Epidemiology and Health

Original Article

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

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Abstract

OBJECTIVES
The purpose of this study was to enhance the understanding of the local-level spatiotemporal dynamics of COVID-19 transmission in the Greater Seoul Area (GSA), Korea, after its initial outbreak in January 2020.

METHODS

Using the weekly aggregates of coronavirus disease 2019 (COVID-19) cases of 77 municipalities in the GSA, we examined the relative risks of COVID-19 infection across local districts over 50 consecutive weeks in 2020. To this end, we employed a spatiotemporal generalized linear mixed model under the hierarchical Bayesian framework. This allowed us to empirically examine the random effects of spatial alignments, temporal autocorrelation, and spatiotemporal interaction, along with fixed effects. Specifically, we utilized the conditional autoregressive and the weakly informative penalized complexity priors for hyperparameters of the random effects.

RESULTS

Spatiotemporal interaction dominated the overall variability of random influences, followed by spatial correlation, whereas the temporal correlation appeared to be small. Considering these findings, we present dynamic changes in the spread of COVID-19 across local municipalities in the GSA as well as regions at elevated risk for further policy intervention.

CONCLUSIONS

The outcomes of this study can contribute to advancing our understanding of the local-level COVID-19 spread dynamics within densely populated regions in Korea throughout 2020 from a different perspective, and will contribute to the development of regional safety planning against infectious diseases.

Summary

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

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

Citations

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A Review of Bayesian Spatiotemporal Models in Spatial Epidemiology
Yufeng Wang, Xue Chen, Feng Xue
ISPRS International Journal of Geo-Information.2024; 13(3): 97. CrossRef

COVID-19: Perspective

Herd immunity: challenges and the way forward in Korea: Jiyoung Oh, Sohyun Kim, Boyeong Ryu, Minjoung Shin, Bryan Inho Kim; Epidemiol Health. 2021;43:e2021054. Published online August 18, 2021; DOI: https://doi.org/10.4178/epih.e2021054

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Abstract Summary PDF

Abstract

Vaccination is considered to be the most effective measure for preventing the spread of coronavirus disease 2019 (COVID-19). Many countries, including of Korea, are focusing on achieving herd immunity with the goal of reaching a vaccination rate of 70-80%. However, achieving herd immunity does not mean eradicating COVID-19, and the following challenges can occur in the process of achieving herd immunity. First, as the vaccination rate is likely to slow down over time, it is necessary to promote the benefits of vaccination through risk communication strategies and provide incentives for those who have been vaccinated. Second, a booster dose may be required depending on future studies on vaccine-induced immunity. Third, since variants capable of evading immunity and with higher transmissibility can emerge, rapid contract tracing and regular community genomic surveillance could help mitigate the impact of new variants. When the impact of COVID-19 is controlled to the level of seasonal influenza, the current public health measures that have been strictly imposed on society since the beginning of the pandemic will no longer be needed. The overall response strategy to COVID-19 will need to change accordingly, based on evaluations of the level of population immunity. These changes will include more efficient and targeted contact tracing and eased quarantine measures for vaccinated close contacts and travelers. Mask wearing and a minimum of social distancing will still be required in the journey towards the end of the pandemic. The COVID-19 pandemic will end, but the virus will not disappear.

Summary

Korean summary
한국을 포함한 많은 국가에서 예방접종률 70~80% 달성을 목표로 집단면역을 달성하는데 집중하고 있으나, 집단면역 달성은 코로나19 퇴치를 의미하지 않으며, 집단면역을 달성해 나가는 과정에서 여러 어려움이 발생할 수 있다. 코로나19의 전반적인 영향력이 계절성 인플루엔자와 같은 관리가능한 수준으로 낮아진다면 현재의 코로나19 대응조치들은 인구집단의 면역 수준을 고려하여 점차 완화될 것이지만 마스크 착용과 최소한의 사회적 거리두기는 당분간 지속될 것이며, 코로나19 대유행이 끝나더라도 바이러스는 사라지지 않을 것이다.

Key Message
Achieving herd immunity does not mean eradicating COVID-19, and some challenges can occur in the process of achieving herd immunity. When the impact of COVID-19 is controlled to the level of seasonal influenza, the current public health measures that have been strictly imposed on society since the beginning of the pandemic will no longer be needed. The overall response strategy to COVID-19 will need to change accordingly, based on evaluations of the level of population immunity. However, mask wearing and a minimum of social distancing will still be required in the journey towards the end of the pandemic. The COVID-19 pandemic will end, but the virus will not disappear.

Citations

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Towards a sustainable integrated management approach to uncertainty surrounding COVID‐19
Tiep Nguyen, Leonie Hallo, Nicholas Chileshe, Nghia Hoai Nguyen
Systems Research and Behavioral Science.2023; 40(6): 819. CrossRef
Evolution of Tourism Risk Communication: A Bibliometric Analysis and Meta-Analysis of the Antecedents of Communicating Risk to Tourists
Weina Liu, Chaonan Xu, Yajie Peng, Xinlong Xu
Sustainability.2023; 15(12): 9693. CrossRef
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Bruna T. Tiyo, Gabriela J. H. Schmitz, Marina M. Ortega, Laís T. da Silva, Alexandre de Almeida, Telma M. Oshiro, Alberto J. da S. Duarte
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Original Articles

Modeling the relationship between malaria prevalence and insecticide-treated bed net coverage in Nigeria using a Bayesian spatial generalized linear mixed model with a Leroux prior: Oluyemi A. Okunlola, Oyetunde T. Oyeyemi, Adewale F. Lukman; Epidemiol Health. 2021;43:e2021041. Published online June 4, 2021; DOI: https://doi.org/10.4178/epih.e2021041

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Abstract

OBJECTIVES
To evaluate malaria transmission in relation to insecticide-treated net (ITN) coverage in Nigeria.

METHODS

We used an exploratory analysis approach to evaluate variation in malaria transmission in relation to ITN distribution in 1,325 Demographic and Health Survey clusters in Nigeria. A Bayesian spatial generalized linear mixed model with a Leroux conditional autoregressive prior for the random effects was used to model the spatial and contextual variation in malaria prevalence and ITN distribution after adjusting for environmental variables.

RESULTS

Spatial smoothed maps showed the nationwide distribution of malaria and ITN. The distribution of ITN varied significantly across the 6 geopolitical zones (p<0.05). The North-East had the least ITN distribution (0.196±0.071), while ITN distribution was highest in the South-South (0.309±0.075). ITN coverage was also higher in rural areas (0.281±0.074) than in urban areas (0.240±0.096, p<0.05). The Bayesian hierarchical regression results showed a non-significant negative relationship between malaria prevalence and ITN coverage, but a significant spatial structured random effect and unstructured random effect. The correlates of malaria transmission included rainfall, maximum temperature, and proximity to water.

CONCLUSIONS

Reduction in malaria transmission was not significantly related to ITN coverage, although much could be achieved in attempts to curtail malaria transmission through enhanced ITN coverage. A multifaceted and integrated approach to malaria control is strongly advocated.

Summary

Key Message
Scaling up equity in ITN distribution and coverage, awareness and knowledge on ITN utilization are important integrated approaches to mitigate malaria transmission in Nigeria.

Citations

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A Systematic Review of Areal Units and Adjacency Used in Bayesian Spatial and Spatio-Temporal Conditional Autoregressive Models in Health Research
Zemenu Tadesse Tessema, Getayeneh Antehunegn Tesema, Susannah Ahern, Arul Earnest
International Journal of Environmental Research and Public Health.2023; 20(13): 6277. CrossRef
Malaria transmission in Africa: Its relationship with yellow fever and measles
Oluyemi A. Okunlola, Oyetunde T. Oyeyemi, Luzia Helena Carvalho
PLOS ONE.2022; 17(5): e0268080. CrossRef
Bayesian spatio-temporal modelling and mapping of malaria and anaemia among children between 0 and 59 months in Nigeria
Jecinta U. Ibeji, Henry Mwambi, Abdul-Karim Iddrisu
Malaria Journal.2022;[Epub] CrossRef

Dynamics of the COVID-19 epidemic in the post-vaccination period in Korea: a rapid assessment: Kyung-Duk Min, Sangwoo Tak; Epidemiol Health. 2021;43:e2021040. Published online May 27, 2021; DOI: https://doi.org/10.4178/epih.e2021040

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Coronavirus disease 2019 (COVID-19) has had a tremendous impact on public health and socioeconomic conditions globally. Although non-pharmaceutical interventions (NPIs) such as social distancing effectively reduced the incidence of COVID-19, especially in Korea, demand for vaccination has increased to minimize the social costs of NPIs. This study estimated the potential benefits of COVID-19 vaccination in Korea.

METHODS

A mathematical model with vaccinated–susceptible–latent–infectious–recovered compartments was used to simulate the COVID-19 epidemic. The compartments were stratified into age groups of 0-19 years, 20-59 years, and 60 years or older. Based on the Korea Disease Control and Prevention Agency national vaccination plan for the second quarter of 2021, announced on March 15, we developed vaccination scenarios (with 150,000 dose/d and 100% compliance as the main scenario). Comparing scenarios without vaccination or with higher/lower vaccination rates and compliance, we estimated the numbers of COVID-19 cases that will be prevented by vaccination.

RESULTS

The results projected 203,135 cases within a year after April 2021 without vaccination, which would be reduced to 71,248 (64.9% decrease) by vaccination. Supposing a vaccination rate of 150,000 dose/d and 100% compliance, social distancing interventions for those aged 20 or more can be retracted after January 1, 2022.

CONCLUSIONS

We expect COVID-19 vaccination to be effective in Korea. Health authorities should minimize delays in vaccination and vaccine avoidance to maximize the effectiveness of vaccination and end social distancing early.

Summary

Korean summary
본 연구에서 국내 백신 접종 시작이후의 코로나19 유행 추이를 수학적 모형을 통하여 예측하였다. 연구 결과, 백신 접종이 전혀 진행되지 않을 경우, 2021년 4월부터 1년간 203,135 건의 확진 사례가 보고될 것으로 예측되었으나, 하루 15만 도즈의 접종이 진행될 경우 같은 기간의 확진자 수를 64.9% 감소시킬 수 있을 것으로 나타났으며, 20세 이상을 대상으로한 사회적 거리두기 정책은 2022년 1월에 중지될 수 있을 것으로 예상되었다.

Key Message
A mathematical model with vaccinated–susceptible–latent–infectious–recovered compartments was used to simulate the COVID-19 epidemic in Korea. The results projected 203,135 cases within a year after April 2021 without vaccination, which would be reduced to 71,248 (64.9% decrease) by vaccination (150,000 doses per day and 100% compliance). Supposing a vaccination rate of 150,000 doses per day and 100% compliance, social distancing intervention for those aged 20 or more can be retracted after January 1, 2022.

Citations

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Predictive models for health outcomes due to SARS-CoV-2, including the effect of vaccination: a systematic review
Oscar Espinosa, Laura Mora, Cristian Sanabria, Antonio Ramos, Duván Rincón, Valeria Bejarano, Jhonathan Rodríguez, Nicolás Barrera, Carlos Álvarez-Moreno, Jorge Cortés, Carlos Saavedra, Adriana Robayo, Oscar H. Franco
Systematic Reviews.2024;[Epub] CrossRef
Mathematical Modeling of COVID-19 Transmission and Intervention in South Korea: A Review of Literature
Hyojung Lee, Sol Kim, Minyoung Jeong, Eunseo Choi, Hyeonjeong Ahn, Jeehyun Lee
Yonsei Medical Journal.2023; 64(1): 1. CrossRef
Neural network method and multiscale modeling of the COVID-19 epidemic in Korea
Ziqian Li, Jiwei Jia, Guidong Liao, Young Ju Lee, Siyu Liu
The European Physical Journal Plus.2023;[Epub] CrossRef
Impact of vaccination and non-pharmacological interventions on COVID-19: a review of simulation modeling studies in Asia
Karan Thakkar, Julia Regazzini Spinardi, Jingyan Yang, Moe H. Kyaw, Egemen Ozbilgili, Carlos Fernando Mendoza, Helen May Lin Oh
Frontiers in Public Health.2023;[Epub] CrossRef
Cost-effectiveness analysis of COVID-19 variants effects in an age-structured model
Giphil Cho, Young Jin Kim, Sang-hyup Seo, Geunsoo Jang, Hyojung Lee
Scientific Reports.2023;[Epub] CrossRef
Impact of national Covid-19 vaccination Campaign, South Korea
Seonju Yi, Young June Choe, Do Sang Lim, Hye Roen Lee, Jia Kim, Yoo-Yeon Kim, Ryu Kyung Kim, Eun Jung Jang, Sangwon Lee, Eunjoo Park, Seung-Jin Kim, Young-Joon Park
Vaccine.2022; 40(26): 3670. CrossRef
Multi-Faceted Analysis of COVID-19 Epidemic in Korea Considering Omicron Variant: Mathematical Modeling-Based Study
Youngsuk Ko, Victoria May Mendoza, Renier Mendoza, Yubin Seo, Jacob Lee, Jonggul Lee, Donghyok Kwon, Eunok Jung
Journal of Korean Medical Science.2022;[Epub] CrossRef
The economic impact of COVID-19 interventions: A mathematical modeling approach
Jung Eun Kim, Heejin Choi, Yongin Choi, Chang Hyeong Lee
Frontiers in Public Health.2022;[Epub] CrossRef
Analysis of Superspreading Potential from Transmission Clusters of COVID-19 in South Korea
Hyojung Lee, Changyong Han, Jooyi Jung, Sunmi Lee
International Journal of Environmental Research and Public Health.2021; 18(24): 12893. CrossRef

Hand-to-face contact behaviors during indoor activities in daily life among Korean adults: an observational pilot study using videotaping: Hyang Soon Oh, Mikyung Ryu, Youngran Yang; Epidemiol Health. 2021;43:e2021030. Published online April 22, 2021; DOI: https://doi.org/10.4178/epih.e2021030

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Abstract Summary PDF

Abstract

OBJECTIVES
Hand-to-face contact (HFC) is the major route for the self-inoculation of pathogens. This study aimed to describe the characteristics of HFC behaviors among Korean adults during indoor activities.

METHODS

Thirty participants were enrolled in the study, and 2 hours of videotaped data were collected from each participant. Contact data were recorded by examining the frequency and duration of HFC on the videos. Three training sessions were conducted for 2 readers to ensure the accuracy and reliability of videotape reading. Re-reading and verification of selected video data were performed to confirm intrapersonal and interpersonal validity. Contact exposure (CE) was determined by multiplying the contact frequency (CF) by the contact duration (CD) to quantify the intensity of contact during the observation time (2 hours).

RESULTS

A total of 3,007 HFCs (1,305 mucous membrane contacts and 1,702 non-mucous membrane contacts) were observed for 60 person-hours. The median CF (person/2 hr) of the mucous membranes (eye; 4.0, nose; 15.5, mouth; 16.5) was 39.5/person and the median total CD was 177.0 sec/person. The median CE (frequency-duration/sec/person) was 5,795.0 (mouth: 1,356.0, nose: 600.0, eye: 57.5).

CONCLUSIONS

This study showed that the mouth and nose were the most frequent exposure sites for HFC. Avoiding habitual HFC, awareness of self-inoculation by HFC, and vigorous hand hygiene should be strengthened to prevent the spread of infections.

Summary

Korean summary
· 얼굴의 가장 빈번한 직접 자가 손접촉 노출은 입과 코에서 발생했습니다. · 접촉 노출량 지표 (contact exposure)는 입과 코에 자가 손접촉을 보다 잘 구별할 수 있습니다. · 습관적인 손-얼굴 접촉을 피하고, 마스크 사용 및 철저한 손위생으로 감염성 질환의 전파를 예방해야 합니다.

Key Message
• Average contact frequency (no./person) and contact duration (sec/person) of hand-to-face contact to the mucous membranes were high on the mouth, nose and then nose. • Contact exposure could differentiate more distinguished the hand contacts to mouth and to nose than contact frequency. • Hand-to face contacts, especially to mouth and then to nose can be the most frequent route of self-inoculation among Korean adults. • Avoiding habitual hand-to-face contacts, mask use, and vigorous hand hygiene should be strengthened as we counter epidemics of transmitting infectious diseases.

Citations

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Marta Arévalo-Baeza, Alejandro Viuda-Serrano, Carmen Juan-Llamas, Pablo Sotoca-Orgaz, Iván Asín-Izquierdo
JMIR Serious Games.2023; 11: e45600. CrossRef
Hemşirelik Öğrencilerine Eğitimleri Sırasında Öğretilen Asepsi Uygulamalarının Covid -19 Pandemi Dönemindeki Bireysel Uygulamalarına Etkisi
Ayşe SERPİCİ, Neriman AKANSEL, Nursel VATANSEVER, Vahit DALKIZAN
Uludağ Üniversitesi Tıp Fakültesi Dergisi.2023; 49(2): 245. CrossRef
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Perspective

Neglected paths of transmission of milkborne brucellosis and tuberculosis in developing countries: novel control opportunities: Arockiasamy Arun Prince Milton, Samir Das, Sandeep Ghatak; Epidemiol Health. 2020;42:e2020073. Published online December 4, 2020; DOI: https://doi.org/10.4178/epih.e2020073

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Abstract PDF

Abstract

Brucellosis and tuberculosis are lingering zoonotic infections that are endemic in many developing parts of the world, with considerable economic and health costs. Although guidelines for the control of these diseases exist, we highlight neglected transmission routes of these diseases. We show that informal, door-to-door marketing of unpasteurized milk provides an important route for disease transmission through kitchen cross-contamination. Furthermore, the practice of discarding the first strippings of milk at farms needs adjustment to avoid floor and environmental contamination. Herein, we propose handling guidelines and a design for a milk stripping collection vessel. We believe that taking action to block these hitherto unrecognized transmission routes will complement existing efforts and guidelines.

Summary

Citations

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A review of three decades of use of the cattle brucellosis rough vaccine Brucella abortus RB51: myths and facts
J. M. Blasco, E. Moreno, P. M. Muñoz, R. Conde-Álvarez, I. Moriyón
BMC Veterinary Research.2023;[Epub] CrossRef
Editorial: Taking a Fresh Look at Old Zoonoses, What Have We Been Missing in One Health Research and Education?
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Frontiers in Public Health.2022;[Epub] CrossRef

Original Article

A small window into the status of malaria in North Korea: estimation of imported malaria incidence among visitors from South Korea: Jisun Sung, Hae-Kwan Cheong, Ah-Young Lim, Jong-Hun Kim; Epidemiol Health. 2020;42:e2020068. Published online November 21, 2020; DOI: https://doi.org/10.4178/epih.e2020068

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Abstract Summary PDF: Abstract
OBJECTIVES
This study aimed to develop hypotheses on trends in malaria incidence in North Korea using malaria incidence among South Korean visitors to North Korea.
METHODS
The number of South Korean tourists who visited Mount Kumgang from 2000 to 2008 and the number of South Korean employees at the Kaesong Industrial Complex from 2005 to 2015 were obtained from the Korean Statistical Information Service. The number of malaria cases among South Koreans who visited North Korea was obtained from a previous report. The incidence of malaria per 100,000 person-years was calculated using these data and compared with the malaria incidence in North Korea derived from published articles.
RESULTS
A high incidence of malaria in 2001 and a sharp decline in the following years were observed in both South and North Korean data. Since then, North Korean data showed a relatively low and stable incidence, but the incidence among South Koreans visiting North Korea increased in 2006. Considering the trends in mass primaquine preventive treatment, floods, and economic growth rate, the incidence of malaria may have increased in North Korea in 2006. Since 2009, the incidence of malaria decreased gradually according to both South and North Korean data.
CONCLUSIONS
The trends of malaria incidence in North Korea could be reflected through its incidence among South Koreans who visited North Korea. For future inter-Korean collaboration aiming to eradicate malaria, we propose that a North Korean malaria monitoring system be established applying this method.; Summary

Korean summary
본 연구는 2000-2008년 금강산을 여행한 대한민국 국민과 2005-2015년 개성공단에서 근무한 대한민국 국민에서의 말라리아 발생률을 추정하여 국제사회에 보고된 북한의 말라리아 발생률과 비교 평가하였다. 향후 남북한의 교류가 활성화 되었을 때 북한을 방문하고 돌아온 국민에서의 말라리아 발생률 자료를 사용하여 북한 현지에서의 말라리아 발생률 현황 추이를 살펴볼 수 있을 것으로 보인다.

COVID-19: Perspective

Atypical modes of COVID-19 transmission: how likely are they?: Viroj Wiwanitkit; Epidemiol Health. 2020;42:e2020059. Published online August 11, 2020; DOI: https://doi.org/10.4178/epih.e2020059

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Abstract

Coronavirus disease 2019 (COVID-19) is a new emerging pandemic, which has so far infected more than 20 million people throughout the world. Typically, this infection is transmitted from humans to humans via respiratory contact. However, the possibility that COVID-19 might be transmitted via atypical modes of transmission is an important public health consideration. In this short review article, the author summarizes and discusses the data on atypical modes of COVID-19 transmission. Based on the available data, it seems that there is still no evidence that COVID-19 can be transmitted via atypical modes of transmission.

Summary

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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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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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Assessing changes in incubation period, serial interval, and generation time of SARS-CoV-2 variants of concern: a systematic review and meta-analysis
Xiangyanyu Xu, Yanpeng Wu, Allisandra G. Kummer, Yuchen Zhao, Zexin Hu, Yan Wang, Hengcong Liu, Marco Ajelli, Hongjie Yu
BMC Medicine.2023;[Epub] CrossRef
Incubation Period of COVID-19 Caused by Unique SARS-CoV-2 Strains
Yu Wu, Liangyu Kang, Zirui Guo, Jue Liu, Min Liu, Wannian Liang
JAMA Network Open.2022; 5(8): e2228008. CrossRef
Relative infectiousness of asymptomatic SARS-CoV-2 infected persons compared with symptomatic individuals: a rapid scoping review
David McEvoy, Conor McAloon, Aine Collins, Kevin Hunt, Francis Butler, Andrew Byrne, Miriam Casey-Bryars, Ann Barber, John Griffin, Elizabeth Ann Lane, Patrick Wall, Simon John More
BMJ Open.2021; 11(5): e042354. CrossRef
Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis
Pratha Sah, Meagan C. Fitzpatrick, Charlotte F. Zimmer, Elaheh Abdollahi, Lyndon Juden-Kelly, Seyed M. Moghadas, Burton H. Singer, Alison P. Galvani
Proceedings of the National Academy of Sciences.2021;[Epub] CrossRef
Household Transmission of SARS-CoV-2
Zachary J. Madewell, Yang Yang, Ira M. Longini, M. Elizabeth Halloran, Natalie E. Dean
JAMA Network Open.2020; 3(12): e2031756. CrossRef

COVID-19: Brief Communication

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

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Abstract Summary PDF Supplementary Material

Abstract

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Summary

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

Citations

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Characterization of COVID-19 cases in the early phase (March to July 2020) of the pandemic in Kenya
Philip Ngere, Joyce Onsongo, Daniel Langat, Elizabeth Nzioka, Faith Mudachi, Samuel Kadivane, Bernard Chege, Elvis Kirui, Ian Were, Stephen Mutiso, Amos Kibisu, Josephine Ihahi, Gladys Mutethya, Trufosa Mochache, Peter Lokamar, Waqo Boru, Lyndah Makayotto
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Epidemiologic Investigation

Healthcare worker infected with Middle East Respiratory Syndrome during cardiopulmonary resuscitation in Korea, 2015: Hae-Sung Nam, Mi-Yeon Yeon, Jung Wan Park, Jee-Young Hong, Ji Woong Son; Epidemiol Health. 2017;39:e2017052. Published online November 12, 2017; DOI: https://doi.org/10.4178/epih.e2017052

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
During the outbreak of the Middle East Respiratory Syndrome (MERS) in Korea in 2015, the Korea Centers for Disease Control and Prevention (KCDC) confirmed a case of MERS in a healthcare worker in Daejeon, South Korea. To verify the precise route of infection for the case, we conducted an in-depth epidemiological investigation in cooperation with the KCDC.

METHODS

We reviewed the MERS outbreak investigation report of the KCDC, and interviewed the healthcare worker who had recovered from MERS. Using the media interview data, we reaffirmed and supplemented the nature of the exposure.

RESULTS

The healthcare worker, a nurse, was infected while performing cardiopulmonary resuscitation (CPR) for a MERS patient in an isolation room. During the CPR which lasted for an hour, a large amount of body fluid was splashed. The nurse was presumed to have touched the mask to adjust its position during the CPR. She suggested that she was contaminated with the MERS patient’s body fluids by wiping away the sweat from her face during the CPR.

CONCLUSIONS

The possible routes of infection may include the following: respiratory invasion of aerosols contaminated with MERS-coronavirus (MERS-CoV) through a gap between the face and mask; mucosal exposure to sweat contaminated with MERS-CoV; and contamination during doffing of personal protective equipment. The MERS guidelines should reflect this case to decrease the risk of infection during CPR.

Summary

Korean summary
2015년 한국의 Middle East respiratory syndrome (MERS) 유행 기간 중 질병관리본부는 MERS 환자 심폐소생술(cardio–pulmonary resuscitation, CPR)에 참여한 간호사에서 MERS를 확진하였다. 이 사례에 대해 대전광역시 메르스 대응 민간역학조사지원단에서 심층역학조사를 실시한 결과 (1) CPR 수행 중 MERS-CoV에 오염된 에어로졸의 호흡기 침투, (2) MERS-CoV에 오염된 땀의 점막 침투, (3) 보호구 탈의 과정에서 MERS-Cov에 오염 등이 가능한 감염 경로로 파악되었다. 본 사례는 MERS 환자에 대한 CPR 수행 및 수행자의 보호구 착용과 관련하여 MERS 관리 지침의 개정이 필요함을 시사한다.

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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.

Citations

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

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

17,628 View
186 Download
22 Web of Science
28 Crossref

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 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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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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104 Download
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Abstract PDF

Abstract

<p>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.</p>

Summary

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