Osong Public Health and Research Perspectives

Editorial

The neglected issues of global health security that we should prepare for in our society: Jong-Koo Lee; Osong Public Health Res Perspect. 2022;13(3):171-173. Published online June 30, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0185

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Original Articles

Changes in the pattern and disease burden of acute respiratory viral infections before and during the COVID-19 pandemic: Chungmin Park, Donghan Lee, Bryan Inho Kim, Sujin Park, Gyehee Lee, Sangwoo Tak; Osong Public Health Res Perspect. 2022;13(3):203-211. Published online June 30, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0144

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Abstract PDF: Objectives
We conducted a comparative analysis of the differences in the incidence of 8 acute respiratory viruses and the changes in their patterns before and during the coronavirus disease 2019 (COVID-19) pandemic.
Methods
Three sentinel surveillance systems of the Korea Disease Control and Prevention Agency and data from the Health Insurance Review and Assessment Service were analyzed. The average numbers of reported cases and the related hospital admissions and outpatient data were compared between April 2018–2019 and 2020–2021. Changes in the disease burden and medical expenditures between these 2 time periods were evaluated.
Results
During the COVID-19 pandemic, the number of reported cases of all acute viral respiratory infections, except for human bocavirus, decreased significantly. Data from the Health Insurance Review and Assessment Service also showed decreases in the actual amount of medical service usage and a marked reduction in medical expenditures.
Conclusion
Non-pharmacological interventions in response to COVID-19 showed preventive effects on the transmission of other respiratory viruses, as well as COVID-19. Although COVID-19 had a tremendous impact on society as a whole, with high social costs, there were also positive effects, such as a reduction in the incidence of acute viral respiratory infections.

Epidemiological characteristics of carbapenem-resistant Enterobacteriaceae and carbapenem-resistant Acinetobacter baumannii in a tertiary referral hospital in Korea: Sollan Kang, Ihn Sook Jeong; Osong Public Health Res Perspect. 2022;13(3):221-229. Published online June 30, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0097

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Abstract PDF: Objectives
This study aimed to identify the epidemiological characteristics of patients with carbapenem-resistant Enterobacteriaceae and Acinetobacter baumannii (CRE/CRAB) isolates in a tertiary referral hospital in Korea.
Methods
We collected and analyzed data from 528 adults admitted to a tertiary referral hospital from August 1, 2018 to February 29, 2020. The CRE/CRAB isolates were confirmed as being present at the time of patients’ admission or acquired during hospitalization based on their medical records. The t-test, chi-square test, or Fisher exact test and stepwise multiple logistic regression were performed.
Results
While the proportion of community-acquired CRE/CRAB was low (6%), 20% of CRE/CRAB isolates were identified in patients at the time of hospitalization. The risk of CRAB isolation was positively associated with mechanical ventilator use (odds ratio [OR], 3.52; 95% confidence interval [CI], 1.96−6.33) and total parenteral nutrition use (OR, 3.64; 95% CI, 1.87−7.08).
Conclusion
Over 20% of CRE/CRAB isolates in a tertiary referral hospital in Korea were found at the time of patients’ admission. Furthermore, patients with mechanical ventilation and/or total parenteral nutrition tended to acquire CRAB more frequently. Thus, active surveillance for CRE/CRAB at the time of hospitalization is strongly required, particularly for patients who are expected to require mechanical ventilation or total parenteral nutrition.

Review Article

Effect of clofibrate on reducing neonatal jaundice: a systematic review and meta-analysis: Fatemeh Eghbalian, Lotfollah Karimi, Roya Raeisi, Ayda Hasanpour Dehkordi, Hamid Bouraghi; Osong Public Health Res Perspect. 2022;13(3):174-183. Published online June 30, 2022; DOI: https://doi.org/10.24171/j.phrp.2021.0336

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Abstract PDF: In neonates, bilirubin tends to be deposited in body tissues, especially the skin and mucous membranes. Jaundice is an early symptom of bilirubin excretion disorders. Therefore, the aim of this study was to investigate the effect of clofibrate on reducing neonatal jaundice. In this systematic review, international databases, including PubMed, Scopus, Web of Science, Embase, Cochrane, and Google Scholar, were searched without time and language restrictions. The reference lists of all studies ultimately included were manually searched. In the 17 articles reviewed, with a sample size of 665 people published between 2005 and 2019, the average weight of the neonates varied from 2,186 g to 4,000 g. Furthermore, the average age of neonates varied from 2.09 days to 9.8 days. Four doses of clofibrate (25, 30, 50, 100 mg/kg of neonatal body weight) were used. The bilirubin level of neonates significantly decreased in the intervention group 24, 36, 48, and 72 hours after the start of treatment. Clofibrate administration decreased total serum bilirubin, especially from the second day onwards, and also reduced hospitalization time, hospital costs, and side effects from hospitalization.

Original Article

Transmission parameters of coronavirus disease 2019 in South Asian countries: Mridul Sannyal, Abul Mukid Mohammad Mukaddes; Osong Public Health Res Perspect. 2022;13(3):191-202. Published online June 23, 2022; DOI: https://doi.org/10.24171/j.phrp.2021.0234

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Abstract PDF: Objectives
This study aimed to estimate the transmission parameters, effective reproduction number, epidemic peak, and future exposure of coronavirus disease 2019 (COVID-19) in South Asian countries.
Methods
A susceptible-exposed-infected-recovered-death (SEIRD) model programmed with MATLAB was developed for this purpose. Data were collected (till June 28, 2021) from the official webpage of World Health Organization, along with the Center for Systems Science and Engineering at Johns Hopkins University. The model was simulated to measure the primary transmission parameters. The reproduction number was measured using the next-generating matrix method.
Results
The primary transmission rate followed an exponential Gaussian process regression. India showed the highest transmission rate (0.037) and Bhutan the lowest (0.023). The simulated epidemic peaks matched the reported peaks, thereby validating the SEIRD model. The simulation was carried out up to December 31, 2020 using the reported data till June 9, 2020.
Conclusion
The information gathered in this research will be helpful for authorities to prevent the transmission of COVID-19 in the subsequent wave or in the future.

Brief Report

Safety monitoring of COVID-19 vaccination among adolescents aged 12 to 17 years old in the Republic of Korea: Seontae Kim, Insob Hwang, Mijeong Ko, Yunhyung Kwon, Yeon-Kyeng Lee; Osong Public Health Res Perspect. 2022;13(3):230-237. Published online June 10, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0122

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Abstract PDF: Objectives
This study aimed to disseminate information on coronavirus disease 2019 (COVID-19) vaccine safety among adolescents aged 12 to 17 years in the Republic of Korea.
Methods
Two databases were used to assess COVID-19 vaccine safety in adolescents aged 12 to 17 years who completed the primary Pfizer-BioNTech vaccination series. Adverse events reported to the web-based COVID-19 vaccination management system (CVMS) and collected in the text message-based system were analyzed.
Results
From March 5, 2021 to February 13, 2022, 12,216 adverse events among 12- to 17-year-olds were reported to theCVMS, of which 97.1% were non-serious adverse events and 2.9% were serious adverse events, including 85 suspected cases of anaphylaxis, 74 suspected cases of myocarditis and/or pericarditis, and 2 deaths. From December 13, 2021 to January 26, 2022, 10,389 adolescents responded to a text message survey, and local/systemic adverse events were more common after dose 2 than after dose 1. The most commonly reported events following either vaccine dose were pain at the injection site, headache, fatigue/tiredness, and myalgia.
Conclusion
The overall results are consistent with safety data reported in the United States and a controlled trial and serious adverse.events were rare among adolescents aged 12 to 17 years following COVID-19 vaccination.

Original Articles

Voluntary testing for COVID-19: perceptions and utilization among the inhabitants of Saudi Arabia: Ehab A. Abo-Ali, Ahmed Mousa, Rania Hussien, Shahad Mousa, Shayma Al-Rubaki, Mennatulla Omar, Badr Al-Haffashi, Abdullah Almilaibary; Osong Public Health Res Perspect. 2022;13(3):212-220. Published online June 10, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0062

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Abstract PDF: Objectives
Voluntary testing (VT) plays a crucial role in the prevention and control of infectious diseases. The present study investigated the perceptions and utilization of VT services for coronavirus disease 2019 (COVID-19) among the inhabitants of Saudi Arabia.
Methods
In total, 3,510 adult participants from all provinces of Saudi Arabia were recruited via a national online survey.
Results
Of the 3,510 participants, 88.9% were aware of the testing services available to them and of those, more than half (59.5%) had used the VT services and 96.1% were satisfied with the services. Contact with a positive COVID-19 case was the top reason for accessing VT, while a lack of awareness about the availability of VT services was the top perceived limiting factor. A history of chronic health conditions, anxiety and/or depression, and previous symptoms suggestive of COVID-19 were found to be predictors of the utilization of VT services (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.22−1.96; OR 1.48, 95% CI 1.16−1.88; and OR 3.31, 95% CI 2.77−3.95), respectively.
Conclusion
The awareness of voluntary COVID-19 testing services was satisfactory among the Saudi Arabian population, but can be improved. Sociodemographic and health history predictors of the utilization of VT services were identified.

Seroprevalence of immunoglobulin G antibodies against SARS-CoV-2 in children and adolescents in Delhi, India, from January to October 2021: a repeated cross-sectional analysis: Pragya Sharma, Saurav Basu, Suruchi Mishra, Mongjam Meghachandra Singh; Osong Public Health Res Perspect. 2022;13(3):184-190. Published online June 10, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0014

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Abstract PDF: Objectives
The aim of this study was to assess changes in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) seroprevalence among children and adolescents in Delhi, India from January 2021 to October 2021
Methods
This was a repeated cross-sectional analysis of participants aged 5 to 17 years from 2 SARS-CoV-2 seroprevalence surveys conducted in Delhi, India during January 2021 and September to October 2021. Anti-SARS-CoV-2 IgG antibodies were detected by using the VITROS assay (90% sensitivity, 100% specificity).
Results
The seroprevalence among 5- to 17-year-old school-age children and adolescents increased from 52.8% (95% confidence interval [CI], 51.3%−54.3%) in January 2021 to 81.8% (95% CI, 80.9%−82.6%) in September to October 2021. The assay-adjusted seroprevalence was 90.8% (95% CI, 89.8%−91.7%). Seropositivity positively correlated with participants’ age (p<0.001), but not sex (p=0.388). A signal to cut-off ratio ≥4.00, correlating with the presence of neutralization antibodies, was observed in 4,814 (57.9%) participants.
Conclusion
The high percentage of seroconversion among children and adolescents indicates the presence of natural infection-induced immunity from past exposure to the SARS-CoV-2 virus. However, the lack of hybrid immunity and the concomitant likelihood of lower levels of neutralization antibodies than in adults due to the absence of vaccination warrants careful monitoring and surveillance of infection risk and disease severity from newer and emergent variants.

Editorial

Preparedness of primary care responses to the next pandemic: Jong-Koo Lee; Osong Public Health Res Perspect. 2022;13(2):81-83. Published online April 29, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0136

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Review Article

Immune-related therapeutics: an update on antiviral drugs and vaccines to tackle the COVID-19 pandemic: Iqra Mir, Sania Aamir, Syed Rizwan Hussain Shah, Muhammad Shahid, Iram Amin, Samia Afzal, Amjad Nawaz, Muhammad Umer Khan, Muhammad Idrees; Osong Public Health Res Perspect. 2022;13(2):84-100. Published online April 27, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0024

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Graphical Abstract Abstract PDF: The coronavirus disease 2019 (COVID-19) pandemic rapidly spread globally. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, is a positive-sense single-stranded RNA virus with a reported fatality rate ranging from 1% to 7%, and people with immune-compromised conditions, children, and older adults are particularly vulnerable. Respiratory failure and cytokine storm-induced multiple organ failure are the major causes of death. This article highlights the innate and adaptive immune mechanisms of host cells activated in response to SARS-CoV-2 infection and possible therapeutic approaches against COVID-19. Some potential drugs proven to be effective for other viral diseases are under clinical trials now for use against COVID-19. Examples include inhibitors of RNA-dependent RNA polymerase (remdesivir, favipiravir, ribavirin), viral protein synthesis (ivermectin, lopinavir/ ritonavir), and fusion of the viral membrane with host cells (chloroquine, hydroxychloroquine, nitazoxanide, and umifenovir). This article also presents the intellectual groundwork for the ongoing development of vaccines in preclinical and clinical trials, explaining potential candidates (live attenuated-whole virus vaccines, inactivated vaccines, subunit vaccines, DNAbased vaccines, protein-based vaccines, nanoparticle-based vaccines, virus-like particles and mRNA-based vaccines). Designing and developing an effective vaccine (both prophylactic and therapeutic) would be a long-term solution and the most effective way to eliminate the COVID-19 pandemic.

Original Articles

Epidemiological characteristics of varicella outbreaks in the Republic of Korea, 2016–2020: Eun-Young Kim, Chungmin Park, Gyehee Lee, Suyeon Jeong, Jeongsuk Song, Dong-Han Lee; Osong Public Health Res Perspect. 2022;13(2):133-141. Published online April 26, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0087

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Abstract PDF: Objectives
We described the trends and epidemiological characteristics of varicella outbreaks from 2016 to 2020 in the Republic of Korea. Methods: We investigated variables such as the outbreak setting, age of patients, vaccination status, and lesion count. The collected data were analyzed with the Cochrane-Armitage trend test and Kruskal-Wallis test. These statistical tests were performed using R ver. 4.0.3. Results: The number of varicella outbreaks increased from 2016 to 2018; however, after a slight decrease in the number of outbreaks in 2019, the number fell sharply in 2020. The median size of outbreaks decreased from 8 to 9 cases during 2016−2019 to 6 cases in 2020. The median duration of outbreaks was 18 days during 2016−2017, 28 days in 2018, 29 days in 2019, and 15 days in 2020. Varicella outbreaks occurred most frequently in elementary schools, and vaccination coverage of patients increased from 89.4% in 2016 to 97.2% in 2019. The median age of patients with outbreak-related varicella decreased from 8 years in 2016 to 6 years in 2020. Conclusion: Significant changes were observed in the age of patients with outbreak-related varicella. Ongoing monitoring of varicella outbreaks should be conducted. Further research will be needed to measure the disease burden of varicella and enable evidence-based policy decisions.

COVID-19 outbreak response at a nursing hospital in South Korea in the post-vaccination era, including an estimation of the effectiveness of the first shot of the Oxford-AstraZeneca COVID-19 vaccine (ChAdOx1-S): Chanhee Kim, Geon Kang, Sun Gu Kang, Heeyoung Lee; Osong Public Health Res Perspect. 2022;13(2):114-122. Published online April 26, 2022; DOI: https://doi.org/10.24171/j.phrp.2021.0262

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Abstract PDF: Objectives
We descriptively reviewed a coronavirus disease 2019 (COVID-19) outbreak at a nursing hospital in Gyeonggi Province (South Korea) and assessed the effectiveness of the first dose of the Oxford-AstraZeneca vaccine in a real-world population. Methods: The general process of the epidemiological investigation included a public health intervention. The relative risk (RR) of vaccinated and unvaccinated groups was calculated and compared to confirm the risk of severe acute respiratory syndrome coronavirus-2 (SARSCoV-2) infection, and vaccine effectiveness was evaluated based on the calculated RR. Results: The population at risk was confined to ward E among 8 wards of Hospital X, where the outbreak occurred. This population comprised 55 people, including 39 patients, 12 nurses, and 4 caregivers, and 19 cases were identified. The RR between the vaccinated and unvaccinated groups was 0.04, resulting in a vaccine effectiveness of 95.3%. The vaccination rate of the nonpatients in ward E was the lowest in the entire hospital, whereas the overall vaccination rate of the combined patient and non-patient groups in ward E was the third lowest. Conclusion: The first dose of the Oxford-AstraZeneca vaccine (ChAdOx1-S) was effective in preventing SARS-CoV-2 infection. To prevent COVID-19 outbreaks in medical facilities, it is important to prioritize the vaccination of healthcare providers.

Sex differences in factors associated with prediabetes in Korean adults: Jin Suk Ra; Osong Public Health Res Perspect. 2022;13(2):142-152. Published online April 22, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0053

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Abstract PDF: Objectives
Identifying the factors associated with prediabetes is necessary for the early detection and management of high-risk individuals with prediabetes. The purpose of this study was to identify the factors associated with prediabetes according to sex in Korean adults. Methods: Using the Korean National Health and Nutrition Examination Survey from 2015 to 2019, a total of 13,595 adults (5,565 males and 8,030 females) aged ≥20 years were included in the data analysis. Logistic regression analysis was performed to identify the factors associated with prediabetes according to sex in Korean adults. Results: In both males and females, age and a family history of type 2 diabetes were associated with prediabetes. In males, current and past smoking habits were associated with increased prediabetes. In addition, low-intensity physical activity and prolonged sedentary behavior were associated with a higher prevalence of prediabetes. Females with a lower education level (less than middle school graduation) showed a higher risk of prediabetes. Conclusion: Sex-specific prevention strategies for prediabetes should be developed. In addition, older individuals and those with a family history of type 2 diabetes should be screened for prediabetes.

Phylogenetic and genome-wide mutational analysis of SARS-CoV-2 strains circulating in Nigeria: no implications for attenuated COVID-19 outcomes: Daniel B. Kolawole, Malachy I. Okeke; Osong Public Health Res Perspect. 2022;13(2):101-113. Published online April 22, 2022; DOI: https://doi.org/10.24171/j.phrp.2021.0329

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Graphical Abstract Abstract PDF: Objectives
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). The COVID-19 incidence and mortality rates are low in Nigeria compared to global trends. This research mapped the evolution of SARS-CoV-2 circulating in Nigeria and globally to determine whether the Nigerian isolates are genetically distinct from strains circulating in regions of the world with a high disease burden. Methods: Bayesian phylogenetics using BEAST 2.0, genetic similarity analyses, and genomewide mutational analyses were used to characterize the strains of SARS-CoV-2 isolated in Nigeria. Results: SARS-CoV-2 strains isolated in Nigeria showed multiple lineages and possible introductions from Europe and Asia. Phylogenetic clustering and sequence similarity analyses demonstrated that Nigerian isolates were not genetically distinct from strains isolated in other parts of the globe. Mutational analysis demonstrated that the D614G mutation in the spike protein, the P323L mutation in open reading frame 1b (and more specifically in NSP12), and the R203K/ G204R mutation pair in the nucleocapsid protein were most prevalent in the Nigerian isolates. Conclusion: The SARS-CoV-2 strains in Nigeria were neither phylogenetically nor genetically distinct from virus strains circulating in other countries of the world. Thus, differences in SARS-CoV-2 genomes are not a plausible explanation for the attenuated COVID-19 outcomes in Nigeria.

The effect of an application-based educational intervention with a social cognitive theory model on pregnant women in Denpasar, Bali, Indonesia: a randomized controlled trial: Ni Wayan Ariyani, I Made Ady Wirawan, Gede Ngurah Indraguna Pinatih, Anak Agung Ngurah Jaya Kusuma; Osong Public Health Res Perspect. 2022;13(2):153-161. Published online April 14, 2022; DOI: https://doi.org/10.24171/j.phrp.2021.0209

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Abstract PDF: Objectives
The aim of this study was to elucidate the effect of application-based antenatal education based on social cognitive theory (SCT) on Health Promoting Lifestyle Profile II (HPLP II) scores, compliance with iron tablet consumption, and readiness for childbirth and complications among pregnant women in Denpasar, Bali, Indonesia. Methods: This randomized controlled trial included 71 pregnant women in the treatment group and 74 pregnant women in the control group. The treatment group application-based antenatal education based on SCT, while the control group attended a conventional pregnancy class. Iron tablet consumption was verified by counting the remaining iron tablets. Information on participants’ lifestyles was collected using the HPLP II questionnaire with the help of an assistant. The collected data were statistically analyzed using IBM SPSS ver. 24.0. Results: The antenatal education intervention effectively increased the HPLP II score by 0.32 points (2.62±0.331 before the intervention and 2.94±0.273 after). Meanwhile, the control group had a 0.13-point increase (p=0.001), from 2.67±0.336 to 2.80±0.275. There was no significant difference in iron tablet consumption (p=0.333) or readiness for delivery and complications (p=0.557) between the treatment and control groups. Conclusion: Application-based antenatal education with SCT effectively increased the HPLP II scores of pregnant women in Denpasar, Bali. Although there was no significant difference in iron tablet consumption or readiness for delivery and complications, the values increased to a greater extent in the treatment group than in the control group. This education model is more suited to urban pregnant women who employed and have good internet access.

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