021; 18(8): 4363. CrossRef
Depinar, a drug that potentially inhibits the binding and entry of COVID-19 into host cells based on computer-aided studies
Meysam Yazdani, Jafar Khezri, Nastaran Hadizadeh, Javad Zamani Amir Zakaria, Mousa Naderi, Sahar Mahmoodian, Ali Asghar Karkhanei, Farideh Razi, Mohammad Hossein Sanati, Ehsan Hashemi
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JCI Insight.2021;[Epub] CrossRef
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Abdullah M Alnuqaydan, Abdulmajeed G Almutary, Arulmalar Sukamaran, Brian Tay Wei Yang, Xiao Ting Lee, Wei Xuan Lim, Yee Min Ng, Rania Ibrahim, Thiviya Darmarajan, Satheeshkumar Nanjappan, Jestin Chellian, Mayuren Candasamy, Thiagarajan Madheswaran, Ankur
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European Journal of Pharmacology.2021; 906: 174248. CrossRef
Design a pediatric isolation bed and characterization of its purification efficacy in ambient air
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Biosafety and Health.2021; 3(3): 172. CrossRef
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Soo Kang, Tae Kyu Ahn, Young Ho Seo, Young Ju Suh, Jin Hui Paik
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Hayoung Choi
The Korean Journal of Internal Medicine.2021; 36(5): 1061. CrossRef
Brief on Recent Application of Liposomal Vaccines for Lower Respiratory Tract Viral Infections: From Influenza to COVID-19 Vaccines
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Indian Journal of Medical Research.2021; 153(3): 287. CrossRef
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Minjung Lee, Youngkee Ju, Myoungsoon You
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Rajaa M. Al-Raddadi, Omaima I. Shabouni, Zeyad M. Alraddadi, Abdulmohsen H. Alzalabani, Ahmad M. Al-Asmari, Adel Ibrahim, Abdullatif Almarashi, Tariq A. Madani
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International Journal of Environmental Research and Public Health.2020; 17(1): 305. CrossRef
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Salah T. Al Awaidy, Ali Abdullah Al Maqbali, Iyad Omer, Suad Al Mukhaini, Mohammed Ali Al Risi, Majed Sultan Al Maqbali, Ali Al Reesi, Mujahid Al Busaidi, Fatma Hashim Al Hashmi, Talib Khamis Al Maqbali, Vidyanand Vaidya, Elham Said Ahmed Al Risi, Talib K
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Minjung Lee, Myoungsoon You
International Journal of Environmental Research and Public Health.2020; 17(9): 2977. CrossRef
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Enhancing hospital event-based surveillance system – Findings from a pilot study, Vietnam, 2017-2018
Satoko Otsu, Hien Do, Tuan Anh Ha, Tu H. Ngo, Quang D. Tran, Orla Condell, Tuan V. Le, Nghia D. Ngu, Thanh V. Hoang, Tan Q. Dang, Phu D. Tran, Phuong T. N. Tran, Anh T. Lai, Masaya Kato, Cindy Chiu
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Anca Docea, Aristidis Tsatsakis, Dana Albulescu, Oana Cristea, Ovidiu Zlatian, Marco Vinceti, Sterghios Moschos, Dimitris Tsoukalas, Marina Goumenou, Nikolaos Drakoulis, Josef Dumanov, Victor Tutelyan, Gennadii Onischenko, Michael Aschner, Demetrios Spand
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Yanqun Wang, Jing Sun, Xiaobo Li, Airu Zhu, Wenda Guan, De-Qiang Sun, Mian Gan, Xuefeng Niu, Jun Dai, Lu Zhang, Zhaoyong Zhang, Yongxia Shi, Shuxiang Huang, Chris Ka Pun Mok, Zifeng Yang, Zhongfang Wang, Wenjie Tan, Yimin Li, Ling Chen, Rongchang Chen, Ma
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A Canary in a COVID Coal Mine: Building Better Healthcare Biopreparedness Policy
Saskia Popescu
World Medical & Health Policy.2020; 12(3): 223. CrossRef
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Qing-Bin Lu, Yong Zhang, Ming-Jin Liu, Hai-Yang Zhang, Neda Jalali, An-Ran Zhang, Jia-Chen Li, Han Zhao, Qian-Qian Song, Tian-Shuo Zhao, Jing Zhao, Han-Yu Liu, Juan Du, Ai-Ying Teng, Zi-Wei Zhou, Shi-Xia Zhou, Tian-Le Che, Tao Wang, Tong Yang, Xiu-Gang Gu
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Mujeeb Khan, Syed F. Adil, Hamad Z. Alkhathlan, Muhammad N. Tahir, Sadia Saif, Merajuddin Khan, Shams T. Khan
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Japanese Journal of Infectious Diseases.2019; 72(3): 160. CrossRef
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International Journal of Nursing Studies.2019; 91: 70. CrossRef
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Royal Society Open Science.2019; 6(3): 181164. CrossRef
Comparative Analysis of Eleven Healthcare-Associated Outbreaks of Middle East Respiratory Syndrome Coronavirus (Mers-Cov) from 2015 to 2017
Sibylle Bernard-Stoecklin, Birgit Nikolay, Abdullah Assiri, Abdul Aziz Bin Saeed, Peter Karim Ben Embarek, Hassan El Bushra, Moran Ki, Mamunur Rahman Malik, Arnaud Fontanet, Simon Cauchemez, Maria D. Van Kerkhove
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A Novel Bacterium-Like Particle Vaccine Displaying the MERS-CoV Receptor-Binding Domain Induces Specific Mucosal and Systemic Immune Responses in Mice
Entao Li, Hang Chi, Pei Huang, Feihu Yan, Ying Zhang, Chuanyu Liu, Zhenshan Wang, Guohua Li, Shengnan Zhang, Ruo Mo, Hongli Jin, Hualei Wang, Na Feng, Jianzhong Wang, Yuhai Bi, Tiecheng Wang, Weiyang Sun, Yuwei Gao, Yongkun Zhao, Songtao Yang, Xianzhu Xia
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BMC Pulmonary Medicine.2019;[Epub] CrossRef
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Gender Difference in the Effects of Outdoor Air Pollution on Cognitive Function Among Elderly in Korea
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Frontiers in Public Health.2019;[Epub] CrossRef
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A Case Study Evaluating the Risk of Infection from Middle Eastern Respiratory Syndrome Coronavirus (MERS‐CoV) in a Hospital Setting Through Bioaerosols
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Myoung-don Oh, Wan Beom Park, Sang-Won Park, Pyoeng Gyun Choe, Ji Hwan Bang, Kyoung-Ho Song, Eu Suk Kim, Hong Bin Kim, Nam Joong Kim
The Korean Journal of Internal Medicine.2018; 33(2): 233. CrossRef
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Canadian Journal of Infectious Diseases and Medical Microbiology.2018; 2018: 1. CrossRef
Chaperna-Mediated Assembly of Ferritin-Based Middle East Respiratory Syndrome-Coronavirus Nanoparticles
Young-Seok Kim, Ahyun Son, Jihoon Kim, Soon Bin Kwon, Myung Hee Kim, Paul Kim, Jieun Kim, Young Ho Byun, Jemin Sung, Jinhee Lee, Ji Eun Yu, Chan Park, Yeon-Sook Kim, Nam-Hyuk Cho, Jun Chang, Baik L. Seong
Frontiers in Immunology.2018;[Epub] CrossRef
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International Journal of Nursing Practice.2018;[Epub] CrossRef
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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
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A. Bleibtreu, S. Jaureguiberry, N. Houhou, D. Boutolleau, H. Guillot, D. Vallois, J. C. Lucet, J. Robert, B. Mourvillier, J. Delemazure, M. Jaspard, F. X. Lescure, C. Rioux, E. Caumes, Y. Yazdanapanah
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Aidan Findlater, Isaac I. Bogoch
Trends in Parasitology.2018; 34(9): 772. CrossRef
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Ryan Aguanno, Ahmed ElIdrissi, Amgad A. Elkholy, Peter Ben Embarek, Emma Gardner, Rebecca Grant, Heba Mahrous, Mamunur Rahman Malik, Gounalan Pavade, Sophie VonDobschuetz, Lidewij Wiersma, Maria D. Van Kerkhove
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Svenja Veit, Sylvia Jany, Robert Fux, Gerd Sutter, Asisa Volz
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Alex R Cook, Xiahong Zhao, Mark I C Chen, Eric A Finkelstein
BMJ Open.2018; 8(2): e017355. CrossRef
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Yonsei Medical Journal.2017; 58(1): 174. CrossRef
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Yaseen M. Arabi, Hanan H. Balkhy, Frederick G. Hayden, Abderrezak Bouchama, Thomas Luke, J. Kenneth Baillie, Awad Al-Omari, Ali H. Hajeer, Mikiko Senga, Mark R. Denison, Jonathan S. Nguyen-Van-Tam, Nahoko Shindo, Alison Bermingham, James D. Chappell, Mari
New England Journal of Medicine.2017; 376(6): 584. CrossRef
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Hassan E. El Bushra, Hussain A. Al Arbash, Mutaz Mohammed, Osman Abdalla, Mohamed N. Abdallah, Zayid K. Al-Mayahi, Abdallah M. Assiri, Abdulaziz A. BinSaeed
American Journal of Infection Control.2017; 45(5): 502. CrossRef
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Jung Wan Park, Keon Joo Lee, Kang Hyoung Lee, Sang Hyup Lee, Jung Rae Cho, Jin Won Mo, Soo Young Choi, Geun Yong Kwon, Ji-Yeon Shin, Jee Young Hong, Jin Kim, Mi-Yeon Yeon, Jong Seok Oh, Hae-Sung Nam
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Clinical Infectious Diseases.2017; 64(suppl_2): S167. CrossRef
A novel neutralizing monoclonal antibody targeting the N-terminal domain of the MERS-CoV spike protein
Yingzhu Chen, Shuai Lu, Hao Jia, Yao Deng, Jianfang Zhou, Baoying Huang, Yueyang Yu, Jiaming Lan, Wenling Wang, Yongliang Lou, Kun Qin, Wenjie Tan
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Hyunho Jeong, Sikyoung Jeong, Juseok Oh, Seon Hee Woo, Byung Hak So, Jeong Hee Wee, Ji Hoon Kim, Ji Yong Im, Seung Pill Choi, Kyoungnam Park, Byul Nim Hee Cho, Sungyoup Hong
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Original Article

Demographic characteristics and intravenous drug use among hepatitis C patients in the Kota Setar district, Kedah, Malaysia: Wei Leong Tan, Goh Yihui, Muhammad Radzi Abu Hassan; Epidemiol Health. 2015;37:e2015032. Published online July 10, 2015; DOI: https://doi.org/10.4178/epih/e2015032

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Abstract PDF

Abstract

OBJECTIVES
This study explored the demographic characteristics of hepatitis C patients in the Kota Setar (KS) district, Kedah, Malaysia, the prevalence of intravenous drug use (IVDU) as a risk factor among these patients, and the associations between IVDU and demographic characteristics.

METHODS

Retrospective data pertaining to 713 patients from January 2009 to December 2013 were retrieved from hospital and disease notification records for analysis. The risk factors for hepatitis C virus (HCV) infection were grouped into IVDU and non-IVDU risk factors for analysis using multiple logistic regression.

RESULTS

Of the hepatitis C patients included in this study, the most common age group was 31 to 40 years (30.2%), and male patients (91.2%) made up the overwhelming majority. Ethnic Malays constituted approximately 80.4% of the patients, and IVDU was the main risk factor (77.8%) for HCV infection. Multiple logistic regression showed that male patients were 59 times more likely to have IVDU as a risk factor for HCV infection. Single patients were 2.5 times more likely to have IVDU as a risk factor. Patients aged ≥71 years were much less likely than patients aged ≤30 years to have IVDU as a risk factor for HCV infection.

CONCLUSIONS

IVDU was found to be an important risk factor for HCV infection among patients in the KS district. The factors associated with IVDU included age, sex, and marital status. Appropriate preventive measures should be developed to target the groups in which IVDU is most likely to be a risk factor for HCV infection.

Summary

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Reviews

Tularemia, a re-emerging infectious disease in Iran and neighboring countrie: Afsaneh Zargar, Max Maurin, Ehsan Mostafavi; Epidemiol Health. 2015;37:e2015011. Published online February 22, 2015; DOI: https://doi.org/10.4178/epih/e2015011

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Abstract PDF

Abstract

OBJECTIVES
Tularemia is a zoonotic disease transmitted by direct contact with infected animals and through arthropod bites, inhalation of contaminated aerosols, ingestion of contaminated meat or water, and skin contact with any infected material. It is widespread throughout the northern hemisphere, including Iran and its neighbors to the north, northeast, and northwest.

METHODS

In this paper, the epidemiology of tularemia as a re-emerging infectious disease in the world with a focus on Iran and the neighboring countries is reviewed.

RESULTS

In Iran, positive serological tests were first reported in 1973, in wildlife and domestic livestock in the northwestern and southeastern parts of the country. The first human case was reported in 1980 in the southwest of Iran, and recent studies conducted among at-risk populations in the western, southeastern, and southwestern parts of Iran revealed seroprevalences of 14.4, 6.52, and 6%, respectively.

CONCLUSIONS

Several factors may explain the absence of reported tularemia cases in Iran since 1980. Tularemia may be underdiagnosed in Iran because Francisella tularensis subspecies holarctica is likely to be the major etiological agent and usually causes mild to moderately severe disease. Furthermore, tularemia is not a disease extensively studied in the medical educational system in Iran, and empirical therapy may be effective in many cases. Finally, it should be noted that laboratories capable of diagnosing tularemia have only been established in the last few years. Since both recent and older studies have consistently found tularemia antibodies in humans and animals, the surveillance of this disease should receive more attention. In particular, it would be worthwhile for clinical researchers to confirm tularemia cases more often by isolating F. tularensis from infected humans and animals.

Summary

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Major infectious diseases affecting the Afghan immigrant population of Iran: a systematic review and meta-analysis: Behzad Pourhossein, Amin Doosti Irani, Ehsan Mostafavi; Epidemiol Health. 2015;37:e2015002. Published online January 7, 2015; DOI: https://doi.org/10.4178/epih/e2015002

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Abstract PDF

Abstract

OBJECTIVES
As Afghans make up the largest group of foreign nationals in Iran, the aim of this study was to assess the proportion of Afghan immigrants among those afflicted by the most prevalent infectious diseases in Iran.

METHODS

National and international online scientific databases were searched through November 2013. The reference lists of included studies were also searched. All descriptive studies concerning the most common infectious diseases in Iran, including tuberculosis, multiple-drug-resistant tuberculosis, malaria, cholera, Crimean-Congo hemorrhagic fever, leishmaniasis, and hepatitis B were retrieved. The nationality of patients was not considered. The selection of studies and data extraction was performed separately by two authors. Results were reported using a random effect model with a 95% confidence interval (CI).

RESULTS

The overall proportion of Afghan immigrants with the aforementioned infectious diseases was 29% (95% CI, 21 to 37). According to a stratified analysis, the proportion of Afghan immigrants afflicted with tuberculosis was (29%), multiple-drug-resistant tuberculosis (56%), malaria (40%), cholera (8%), Crimean-Congo hemorrhagic fever (25%), leishmaniasis (7%), and hepatitis B (14%).

CONCLUSIONS

It is highly recommended to monitor the health status of the Afghan immigrants when entering Iran, to reduce the spread of communicable diseases, which are viewed as serious in international health regulations.

Summary

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Original Articles

Prevalence of fungal infections using National Health Insurance data from 2009-2013, South Korea: Hee Jung Yoon, Hwa Young Choi, Young Kwon Kim, Yeong Jun Song, Moran Ki; Epidemiol Health. 2014;36:e2014017. Published online September 11, 2014; DOI: https://doi.org/10.4178/epih/e2014017

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The symptoms of fungal infections vary from minor to severe. According to recent reports, fungal infection prevalence is increasing due to increases in the aging population and in patients with compromised immune systems. However, the total prevalence of fungal infections in South Korea is unknown. We investigated the recent 5-year prevalence of each type of fungal infection in South Korea across age, sex, and regional groups.

METHODS

Nationwide data from the National Health Insurance of South Korea were used. The target population included patients who had received treatment for a fungal infection that was listed as the main disease. For each patient, multiple treatments were counted as one case per year in the data analysis.

RESULTS

The annual prevalence of all-type mycoses increased from 6.9% in 2009 to 7.4% in 2013. Among the specific groups, the prevalence of dermatophytosis was highest (5.2%), followed by that of opportunistic mycoses (1.7%) and superficial mycoses (0.2%). The prevalence of subcutaneous mycoses and generalized mycoses was very low (8 cases per 100,000 persons and 3 cases per 1 million persons, respectively).

CONCLUSIONS

Every year, approximately 7.1% of the Korean population receives treatment for fungal diseases. Cases of opportunistic mycoses are assumed to increase each year. Therefore, further research is needed to understand and monitor the prevalence of mycoses to establish management policies to reduce the burden of fungal diseases.

Summary

Korean summary
2009-2013년도 한국의 건강보험자료를 활용하여 진균 종류별로 연령별, 성별, 지역별 유병률을 검토하였다. 그 결과 한국 인구의 약 7.1%가 매년 진균 질환으로 치료를 받고 있는 것으로 나타났다. 특히 기회감염 진균증의 연도별 증가 양상이 관찰되었다. 진균증 유병률에 대한 이해와 관심이 필요하며 이를 토대로 진균 질환 관리 정책 수립이 필요하다.

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The costs of hepatitis A infections in South Korea: Kyohyun Kim, Baek-Geun Jeong, Moran Ki, Mira Park, Jin Kyung Park, Bo Youl Choi, Weon-Seob Yoo; Epidemiol Health. 2014;36:e2014011. Published online August 18, 2014; DOI: https://doi.org/10.4178/epih/e2014011

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Abstract PDF Supplementary Material

Abstract

OBJECTIVES
The incidence of hepatitis A infections among young adults has recently increased in South Korea. Although universal vaccination has often been suggested to mitigate the problem, its rationale has not been well-understood. Estimating the societal costs of hepatitis A infections might support the development of intervention strategies.

METHODS

We classified hepatitis A infections into eight clinical pathways and estimated the number of occurrences and cost per case for each clinical pathway using claim data from National Health Insurance and several national surveys as well as assumptions based on previous studies. To determine the total costs of a hepatitis A infection, both direct and indirect costs were estimated. Indirect costs were estimated using the human-capital approach. All costs are adjusted to the year 2008.

RESULTS

There were 30,240 identified cases of hepatitis A infections in 2008 for a total cost of 80,873 million won (2.7 million won per case). Direct and indirect costs constituted 56.2% and 43.8% of the total costs, respectively. People aged 20-39 accounted for 71.3% of total cases and 74.6% of total costs. Medical costs per capita were the lowest in the 0-4 age group and highest in the 20-29 age group.

CONCLUSIONS

This study could provide evidence for development of cost-effective interventions to control hepatitis A infections. But the true costs including uncaptured and intangible costs of hepatitis A infections might be higher than our results indicate.

Summary

Citations

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The Korean Journal of Internal Medicine.2019; 34(6): 1297. CrossRef
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Nosocomial Bloodstream Infection in Intensive Care Unit in a General Hospital.: Ki Sook Kim, Soonduck Kim, Sunmi Ji, Jesuk Lee; Korean J Epidemiol. 2007;29(1):70-79.

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Abstract PDF: Abstract
PURPOSE
Despite of the development of recent medical technology, bloodstream infection (BSI) still has significant influences on mortality and morbidity of patients admitted to the ICU. The BSI has the second most frequent site. Especially BSI in ICU have higher infection rate than general ward. This study was investigated the incidence rate of the nosocomial BSI, risk factors and bacterial pathogens of BSI in ICU for a general hospital.
METHODS
This study was carried out for those 443 patients in ICU of general hospital during the period from March 2002 to February 2003. The definition for BSI was based on that of CDC. Data was collected by questionnaire, medical record review. The statistical SPSS(ver. 10.0) was used to analyze data that included chi-square, t-test and logistic regression.
RESULTS
In the incidence rates of the BSI were 76.7 in 1,000 per patients, 7.0 in per 1,000 patients days and 32.1 in per 1,000 patients with central lines, 3.2 in per 1,000 cental line days. In the incidence rates of the BSI by type of ICU showed MICU 10.1, SICU 2.9 in per 1,000 patients days. The significant risk factors were identified as type of ICU(OR=5.119, p=0.001), length of stay(OR=1.039, p=0.001). The causal microbes of the BSI were CNS 35.5%, MRSA 23.6%. The bacterial pathogens of central catheter-related BSI were CNS 50%, MRSA 50%.
CONCLUSION
The occurrence of ICU-acquired infection was significantly related to the increase in morbidity and mortality. Ongoing targeted surveillance and infection control strategies is necessary to control this problem.; Summary

Infection of Methicillin-Resistant S. Aureus Nasal Carriage in the Community Pediatric Population.: Jiyoung Park, Soonduck Kim, Jesuk Lee; Korean J Epidemiol. 2006;28(2):171-181.

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Abstract PDF: Abstract
PURPOSE
Methcillin-resistant Staphylococcus aureus(MRSA) is known as a major cause of hospital acquired infection. The infection with MRSA bacteria is becoming frequent in the community because there are many people who have risk factors with low immunity. This study is intended to investigate the prevalence of MRSA in children and determine risk factors using genetic analysis.
METHODS
Children aged between 3 and 7 years were recruited from six preschool institutions from Nov. 2004 to Feb. 2005 based in Seoul, Gyeonggi Province and Gyeongsang Province. A questionnaires was distributed to 1,000 parent of these children along with the letter of consent. A total of 242 questionnaires were collected and used for this study. Nasal secretion samples were collected using sterilized specimen containers and incubated in culture medium using mannitol salt agar to separate S. aureus. MRSA samples were identified through coagulase test and MICRO SCAN. PCR was performed on MRSA isolates to detect genetic sequence specific of MRSA.
RESULTS
Of total 242 respondents, 16(6.6%) were found to be positive for MRSA. By residence area, 2(1.9%) out of 103 were positive in Seoul, 4(10.3%) out of 39 were positive in Gyeonggi Province and 10(10.0%) out of 100 were positive in Gyeongsang Province, showing a significant difference(p=0.037). A logistics regression was performed to evaluate the influences of variables that were significant. Gyeongsang Province had prevalence of MRSA(OR=5.520), and Gyeonggi Province(OR=5.710). Based on PCR, the distribution of genotypes of MRSA showed various patterns. But there was no difference between regions.
CONCLUSIONS
MRSA infection was high in children when one of their parents were working in hospital or when one of their family members have underlying disease. This study provided evidence that the prevalence of MRSA is largely influenced by individual element such as family and health condition.; Summary

Outbreak of Salmonellosis Misdiagnosed with Amebiasis in Gumi City and Chilgok County, Korea.: Hyun Sul Lim, Geun Ryang Bae, Tai Soon Yong; Korean J Epidemiol. 2002;24(1):54-62.

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Abstract PDF: Abstract
PURPOSE
S: In May 29, 1999, the health department in Gumi city received a report from a local pediatrician that three children who attended a kindergarten were diagnosed with amebic dysentery. By May 31, fifteen more children from the same kindergarten were diagnosed with amebic dysentery. We conducted an investigation in order to verify the diagnosis, and to implement appropriate control measures.
METHODS
We conducted a questionnaire survey on 264 children in 3 kindergarten in Gumi city. Furthermore, 726 children in 4 kindergarten and 13 academies in Chilgok county whose lunch is supplied by the same unlicensed catering company were monitored for diarrheal symptoms.
RESULTS
Of 264 children in Gumi city, 74 children fitted the case definition (attack rate, 28%). Of 726 children in Chilgok county, 50 children were reported to have diarrheal symptoms. The clinical picture was dominated by the following symptoms; abdominal pain (85.1%), fever (83.8%), headache (50.0%), chilling (45.9%), vomiting (28.4%). The median duration of diarrhea was 2 days, and the median frequency of diarrhea was 3 times/day. Salmonella Typhimurium of the same antibiogram pattern were isolated from fifteen cases. However, no evidence of amebiasis was found from laboratory results or epidemiologic pattern.
CONCLUSIONS
: This epidemic was caused by Salmonella Typhimurium, which were present in lunch supplied by the unlicensed catering company. Improvement of the diagnostic ability in local health centers as well as public health centers and reinforcement of strict protocols regarding appropriate management of catering services should be emphasized; Summary

An Epidemiologic Study on the Nosocomial Bloodstream Infection in Two Hospitals.: Mi Jeung Ahn, Chang Kyu Lee, Chae Seung Lim, You Cheol Shin, Soon Duck Kim; Korean J Epidemiol. 2001;23(2):33-43.

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Abstract PDF: Abstract
PURPOSE
In this study, nosocomial bloodstream infection rate and fatality rate for 774 and 386 patients, who whose blood cultivation were obtained after 48 hours of hospitalization between March 1999 and February 2000 in two university hospitals, were sought. A distribution of etiologic agent and risk factors of the nosocoial bloodstream infection were also investigated.
METHODS
This study was carried out through medical record review and a structural questionnaire. Besides registers of microbe cultivation in the department of clinical pathology and medical records of patients were checked. The nosocomial bloodstream infection was also checked through medical records of patients using the standard of CDC. Statistical analysis were performed using SAS 6.12.
RESULTS
The nosocomial bloodstream infection rate in hospital K and hospital A were 3.9 and 3.5 per 1,000 discharged patients, respectively. Although the rates were increased accoding to patients' age, they were different by medical departments, showing the highest level in the ICU. The fatality rate from nosocomial bloodstream infection in hospital K and hospital A were 12.5% and 21.8%, respectively. A distribution of etiologic agent of the nosocomial bloodstream infection in hospital K was 17 cases(21.8%) of Coagulase negative staphylococcus(CNS), 12 cases(15.0%) of Staphylococcus aureus and 8 cases(10.0%) of Enterococcus spp. For hospital A, it was 14 cases925.4%) of Coagulase negative taphylococcus(CNS), 9 cases(16.4%) of Staphylococcus aureus and 7 cases(12.7%) of Klebsiella pneumoniae. While risk factors of the nosocomial bloodstream infection edentified in hospital K were ICU, intracranial injury and hospitalization period, those for hospital A were a use of the central nenous tube, intracranial injury and hospitalization period.
CONCLUSION
It is expected that nosocomial bloodstream infection increases as aged group increases by the change of the population structure, as the usage of invasive instrument increases by development of new medical instrument as well as large scale hospitals. For these reasons, further studies developing countermeasures against nosocomial bloodstream infection are recommended.; Summary

An Epidemiologic Study on Sudden Deaths of Cattle Occurred in Kyongju.: Hyun Sul Lim, Hae Kwan Cheong, Jung Ran Kim, Ik Jung Kim, Gyoung Yim Ha; Korean J Epidemiol. 2001;23(1):59-68.

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Abstract PDF: Abstract
PURPOSE
This study was conducted to provide the baseline data for the epidemiologic and microbiologic investigation for the etiology of sudden deaths of cattle in Sara-Ri, Seo Myun, Kyongju.
METHODS
This survey was performed between April 11 and 22, 1994. Epidemiologic investigation consisted of interview of the residents, as well as pathologic and microbiologic test on tissues and blood samples from cardiac puncture.
RESULTS
The dead numbers of cattle were 149 in 35 households during about 20 years. The cows(63.9%) were more than bulls(36.1%) and most of them were raised in playpen(95.7%). The first death occurred in 1974, and then number of deaths increased until 1994. Besides the age of cattle at death was over two years old (88.3%), most of them(69.4%) died within one hour after onset of noticeable symptom by the farmers. The most common symptom of cattle at death was 'sudden death after screaming(71.1%)' and 'seizure (33.3%)'. Colonies from blood of case 3 showed double hemolysis in blood agar plate. The microbiologic test results in the culture of Clostridium perfringens. The pathological features were characterized as most of renal tubules revealed coagulative necrosis. Some gram-positive bacilli are scattered in interstitium.
CONCLUSIONS
Above results suggest C. perfringens as a possible pathogen of this ourbreak in livestock. The possibility of human infection, although nonfatal, and lack of vaccination against C. perfringens raises a need for stronger preventive action toward this communicable disease of cattle on this village.; Summary

Measles Outbreak among Institutional Infants after Hospital Infection.: Hyung Cheol Park, Eun Young Park, Sun Hee Cho, Young Jun Choi, Hyun Kyun Ki, Young Hwa Jung, Kyung Rye Moon, So Yeon Ryu, Ki Soon Kim; Korean J Epidemiol. 2001;23(1):50-58.

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Abstract PDF: Abstract
PURPOSE
S: This study was to investigate the source of infection, mode of transmission and incidence of a measles outbreak among infants living in a Gwangju welfare institution in July 2000.
METHODS
The information about 63 children was collected through the nurses interview and blood sampling and laryngopharyngeal swab were conducted to the children. In addition, an epidemiologic survey was performed to confirm the infection dissemination route.
RESULTS
Before the outbreak, two children living at the institution were admitted to a university hospital for other health problems. These children shared a room with a 5 year old diagnosed with meningitis who was later diagnosed as having measles after rashes appeared. The two children developed measles after returning to their institution and the infection spread to other children in the institution. Among 63 children observed, 14 children(22.2%) developed measles, secondary attack rate of measles due to index cases was 19.7%. And 78.6% of the patients were between 4 and 8 months old. The room where the index case lived showed an attack rate of 81.8%, which is a much higher rate compared to other rooms. The attack rate among boys(26.0%) was higher than that of girls(12.5%), but it was not statistically significant.
CONCLUSIONS
This outbreak was considered to be a nosocomial infection, where the index cases were admitted to a hospital, infected and the infection spread to children. Further studies are necessary to find out the maternal antibody levels of infants of post-vaccinated mothers and the optimal age for measles vaccination.; Summary

Factors for Chronic Hepatitis Defined as Elevated Level of Aminotransferases among Koreans.: Jin Ho Chun, Jong Tae Lee, Hae Sook Sohn; Korean J Epidemiol. 1999;21(1):53-63.

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Sustained abnormal liver function is closely associated with chronic hepatitis in Korea with high prevalence of hepatitis B infection. Follow up about AST and ALT on 839 adults(male 727, female 112) was executed with interval of at least 6 months for 2 years to evaluate the factors contribute to the progression of chronic hepatitis. HBsAg, HBsAb, anti-HCV, body mass index(BMI), total cholesterol, fasting blood sugar(FBS), Clonorchis sinensis in stool(Cs), fatty liver on abdominal sonogram and alcohol habit were also checked. We defined abnormal liver function as both of AST 35 U/L and ALT 50 U/L. As the result of first time liver function test(LFT), the frequency of abnormal liver function was 13.6%(114/839). The positive rate of HBsAg and HBsAb was 7.0% and 73.9%, respectively, and the positive rate of anti-HCV and Cs was 0.7% and 1.3%. As the result of the follow up, 6.2%(52/839) in total has a tendency of chronic hepatitis with sustained abnormal LFT. Among abnormal LFT, 45.6%(52/114) was sustained LFT abnormality, and 12.8%(93/725) was aggravated LFT abnormality from normal LFT at the first check. From these results, male and hepatitis B infection were evaluated as important factors for the progression of chronic hepatitis. HBsAb considered that has a protective effect to the progression of chronic hepatitis. Therefore, even though no symptoms or sign, periodic examination for hepatitis B marker and LFT is important to control the chronic hepatitis, especially for male. Furthermore, because only 25%(13/52) of sustained abnormal LFT was HBsAg positive, it suggests that further study for evaluating the factors except hepatitis B infection would be needed for the control of chronic hepatitis.; Summary

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