Osong Public Health and Research Perspectives

Editorial

To become a more stronger and safer country: Jong-Koo Lee; Osong Public Health Res Perspect. 2023;14(2):67-69. Published online April 28, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0105

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Review Article

Points to consider when developing drugs for dry eye syndrome: Suyoung Bae, Hosun Seung, Ho Jung Oh; Osong Public Health Res Perspect. 2023;14(2):70-75. Published online April 26, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0031

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Graphical Abstract Abstract PDF: Changes in both the social environment (e.g., the increased use of electronic media) and the atmospheric environment (e.g., air pollution and dust) have contributed to an increasing incidence of eye disease and an increased need for eye care. Notably, the signs and symptoms of dry eye syndrome can impact the daily quality of life for various age groups, including the elderly, and usually requires active treatment. The symptoms of dry eye syndrome include tear film instability, hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities. As treatments for dry eye are being developed, a standardized guideline is needed to increase the efficiency of drug development and improve the quality of clinical trial data. In this paper, we present general considerations for the pharmaceutical industry and clinical trial investigators designing clinical trials focused on the development of drugs to treat dry eye syndrome.

Original Articles

The incidence and clinical characteristics of myocarditis and pericarditis following mRNA-based COVID-19 vaccination in Republic of Korea adolescents from July 2021 to September 2022: Ju-Young Sim, Seung-Yun Kim, Eun-Kyoung Kim; Osong Public Health Res Perspect. 2023;14(2):76-88. Published online April 18, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0032

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Graphical Abstract Abstract PDF

Objectives
Age-specific information regarding myocarditis/pericarditis in adolescents following mRNA-based coronavirus disease 2019 (COVID-19) vaccination in Asia remains insufficient. This study investigated the incidence and clinical characteristics of myocarditis/pericarditis in Republic of Korea adolescents after mRNA-based COVID-19 vaccination.
Methods
This retrospective descriptive study utilized patient data from the Korea Immunization Management System. Incidence rates were calculated according to age and sex. Clinical characteristics (symptoms/signs, laboratory values, and imaging results) were compared between mild and severe cases.
Results
Between July 19, 2021 and September 30, 2022, 3,728,224 individuals aged 12 to 19 years received 6,484,165 mRNA-based COVID-19 vaccines, and 173 cases met the case definition for myocarditis/pericarditis: 151 mild (87.3%) and 22 severe (12.7%). The incidence was 3.8-fold higher in males than in females. Troponin I/ troponin T was elevated in 96% of myocarditis cases, demonstrating higher sensitivity than creatine kinase-myocardial band (67.6%) or C-reactive protein (75.2%). ST-segment or Twave on electrography abnormalities were found in 60.3% (85/141). Paroxysmal/sustained atrial/ventricular arrhythmias were more common in severe than in mild cases (45.5% vs. 16.8%, p=0.008). Edema on T2-weighted magnetic imaging occurred in 21.6% (8/37) and 62.5% (5/8) of mild and severe cases, respectively (p=0.03). Abnormal pericardial fluid collection or pericardial inflammation was found in 75.4% of pericarditis cases (49/65).
Conclusion
Myocarditis/pericarditis occurred in rare cases following mRNA-based COVID-19 vaccination. Most cases were mild, but the incidence was higher in adolescent males and after the second dose. As bivalent severe acute respiratory syndrome coronavirus 2 mRNA vaccination started in Republic of Korea in October 2022, the post-vaccination incidence of myocarditis/pericarditis should be closely monitored, considering clinical characteristics.

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To become a more stronger and safer country
Jong-Koo Lee
Osong Public Health and Research Perspectives.2023; 14(2): 67. CrossRef

Risk factors for deaths associated with COVID-19 according to the cause of death classification in Republic of Korea: Na-Young Kim, Seong-Sun Kim, Hyun Ju Lee, Dong Hwi Kim, Boyeong Ryu, Eunjeong Shin, Donghyok Kwon; Osong Public Health Res Perspect. 2023;14(2):89-99. Published online April 18, 2023; DOI: https://doi.org/10.24171/j.phrp.2022.0312

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Graphical Abstract Abstract PDF: Objectives
This study aimed to classify coronavirus disease 2019 (COVID-19)-related deaths according to whether COVID-19 was listed as the cause of death, and to investigate the differences in demographic characteristics and risk factors for COVID-19 death classifications.
Methods
A total of 5,625 deaths in South Korea among patients with confirmed COVID-19 from January 20, 2020 to December 31, 2021 were selected. Excluding false reports and unnatural deaths, 5,597 deaths were analyzed. Based on death report data, deaths were classified according to whether the cause of death was listed as COVID-19 (CD) or not (NCD). The epidemiological characteristics and causes of deaths were investigated using descriptive, univariate, and multivariate statistical analyses. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to analyze the risk factors.
Results
The case fatality ratio was 0.89% and increased with age. Additionally, 96.4% of the subjects had an underlying disease, and 53.4% died in winter. The proportion of NCDs was 9.3%, of whom 19.1% died at home and 39.0% were confirmed to have COVID-19 after death. Malignant neoplasms (102/416 vs. 637/4,442; OR, 1.71; 95% CI, 1.36−2.16; p<0.001) were significantly associated with NCD.
Conclusion
This is the first study to analyze risk factors by cause of death using COVID-19 death report data in South Korea. These results are expected to be used as evidence for establishing a death monitoring system that can collect timely information in a new infectious disease pandemic.

Quality of life in patients treated for COVID-19–associated mucormycosis at a tertiary care hospital: Pragya Kumar, Rajath Rao UR, Nilanjan Roy, Deepika Agrawal, Shamshad Ahmad, Kranti Bhavana; Osong Public Health Res Perspect. 2023;14(2):119-128. Published online April 18, 2023; DOI: https://doi.org/10.24171/j.phrp.2022.0307

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Graphical Abstract Abstract PDF: Objectives
Coronavirus disease 2019 (COVID-19)–associated mucormycosis (CAM) has emerged as a formidable infection in patients with COVID-19. The aggressive management of CAM affects quality of life (QOL); thus, this study was designed to assess the QOL in patients with CAM at a tertiary healthcare institution.
Methods
This cross-sectional study of 57 patients with CAM was conducted over 6 months using a semi-structured standard questionnaire (the abbreviated World Health Organization Quality of Life questionnaire [WHO-BREF]) and a self-rated improvement (SRI) scale ranging from 0 to 9. Cut-off values of ≤52 and <7 were considered to indicate poor QOL and poor improvement, respectively. The correlations of QOL and SRI scores were evaluated using Spearman rho values.
Results
In total, 27 patients (47.4%; 95% confidence interval [CI], 34.9%–60.1%) and 26 patients (45.6%; 95% CI, 33.4%–58.4%) had poor QOL and poor SRI scores, respectively. The overall median (interquartile range) QOL score was 52 (41–63). Headache (adjusted B, −12.3), localized facial puffiness (adjusted B , −16.4), facial discoloration (adjusted B, −23.4), loosening of teeth (adjusted B, −18.7), and facial palsy (adjusted B, −38.5) wer e significantly associated with the QOL score in patients with CAM.
Conclusion
Approximately 1 in 2 patients with CAM had poor QOL and poor improvement. Various CAM symptoms were associated with QOL in these patients. Early recognition is the key to optimal treatment, improved outcomes, and improved QOL in patients with CAM.

Analysis of pregnant women with critically severe COVID-19 in Republic of Korea from February 2020 and December 2021: Ji Joo Lee, Sang-Eun Lee, Yeonjung Kim, Young-Joon Park; Osong Public Health Res Perspect. 2023;14(2):129-137. Published online April 5, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0025

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Graphical Abstract Abstract PDF: Objectives
This study aimed to describe the characteristics and risk factors for severe disease in pregnant women infected with coronavirus disease 2019 (COVID-19) from the early days of the COVID-19 epidemic in Korea to the predominant period of the Delta variant.
Methods
A retrospective cohort study was conducted among pregnant women diagnosed with COVID-19 between February 2020 and December 2021. Logistic regression analysis was performed to compare severe and mild cases after adjusting for pregnant women’s age, nationality, infection route, outbreak area, infection period, symptoms, underlying disease, smoking status, trimester, and COVID-19 vaccination status.
Results
In total, 2,233 pregnant women were diagnosed with COVID-19 by December 2021. Among these, 96.7% had mild symptoms, 3.3% had severe symptoms, and 0.04% died. The risk factors for severe disease in pregnant women with confirmed COVID-19 were being in the age group of 35 to 45 years, having hyperlipidemia, being in the second or third trimester of pregnancy at the time of COVID-19 diagnosis, being infected during the Delta-predominant period, and having a fever (≥38 °C) at diagnosis. Furthermore, 47.1% of patients in the mild group and 84.9% of patients in the severe group had 3 or more risk factors.
Conclusion
Pregnant women with COVID-19 mainly experienced mild symptoms, but those with risk factors were at a higher risk of developing severe symptoms. Therefore, treatment and follow-up management should be thoroughly implemented.

COVID-19 outbreak in a religious village community in Republic of Korea and risk factors for transmission: Jiae Shim, Eunju Lee, Eunyoung Kim, Yeonhwa Choi, Giseok Kang, Bryan Inho Kim; Osong Public Health Res Perspect. 2023;14(2):110-118. Published online April 5, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0002

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Graphical Abstract Abstract PDF: Objectives
This study aimed to assess the scale and transmission patterns of coronavirus disease 2019 (COVID-19) in a religious village community in South Korea, to determine the risk factors of transmission, and to evaluate vaccine effectiveness.
Methods
An epidemiological survey was conducted, and data were collected and analyzed from 602 villagers in the religious village community. Multivariate logistic regression analysis was used to identify the risk factors for COVID-19 transmission and to evaluate vaccine effectiveness.
Results
The outbreak attack rate was 72.1% (434/602). The attack rate was high among women in their 60s, the unemployed, residents living near religious facility (<500 m), and the unvaccinated. Age, the distance between religious facility and residences, and the absence of vaccination were identified as risk factors for transmission. Vaccine effectiveness was 49.0%, and the highest effectiveness was seen in the age group of 59 years or younger (65.8%).
Conclusion
This village community was isolated, with little communication with the outside world. However, the frequency of close contact between residents was relatively high, contributing to the spread of COVID-19 in the village even with relatively short exposure. Vaccination rates in the village community were also lower than those in the general public. Public health authorities should consider the potential impact of cultural factors, including religion, that could lead to the exponential spread of COVID-19 in closed village communities.

Correspondences

Response to the comment of Perone by the corresponding author Kim: Yongmoon Kim, Bryan Inho Kim, Sangwoo Tak; Osong Public Health Res Perspect. 2023;14(2):147-147. Published online March 24, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0072R

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Comments on the article "Time-series comparison of COVID-19 case fatality rates across 21 countries with adjustment for multiple covariates": Gaetano Perone; Osong Public Health Res Perspect. 2023;14(2):146-146. Published online March 24, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0072L

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Original Articles

Vaccine hesitancy in patients with COVID-19 who have back pain: Askeri Türken, Haşim Çapar; Osong Public Health Res Perspect. 2023;14(2):100-109. Published online March 24, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0003

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Graphical Abstract Abstract PDF: Objectives
Musculoskeletal pain is among the most common symptoms in patients diagnosed with coronavirus disease 2019 (COVID-19), and it has placed a significant burden on health worldwide during the pandemic. This study explored vaccine hesitancy and associated factors in patients with positive COVID-19 polymerase chain reaction test results who were hospitalized and had back pain.
Methods
A cross-sectional study was conducted among 170 hospitalized COVID-19 patients over 18 years of age. Data were analyzed using descriptive statistics with IBM SPSS ver. 25.0.
Results
COVID-19 patients who were married considered COVID-19 vaccinations riskier than unmarried COVID-19 patients. Patients who had not been vaccinated expressed higher levels of distrust towards COVID-19 vaccines than patients who had been vaccinated. Participants had relatively little hesitation toward the Sinovac vaccine. High vaccine confidence was found in all participants regardless of vaccination status. Those who had not received the COVID-19 vaccine reported higher risk perceptions than those who had received at least 1 dose of any COVID-19 vaccine.
Conclusion
Measurements of the hesitancy of vaccinated and non-vaccinated patients or members of society towards vaccines can be an important parameter for health authorities to find solutions.

Estimated impact of the national hepatitis B immunization program on acute viral hepatitis B among adolescents in Republic of Korea: Chungman Chae, Sangwoo Tak; Osong Public Health Res Perspect. 2023;14(2):138-145. Published online March 24, 2023; DOI: https://doi.org/10.24171/j.phrp.2022.0321

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Graphical Abstract Abstract PDF: Objectives
We aimed to estimate the impact of the national hepatitis B immunization program on the incidence of acute hepatitis B infection among adolescents in South Korea.
Methods
We estimated the counterfactual incidence rate of reported acute hepatitis B among adolescents from 2016 to 2020 compared to the assumption that the national hepatitis B immunization program for children had not been implemented since 1995. The impact of the national hepatitis B immunization program for adolescents was measured by estimating the absolute risk reduction and averted acute hepatitis B infections among adolescents from 2016 to 2020 attributed to the national immunization program.
Results
The relative risk reduction of acute hepatitis B among adolescents was estimated to be 83.5% after implementing the national hepatitis B immunization program. The incidence rate of reported acute hepatitis B infections among adolescents decreased from 0.39 to 0.06 per 100,000 person-years, and 43 acute hepatitis B infections, including 17 symptomatic cases, were averted annually from 2016 to 2020 by the national hepatitis B immunization program.
Conclusion
The national hepatitis B immunization program for children was effective in preventing acute hepatitis B infection among adolescents in South Korea.

Special Article

A framework for nationwide COVID-19 vaccine safety research in the Republic of Korea: the COVID-19 Vaccine Safety Research Committee: Na-Young Jeong, Hyesook Park, Sanghoon Oh, Seung Eun Jung, Dong-Hyun Kim, Hyoung-Shik Shin, Hee Chul Han, Jong-Koo Lee, Jun Hee Woo, Byung-Joo Park, Nam-Kyong Choi; Osong Public Health Res Perspect. 2023;14(1):5-14. Published online February 28, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0026

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Graphical Abstract Abstract PDF

With the introduction of coronavirus disease 2019 (COVID-19) vaccines, the Korea Disease Control and Prevention Agency (KDCA) commissioned the National Academy of Medicine of Korea to gather experts to independently assess post-vaccination adverse events. Accordingly, the COVID-19 Vaccine Safety Research Committee (CoVaSC) was launched in November 2021 to perform safety studies and establish evidence for policy guidance. The CoVaSC established 3 committees for epidemiology, clinical research, and communication. The CoVaSC mainly utilizes pseudonymized data linking KDCA’s COVID-19 vaccination data and the National Health Insurance Service’s claims data. The CoVaSC’s 5-step research process involves defining the target diseases and organizing ad-hoc committees, developing research protocols, performing analyses, assessing causal relationships, and announcing research findings and utilizing them to guide compensation policies. As of 2022, the CoVaSC completed this research process for 15 adverse events. The CoVaSC launched the COVID-19 Vaccine Safety Research Center in September 2022 and has been reorganized into 4 divisions to promote research including international collaborative studies, long-/short-term follow-up studies, and education programs. Through these enhancements, the CoVaSC will continue to swiftly provide scientific evidence for COVID-19 vaccine research and compensation and may serve as a model for preparing for future epidemics of new diseases.

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Citations to this article as recorded by

To become a more stronger and safer country
Jong-Koo Lee
Osong Public Health and Research Perspectives.2023; 14(2): 67. CrossRef

Editorial

How we will reach a safer community: Jong-Koo Lee; Osong Public Health Res Perspect. 2023;14(1):1-4. Published online February 27, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0057

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Original Articles

The first reported hepatitis E outbreak in a food manufacturing factory: Korea, 2022: Hansol Yeom, Soonryu Seo, Youngsil Yoon, Jaeeun Lee, Myung-Guk Han, Deog-Yong Lee, Sun-Whan Park, Song A Park, Sook-Hyang Jeong, Jin Gwack; Osong Public Health Res Perspect. 2023;14(1):15-22. Published online February 22, 2023; DOI: https://doi.org/10.24171/j.phrp.2022.0305

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Graphical Abstract Abstract PDF: Objectives
On February 16, 2022, 12 cases of hepatitis E virus (HEV) infection were reported in a food manufacturing factory in Korea. The aim of this study was to identify additional cases and to determine the source of this HEV outbreak. Methods: This study was an in-depth investigation of 12 HEV immunoglobulin M (IgM)-positive cases and their demographic, clinical, and epidemiological characteristics. On-site specimens were collected from the environment and from humans, and a follow-up investigation was conducted 2 to 3 months after the outbreak. Results: Among 80 production workers in the factory, 12 (15.0%) had acute HEV infection, all of whom were asymptomatic. The follow-up investigation showed that 3 cases were HEV IgMpositive, while 6 were HEV IgG-positive. HEV genes were not detected in the HEV IgM-positive specimens. HEV genes were not detected in the food products or environmental specimens collected on-site. HEV was presumed to be the causative pathogen. However, it could not be confirmed that the source of infection was common consumption inside the factory. Conclusion: This was the first domestic case of an HEV infection outbreak in a food manufacturing factory in Korea. Our results provide information for the future control of outbreaks and for the preparation of measures to prevent domestic outbreaks of HEV infection.

Association between the empirical dietary inflammatory index and musculoskeletal pain in community-dwelling older adults: a cross-sectional study: Mahshid Rezaei, Zahra Tajary, Zahra Esmaeily, Atefeh Eyvazkhani, Shahrzad Daei, Marjan Mansouri Dara, Mohaddeseh Rezaei, Abolghassem Djazayeri, Ahmadreza Dorosty Motlagh; Osong Public Health Res Perspect. 2023;14(1):51-58. Published online February 20, 2023; DOI: https://doi.org/10.24171/j.phrp.2022.0194

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Graphical Abstract Abstract PDF: Objectives
Inflammation has been proposed to be one of the main causes of musculoskeletal pain. Diet is a lifestyle factor that plays an important role in managing inflammation; thus, we assessed the inflammatory potential of diets using the empirical dietary inflammatory index (EDII) to investigate the relationship between diet and musculoskeletal pain.
Methods
This cross-sectional study included 212 elderly individuals who were selected from health centers in Tehran, Iran. Dietary intake was evaluated using a valid and reliable 147-item food frequency questionnaire. To measure the intensity of pain, a visual analogue scale was used. Multiple linear regression was applied to assess the association between the EDII and musculoskeletal pain.
Results
In total, 62.7% and 37.3% of participants had mild and severe pain, respectively. The EDII values were 0.97±0.72 and 1.10±0.66, respectively, in those with mild and severe pain. A higher EDII score was associated with more intense musculoskeletal pain after adjusting for age and sex (β=0.20; 95% confidence interval [CI], 0.06–0.26; p<0.001), but not after adjustment for other confounders (β=–0.13; 95% CI, –1.54 to 0.60; p=0.39).
Conclusion
Our findings indicated that higher dietary inflammation might not be associated with musculoskeletal pain in older adults. However, further investigations are required to confirm these findings.

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