Osong Public Health and Research Perspectives

Volume 14(4); August 2023

Editorial

How we can prevent a resurgence this year: Jong-Koo Lee; Osong Public Health Res Perspect. 2023;14(4):233-234. Published online August 30, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0235

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Review Article

Public health agencies’ use of social media for communication during pandemics: a scoping review of the literature: Babatunde Abiodun Balogun, Anne Hogden, Nenagh Kemp, Lin Yang, Maria Agaliotis; Osong Public Health Res Perspect. 2023;14(4):235-251. Published online August 9, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0095

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Abstract PDF: Public health agencies (PHAs) have increasingly incorporated social media into their communication mix during successive pandemics in the 21st century. However, the quality, timing, and accuracy of their health messages have varied significantly, resulting in mixed outcomes for communication, audience engagement, and pandemic management. This study aimed to identify factors influencing the effectiveness of pandemic-related health messages shared by PHAs on social media and to report their impact on public engagement as documented in the literature. A scoping literature review was conducted following a predefined protocol. An electronic search of 7 relevant databases and 5 grey literature repositories yielded 9,714 papers published between January 2003 and November 2022. Seventy-three papers were deemed eligible and selected for review. The results underscored the insufficiency of social media guidance policies for PHAs. Six themes were identified: message source, message topic, message style, message timing, content credibility and reliability, and message recipient profile. These themes encompassed 20 variables that could inform PHAs’ social media public health communication during pandemics. Additionally, the findings revealed potential interconnectedness among the variables, and this study concluded by proposing a conceptual model that expands upon existing theoretical foundations for developing and evaluating pandemic-related health messaging.

Original Articles

Risk factors for transmission in a COVID-19 cluster infection in a high school in the Republic of Korea: Jin-Hwan Jeon, Su Jin Kang, Se-Jin Jeong, Hyeon-Cheol Jang, Young-Joon Park, Sang-Eun Lee; Osong Public Health Res Perspect. 2023;14(4):252-262. Published online July 27, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0125

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Abstract PDF: Objectives
This study aimed to examine the scale, characteristics, risk factors, and modes of transmission in a coronavirus disease 2019 (COVID-19) outbreak at a high school in Seoul, Republic of Korea.
Methods
An epidemiological survey was conducted of 1,118 confirmed cases and close contacts from a COVID-19 outbreak at an educational facility starting on May 31, 2021. In-depth interviews, online questionnaires, flow evaluations, and CCTV analyses were used to devise infection prevention measures. Behavioral and spatial risk factors were identified, and statistical significance was tested.
Results
Among 3rd-year students, there were 33 confirmed COVID-19 cases (9.6%). Students who used a study room in the annex building showed a statistically significant 4.3-fold elevation in their relative risk for infection compared to those who did not use the study room. Moreover, CCTV facial recognition analysis confirmed that 17.8% of 3rd-year students did not wear masks and had the lowest percentage of mask-wearers by grade. The air epidemiological survey conducted in the study room in the annex, which met the 3 criteria for a closed space, confirmed that there was only 10% natural ventilation due to the poor ventilation system.
Conclusion
To prevent and manage the spread of COVID-19 in educational facilities, advance measures that consider the size, operation, and resources of each school are crucial. In addition, various survey methodologies should be used in future studies to quickly analyze a wider range of data that can inform an evidence-based quarantine response.

Household secondary attack rates and risk factors during periods of SARS-CoV-2 Delta and Omicron variant predominance in the Republic of Korea: Jin Lee, Mijeong Ko, Seontae Kim, Dosang Lim, Gemma Park, Sang-Eun Lee; Osong Public Health Res Perspect. 2023;14(4):263-271. Published online August 11, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0133

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Abstract PDF: Objectives
The household secondary attack rate (SAR) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an important indicator for community transmission. This study aimed to characterize transmission by comparing household SARs and identifying risk factors during the periods of Delta and Omicron variant predominance in Republic of Korea.
Methods
We defined the period of Delta variant predominance (Delta period) as July 25, 2021 to January 15, 2022, and the period of Omicron variant predominance (Omicron period) as February 7 to September 3, 2022. The number of index cases included was 214,229 for the Delta period and 5,521,393 for the Omicron period. To identify the household SARs and risk factors for each period, logistic regression was performed to determine the adjusted odds ratio (aOR).
Results
The SAR was 35.2% for the Delta period and 43.1% for the Omicron period. The aOR of infection was higher in 2 groups, those aged 0 to 18 years and ≥75 years, compared to those aged 19 to 49 years. Unvaccinated individuals (vs. vaccinated individuals) and individuals experiencing initial infection (vs. individuals experiencing a second or third infection) had an increased risk of infection with SARS-CoV-2.
Conclusion
This study analyzed the household SARs and risk factors. We hope that the results can help develop age-specific immunization plans and responses to reduce the SAR in preparation for emerging infectious diseases or potential new variants of SARS-CoV-2.

Increased viral load in patients infected with severe acute respiratory syndrome coronavirus 2 Omicron variant in the Republic of Korea: Jeong-Min Kim, Dongju Kim, Nam-Joo Lee, Sang Hee Woo, Jaehee Lee, Hyeokjin Lee, Ae Kyung Park, Jeong-Ah Kim, Chae Young Lee, Il-Hwan Kim, Cheon Kwon Yoo, Eun-Jin Kim; Osong Public Health Res Perspect. 2023;14(4):272-278. Published online July 27, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0024

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Abstract PDF: Objectives
Coronavirus disease 2019 (COVID-19) has been declared a global pandemic owing to the rapid spread of the causative agent, severe acute respiratory syndrome coronavirus 2. Its Delta and Omicron variants are more transmissible and pathogenic than other variants. Some debates have emerged on the mechanism of variants of concern. In the COVID-19 wave that began in December 2021, the Omicron variant, first reported in South Africa, became identifiable in most cases globally. The aim of this study was to provide data to inform effective responses to the transmission of the Omicron variant.
Methods
The Delta variant and the spike protein D614G mutant were compared with the Omicron variant. Viral loads from 5 days after symptom onset were compared using epidemiological data collected at the time of diagnosis.
Results
The Omicron variant exhibited a higher viral load than other variants, resulting in greater transmissibility within 5 days of symptom onset.
Conclusion
Future research should focus on vaccine efficacy against the Omicron variant and compare trends in disease severity associated with its high viral load.

Effects of an arteriovenous fistula stenosis prevention program in patients receiving hemodialysis: Haegyeong Lee, Gyuli Baek, Eunju Lee; Osong Public Health Res Perspect. 2023;14(4):279-290. Published online August 9, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0101

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Abstract PDF: Objectives
To increase the efficiency of hemodialysis, an appropriate vascular pathway must be created, and its function must be maintained. This study aimed to identify the effects of an arteriovenous fistula (AVF) stenosis prevention program on upper muscular strength, blood flow, physiological indexes, and self-efficacy among patients receiving hemodialysis.
Methods
The participants were patients receiving hemodialysis at Keimyung University Dongsan Medical Center in Daegu, Republic of Korea. They were divided into experimental and control groups based on the day of the week they received hemodialysis at the outpatient department and included 25 participants each. The study was conducted for 8 weeks.
Results
The AVF stenosis prevention program was effective in improving upper extremity muscle strength (F=15.23, p<0.001) and blood flow rate (F=36.00, p<0.001). As a result of the program, the phosphorus index level, which is a physiological indicator in hemodialysis patients, decreased (F=8.64, p<0.001). Encouragement and support through text messages and practice lists also resulted in an increase in self-efficacy (F=18.62, p<0.001).
Conclusion
The AVF stenosis prevention program in this study resulted in an increase in upper extremity muscle strength through grip strength exercises and was effective in preventing AVF stenosis by increasing the blood flow rate.

Prevalence and patterns of adverse events following childhood immunization and the responses of mothers in Ile-Ife, South West Nigeria: a facility-based cross-sectional survey: Olorunfemi Akinbode Ogundele, Funmito Omolola Fehintola, Mubarak Salami, Rahmat Usidebhofoh, Mary Aderemi Abaekere; Osong Public Health Res Perspect. 2023;14(4):291-299. Published online July 27, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0071

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Abstract PDF: Objectives
This study aimed to examine the prevalence and pattern of adverse events following childhood immunization and the responses of mothers in Ile-Ife, South West Nigeria.
Methods
This descriptive cross-sectional study was conducted among 422 mothers of children aged 0 to 24 months attending any of the 3 leading immunization clinics in Ile-Ife, Nigeria. The respondents were selected using the multi-stage sampling technique. Data were collected using a pretested structured interviewer-administered questionnaire and analyzed using IBM SPSS ver. 26.0. The chi-square test was used to test associations, while binary logistic regression was used to determine the predictors of mothers’ responses to adverse events following immunization (AEFIs). A p-value of <0.05 was considered statistically significant.
Results
The mean age of the respondents was 29.99±5.74 years. About 38% of the children had experienced an AEFI. Most mothers believed that the pentavalent vaccine was the most common cause of AEFIs (67.5%). Fever (88.0%) and pain and swelling (76.0%) were the most common AEFIs. More than half of the mothers (53.7%) administered home treatment following an AEFI. Younger mothers (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.20–5.01), mothers who delivered their children at a healthcare facility (OR, 3.24; 95% CI, 1.08–9.69), and mothers who were knowledgeable about reporting AEFIs (OR, 2.53; 95% CI, 1.04–7.70) were most likely to respond appropriately to AEFIs.
Conclusion
The proportion of mothers who responded poorly to AEFIs experienced by their children was significant. Therefore, strategies should be implemented to improve mothers’ knowledge about AEFIs to improve their responses.

Mental health and its determinants among adolescents living in families with separated or divorced parents in an urban area of Vietnam: Binh Thang Tran, Minh Tu Nguyen, Minh Tam Nguyen, Thanh Gia Nguyen, Vo Nu Hong Duc, Thi Tra My Tran; Osong Public Health Res Perspect. 2023;14(4):300-311. Published online August 9, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0110

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Abstract PDF: Objectives
We assessed the prevalence of stress, anxiety, and depression among adolescents living in families with separated or divorced parents in Hue City, Vietnam and identified factors associated with these conditions.
Methods
This cross-sectional study enrolled 309 adolescents, aged 12 to 17 years, living in families with separated or divorced parents in Hue City, Vietnam. The depression anxiety stress scale-21 (DASS-21) was used to measure stress, anxiety, and depression. Predictors of overall and individual mental health problems were identified using ordered and binary logistic regression, respectively.
Results
The DASS-21 scale revealed a 49.2% prevalence of stress, while anxiety and depression had s prevalence rates of 61.5%. Among participants, 42.4% experienced all 3 mental health issues. Several factors were identified as significant predictors of mental health problems, including poor to average economic status (adjusted odds ratio [aOR], 2.00; 95% confidence interval [CI], 1.21–3.31; p=0.007); being in high school (aOR, 5.02; 95% CI, 2.93–8.60; p<0.001); maternal occupation of teacher, healthcare professional, or official (aOR, 2.39; 95% CI, 1.13–5.03; p=0.022); longer duration of family separation or divorce (aOR, 1.24; 95% CI, 1.05–1.45; p=0.009); living with one’s mother (aOR, 1.69; 95% CI, 1.03–2.76; p=0.04); alcohol consumption (aOR, 1.70; 95% CI, 0.99–2.92; p=0.050); and being bullied (aOR, 5.33; 95% CI, 1.10–25.69; p=0.037). Most of these factors were associated with stress, anxiety, and depression. Additionally, smoking was associated with stress.
Conclusion
Adolescents with separated or divorced parents were at increased risk of stress, anxiety, and depression. The findings of this study provide important implications for prevention programs.

Short Communications

Epidemiological characteristics of carbapenemase-producing Enterobacteriaceae outbreaks in the Republic of Korea between 2017 and 2022: Hyoseon Jeong, Junghee Hyun, Yeon-Kyeng Lee; Osong Public Health Res Perspect. 2023;14(4):312-320. Published online August 21, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0069

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Abstract PDF: Objectives
We aimed to describe the epidemiological characteristics of carbapenemase-producing Enterobacteriaceae (CPE) outbreaks in healthcare settings in the Republic of Korea between 2017 and 2022.
Methods
Under the national notifiable disease surveillance system, we obtained annual descriptive statistics regarding the isolated species, carbapenemase genotype, healthcare facility type, outbreak location and duration, and number of patients affected and recommended interventions. We used epidemiological investigation reports on CPE outbreaks reported to Korea Disease Control and Prevention Agency from June 2017 to September 2022.
Results
Among the 168 reports analyzed, Klebsiella pneumoniae (85.1%) was the most frequently reported species, while K. pneumoniae carbapenemase (KPC, 82.7%) was the most common carbapenemase genotype. Both categories increased from 2017 to 2022 (p<0.01). General hospitals had the highest proportion (54.8%), while tertiary general hospitals demonstrated a decreasing trend (p<0.01). The largest proportion of outbreaks occurred exclusively in intensive care units (ICUs, 44.0%), and the frequency of concurrent outbreaks in ICUs and general wards increased over time (p<0.01). The median outbreak duration rose from 43.5 days before the coronavirus disease 2019 (COVID-19) pandemic (2017–2019) to 79.5 days during the pandemic (2020–2022) (p=0.01), and the median number of patients associated with each outbreak increased from 5.0 to 6.0 (p=0.03). Frequently recommended interventions included employee education (38.1%), and 3 or more measures were proposed for 45.2% of outbreaks.
Conclusion
In the Republic of Korea, CPE outbreaks have been consistently dominated by K. pneumoniae and KPC. The size of these outbreaks increased during the COVID-19 pandemic. Our findings highlight the need for continuing efforts to control CPE outbreaks using a multimodal approach, while considering their epidemiology.

Trends of legionellosis reported in Jeju Province, Republic of Korea, 2015–2022: Juyoung Park, Jong-Myon Bae; Osong Public Health Res Perspect. 2023;14(4):321-327. Published online August 21, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0145

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Abstract PDF: Objectives
The number of reported cases of Legionnaires’ disease (LD) in the Republic of Korea surged nationally in 2016; however, in 2022, this number was higher in Jeju Province than the previous national peak. A descriptive epidemiological study was conducted to analyze trends in the incidence of reported LD cases in Jeju Island from 2015 to 2022.
Methods
The data for this study were obtained from case reports submitted to the Korea Disease Control and Prevention Agency through its Disease and Health Integrated Management System. The selection criteria were cases or suspected cases of LD reported among Jeju residents between 2015 and 2022. The 95% confidence interval of the crude incidence rate was calculated using the Poisson distribution.
Results
Since 2020, the incidence rate of LD in Jeju has risen sharply, showing a statistically significant difference from the national incidence rate. A particular medical institution in Jeju reported a significant number of LD cases. Screening with the urine antigen test (UAT) also increased significantly.
Conclusion
Our findings indicate that the rapid increase in cases of LD in Jeju Province since 2020 was due to the characteristics of medical-care use among Jeju residents, which were focused on a specific medical institution. According to their clinical practice guidelines, this medical institution conducted UATs to screen patients suspected of pneumonia.

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