Epidemiology and Health

Original Articles

Epidemiological features of the 2024 pertussis outbreak in Gyeonggi Province, Korea: Yeon Hwa Chang, Kyujin Chang, Yeong Jun Ju; Epidemiol Health. 2025;47:e2025072. Published online December 13, 2025; DOI: https://doi.org/10.4178/epih.e2025072

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Abstract Summary PDF: Abstract
OBJECTIVES
In 2024, Korea experienced a nationwide pertussis epidemic, with Gyeonggi Province accounting for nearly one-third of reported cases. This study investigated the epidemiological characteristics of the outbreak and explored the association between vaccination history and healthcare utilization.
METHODS
We analyzed 14,275 pertussis cases reported in Gyeonggi Province in 2024 using de-identified national surveillance data. Comparisons were performed by age group (<20 vs. ≥20 years) and vaccination status (<20 years). The chi-square and Mann–Whitney U tests were used, and effect sizes were assessed using Cramér’s V.
RESULTS
Of all cases, 89.8% occurred in individuals <20 years, particularly those aged 10-14 years. Children and adolescents were more often involved in clusters and had more identified contacts than adults, whereas adults had higher rates of hospitalization (13.2 vs. 5.9%) and emergency visits (4.4 vs. 0.9%; p<0.001). Among individuals <20 years, hospitalization was more common in the unvaccinated or unknown group (11.7%) than in the fully (5.9%) or partially vaccinated (5.5%) groups (p=0.045).
CONCLUSIONS
The epidemic was concentrated in school-aged populations, particularly adolescents. While vaccination status showed a limited association with healthcare utilization, individuals who were unvaccinated or had an undocumented vaccination history experienced delayed diagnosis and higher care needs. These findings highlight the importance of strengthening adolescent-focused vaccination strategies and preparedness for future pertussis outbreaks.; Summary

Korean summary
2024년 한국의 백일해 유행에 대해 총 인구의 1/4이 거주하는 경기도 유행을 분석한 결과, 학령기 청소년에 집중적으로 발생하였으며 미접종 또는 접종력 불명확일 때 진단 지연 및 더 많은 의료 이용과 연관되었다. 백일해 재유행 예방을 위해서는 청소년에 초점을 맞춘 전략 개선이 필요하다.

Key Message
Analysis of the pertussis epidemic in Gyeonggi Province, home to one quarter of the national population, during the 2024 outbreak in Korea showed that cases were concentrated among school-aged adolescents. Individuals who were unvaccinated or had an undocumented vaccination history experienced delayed diagnosis and higher care needs. Improving adolescent-focused prevention strategies is essential to prevent pertussis re-emergence.

A large-scale norovirus outbreak associated with kimchi consumption across multiple schools in a Korean city in 2024: Eunkyung Park, Sumi Cho, Eunyoung Kim, Jung Im Park, Ju-Hyung Lee, Jin Gwack; Epidemiol Health. 2025;47:e2025057. Published online October 3, 2025; DOI: https://doi.org/10.4178/epih.e2025057

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Norovirus is a major global concern for foodborne outbreaks. We investigated a large-scale norovirus outbreak in a Korean city to identify the source of infection and implement control measures.
METHODS
A retrospective cohort study was conducted. Data were collected from questionnaires and laboratory test results, along with an environmental investigation. Human and environmental samples were obtained.
RESULTS
The overall attack rate was 20.2%, with 862 cases among 4,276 individuals exposed across 24 affected schools. Norovirus GII.17 was detected in symptomatic individuals, asymptomatic food handlers, and cabbage kimchi products. Kimchi consumption was significantly associated with illness (relative risk, 3.85; 95% confidence interval [CI], 3.12 to 4.74) and was confirmed as the outbreak source. In multivariate logistic regression, both high school status (odds ratio [OR], 1.49; 95% CI, 1.11 to 2.00) and kimchi consumption (OR, 5.56; 95% CI, 4.24 to 7.30) emerged as significant risk factors.
CONCLUSIONS
Kimchi contamination likely occurred either through ingredients or food handlers during the manufacturing process. This study provides key insights for prevention and rapid response to norovirus outbreaks, emphasizing the vulnerability of school food services. We highlight the importance of stringent food safety practices and routine training for food handlers, particularly in manufacturing facilities, given the role of asymptomatic carriers.; Summary

Korean summary
학교를 중심으로 발생한 대규모 노로바이러스 유행에 대한 역학조사 결과 오염된 김치가 원인으로 추정되었다. 이번 유행은 학교 등 단체 음식을 제공하는 식품 제조 과정에서 식재료 위생 및 무증상 조리종사자에 대한 관리의 중요성을 시사한다.

Key Message
An epidemiological investigation into a large-scale norovirus outbreak associated with 24 schools identified contaminated kimchi as the likely source. The outbreak underscores the critical need for proper hygiene management of food ingredients and effective control of asymptomatic food handlers during the preparation of mass meals in institutional settings such as school food services.

An outbreak of Clostridium perfringens infection on a training ship anchored in Busan, Korea: Seonmi Kim, Hyunjin Son; Epidemiol Health. 2024;46:e2024086. Published online November 7, 2024; DOI: https://doi.org/10.4178/epih.e2024086

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Abstract Summary PDF

Abstract

OBJECTIVES
In September 2023, an outbreak of food-borne disease occurred among students on a training ship docked in Busan. This was an epidemiological investigation with the aim of improving infection prevention activities and group meal service practices on board ships.

METHODS

In this study, a case was defined as an individual who experienced diarrhea more than twice a day during their training period aboard the training ship. A total of 171 exposed individuals including 6 food handlers was well-defined; therefore, a retrospective cohort study was conducted. We administered a questionnaire and conducted laboratory tests including 38 rectal swab samples. Relative risk (95% confidence interval) for each food item was calculated.

RESULTS

Of the 165 students and school staff members, 41 met the case definition, resulting in an attack rate of 24.8%; all cases were students. The shape of the epidemic curve was unimodal, with the peak from 00:00 to 06:00 on September 7, 2023. Clostridium perfringens was detected in 9 cases, and no other pathogens were found. Significant relative risk was shown in 11 different food items.

CONCLUSIONS

C. perfringens was the causative pathogen of this outbreak on the training ship. Due to the lack of preserved food samples, the exact source of infection could not be confirmed. Ships are not classified as collective dining facilities, leaving them in a management blind spot. Therefore, specialized guidelines, voluntary inspections by the operating entities, and continuous education for managers and staff are necessary.

Summary

Korean summary
부산의 훈련선에서 발생한 식중독은 Clostridium perfringens에 감염되어 발생한 것으로 확인되었으며, 165명 중 24.8%가 감염되었고, 2023년 9월 7일 0시에서 6시 사이에 유행곡선의 정점을 기록했다. 본 연구는 선박이 집단 급식시설로 분류되지 않아 관리의 사각지대에 놓인 점을 감안하여, 전문적인 가이드라인과 지속적인 교육, 자발적인 점검이 필요함을 제언하고 있다.

Key Message
A food-borne disease outbreak occurred on a training ship in Busan, affecting a significant number of people with Clostridium perfringens infection. Among the 165 people, the attack rate was 24.8%, with the epidemic peak occurring between 0:00 and 06:00 on September 7, 2023. This study recommends implementing specialized guidelines, voluntary inspections, and continuous education to improve infection prevention practices on ships, which are not classified as collective dining facilities and thus remain in a management blind spot.

Citations

Citations to this article as recorded by

Antimicrobial Resistance on Ships: A Narrative Review
Yusuff Adebayo Adebisi, Adeola Bamisaiye, Don Eliseo-Lucero Prisno
Infectious Diseases Now.2025; 55(2): 105027. CrossRef
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

Epidemiologic Investigation

Salmonellosis outbreaks linked to eggs at 2 gimbap restaurants in Korea: Jun Suk Eun, Joohyun Han, Ji-Hyun Lim, Eunkyung Shin, Junyoung Kim, Da-Jung Ko, Jaeil Yoo, Sungil Kim, Jin Sook Kim, Jung Sub Park, Ji-Hyuk Park; Epidemiol Health. 2024;46:e2024036. Published online March 7, 2024; DOI: https://doi.org/10.4178/epih.e2024036

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Salmonellosis outbreaks occurred at 2 restaurants 2 days apart, and an epidemiological investigation was conducted to determine whether the outbreaks were connected.

METHODS

Case studies were conducted for both outbreaks. Stool samples were collected from individuals, and food samples were collected from the restaurants. Pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing analyses were performed on outbreak-related Salmonella enterica serovar Enteritidis (Salmonella Enteritidis) isolates. Traceback investigations were also conducted for the ingredients from gimbap restaurants A and B.

RESULTS

In total, 106 people from gimbap restaurant A and 5 from gimbap restaurant B met the case definition. Salmonella Enteritidis was detected in samples from 2 food handlers, 22 patients, and 1 food (iceberg lettuce) at gimbap restaurant A and from 1 patient at gimbap restaurant B. According to PFGE, all isolates were identified as SEGX01.089. The molecular typing of all isolates showed the same pattern, and the genetic distance was close according to phylogenetic analysis. Eggs were the only food ingredient that was supplied to both gimbap restaurants.

CONCLUSIONS

The outbreaks were caused by Salmonella Enteritidis, and the source of infections was suspected to be contaminated eggs. To prevent foodborne outbreaks of Salmonella, restaurants should heat eggs sufficiently, and egg farms need to establish management systems that prevent Salmonella infections.

Summary

Korean summary
동일한 도시의 두 식당에서 2일 간격으로 살모넬라감염증 유행이 발생하여, 원인을 확인하고 두 유행 간에 연관이 있는지를 규명하기 위해 역학조사를 시행하였다. 병원체에 대한 유전자형 분석과 식재료 역추적조사 결과를 바탕으로 두 유행은 Salmonella Enteritidis에 의해 발생하였고, 감염원은 동일한 농장에서 공급된 오염된 계란으로 추적하였다.

Key Message
Salmonellosis outbreaks occurred at 2 restaurants in the same city 2 days apart, and epidemiological investigations were conducted to identify the causes and determine whether the outbreaks were connected. Based on the genetic characterization of the pathogens and traceback investigation of the food ingredients, the outbreaks were caused by Salmonella Enteritidis and the source of infection was traced to contaminated eggs, which were supplied from the same farm.

Citations

Citations to this article as recorded by

Bacteriophage emulsion for prevention of Salmonella contamination in eggshells
Su Jin Jo, Sang Guen Kim, Sib Sankar Giri, Sung Bin Lee, Jae Hong Park, Mae Hyun Hwang, Da Sol Park, Eun Jae Park, Se Chang Park
International Journal of Food Microbiology.2026; 445: 111470. CrossRef
Gompertz-derived growth kinetics of Salmonella enterica serovar Bareilly inoculated in precooked ingredients for Gimbap
Jae-Hyun Yoon, Hyunji Song, Euijin Choo, Sun-Young Lee
Food Science and Biotechnology.2025; 34(10): 2353. CrossRef
Emergence of Distinct Salmonella enterica Serovar Enteritidis Lineage since 2020, South Korea
Eunkyung Shin, Tae-Min La, Jaeil Yoo, Junyoung Kim, Ji-Yeon Hyeon
Emerging Infectious Diseases.2025;[Epub] CrossRef
A Novel Lytic Salmonella Phage Harboring an Unprecedented Tail-Protein Domain Combination Capable of Lysing Cross-Host-Transmitted Salmonella Strains
Ling Zhang, Mingqiang Guo, Xiaoyu Ma, Wei Wang, Wanpeng Ma, Yifan Liu, Junxiang Wei, Zhanqiang Su
Foods.2025; 14(16): 2850. CrossRef
Emergency department outcomes of children with non-typhoidal Salmonella gastroenteritis: a single-center cohort study with adult comparators
Da Som Hwang, Hwan Sun Moon, Min-Jung Kim, So-Hyun Paek
Pediatric Emergency Medicine Journal.2025;[Epub] CrossRef
2019–2022년 국내 수인성‧식품매개감염병 원인세균 병원체 감시현황
문의 홍, 은경 신, 준영 김, 재일 유
Public Health Weekly Report.2024; 17(45): 1941. CrossRef

COVID-19: Original Article

Clinical symptom profile of hospitalized COVID-19 Brazilian patients according to SARS-CoV-2 variants: Natália Satchiko Hojo-Souza, Vander Luis de Souza Freitas, Daniel Ludovico Guidoni, Fernanda Sumika Hojo de Souza; Epidemiol Health. 2023;45:e2023079. Published online August 28, 2023; DOI: https://doi.org/10.4178/epih.e2023079

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Abstract Summary PDF

Abstract

OBJECTIVES
The aim of this study was to investigate the prevalence of the main symptoms in Brazilian coronavirus disease 2019 (COVID-19) patients hospitalized during 4 distinct waves, based on their infection with different severe acute respiratory disease coronavirus 2 (SARS-CoV-2) variants.

METHODS

This study included hospitalized patients who tested positive for SARS-CoV-2 during 15 weeks around the peak of each of 4 waves: W1, ancestral strain/B.1 lineage (May 31 to September 12, 2020); W2, Gamma/P.1 variant (January 31 to May 15, 2021); W3, Omicron variant (December 5, 2021 to March 19, 2022); and W4, BA.4/BA.5 subvariants (May 22 to September 3, 2022). Symptom data were extracted from the Brazilian Severe Acute Respiratory Syndrome Database. Relative risks were calculated, and an analysis of symptom networks was performed.

RESULTS

Patients who were hospitalized during the prevalence of the Gamma/P.1 variant demonstrated a higher risk, primarily for symptoms such as fatigue, abdominal pain, low oxygen saturation, and sore throat, than patients hospitalized during the first wave. Conversely, patients who were hospitalized during the predominance of the Omicron variant exhibited a lower relative risk, particularly for symptoms such as loss of smell, loss of taste, diarrhea, fever, respiratory distress, and dyspnea. Similar results were observed in COVID-19 patients who were hospitalized during the wave of the Omicron subvariants BA.4/BA.5. A symptom network analysis, conducted to explore co-occurrence patterns among different variants, revealed significant differential profiles across the 4 waves, with the most notable difference observed between the W2 and W4 networks.

CONCLUSIONS

Overall, the relative risks and patterns of symptom co-occurrence associated with different SARS-CoV-2 variants may reflect disease severity.

Summary

Key Message
The study highlights the varying prevalence and distinct symptom profiles among Brazilian COVID-19 patients hospitalized during different waves linked to specific SARS-CoV-2 variants. It suggests that the manifestation of symptoms differs significantly across variant-driven waves, signifying potential shifts in disease severity. Specifically, patients during the Gamma/P.1 variant wave showed higher risks for symptoms like fatigue, abdominal pain, and respiratory impairment, while those during the Omicron wave exhibited lower risks for certain symptoms like loss of smell and taste, indicating changing symptomatology and potentially evolving disease impact linked to different variants.

Citations

Citations to this article as recorded by

Analysis of longitudinal social media for monitoring symptoms during a pandemic
Shixu Lin, Lucas Garay, Yining Hua, Zhijiang Guo, Wanxin Li, Minghui Li, Yujie Zhang, Xiaolin Xu, Jie Yang
Journal of Biomedical Informatics.2025; 162: 104778. CrossRef
Gastrointestinal symptoms in COVID-19 and disease severity: a Japanese registry-based retrospective cohort study
Yuta Matsubara, Hiroki Kiyohara, Yohei Mikami, Kosaku Nanki, Ho Namkoong, Shotaro Chubachi, Hiromu Tanaka, Shuhei Azekawa, Shinya Sugimoto, Yusuke Yoshimatsu, Tomohisa Sujino, Kaoru Takabayashi, Naoki Hosoe, Toshiro Sato, Makoto Ishii, Naoki Hasegawa, Yuk
Journal of Gastroenterology.2024; 59(3): 195. CrossRef
Prevalence and Factors Associated with Olfactory Dysfunction in Individuals with COVID-19 in Brazil: A Study of 20,669 Cases from 2020 to 2021
Carlos Dornels Freire de Souza, Amanda Júlia de Arruda Magalhães, Yasmin Vitória Silva Nobre, Carlos Alberto Souza, André Luis Oliveira do Nascimento, Luísa Robalinho de Faria, Márcio Bezerra-Santos, Anderson da Costa Armstrong, Jandir Mendonça Nicácio, O
Medical Principles and Practice.2024; 33(2): 164. CrossRef
Risks of Adverse Outcomes for Hospitalized COVID-19 Patients during the Four Waves in Brazil According to SARS-CoV-2 Variants, Age Group, and Vaccine Status
Natália Satchiko Hojo-Souza, Waasila Jassat, Daniel Ludovico Guidoni, Fernanda Sumika Hojo de Souza
Viruses.2023; 15(10): 1997. CrossRef

Epidemiologic Investigations

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

An outbreak of neurologic symptoms among patients exposed to an unknown stench in a high school near an industrial complex: an epidemiological investigation: Kiook Baek, Seongmin Jo, Chulyong Park, Joon Sakong; Epidemiol Health. 2022;44:e2022105. Published online November 9, 2022; DOI: https://doi.org/10.4178/epih.e2022105

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Seven students at a high school in Korea visited the emergency room with non-specific neurological symptoms after a stench was noticed during a school entrance ceremony. In relation to this incident, 105 patients visited medical institutions over 5 days. A team of environmental and epidemiological experts was assembled to investigate the incident.
METHODS
Our team of experts participated in the investigation 1 month post-incident. Previously, only air samples had been analyzed. We received results of air samples analyzed by other investigators, medical records of some students, and data from police interviews of patients. Additional investigation and interviews were conducted, and the events were reconstructed in spatial and temporal order.
RESULTS
A cluster of patients was observed on the south side and parts of the north side of the upper floor. A stench like that reported during the incident had been noticed for about 2 years near the school. Students consistently described a similar stench occurring frequently in the vicinity of the school. According to student statements, the odor mainly resembled something burning. The carboxyhemoglobin levels of some students were observed to be >1.5%.
CONCLUSIONS
In the investigation, 2 suspected sources were identified: a science room storing chemicals downstairs from the auditorium and various industrial facilities near the school. Combining the scattered evidence, we considered a toxic puff of gas, perhaps from brief incineration or leakage in a specific area, to be the likely cause of the incident. We describe our approach and the limitations encountered during the investigation.; Summary

Korean summary
본 논문은 일개 고등학교에서 원인미상의 악취와 함께 100명 이상의 환자가 발생한 사건에 대한 조사과정을 담은 문헌이다. 본 연구진은 사건 발생 후 약 1달 후에 조사진에 합류하였으며, 발생 당시 환자 분포 점지도 작성, 인근 지역 사업장 및 악취발생 장소 점지도 작성, 사건 전후 시계열적 사건분석, 기상자료, 관계자 인터뷰 자료 분석 등의 역학적 기법을 동원하여 원인을 인근 지역에서 발생한 퍼프 가스의 유입으로 추정하였다. 본 사건의 원인은 결국 미제로 종결되었지만 추후 유사 사례 발생시 본 조사의 방법론을 참고할 수 있을 것이며, 의료진의 조기 개입을 수행하지 못함으로 인한 초기 상세 인터뷰 자료 확보, 생체 시료 수집 등이 이루어지지 못한 본 조사 과정의 한계점을 반면교사로 삼을 수 있을 것이다.

Key Message
This paper presents an investigation of an outbreak of over 100 patients experiencing an unexplained odor in a high school. The research team utilized epidemiological methods, including dot mapping, temporal analysis of events, and interview data analysis. The source of the odor was estimated to be the inflow of puff gas from surrounding areas. Although the toxic puff gas discharge facility was not identified, sharing the experience from this investigation could help with future investigations of similar incidents.

Analysis of the on-ship transmission of the COVID-19 mass outbreak on the Republic of Korea Navy amphibious warfare ship: Soo Hyeon Cho, Young-Man Kim, Gyeongyong Seong, Sunkyun Park, Seoncheol Park, Sang-Eun Lee, Young Joon Park; Epidemiol Health. 2022;44:e2022065. Published online August 11, 2022; DOI: https://doi.org/10.4178/epih.e2022065

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This investigation was conducted to determine the size and pattern, source, and transmission route of the coronavirus disease 2019 (COVID-19) outbreak on the Republic of Korea Navy (ROKN) amphibious warfare ship.

METHODS

We investigated the characteristics of all crew members and tracked the medical records of the confirmed cases. Fourteen essential ship operation personnel were interviewed. The study design was a retrospective cohort study, and the incidence rate ratio was through a statistical program.

RESULTS

The COVID-19 incidence on the ROKN amphibious warfare ship was 44.7% (38/85). It was estimated that the main propagation route started from the 1st floor worker, which spread to the same floor, and then to other floors. In the case of the working area, the incidence rate of crew members below the 1st floor without ventilation was higher than those on the 2nd or higher floors with natural ventilation.

CONCLUSIONS

This case is the first case of a COVID-19 outbreak on the ROKN amphibious warfare ship, and it is estimated that the incidence rate is high because of the closed and dense environment. To prevent the spread of various respiratory diseases including COVID-19, unified mitigation such as vaccination, observing personal quarantine rules, periodic ventilation, preemptive testing, and blocking transmission through prompt contact management is necessary.

Summary

Korean summary
본 조사는 국내 첫 해군 상륙함 내 코로나19 집단발생의 규모 및 양상, 감염원과 전파경로를 규명하기 위해 수행되었다. 해군 상륙함에서의 발생률은 44.7%였으며 자연 환기가 가능한 2층 이상 근무자에 비해 환기가 불가능한 1층 이하 근무자의 발생률이 높았고 이는 통계적으로 유의했다. 밀폐된 환경에서 밀접한 생활을 하는 해군 상륙함의 특성을 고려하여 개인방역수칙 준수, 주기적 환기, 선제적 검사, 신속한 접촉자 관리 등을 통한 전파 차단이 필요할 것으로 판단된다.

Key Message
This investigation was conducted to determine the size and pattern of the outbreak of the COVID-19 infection, the source of infection and the transmission route on the ROK Navy Amphibious Warfare ship. The incidence on ROKN Amphibious Warfare ship was 44.7% (38/85) and the incidence rate of crew members below the first floor without ventilation was higher than those on the second floor or higher with natural ventilation. To prevent various respiratory diseases including COVID-19, unified mitigation such as vaccination, observing personal quarantine rules, periodic ventilation, preemptive testing, and blocking transmission through prompt contact management is necessary.

Citations

Citations to this article as recorded by

Indoor Air Quality and COVID-19: A Scoping Review
Axelle Braggion, Adeline Dugerdil, Olwen Wilson, Francesca Hovagemyan, Antoine Flahault
Public Health Reviews.2024;[Epub] CrossRef

Investigation of a human brucellosis outbreak in Douz, Tunisia, 2018: Nejib Charaa, Rabaa Ghrab, Aicha Ben Othman, Mohamed Makhlouf, Hejer Ltaief, Nissaf Ben Alaya, Mohamed Chahed; Epidemiol Health. 2022;44:e2022048. Published online May 18, 2022; DOI: https://doi.org/10.4178/epih.e2022048

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Abstract Summary PDF

Abstract

OBJECTIVES
In 2017, the incidence of human brucellosis in Tunisia was 9.8 per 100,000 population. In the Douz district, 2 cases were reported in March 2018. Prior to that date, the last indigenous cases to be reported in Douz had been in 2015. This study aimed to identify the source of this new contamination and recommend control interventions.

METHODS

This case-control study included residents of Douz who presented with clinical symptoms of brucellosis and had a subsequent Wright test antibody titer ≥ 1/160. The controls were neighbors of the infected cases who had a negative Rose Bengal test. Univariate and multivariate analyses were performed to estimate the odds ratios of risk factors. Goats belonging to the cases and controls were actively screened.

RESULTS

Twenty-five infected cases and 52 uninfected controls were enrolled. All infected cases had consumed goat milk and 92% had purchased it from the same breeder. Consumption of goat milk from this breeder (adjusted odds ratio [aOR], 30.78; 95% confidence interval [CI], 6.47 to 235.91) and overall consumption of raw goat milk (aOR, 14.84; 95% CI, 2.04 to 310.44) were independent risk factors for brucellosis. The breeder had 18 goats, 5 of which were smuggled from a neighboring country. Three of those goats were diagnosed with brucellosis.

CONCLUSIONS

Consumption of raw milk from smuggled sick goats was the main risk factor in this outbreak. The sick goats were slaughtered and an education campaign was conducted. Vaccination, control of cross-border animal movements, and control of goat milk sales must be strengthened to prevent the spread of brucellosis in southwestern Tunisia.

Summary

Key Message
Human brucellosis, despite being a major economic and health problem and the availability of proven control methods, is still endemic in North African countries. The scarcity of epidemiological data, under-reporting, certain weaknesses in surveillance systems and the lack of well-conducted outbreak investigations, contribute to this endemic state. This field epidemiological investigation of a human brucellosis outbreak highlighted the importance of serological surveillance, the slaughter of infected animals, vaccination, control of animal movements across borders and pasteurization of milk in the fight against this disease.

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Utilization of AI – reshaping the future of food safety, agriculture and food security – a critical review
Jerina Rugji, Zeki Erol, Fulya Taşçı, Laura Musa, Ambreen Hamadani, Migena Gjoni Gündemir, Esa Karalliu, Shahida Anusha Siddiqui
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Geospatial analysis of open-source intelligence data to early detect laboratory-acquired infections, using the 2019 brucellosis laboratory leak in China as a case study
Atalay Goshu Muluneh, Samsung Lim, Aye Moa, Chandini Raina Maclntyre
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Long ignored but making a comeback: a worldwide epidemiological evolution of human brucellosis
Zhiguo Liu, Liping Gao, Miao Wang, Min Yuan, Zhenjun Li
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An outbreak of hepatitis A associated with salted clams in Busan, Korea: Hyunjin Son, Miyoung Lee, Youngduck Eun, Wonseo Park, Kyounghee Park, Sora Kwon, Seungjin Kim, Changhoon Kim; Epidemiol Health. 2022;44:e2022003. Published online December 29, 2021; DOI: https://doi.org/10.4178/epih.e2022003

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590 Download
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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
In July 2019, there were multiple reports on patients with hepatitis A among the visitors of a restaurant in Busan. The current study presents the results of an epidemiological investigation and outlines the supplementary measures that would help with hepatitis A control.

METHODS

A cohort study was conducted for all 2,865 customers who visited restaurant A from June to July. Using a standardized questionnaire, participants reported the presence of hepatitis A symptoms and whether they had consumed any of 19 food items. As for participants who had visited public health centers, their specimens were collected.

RESULTS

From the study cohort, 155 participants (5.4%) had confirmed hepatitis A. The epidemic curve was unimodal, and the median number of days from the restaurant visit to symptom onset was 31 days. A genotype analysis indicated that 89 of 90 tested patients had hepatitis A virus (HAV) genotype 1A. The results of a multivariate logistic regression analysis indicated that the ingestion of salted clams increased the risk of hepatitis A by 68.12 times (95% confidence interval [CI], 9.22 to 510.87). In an unopened package of salted clams found and secured through traceback investigation, HAV genotype 1A was detected.

CONCLUSIONS

To prevent people from ingesting uncooked clams, there needs to be more efforts to publicize the dangers of uncooked clams; the food sampling test standards for salted clams should also be expanded. Furthermore, a laboratory surveillance system based on molecular genetics should be established to detect outbreaks earlier.

Summary

Korean summary
2019년 7월, 부산시의 한 식당을 방문한 사람에서 다수의 A형간염 환자가 신고되었다. 2019년 6월 1일부터 7월 28일까지 해당 식당을 방문하여 카드 결제를 한 사람과 동반자 2,865명 전체를 대상으로 코호트 조사를 수행하였다. A형간염에 확진 된 사람은 총 155명으로 발병률은 5.4%였다. 다변량 로지스틱 회귀분석 결과 조개젓 섭취는 A형간염 발병 위험을 68.62배(95% CI, 9.22 to 510.87) 증가시키는 것으로 나타났다. 익히지 않은 조개류를 섭취하지 않도록 더욱 홍보를 강화해야 한다.

Key Message
In July 2019, there were multiple reports on patients with hepatitis A among the visitors of a restaurant in Bu¬san. A cohort study was conducted for all 2,865 customers who visited the restaurant from June to July. From the study cohort, 155 participants (5.4%) had confirmed hepatitis A. The results of a multivariate logistic regression analysis indicated that the ingestion of salted clams increased the risk of hepatitis A by 68.12 times. To prevent people from ingesting uncooked clams, there needs to be more efforts to publicize the dangers of uncooked clams.

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Five‐Year Molecular Surveillance Reveals Widespread Foodborne Enteric Viruses in Bivalve Mollusks From Golfo Nuevo, Argentina
Camila Frydman, Samuel Miño, Elena Barbieri, Solange Galeano, Sergio Ramon Vaudagna, Viviana Parreño, Marina Mozgovoj
Journal of Food Science.2025;[Epub] CrossRef
Gender differences in hepatitis A seropositivity rates according to the Republic of Korea’s vaccination policy
Hyunjin Son, Sunhyun Ahn, Wonseo Park, Gayoung Chun, Unyeong Go, Sang Gon Lee, Eun Hee Lee
Osong Public Health and Research Perspectives.2024; 15(2): 168. CrossRef
Investigating the spatio-temporal variation of hepatitis A in Korea using a Bayesian model
Jaehong Jeong, Mijeong Kim, Jungsoon Choi
Frontiers in Public Health.2023;[Epub] CrossRef
A Study on the Detection Rate of Hepatitis A from Gastroenteritis Patients and the Genotype Analysis of Hepatitis A Virus in Busan
Sun Hee Park, Chanhee Kim, Summi Lee, Jihye Jeong, Junghye Choi, Seung Ju Lee
Journal of Bacteriology and Virology.2023; 53(2): 74. CrossRef
A Study on the Detection Rate of Hepatitis A from Gastroenteritis Patients and the Genotype Analysis of Hepatitis A Virus in Busan
Sun Hee Park, Chanhee Kim, Summi Lee, Jihye Jeong, Junghye Choi, Seung Ju Lee
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International Journal of Biometeorology.2022; 66(9): 1725. CrossRef

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

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Abstract Summary PDF

Abstract

OBJECTIVES
Coronavirus disease 2019 (COVID-19) outbreaks in general hospitals are particularly risky because they not only overburden the regional healthcare delivery system, but also increase the possibility of community transmission. This study shares an experience of a COVID-19 outbreak response in a general hospital in Gyeonggi Province, Korea.

METHODS

Since the first COVID-19 confirmed case was recognized in Hospital A on March 29, 2020, the Immediate Response Team of Gyeonggi Province and Korea Disease Control and Prevention Agency devised a plan to conduct an epidemiological investigation and minimize the paralysis of hospital functions. Apart from the epidemiological investigation, a risk assessment of the hospital and management of contacts, including patients and workers, were also undertaken.

RESULTS

In total, 72 confirmed cases were identified, including 26 hospitalized patients, 16 healthcare personnel, 7 visitors, and 22 cases identified externally. The majority of the confirmed cases were exposed in Ward B or were contacts of people exposed in Ward A (58.3% of 72 cases). Among healthcare personnel, caregivers were found to be the most vulnerable to COVID-19 in this outbreak.

CONCLUSIONS

Preparation for all possible situations in medical facilities is important because it is difficult to find alternative resources. The findings of this study provide information on controlling the further transmission of COVID-19 and furnish evidence of the importance of ordinary management skills to be prepared for COVID-19.

Summary

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

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

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Ayesha Imtiaz, Abdullah Y. Akkam, Lulwah H. AlThumali, Ahlam M. AlHarthi, Honey G. Porte, Wesal S. AlOsaimi, Maha M. A. AlAsmari, Rawda B. G. Salih, Biswadev Mitra
BMC Pediatrics.2025;[Epub] CrossRef
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Seonhee Ahn, Tae Jong Son, Yoonsuk Jang, Jihyun Choi, Young Joon Park, Jiseon Seong, Hyun Hee Kwon, Muk Ju Kim, Donghyok Kwon
Osong Public Health and Research Perspectives.2023; 14(3): 188. CrossRef
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Chul Young Yoon, Junhun Lee, Tae Hoon Kong, Young Joon Seo
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COVID-19 outbreak in a military unit in Korea: Chanhee Kim, Young-Man Kim, Namwoo Heo, Eunjung Park, Sojin Choi, Sehyuk Jang, Nayoung Kim, Donghyok Kwon, Young-Joon Park, Byeongseop Choi, Beomman Ha, Kyounghwa Jung, Changbo Park, Sejin Park, Heeyoung Lee; Epidemiol Health. 2021;43:e2021065. Published online September 8, 2021; DOI: https://doi.org/10.4178/epih.e2021065

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Abstract Summary PDF

Abstract

OBJECTIVES
This study presents the response of a military unit to an outbreak of coronavirus disease 2019 (COVID-19) in Gyeonggi Province. As soon as 2 soldiers were identified as index cases, the infectious disease investigators of the Gyeonggi Provincial Government, Korea Disease Control and Prevention Agency, and the Armed Forces Epidemiologic Investigation Center discussed the investigation and response plan for an imminent massive outbreak.

METHODS

The joint immediate response team (IRT) conducted interviews with confirmed COVID-19 patients, reviewed their medical records, performed contact tracing using global positioning system data, and undertook a field investigation. For risk assessment, the joint IRT visited all 8 sites of the military units and the army chaplain’s church to evaluate the transmission risk at each site. The evaluation items included the size of the site, the use of air conditioning, whether windows were opened, and whether masks were worn. Pooled testing was used for the low-risk population to quickly detect the spread of COVID-19 in the military base.

RESULTS

One day before the symptom onset of the index case, the lecturer and >50% of the attendees were infected with COVID-19 while attending a lecture that lasted 2 hours and 30 minutes. Attendees were not wearing masks and were in a poorly ventilated room.

CONCLUSIONS

Since COVID-19 can be spread before symptom onset, contact tracing must be performed to investigate potential exposures prior to symptom onset and to manage any exposed persons.

Summary

Korean summary
본 연구는 경기도 군부대에서 발생한 코로나19 대응 경험을 공유하는 국내 최초의 연구 결과이다. 본 연구를 통해 정리된 역학조사 과정은 군부대, 기숙사, 교정시설 등 집단 시설의 방역 대책 수립에 도움이 될 것으로 기대한다. 또한, 이번 사례는 집단 감염 발생 시 여러 유관 기관의 협조 체계가 신속한 대응과 추가 전파 예방에 중요하다는 점을 시사한다.

Key Message
This study is the first research in South Korea to share the experience of responding to COVID-19 at the military unit in Gyeonggi-do. The epidemiological investigation process organized through this study is expected to help establish response measures for group facilities such as military units, dormitories, and correctional facilities. In addition, this case suggests that the cooperative system of various related organizations in the event of a mass infection is important for rapid response and prevention of further transmission.

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Yoonjung Kim, Eunyoung Lee, Boyeon Kim, Jinhee Cho, Sook-Won Ryu, Kyung-A Lee
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Osong Public Health and Research Perspectives.2022; 13(4): 263. CrossRef

COVID-19: Original Article

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

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Abstract Summary PDF Supplementary Material

Abstract

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Summary

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

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

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Jiwon Han, Eunok Jung
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Yi-Hsuan Chen, Chi-Tai Fang
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COVID-19: Brief Communication

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

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Abstract Summary PDF Supplementary Material

Abstract

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Summary

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

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COVID-19: Original Article

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

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378 Download
17 Web of Science
7 Crossref

Abstract Summary PDF Supplementary Material

Abstract

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Summary

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

Citations

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COVID-19: Original Article

Estimating the reproductive number and the outbreak size of COVID-19 in Korea: Sunhwa Choi, Moran Ki; Epidemiol Health. 2020;42:e2020011. Published online March 12, 2020; DOI: https://doi.org/10.4178/epih.e2020011

55,183 View
3,326 Download
156 Web of Science
146 Crossref

Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Since the first novel coronavirus disease 2019 (COVID-19) patient in Korea was diagnosed on January 20, 2020, 30 patients were diagnosed until February 17, 2020. However, 5,298 additional patients were confirmed until March 4, 2020. Therefore, our objective was to estimate the reproduction number (R) and evaluate the effectiveness of preventive measures.

METHODS

A COVID-19 transmission model (SEIHR) was established to suit the Korean outbreak. The number of daily confirmed cases in Daegu and North Gyeongsang Province (NGP), the main area of outbreak, was used. The first patient’ symptom onset date in the Daegu/NGP outbreak was assumed as January 22, 2020. The R according to the start date of the effect of preventive measures was estimated.

RESULTS

The estimated R in Hubei Province, China, was 4.0281, whereas the estimated initial R in Korea was 0.555, but later in Daegu/NGP, the value was between 3.472 and 3.543. When the transmission period decreases from 4-day to 2-day, the outbreak ends early, but the peak of the epidemic increases, and the total number of patients does not change greatly. It was found that, if transmission rate decreases, the outbreak ends early, and the size of the peak and the total number of patients also decreases.

CONCLUSIONS

To end the COVID-19 epidemic, efforts to reduce the spread of the virus, such as social distancing and wearing masks, are absolutely crucial with the participation of the public, along with the policy of reducing the transmission period by finding and isolating patients as quickly as possible through the efforts of the quarantine authorities.

Summary

Korean summary
수학적 모델링을 통하여 코로나-19 감염재생산수( R )와 대구, 경북의 유행 규모와 유행 종료 시점 등을 예측해보았다. 그 결과 중국 후베이성의 R=4, 한국 초기 30일간의 유행은 R=0.5, 대구/경북의 3월 4일까지의 유행은 R=3.5 수준으로 나타났다. 하지만 방역당국의 적극적인 코로나-19검사로 환자들의 감염전파기간이 짧아지고, 국민들의 마스크 쓰기, 사회적 거리두기 등의 감염 예방조치 적극 참여로 전파율이 낮아져 5월 1일경에 하루 환자 1명 수준으로 예측되었다.

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COVID-19: Special Article

Epidemiologic characteristics of early cases with 2019 novel coronavirus (2019-nCoV) disease in Korea: Moran Ki, Task Force for 2019-nCoV; Epidemiol Health. 2020;42:e2020007. Published online February 9, 2020; DOI: https://doi.org/10.4178/epih.e2020007

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Abstract Summary PDF Supplementary Material

Abstract

In about 20 days since the diagnosis of the first case of the 2019 novel coronavirus (2019-nCoV) in Korea on January 20, 2020, 28 cases have been confirmed. Fifteen patients (53.6%) of them were male and median age of was 42 years (range, 20-73). Of the confirmed cases, 16, 9, and 3 were index (57.2%), first-generation (32.1%), and second-generation (10.7%) cases, respectively. All first-generation and second-generation patients were family members or intimate acquaintances of the index cases with close contacts. Fifteen among 16 index patients had entered Korea from January 19 to 24, 2020 while 1 patient had entered Korea on January 31, 2020. The average incubation period was 3.9 days (median, 3.0), and the reproduction number was estimated as 0.48. Three of the confirmed patients were asymptomatic when they were diagnosed. Epidemiological indicators will be revised with the availability of additional data in the future. Sharing epidemiological information among researchers worldwide is essential for efficient preparation and response in tackling this new infectious disease.

Summary

Korean summary
2020년 1월 20일 한국의 신종코로나바이러스 감염자가 확진된 이후 약 20일만에 28명이 확진되었다. 확진자중 지표환자가 16명(57.2%), 1세대환자 9명(32.1%), 2세대환자가 3명(10.7%)이다. 지표환자 16명중 15명은 1월 19일-24일에, 1명은 1월 31일에 국내에 입국하였다. 환자들의 잠복기는 평균 3.9일 (중위값 3일), 감염재생산수(R)는 0.48로 추정되었다. 확진자 중 3명은 증상이 없는 상태에서 확진이 되었다. 향후 새로운 정보가 나오면 역학 지표들이 수정될 것이다.

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Original Article

Ebola virus disease outbreak in Korea: use of a mathematical model and stochastic simulation to estimate risk: Youngsuk Ko, Seok-Min Lee, Soyoung Kim, Moran Ki, Eunok Jung; Epidemiol Health. 2019;41:e2019048. Published online November 24, 2019; DOI: https://doi.org/10.4178/epih.e2019048

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
According to the World Health Organization, there have been frequent reports of Ebola virus disease (EVD) since the 2014 EVD pandemic in West Africa. We aim to estimate the outbreak scale when an EVD infected person arrives in Korea.

METHODS

Western Africa EVD epidemic mathematical model SEIJR or SEIJQR was modified to create a Korean EVD outbreak model. The expected number of EVD patients and outbreak duration were calculated by stochastic simulation under the scenarios of Best case, Diagnosis delay, and Case missing.

RESULTS

The 2,000 trials of stochastic simulation for each scenario demonstrated the following results: The possible median number of patients is 2 and the estimated maximum number is 11 when the government intervention is proceeded immediately right after the first EVD case is confirmed. With a 6-day delay in diagnosis of the first case, the median number of patients becomes 7, and the maximum, 20. If the first case is missed and the government intervention is not activated until 2 cases of secondary infection occur, the median number of patients is estimated at 15, and the maximum, at 35.

CONCLUSIONS

Timely and rigorous diagnosis is important to reduce the spreading scale of infection when a new communicable disease is inflowed into Korea. Moreover, it is imperative to strengthen the local surveillance system and diagnostic protocols to avoid missing cases of secondary infection.

Summary

Korean summary
본 연구는 수학적 모델과 확률 시뮬레이션 기법을 이용하여 국내에 유입되지 않았던 에볼라바이러스병(EVD)의 확산 위험도를 정량적으로 예측하는 첫 번째 연구이다. 또한 이 연구를 통해 에볼라바이러스병 환자의 유입 시 발생 가능한 진단 지연 혹은 유입 미인지 상황을 가정하여 발생할 수 있는 2차 감염자 수 및 감염 종식까지의 기간을 계산했고 에볼라바이러스 유입 대비 실시간모니터링의 중요성과 확산 시 상황에 따른 최대 일일 환자수를 합리적으로 제시할 수 있다.

Citations

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Estimating the Transmission Risk of COVID-19 in Nigeria: A Mathematical Modelling Approach
Irany FA, Akwafuo SE, Abah T, Mikler AR
Journal of Health Care and Research.2020; 1(3): 135. CrossRef

Special Article

Causes and countermeasures for repeated outbreaks of hepatitis A among adults in Korea: Moran Ki, Hyunjin Son, Bo Youl Choi; Epidemiol Health. 2019;41:e2019038. Published online September 22, 2019; DOI: https://doi.org/10.4178/epih.e2019038

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Abstract Summary PDF Supplementary Material

Abstract

The 2019 hepatitis A outbreak has become increasingly prevalent among adults in Korea and is the largest outbreak since that in 2009-2010. The incidence in the current outbreak is highest among adults aged 35-44 years, corresponding to the peak incidence among those aged 25-34 years 10 years ago. This may indicate a cohort effect in the corresponding age group. Causes of these repeated outbreaks of hepatitis A in Korea are low level of immunity among adults, Korean food culture that consumes raw seafood such as salted clam and inadequate public health system. Among countermeasures, along with general infectious disease control measures including control of the infectious agent, infection spread, and host, urgent actions are needed to review the vaccination policy and establish an adequate public health system.

Summary

Korean summary
2019년 한국 성인의 A형 간염 유행은 10년전 대규모 유행 이후 가장 큰 규모로발생하고 있다. 주 발생 연령이 10년전 유행보다 10세가 증가한 35-44세로 나타나 연령 코호트 효과라 볼 수 있다. 우리나라의 A형 간염 반복 유행의 원인은 성인의 낮은 집단면역수준, 어패류 생식문화, 공중보건의료체계 미비 등으로 보인다. 이에 대한 대책은 일반적인 감염관리대책인 감염원관리, 전파관리, 숙주관리와 함께 효율적인 백신접종정책, 공고한 공중보건관리체계 마련 등의 근본적 대책이 시급하다.

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From Outbreak to Action: The Need for Policy Change Based on Epidemiological Investigation of Hepatitis A in a Special Care Setting in Central Kerala
Sangeetha Merrin Varghese, C. S. Nandini, Amar Fettle, Abey Sushan, Libu Gnanaseelan Kanakamma, A. L. Sheeja, Betsy A. Jose, P. B. Boban, Prince Alexander
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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

27,776 View
442 Download
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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.

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Epidemiologic Investigation

Epidemiologic research on lung damage caused by humidifier disinfectants: Moo-Song Lee, Hwa Jung Kim; Epidemiol Health. 2016;38:e2016031. Published online July 20, 2016; DOI: https://doi.org/10.4178/epih.e2016031

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Abstract Summary PDF Supplementary Material

Abstract

In April 2011 a tertiary hospital located in Seoul, Korea reported several cases of severe respiratory distress of unknown origin in young adults. To find the route of transmission, causative agent and patient risk factors of the outbreak, an investigation of the epidemic was initiated. A hospital based case-control study was conducted to indicate that humidifier detergent use was the cause of the outbreak. This information led the Ministry of Health and Welfare of Korea issued an order that humidifier detergents should be withdrawn from the market. Here, we describe the major events of planning, execution, and interpretation of the study, and discussions between researchers and public authorities following the decision to perform an epidemiologic study, chronologically.

Summary

Korean summary
본 역학조사는 일개 병원에서 신고한 질병 유행에 대해 다학제적 연구 결과로써, 질병의 임상적 특성과 역학적 원인 파악 후 정책적 대책으로 이어진 사례이다. 향후 가습기 살균제 이외에도 일반국민의 건강에 영향을 미칠 수 있는 다양한 생활환경요인에 관심을 가지고, 필요 시 적극적인 조사와 대응이 필요할 것이다.

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Original Article

A cholera outbreak in Alborz Province, Iran: a matched case-control study: Ghobad Moradi, Mohammad Aziz Rasouli, Parvin Mohammadi, Elham Elahi, Hojatollah Barati; Epidemiol Health. 2016;38:e2016018. Published online May 14, 2016; DOI: https://doi.org/10.4178/epih.e2016018

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Abstract PDF

Abstract

OBJECTIVES
A total of 229 confirmed cholera cases were reported in Alborz Province during an outbreak that lasted from June 2011 to August 2011. This study aimed to identify potential sources of transmission in order to determine suitable interventions in similar outbreaks. In other words, the lessons learned from this retrospective study can be utilized to manage future similar outbreaks.

METHODS

An age-matched and sex-matched case-control study was conducted during the outbreak. For each case, two control subjects were selected from the neighborhood. A case of cholera was defined as a bacteriologically confirmed case with signs and symptoms of cholera. This study was conducted from June 14, 2011 through August 23, 2011. The data were analyzed by calculating odds ratios (ORs) using the logistic regression method.

RESULTS

In this outbreak, 229 confirmed cholera cases were diagnosed. The following risk factors were found to be associated with cholera: consumption of unrefrigerated leftover food (OR, 3.05; 95% confidence interval [CI], 1.72 to 5.41), consumption of vegetables and fruits in the previous three days (OR, 2.75; 95% CI, 1.95 to 3.89), and a history of traveling in the previous five days (OR, 5.31; 95% CI, 2.21 to 9.72).

CONCLUSIONS

Consumption of vegetables and fruits has remained an unresolved risk factor in cholera outbreaks in Iran in recent years. In order to reduce the risk of cholera, sanitary standards for fruits and vegetables should be observed at all points from production to consumption, the population should be educated regarding hygienic food storage during outbreaks, and sanitary standards should be maintained when traveling during cholera outbreaks.

Summary

Citations

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MERS-Epidemiologic Investigations

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.

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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

The first case of the 2015 Korean Middle East Respiratory Syndrome outbreak: Yong-Shik Park, Changhwan Lee, Kyung Min Kim, Seung Woo Kim, Keon-Joo Lee, Jungmo Ahn, Moran Ki; Epidemiol Health. 2015;37:e2015049. Published online November 14, 2015; DOI: https://doi.org/10.4178/epih/e2015049

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Abstract Summary PDF Supplementary Material

Abstract

This study reviewed problems in the prevention of outbreak and spread of Middle East Respiratory Syndrome (MERS) and aimed to provide assistance in establishing policies to prevent and manage future outbreaks of novel infectious diseases of foreign origin via in-depth epidemiological investigation of the patient who initiated the MERS outbreak in Korea, 2015. Personal and phone interviews were conducted with the patient and his guardians, and his activities in Saudi Arabia were investigated with the help of the Saudi Arabian Ministry of Health. Clinical courses and test results were confirmed from the medical records. The patient visited 4 medical facilities and contacted 742 people between May 11, 2015, at symptom onset, and May 20, at admission to the National Medical Center; 28 people were infected and diagnosed with MERS thereafter. Valuable lessons learned included: (1) epidemiological knowledge on the MERS transmission pattern and medical knowledge on its clinical course; (2) improvement of epidemiological investigative methods via closed-circuit television, global positioning system tracking, and review of Health Insurance Review and Assessment Service records; (3) problems revealed in the existing preventive techniques, including early determination of the various people contacted; (4) experiences with preventive methods used for the first time in Korea, including cohort quarantine; (5) reconsideration of the management systems for infectious disease outbreaks across the country, such as this case, at the levels of central government, local government, and the public; (6) reconsideration of hospital infectious disease management systems, culture involving patient visitation, and emergency room environments.

Summary

Korean summary
2015년 한국 메르스 유행의 발단이 된 첫 번째 환자의 역학조사를 통해 신종감염병의 국내 유입 경위 및 유행확산을 막기 위한 대응 과정의 문제점을 되짚어 보았다. 이를 통해 향후 신종감염병의 국내유입을 막기 위한 대비, 대응 정책 수립에 도움이 되길 바라며 이번 메르스 유행이 한국의 병원감염 관리 수준이 향상되는 계기가 되어야 할 것이다.

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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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Epidemiologic Parameters of the Middle East Respiratory Syndrome Outbreak in Korea, 2015
Sun Hee Park, Woo Joo Kim, Jin-Hong Yoo, Jung-Hyun Choi
Infection & Chemotherapy.2016; 48(2): 108. CrossRef
The Korean Middle East Respiratory Syndrome Coronavirus Outbreak and Our Responsibility to the Global Scientific Community
Myoung-don Oh
Infection & Chemotherapy.2016; 48(2): 145. CrossRef
Comparison of incubation period distribution of human infections with MERS-CoV in South Korea and Saudi Arabia
Victor Virlogeux, Vicky J. Fang, Minah Park, Joseph T. Wu, Benjamin J. Cowling
Scientific Reports.2016;[Epub] CrossRef
Structural Factors of the Middle East Respiratory Syndrome Coronavirus Outbreak as a Public Health Crisis in Korea and Future Response Strategies
Dong-Hyun Kim
Journal of Preventive Medicine and Public Health.2015; 48(6): 265. CrossRef
The first case of the 2015 Korean Middle East Respiratory Syndrome outbreak
Yong-Shik Park, Changhwan Lee, Kyung Min Kim, Seung Woo Kim, Keon-Joo Lee, Jungmo Ahn, Moran Ki
Epidemiology and Health.2015; 37: e2015049. CrossRef

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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Younsik Kim
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The impact of the Middle East Respiratory Syndrome coronavirus on inbound tourism in South Korea toward sustainable tourism
Yunseon Choe, Junhui Wang, HakJun Song
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Katelyn J. Yoo, Soonman Kwon, Yoonjung Choi, David M. Bishai
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Kristine M. Smith, Catherine C. Machalaba, Richard Seifman, Yasha Feferholtz, William B. Karesh
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Working experiences of nurses during the Middle East respiratory syndrome outbreak
Hee Sun Kang, Ye Dong Son, Sun‐Mi Chae, Colleen Corte
International Journal of Nursing Practice.2018;[Epub] CrossRef
Asymptomatic Middle East Respiratory Syndrome coronavirus infection using a serologic survey in Korea
Yeong-jun Song, Jeong-Sun Yang, Hee Jung Yoon, Hae-Sung Nam, Soon Young Lee, Hae-Kwan Cheong, Woo-Jung Park, Sung Han Park, Bo Youl Choi, Sung Soon Kim, Moran Ki
Epidemiology and Health.2018; 40: e2018014. CrossRef
Airflow as a Possible Transmission Route of Middle East Respiratory Syndrome at an Initial Outbreak Hospital in Korea
Minki Sung, Seongmin Jo, Sang-Eun Lee, Moran Ki, Bo Youl Choi, JinKwan Hong
International Journal of Environmental Research and Public Health.2018; 15(12): 2757. CrossRef
Surveillance and epidemiologic investigation in public health emergencies caused by infectious diseases
Moran Ki
Journal of the Korean Medical Association.2017; 60(4): 292. CrossRef
Identifying determinants of heterogeneous transmission dynamics of the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea, 2015: a retrospective epidemiological analysis
Hiroshi Nishiura, Akira Endo, Masaya Saitoh, Ryo Kinoshita, Ryo Ueno, Shinji Nakaoka, Yuichiro Miyamatsu, Yueping Dong, Gerardo Chowell, Kenji Mizumoto
BMJ Open.2016; 6(2): e009936. CrossRef
Epidemiologic Parameters of the Middle East Respiratory Syndrome Outbreak in Korea, 2015
Sun Hee Park, Woo Joo Kim, Jin-Hong Yoo, Jung-Hyun Choi
Infection & Chemotherapy.2016; 48(2): 108. CrossRef

MERS-Epidemiologic Investigation

MERS epidemiological investigation to detect potential mode of transmission in the 178th MERS confirmed case in Pyeongtaek, Korea: Kyujin Chang, Moran Ki, Eun Gyu Lee, Soon Young Lee, Byoungin Yoo, Jong Hyuk Choi; Epidemiol Health. 2015;37:e2015036. Published online August 15, 2015; DOI: https://doi.org/10.4178/epih/e2015036

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Abstract Summary PDF Supplementary Material

Abstract

Most cases of Middle East Respiratory Syndrome (MERS) infection in Korea (outbreak: May 11-July 4, 2015) occurred in hospital settings, with uncertain transmission modes in some cases. We performed an in-depth investigation epidemiological survey on the 178th case to determine the precise mode of transmission. A 29- year-old man living in Pyeongtaek presented on June 16 with a febrile sensation, chills, and myalgia. Upon confirmatory diagnosis on June 23, he was treated in an isolation room and discharged on July 2 after cure. An epidemiological investigation of all possible infection routes indicated two likely modes of transmission: exposure to MERS in Pyeongtaek St. Mary’s Hospital during a visit to his hospitalized father (May 18-29), and infection through frequent contact with his father between the latter’s referral to Pyeongtaek Good Samaritan Bagae Hospital for treatment without confirmatory diagnosis until his death (May 29-June 6). Although lack of clear proof or evidence to the contrary does not allow a definitive conclusion, all other possibilities could be excluded by epidemiological inferences. While it is impossible to trace back the modes of transmission of all cases in a large-scale outbreak, case-by-case tracking and isolation of infected individuals and those in close contact with them is important in preventing the spread. Efforts should be made to establish a methodology for rapid tracking of all possible contacts and elimination-based identification of the precise modes of transmission.

Summary

Korean summary
이 논문은 2015년 한국에서 새롭게 발생한 감염병인 메르스 유행 중, 감염경로가 불분명하였던 178번째 환자에 대한 심층 역학조사 과정과 결과를 기술한 것이며, 조사를 통해 얻은 교훈을 학계 및 관계자들과 공유하고자 한다. 조사 결과, 다른 사례들과 마찬가지로 병원감염으로 볼 수 있음을 밝힌다.

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Constructing big data prevention and control model for public health emergencies in China: A grounded theory study
Huiquan Wang, Hong Ye, Lu Liu
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Towards a novel peptide vaccine for Middle East respiratory syndrome coronavirus and its possible use against pandemic COVID-19
Salman Khan, Bilal Shaker, Sajjad Ahmad, Sumra Wajid Abbasi, Muhammad Arshad, Abdul Haleem, Saba Ismail, Anita Zaib, Wasim Sajjad
Journal of Molecular Liquids.2021; 324: 114706. CrossRef
Middle East Respiratory Syndrome (MERS) Virus—Pathophysiological Axis and the Current Treatment Strategies
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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Biomedicine & Pharmacotherapy.2020; 130: 110559. CrossRef
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
Risk Factors for Transmission of Middle East Respiratory Syndrome Coronavirus Infection During the 2015 Outbreak in South Korea
Seung Woo Kim, Jung Wan Park, Hee-Dong Jung, Jeong-Sun Yang, Yong-Shik Park, Changhwan Lee, Kyung Min Kim, Keon-Joo Lee, Donghyok Kwon, Young Joo Hur, BoYoul Choi, Moran Ki
Clinical Infectious Diseases.2017; 64(5): 551. CrossRef
Identifying determinants of heterogeneous transmission dynamics of the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea, 2015: a retrospective epidemiological analysis
Hiroshi Nishiura, Akira Endo, Masaya Saitoh, Ryo Kinoshita, Ryo Ueno, Shinji Nakaoka, Yuichiro Miyamatsu, Yueping Dong, Gerardo Chowell, Kenji Mizumoto
BMJ Open.2016; 6(2): e009936. CrossRef
Epidemiologic Parameters of the Middle East Respiratory Syndrome Outbreak in Korea, 2015
Sun Hee Park, Woo Joo Kim, Jin-Hong Yoo, Jung-Hyun Choi
Infection & Chemotherapy.2016; 48(2): 108. CrossRef

MERS-Letter to the Editor

A lesson learned from the MERS epidemic in Korea: an essay on MERS: Kwang-Ho Meng; Epidemiol Health. 2015;37:e2015034. Published online July 30, 2015; DOI: https://doi.org/10.4178/epih/e2015034

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Abstract Summary PDF Supplementary Material

Abstract

이번 메르스 사태에서 보듯이 감염병의 유행방지는 무엇보다 환자로 확진 받았거나 의심되는 사람들 스스로 다른 사람에게 병을 옮기지 않도록 하는 것이 중요하다. 자신은 다소 불편하더라도 남을 ‘배려하는’ 성숙된 시민의식이 중요하다는 말이다. 남을 배려하는 이런 인문학적 성찰이야말로 메르스와 같은 감염병 예방을 위한 ‘가장 효과적인 백신’이라 할 수 있다.

Summary

Korean summary
이번 메르스 사태에서 보듯이 감염병의 유행방지는 무엇보다 환자로 확진 받았거나 의심되는 사람들 스스로 다른 사람에게 병을 옮기지 않도록 하는 것이 중요하다. 자신은 다소 불편하더라도 남을 ‘배려하는’ 성숙된 시민의식이 중요하다는 말이다. 남을 배려하는 이런 인문학적 성찰이야말로 메르스와 같은 감염병 예방을 위한 ‘가장 효과적인 백신’이라 할 수 있다.

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Ebubekir KAPLAN, Mehmet Cihad AKTAŞ, Hatice KAYA
Sağlık Bilimleri Üniversitesi Hemşirelik Dergisi.2021; 3(3): 135. CrossRef
Beyond the fear: Nurses’ experiences caring for patients with Middle East respiratory syndrome: A phenomenological study
Jin Young Lee, Jeong Hee Hong, Eun Young Park
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Complementing conventional infectious disease surveillance with national health insurance claims data in the Republic of Korea
Jaehun Jung, Jae Hyoung Im, Young-Jin Ko, Kyungmin Huh, Chang-gyo Yoon, Chulwoo Rhee, Young-Eun Kim, Dun-Sol Go, Arim Kim, Yunsun Jung, Munkhzul Radnaabaatar, Seok-Jun Yoon
Scientific Reports.2019;[Epub] CrossRef

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

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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
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Depinar, a drug that potentially inhibits the binding and entry of COVID-19 into host cells based on computer-aided studies
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The Korean Journal of Internal Medicine.2021; 36(5): 1061. 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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Royal Society Open Science.2019; 6(3): 181164. CrossRef
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Editorial

What do we really fear? The epidemiological characteristics of Ebola and our preparedness: Moran Ki; Epidemiol Health. 2014;36:e2014014. Published online August 18, 2014; DOI: https://doi.org/10.4178/epih/e2014014

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Abstract

Ebola virus disease (hereafter Ebola) has a high fatality rate; currently lacks a treatment or vaccine with proven safety and efficacy, and thus many people fear this infection. As of August 13, 2014, 2,127 patients across four West African countries have been infected with the Ebola virus over the past nine months. Among these patients, approximately 1 in 2 has subsequently died from the disease. In response, the World Health Organization has declared the Ebola outbreak in West Africa to be a Public Health Emergency of International Concern. However, Ebola is only transmitted by patients who already present symptoms of the disease, and infection only occurs upon direct contact with the blood or body fluids of an Ebola patient. Consequently, transmission of the outbreak can be contained through careful monitoring for fever among persons who have visited, or come into contact with persons from, the site of the outbreak. Thus, patients suspected of presenting symptoms characteristic of Ebola should be quarantined. To date, South Korea is not equipped with the special containment clinical units and biosafety level 4 facilities required to contain the outbreak of a fatal virus disease, such as Ebola. Therefore, it is necessary for South Korea to make strategies to the outbreak by using present facilities as quickly as possible. It is also imperative that the government establish suitable communication with its citizens to prevent the spread of uninformed fear and anxiety regarding the Ebola outbreak.

Summary

Korean summary
에볼라 바이러스병은 치명률이 높고 효과와 안전성을 모두 검증받은 치료제나 백신이 없어 많은 사람들이 두려워하고 있는 질환이다. 이번에 서아프리카에서 9개월째 지속된 유행으로 8월 13일까지 4개국에서 2127명의 환자가 발생하였고 1145명이 사망하여 2명중 1명꼴인 높은 치명률을 보이고 있다. 이에 WHO에서는 국제보건긴급상황을 선포하였다. 하지만 에볼라 바이러스는 증상이 나타난 이후에 전염되며 환자의 혈액이나 체액에 접촉한 경우에만 감염이 된다. 따라서 유행지역을 방문하였거나 접촉한 사람을 대상으로 발열감시와 함께 환자 격리를 철저히 시행한다면 유행 전파를 막을 수 있다. 한국은 아직 에볼라 바이러스와 같은 질환에 적합한 격리병상이나 실험실 안전 4등급 시설이 없다. 이에 대한 대비를 빠른 시간에 마련하여 대응하는 것이 필요하며, 국민과의 소통을 통해서 막연한 불안과 두려움을 예방하는 것이 무엇보다 중요하다.

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Original Article

Case Series of Mycobacterium Abscessus Infections Associated with a Trigger Point Injection and Epidural Block at a Rural Clinic: Jun Young Song, Jung Bin Son, Min Ki Lee, Jin Gwack, Kil Soo Lee, Ji Young Park; Epidemiol Health. 2012;34:e2012001. Published online January 25, 2012; DOI: https://doi.org/10.4178/epih/e2012001

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Abstract

<sec><title>OBJECTIVES</title>The aim of this report is to investigate <italic>Mycobacterium abscessus</italic> infections at a rural clinic and carry out a surveillance program to determine the extent and source of these infections.</sec><sec><title>METHODS</title>The authors conducted an active surveillance investigation of 36 patients who had visited the clinic since 1 July 2008. Clinical specimens were collected from the patients and an envirnmental investigation. Pulsed-field gel elctrophoresis (PFGE) was performed for comparing with <italic>M. abscessus</italic> isolates from the patients.</sec><sec><title>RESULTS</title>Six specimens were obtained from the 6 patients respectively and 22 environmental samples were obtained. <italic>M. abscessus</italic> was isolated from the wounds of two patients, and various nosocomial pathogens, but not <italic>M. abscessus</italic>, were isolated from the surrounding environment. Two strains of <italic>M. abscessus</italic> from patients were identical as a result of PFGE.</sec><sec><title>CONCLUSION</title>Infection control education including proper hand hygiene should be emphasized for physicians performing invasive procedures. There also needs to be more attention for invasive procedures management, including trigger point injection and epidural block in rural clinics.</sec>

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Case Report

In-Flight Transmission of Novel Influenza A (H1N1): Joon Hyung Kim, Dong-Han Lee, Sang-Sook Shin, Chun Kang, Jin Seok Kim, Byung Yool Jun, Jong-Koo Lee; Epidemiol Health. 2010;32:e2010006. Published online May 31, 2010; DOI: https://doi.org/10.4178/epih/e2010006

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Abstract

The Korea Centers for Disease Control and Prevention confirmed two patients, who had taken the same plane from Los Angeles to Seoul, with novel influenza A (H1N1). Through contact tracing, we concluded that the second patient was infected during the flight.

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Original Articles

An Epidemiological Investigation on an Outbreak of Bacillus Cereus Food Poisoning in a Girls' High School in Sangju-si, Korea, 2008.: Hyun Dong Lee, Sun Ok Lee, Hyun Sul Lim, Kyoung Chan Lee, Kyu Jin Chang, Young A Kang; Korean J Epidemiol. 2008;30(2):168-177. Published online December 31, 2008; DOI: https://doi.org/10.4178/kje.2008.30.2.168

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Abstract PDF

Abstract

PURPOSE
In May 2008, a diarrhea outbreak occurred among students of in a girls' high school (S school) in Sangju-si, Korea. An epidemiological investigation was carried out to clarify the cause and transmission route of the outbreak.

METHODS

S school has been providing meals directly since July 2007. We conducted a questionnaire survey among 591 persons, and examined 283 rectal swabs and 98 environmental specimens. The patient case was defined as a member of S school who had diarrhea more than one time in a day, accompanied with one or more symptoms among abdominal pain or tenesmus from May 19th to May 26th 2008.

RESULTS

The attack rate was 24.0%. Bacillus cereus were cultured from three of the rectal swabs and five of the preserved foods. It was suspicious that contamination was possible in seasoning vegetables, and we found some foods were seasoned with spices after being cooled by moving cooler for about 20 minutes. Enterotoxin positive B. cereus were cultured from two foods cooled by moving cooler. Enterotoxin negative B. cereus were cultured from two environmental specimens of the moving cooler.

CONCLUSIONS

We presumed the cause of the diarrhea outbreak in S school was food poisoning by B. cereus. Because enterotoxin positive B. cereus were cultured from rectal swabs and foods, and the symptoms were corresponded. We estimated the outbreak was occurred by this process that B. cereus in the moving cooler contaminated foods during cooling and then rapidly proliferated.

Summary

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Citations to this article as recorded by

Validity and Reliability of a Questionnaire on the Knowledge, Attitudes, Perceptions and Practices toward Food Poisoning among Malaysian Secondary School Students: A Pilot Study
Pawitra Ramu, Malina Osman, Noor Azira Abdul Mutalib, Musheer A. Aljaberi, Kuo-Hsin Lee, Chung-Ying Lin, Rukman Awang Hamat
Healthcare.2023; 11(6): 853. CrossRef
Epidemiological Investigation for Outbreak of Food Poisoning Caused byBacillus cereusAmong the Workers at a Local Company in 2010
Kum-Bal Choi, Hyun-Sul Lim, Kwan Lee, Gyoung-Yim Ha, Kwang-Hyun Jung, Chang-Kyu Sohn
Journal of Preventive Medicine and Public Health.2011; 44(2): 65. CrossRef

Evaluation of Mumps Vaccine Effectiveness by outbreak investigation in one kindergarten in Ulsan city, 2006.: Kyo Hyun Kim, Heran Ki, Bo Youl Choi, Chang Hui Kim, Dong Han Lee, Un Young Ko, Moran Ki; Korean J Epidemiol. 2008;30(1):110-118. Published online June 30, 2008; DOI: https://doi.org/10.4178/kje.2008.30.1.110

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Abstract PDF

Abstract

PURPOSE
Despite of the high MMR vaccine coverage, the mumps outbreaks is continued in most developed countries including South Korea. To evaluate the effectiveness of MMR vaccine, we carried out mumps outbreak investigation in one kindergarten.

METHODS

In Dec. 2006, a mumps outbreak occurred in a kindergarten. Retrospective study was conducted among 212 respondents (205 children and 7 teachers) in 230 study populations (study participation rate: 92%). To define mumps cases, a questionnaire survey, telephone survey, and mumps antibody test with serum were conducted. MMR vaccination status was verified in 198 children using children's vaccination records, National Immunization Registration System and/or medical records of private clinics or hospitals.

RESULTS

Over 90% children had received one dose of MMR vaccination. However, 2nd dose of MMR vaccination rate was 45.1%. Attack rates of mumps were 22.9%(22/96) for one dose MMR vaccinees and 3.3%(3/92) for two doses vaccinees. MMR vaccine effectiveness of two doses over one dose was 86%. Mumps attack rate in one dose MMR vaccinees increased by the duration after MMR vaccination. Among all mumps cases, asymptomatic mumps infection identified by IgM positive or IgG over 10,000mIU/ml was 58% (26/ 45).

CONCLUSIONS

MMR one dose coverage rate was high(92.1%), but the second dose vaccination rate was very low (45.1%). Mumps attack rate was increased by the duration after the MMR vaccination, and the maximum effectiveness of one dose MMR vaccination was low (77.1%). Therefore, to prevent mumps outbreaks in the kindergarten, second MMR vaccination should be scheduled in 4 years old age, and the coverage rate should be increased over 90%. Further studies for the effectiveness of MMR two doses after 5 and more years are needed.

Summary

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Differential Demographic and Clinical Characteristics between MMR Vaccinated and Unvaccinated Children in South Korea: A Nationwide Study
Dongwon Yoon, Juhwan Kim, Juyoung Shin
Vaccines.2021; 9(6): 653. CrossRef
Seroprevalence of mumps in healthcare workers in South Korea
Sun-Kyung Kim, Jiwon Jung, Sun Hee Kwak, Min Jee Hong, Sung-Han Kim
Clinical and Experimental Vaccine Research.2020; 9(1): 64. CrossRef
Resurgence of Mumps in Korea
Sun Hee Park
Infection & Chemotherapy.2015; 47(1): 1. CrossRef
Mumps outbreak in Incheon, Korea, 2009
Seon Young Cho, Soo Young Lee, Jin Han Kang, Hui Seung Hwang
Korean Journal of Pediatrics.2010; 53(1): 67. CrossRef
Mumps Transmission Control Status and Inapparent Infection Rate among Middle and High School Students during the 2007-2008 Mumps Outbreak in Daegu
Kyo Hyun Kim, Chang Hwi Kim, Bo Youl Choi, Un Yeong Go, Dong Han Lee, Moran Ki
Journal of Preventive Medicine and Public Health.2009; 42(6): 408. CrossRef

An Epidemiological Survey on the Outbreak of Cholera of Overseas Travelers in Daejeon.: Sun Mi Jin, Tae Yong Lee; Korean J Epidemiol. 2006;28(1):119-128.

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Abstract PDF: Abstract
PURPOSE
This study was coducted to describe the epidemiological, characteristics of the outbreak of cholera of overseas travelers on Aug. 2005 in Daejeon. MATERIALS AND METHODS: Interview using a standard questionnaire and rectal swab were conducted to 15 overseas travelers ,27 persons who contacted with travelers RESULTS: Epidemiological characteristics of the 2005 cholera epidemic of Daejeon are as follows: 1. Isolated species were Vibrio cholerae, O1 El Tor Ogawa. There were 6 culture-proven patients, 4 culture-not proven patients and 2 asymptomatic carriers. There was no case of person to person infection and no fatal cases 2. The sex distribution of cholera patients was equal. The most of cholera patients were at the age of fifties. 3. The duration of diarrhea was 4.4 days. The number of diarrhea per 1day was 5.5. 4. Source of Vibrio cholerae in this outbreak was suggested to be the contaminated food from the overseas traveling to epidemic area, Mandalay, Myanmar on Aug. 8, 2005 CONCLUSIONS: It is recommended that the government should be prepared to prevent cholera of overseas travelers effectively. To prevent the outbreak of cholera by chronic carriers, we need to strengthen the monitoring sytem of diarrhoeal diseases.; Summary

Outbreak of Measles among School Ages in Yeongju in 2000.: Hae Kwan Cheong, Geun Ryang Bae, Jin Hwa Jeong, Sue Kyung Park, Byung Chan Park, Jee Hee Kim, Joo Yeon Lee, Byung Kuk Na, Woo Joo Kim; Korean J Epidemiol. 2004;26(1):69-80.

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Abstract PDF: Abstract
BACKGROUND
The outbreak of measles from 2000 to 2001 was the biggest epidemic since measles vaccination was introduced in Korea. Outbreak of measles in Yeongju was one of the earliest milestones of the nationwide outbreak in the year 2000. The authors investigated epidemiologic characteristics of the outbreak in this area.
METHODS
The authors estimated attack rate through the investigation of all the school age cases of measles reported to local health authority between March and May, 2000. Case investigation was done to trace the source of the outbreak. One hundred seventy two cases were examined with medical examination, with interview on their clinical manifestations, and with serologic examination on the anti-measles IgM and IgG antibody.
RESULTS
Overall attack rate among the school children was 4.3%, with highest attack rate in middle school students (8.5%). The outbreak began in March in middle schools, which spread to elementary and high schools. IgG was positive in 160(93.0%) cases and IgM was positive in 94(54.6%) cases, among which 90 cases (95.7%) were also positive for IgG. IgM positive cases had higher prevalence of rash (91.5%) compared to those without IgM (70.5%). Diagnostic criteria based on the clinical manifestation and contact history showed the highest sensitivity (92.6%) compared to conventional diagnostic criteria in outbreak (40.4-44.7%) CONCLUSIONS: High proportion of susceptible children in the population due to primary or secondary vaccine failure played a key role in this outbreak. Clinical manifestation was milder than classical measles and adjustment of diagnostic criteria can be helpful in the management of outbreak.; Summary

Analysis of Transmission Mode of Confirmed Shigellosis in Gyeongju, Korea.: Cheoll Jung, Hyun Sul Lim, Gyoung Yim Ha, Hee Su Kim; Korean J Epidemiol. 2004;26(1):1-16.

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Abstract PDF: Abstract
PURPOSE
This study was carried out to investigate the sources of infection and modes of transmission of an 107 (54males, 53 females) confirmed shigellosis in Gyeongju from Sept. 24 to Oct. 24, 1998.
METHODS
We reviewed hospital records of all confirmed shigellosis. Thirty-two strains of Shigella sonnei isolated were analyzed in order to trace the source of infections by plasmid profile, antimicrobial drug resistance pattern, biotyping and pulsed-field gel electrophoresis (PFGE).
RESULTS
The first source of infection was estimated to be contaminated underground water and simple piped water caused by leakage from the cess pool. Antimicrobial drug resistance pattern showed that all strains were multi-resistant. All isolates had the same XbaI and SfiI PFGE patterns, indicating the epidemiological relationship of the outbreaks strains in this area. The major characteristics of diarrhea were watery (84.2%) in nature. The clinical symptoms among the diarrheal cases included abdominal pain (86.1%), fever (83.2%), headache (78.2%), chill (45.5%) and tenesmus (41.6%). Six cases were asymptomatic. From initial manifestation to admission were 6.2+/-1.6 (median 6) days, so it could be transmitted to others in this infective period. Duration of admission were 5.5 +/-2.4 (median 6) days. We can find familial mean secondary attack rate were 38.5%.
CONCLUSION
It's transmission to other areas were certified by contaminated water and contact with shigellosis, and unknown cases were estimated to be transmitted by contacts with inapparent infection. By plasmid profile and PFGE, the epidemiological relationship of the outbreaks strains in this area seemed to be the same micro-organisms.; 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

A Epidemic Survey of the Shigellosis in Jeju Island during the First Half of Year 2000.: Jong Myon Bae, Sang Won Lee, Byung Guk Yang, Seong Chul Hong, Geun Ryang Bae, Sung Hack Kang; Korean J Epidemiol. 2001;23(1):80-80.

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Abstract PDF: Abstract
PURPOSE
A field investigation was done to evaluate the level of the epidemic of Shigellosis in Jeju Island during the first half of year 2000.
METHODS
Confirming the Shigellosis was done by the structured questionnaire and the result of rectal swab for the residents having a diarrhea.
RESULTS
As the confirmed patients with Shigella sonnei were 933 from 25 April to 14 August 2000, the crude incidence rate was 174 per 100,000 persons. The highest incidence rate was shown in 5-9 year-old group. Especially the south area of Jeju Island, called as Namjejugun, had the major epidemic occurrence.
CONCLUSIONS
The huge and chronic epidemic of Shigellosis was confirmed. The nature of this epidemic suggested that the endemic occurrence had been existed in Jeju Island.; Summary

Epidemiologic Investigation of a Mumps Outbreak in a Middle School in Pohang, Korea: Effect of vaccination during outbreak.: Byung Chan Park, Hae Kwan Cheong, Hyun Sul Lim, Duck Soo Kim, Doohie Kim; Korean J Epidemiol. 2000;22(2):148-158.

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Abstract PDF: Abstract
BACKGROUND
There was a widespread outbreak of mumps at elementary and middle schools in Pohang city in March 1999. We have carried out an epidemiologic survey to trace the source and mode of transmission of the outbreak, as well as evaluating the effect of vaccination as a measure of controlling the outbreak.
METHODS
Questionnaire survey on 959 students showed that attack rate was 10.7%. There was no significant difference between genders in terms of attack rates. However, second graders outnumbered other groups as 16.9%, comparing to 8.1% among first graders and to 7.0% in the third graders.
RESULTS
Cases of mumps were reported in 1998, primarily in the neighboring elementary schools. The disease was also reported earlier in 1999, sporadically. In March, however, number of the cases was sharply on the rise as the middle schools opened for a new semester. Our investigation revealed that infection stemmed from more than three different sources, particularly in the classes of second graders, and then spread to all students, corresponding to the distance between students. Effect of vaccination during the outbreak was pretty good: attack rate of the group vaccinated since May 1st, considering the maximum latent period of infections (21 days), was 0.8%, comparing to 5%. The efficiency of vaccination marked 84.8%.(95% confidence interval 79.66-89.94) Although the authors recommended the students to wear flue masks and wash their hands as often as possible to screen infections among the students, it turned out that such measures had little effect for the prevention of spread.
CONCLUSIONS
The number of mumps cases dropped remarkably among vaccinated the students the prevalent period of the disease. Authors concluded that is effective to control the outbreak if it is done at early stage.; Summary

An Epidemiologic Investigation of Shigella Sonnei Outbreak at a Primary School in Taegu city.: Byung Yeol Chun, Keon Yeop Kim, Ki Soo Park, Sang Won Lee, Young Joo Hur, Sun Hee Park, Ki Sang Kim, Sang Won Lee, Soon Ja Kim, Young Sook Hong; Korean J Epidemiol. 2000;22(2):101-107.

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Abstract PDF: Abstract
PURPOSE
S: This study was conducted to determine the source of infection and mode of transmission of the shigellosis outbreak on March 27, 1998 at a primary school in Taegu city.
METHODS
On-site interview using a standard questionnaire and rectal swab were conducted to 1,629 peoples who ate lunch on March 26 and 1,389 peoples who contacted with suspected cases. And bacteriological examination for 91 environmental materials and 25 food items were performed.
RESULTS
Of the 1,629 persons who ate lunch on March 26, seventy three had culture-confirmed S. sonnei infection(first attack rate: 4.5%). And additional fifty four had shigellosis among those 1,389 persons who might be exposed to the suspected cases(second attack rate: 3.9%). A total of 730 persons who complained one of four typical symptoms or more were treated as suspected cases(first attack rate of suspected cases: 44.8%). S. sonnei was never isolated from water, foods, and other environmental materials. The median incubation period was estimated about two days. The common symptom reported were diarrhea(88.7%), fever(73.4%), abdominal pain(54.7%), and vomiting episode(38.4%) in order. The shorter duration of the outbreak and the large proportion of cases involving students who ate lunch on March 26 are consistent with fecal-oral transmission, although the limited epidemiologic data obtainable do not clearly define the route of transmission.
CONCLUSIONS
Thus the outbreak reported here appear to be related to the unsanitary conditions of food facility in this school.; Summary

An Epidemiological Investigation of Bacterial Dysentery Outbreak in Busan(Pusan), 1999.: Hai Rim Shin, Duk Hee Lee, Heung Man Sul, Sang Won Lee, Young Ju Huh; Korean J Epidemiol. 2000;22(2):93-100.

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Abstract PDF: Abstract
BACKGROUND
In March 1999, six children who attended a nursery school became ill with acute gastroenteritis by Shigella sonnei. The majority of the children became sick one day after sharing a snack which was served from one of the children's home. By the time the outbreak of dysentery was recognized, the rest of family members of the children became also sick. The nursery school was located in a crowded residential area. EPIDEMIOLOGIC INVESTIGATION: After active and passive surveillance was established on patients with diarrhea, 438 patients were registered. Among them, 252 patients were considered to have simple diarrhea, but the rest (186 patients) suffered from more than three consecutive diarrheas. Shigella sonnei was isolated from 75 patients. The first attack rate was estimated at 50.0%, the second, 25.6%-34.3% and the third, 13.5%. The epidemic lasted for two months spreading further from person to person in the highly populous area. The active surveillance was implemented after the occurrence of the secondary attack of dysentery among the residents, who had no obvious direct contact with people associated with the nursery school.
CONCLUSION
This investigation demonstrates the need for prompt implementation of active surveillance when Shigella infection is recognized in a highly populous city.; Summary

An Epidemiologic Investigation of Shigellosis Outbreak in Gangnung 1998.: Sang Hyuk Jung, Woong Sub Park; Korean J Epidemiol. 2000;22(1):1-10.

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Abstract PDF: Abstract
An epidemiologic investigation was carried out to identify the distribution and the cause of Shigellosis outbreak, which was occurred in Gangnung city from August to November, 1998. This study carried out from September, 14, to November, 20, 1998. The total number of Shigellosis confirmed patient is 87. We surveyed and obtained the stool sample from all suspected patients and their members of household. The major findings of this study are as follows. 1. The first patient appeared in September 11 and the number of patients increased to September 13, that is peak time, and the patient number tailed down apparently from September, 18, 1998. 2. The incidence rate per 1,000 is largest in Wangsan-Myeon Doma-Ri(32.9), and second largest in Wangsan-Myeon Mokgea-Ri(31.6), The total incidence rate in Gangnung-shi is 0.4(0.4 for man and 0.3 for woman). The age group with the largest incidence rate per 1,000 is 5-14 age group whose incidence rate is 1.4. 3. The secondary generation attack rate in confirmed patient family is 20.6%, and the secondary attack is 7.8%. 4. We considered the meal of school, environmental factor, milk, carrier of Shigellosis as the cause of outbreak, but we were not able to identify the bacteria of shigellosis. But we suspected the meal of school that played important role in outbreak, because outbreak occurred explosively after students ate the meal of school. 5. We considered three hypotheses for the cause of the outbreak. First, a propagation from external regions; Second, an outbreak from contaminated foods; Third, a propagation from carriers in Gangnung. In order to obtain the further information for first and third hypothesis, we should perform PFGE(Pulsed-field gelectrophoresis) with the shigella bacteria of each epidemic region.; Summary

The Epidemiological Characteristics of a Shigellosis Outbreak (1998) in Wonju City, Kangwon-Do.: Jong Ku Park, Chun Bae Kim, Won Seok Seok, Kee Ho Park, Seungjun Wang; Korean J Epidemiol. 1999;21(2):131-141.

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Abstract PDF: Abstract
From September 8-28 1998, 55 cases of shigellosis, characterized by watery diarrhea, high fever, abdominal cramps and headache were reported at K elementary school in Wonju City. The isolated serotype was Shigella sonnei (group D). We collected bacteriologic specimens from high-risk populations, disinfected epidemic areas, and monitored all the medical facilities in Wonju City. Through these efforts, we found 168 cases of shigellosis, and of these, 117 were culture-confirmed and 51 were diagnosed by symptoms. The incidence rate per 10,000 population in Wonju City was 1.00 in males and 1.19 in females. The secondary attack rate was 13.6%. The mode of transmission at K elementary school was most often caused by the common epidemic source of single exposure. The source of infection was believed to be the foods distributed on September 7. However, epidemiologic evidence suggested that the sources of infection were scattered over many places within the city. The reasons included: i) shigellosis is an endemic disease in Korea; ii) there were shigellosis-like patients at J primary school in Wonju City in late August; and iii) there was a shigellosis outbreak at Chongil Myun, Hoeng Seong Gun, which was located near Wonju City, in early August.; Summary

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