Osong Public Health and Research Perspectives

From articles published in Osong Public Health and Research Perspectives during the past two years (2020 ~ ).

Brief Report

Genomic Surveillance of SARS-CoV-2: Distribution of Clades in the Republic of Korea in 2020: Ae Kyung Park, Il-Hwan Kim, Junyoung Kim, Jeong-Min Kim, Heui Man Kim, Chae young Lee, Myung-Guk Han, Gi-Eun Rhie, Donghyok Kwon, Jeong-Gu Nam, Young-Joon Park, Jin Gwack, Nam-Joo Lee, SangHee Woo, Jin Sun No, Jaehee Lee, Jeemin Ha, JeeEun Rhee, Cheon-Kwon Yoo, Eun-Jin Kim; Osong Public Health Res Perspect. 2021;12(1):37-43. Published online February 23, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.12.1.06

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Abstract PDF: Since a novel beta-coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in December 2019, there has been a rapid global spread of the virus. Genomic surveillance was conducted on samples isolated from infected individuals to monitor the spread of genetic variants of SARS-CoV-2 in Korea. The Korea Disease Control and Prevention Agency performed whole genome sequencing of SARS-CoV-2 in Korea for 1 year (January 2020 to January 2021). A total of 2,488 SARS-CoV-2 cases were sequenced (including 648 cases from abroad). Initially, the prevalent clades of SARS-CoV-2 were the S and V clades, however, by March 2020, GH clade was the most dominant. Only international travelers were identified as having G or GR clades, and since the first variant 501Y.V1 was identified (from a traveler from the United Kingdom on December 22^nd, 2020), a total of 27 variants of 501Y.V1, 501Y.V2, and 484K.V2 have been classified (as of January 25^th, 2021). The results in this study indicated that quarantining of travelers entering Korea successfully prevented dissemination of the SARS-CoV-2 variants in Korea.

Review Articles

COVID-19 Patients: A Systematic Review and Meta-Analysis of Laboratory Findings, Comorbidities, and Clinical Outcomes Comparing Medical Staff versus the General Population: Mina Ebrahimi, Amal Saki Malehi, Fakher Rahim; Osong Public Health Res Perspect. 2020;11(5):269-279. Published online October 22, 2020; DOI: https://doi.org/10.24171/j.phrp.2020.11.5.02

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Abstract PDF Supplementary Material: This review compared coronavirus disease 2019 (COVID-19) laboratory findings, comorbidities, and clinical outcomes in patients from the general population versus medical staff to aid diagnosis of COVID-19 in a more timely, efficient, and accurate way. Electronic databases were searched up to 23^rd March, 2020. The initial search yielded 6,527 studies. Following screening, 24 studies were included [18 studies (11,564 cases) of confirmed COVID-19 cases in the general public, and 6 studies (394 cases) in medical staff] in this review. Significant differences were observed in white blood cell counts (p < 0.001), lymphocyte counts (p < 0.001), platelet counts (p = 0.04), procalcitonin levels (p < 0.001), lactate dehydrogenase levels (p < 0.001), and creatinine levels (p = 0.03) when comparing infected medical staff with the general public. The mortality rate was higher in the general population than in medical staff (8% versus 2%). This review showed that during the early stages of COVID-19, laboratory findings alone may not be significant predictors of infection and may just accompany increasing C-reactive protein levels, erythrocyte sedimentation rates, and lactate dehydrogenase levels. In the symptomatic stage, the lymphocyte and platelet counts tended to decrease. Elevated D-dimer fibrin degradation product was associated with poor prognosis.

COVID-19: Weighing the Endeavors of Nations, with Time to Event Analysis: Shine Stephen, Alwin Issac, Jaison Jacob, VR Vijay, Rakesh Vadakkethil Radhakrishnan, Nadiya Krishnan; Osong Public Health Res Perspect. 2020;11(4):149-157. Published online August 31, 2020; DOI: https://doi.org/10.24171/j.phrp.2020.11.4.02

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Abstract PDF: The cataclysmic COVID-19 pandemic erupted silently causing colossal impact worldwide, the repercussions of which indicated a lackadaisical vigilance in preparation for such a pandemic. This review assessed the measures taken by nations to contain this pandemic. A literature review was conducted using Medline, Google Scholar, Science Direct, Scopus, and WHO website. There were 8 nations (selected from the GHS index list) appraised for containment strategies. This was achieved by using mortality rate (per million) as the primary endpoint. The nations which were proactive, initiated scientific strategies earlier with rigor, appeared to have succeeded in containing the pandemic, although it is still too early to arbitrate a verdict. The so called “pandemic war” mandates international, interdisciplinary, and interdepartmental collaboration. Furthermore, building trust and confidence between the government and the public, having transparent communication, information sharing, use of advanced research-technology, and plentiful resources are required in the fight against COVID-19.

Brief Report

Early Intervention Reduces the Spread of COVID-19 in Long-Term Care Facilities in the Republic of Korea: Shin Young Park, Gawon Choi, Hyeyoung Lee, Na-young Kim, Seon-young Lee, Kyungnam Kim, Soyoung Shin, Eunsu Jang, YoungSin Moon, KwangHwan Oh, JaeRin Choi, Sangeun Lee, Young-Man Kim, Jieun Kim, Seonju Yi, Jin Gwack, Ok Park, Young Joon Park; Osong Public Health Res Perspect. 2020;11(4):259-264. Published online August 31, 2020; DOI: https://doi.org/10.24171/j.phrp.2020.11.4.16

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Abstract PDF: This study describes the epidemiological characteristics of coronavirus disease 2019 (COVID-19) based on reported cases from long-term care facilities. As of April 20^th, 2020, 3 long-term care facilities in a metropolitan area of South Korea had reported cases of COVID-19. These facilities’ employees were presumed to be the sources of infection. There were 2 nursing hospitals that did not report any additional cases. One nursing home had a total of 25 cases, with an attack rate of 51.4% (95% CI 35.6–67.0), and a fatality rate of 38.9% (95% CI 20.3–61.4) among residents. The results from this study suggest that early detection and maintenance of infection control minimizes the risk of rapid transmission.

Short Communication

Coronavirus Disease-19: Quarantine Framework for Travelers Entering Korea: Osong Public Health Res Perspect. 2020;11(3):133-139. Published online May 8, 2020; DOI: https://doi.org/10.24171/j.phrp.2020.11.3.04

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Abstract PDF: South Korea is operating a flexible quarantine management system which is based on the results of epidemiological investigations of patients arriving from overseas with coronavirus disease-19 (COVID-19), and closely monitoring COVID-19 outbreaks. South Korea has designated countries with a localized, high prevalence of infection as “quarantine inspection required areas” and has reinforced quarantine measures by applying special immigration procedures for people entering South Korea. Furthermore, South Korea also provides information on international travel history of entrants (who are South Korean citizens and foreign nationals) to all medical institutions, through the smart quarantine information system. On March 11^th 2020, the World Health Organization characterized COVID-19 as a pandemic. Inevitably, the number of patients from overseas with COVID-19 (based on 10,000 people entering South Korea), increased to 10 cases in the second week of March, 37 cases in the third week, and 67.7 cases in the fourth week. However, after enforcing quarantine strengthening measures, and with a decrease in the number of people entering the country, the number of cases decreased to 52.0 in the first week of April.

Original Article

Factors influencing acceptance of the COVID-19 vaccine in Malaysia: a web-based survey: June Fei Wen Lau, Yuan Liang Woon, Chin Tho Leong, Hoon Shien Teh; Osong Public Health Res Perspect. 2021;12(6):361-373. Published online November 25, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0085

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Abstract PDF Supplementary Material: Objectives
The coronavirus disease 2019 (COVID-19) pandemic has set a precedent for the fastest-produced vaccine as a result of global collaboration and outreach. This study explored Malaysians’ acceptance of the COVID-19 vaccine and its associated factors.
Methods
A cross-sectional anonymous web-based survey was disseminated to Malaysian adults aged ≥18 years old via social media platforms between July 10, 2020 and August 31, 2020.
Results
In the analysis of 4,164 complete responses, 93.2% of participants indicated that they would accept the COVID-19 vaccine if it was offered for free by the Malaysian government. The median out-of-pocket cost that participants were willing to pay for a COVID-19 vaccine was Malaysian ringgit (MYR) 100 (interquartile range [IQR], 100) if it was readily available and MYR 150 (IQR, 200) if the supply was limited. Respondents with a low likelihood of vaccine hesitancy had 13 times higher odds of accepting the COVID-19 vaccine (95% confidence interval [CI], 8.69 to 19.13). High perceived risk and severity were also associated with willingness to be vaccinated, with adjusted odds ratios of 2.22 (95% CI, 1.44 to 3.41) and 2.76 (95% CI, 1.87 to 4.09), respectively. Age and ethnicity were the only independent demographic characteristics that predicted vaccine uptake.
Conclusion
Public health strategies targeting perceived risk, perceived susceptibility and vaccine hesitancy could be effective in enhancing vaccine uptake.

Review Article

Review of the early reports of the epidemiological characteristics of the B.1.1.7 variant of SARS-CoV-2 and its spread worldwide: Yeonju Kim, Eun-Jin Kim, Sang-Won Lee, Donghyok Kwon; Osong Public Health Res Perspect. 2021;12(3):139-148. Published online June 24, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0037

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Abstract PDF: The variant B.1.1.7 of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the RNA virus causing the pandemic more than a year worldwide, was reported from United Kingdom (UK) in late December 2020. It was reported that mortality increases by 65% and transmissibility increases by 70%, which may result in an increase of reproduction number to 1.13−1.55 from 0.75−0.85. To analyze the global increasing trend of the variant B.1.1.7, we extracted results of B.1.1.7 from GISAID on May 11 and May 12, 2021, and conducted a doseresponse regression. It took 47 days to reach 20% and 121 days to reach 50% among the sequence submitted from UK. In Korea, cases of B.1.1.7 have increased since the first report of three cases on December 28, 2020. Positive rate of B.1.1.7 in Korea was 21.6% in the week from May 9 to May 15, 2021. Detection rate of the variants is expected to increase further and new variants of SARS-CoV-2 are emerging, so a close monitoring and control would be maintained for months.

Original Articles

Epidemiological, imaging, laboratory, and clinical characteristics and factors related to mortality in patients with COVID-19: a single-center study: Zohreh Azarkar, Hamid Salehiniya, Toba Kazemi, Hamid Abbaszadeh; Osong Public Health Res Perspect. 2021;12(3):169-176. Published online May 26, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0012

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Abstract PDF: Objectives
Coronavirus disease 2019 (COVID-19) is a novel pandemic. Considerable differences in disease severity and the mortality rate have been observed in different parts of the world. The present study investigated the characteristics and outcomes of patients hospitalized with COVID-19 in Iran.
Methods
We established a retrospective cohort to study hospitalized COVID-19 patients in Iran. Epidemiological, imaging, laboratory, and clinical characteristics and outcomes were recorded from medical documents. The chi-square test, t-test, and logistic regression models were used to analyze the data. A p<0.05 was considered to indicate statistical significance.
Results
In total, 364 cases (207 males and 157 females) were analyzed. The most common symptoms were cough, fever, and dyspnea. Multifocal bilateral ground-glass opacities with peripheral distribution were the predominant imaging finding. The mean age of patients was 54.28±18.81 years. The mean age of patients who died was 71.50±14.60 years. The mortality rate was 17.6%. The total proportion of patients with a comorbidity was 47.5%, and 84.4% of patients who died had a comorbidity. Sex, history of diabetes mellitus, and dyslipidemia were not significantly associated with mortality (p>0.05). However, mortality showed significant relationships with body mass index; age; history of hypertension, chronic kidney disease (CKD), ischemic heart disease, cerebrovascular accident (CVA), pulmonary disease, and cancer; and abnormal high-resolution computed tomography (HRCT) findings (p<0.05 for all). Cancer had the highest odds ratio.
Conclusion
Comorbidities (especially cancer, CKD, and CVA), severe obesity, old age, and abnormal HRCT findings affected the health outcomes of patients hospitalized with COVID-19.

Impact of fatigue on quality of life among breast cancer patients receiving chemotherapy: Fares Mohammed Saeed Muthanna, Mahmathi Karuppannan, Bassam Abdul Rasool Hassan, Ali Haider Mohammed; Osong Public Health Res Perspect. 2021;12(2):115-125. Published online April 29, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.12.2.09

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Abstract PDF: Objectives
Fatigue is the most frequently reported symptom experienced by cancer patients and has a profound effect on their quality of life (QOL). The study aimed to determine the impact of fatigue on QOL among breast cancer patients receiving chemotherapy and to identify the risk factors associated with severe fatigue incidence.
Methods
This was an observational prospective study carried out at multiple centers. In total, 172 breast cancer patients were included. The Functional Assessment of Chronic Illness Therapy-Fatigue Questionnaire was used to measure QOL, while the Brief Fatigue Inventory (BFI) was used to assess the severity of fatigue.
Results
The total average mean and standard deviation of QOL were 84.58±18.07 and 4.65±1.14 for BFI scores, respectively. A significant association between fatigue and QOL was found in linear and multiple regression analyses. The relationships between fatigue severity and cancer stage, chemotherapy dose delay, dose reduction, chemotherapy regimen, and ethnicity were determined using binary logistic regression analysis.
Conclusion
The findings of this study are believed to be useful for helping oncologists effectively evaluate, monitor, and treat fatigue related to QOL changes.

Global variation of COVID-19 mortality rates in the initial phase: Saman Hasan Siddiqui, Azza Sarfraz, Arjumand Rizvi, Fariha Shaheen, Mohammad Tahir Yousafzai, Syed Asad Ali; Osong Public Health Res Perspect. 2021;12(2):64-72. Published online April 29, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.12.2.03

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Abstract PDF Supplementary Material: Objectives
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused devastation in over 200 countries. Italy, Spain, and the United States (US) were most severely affected by the first wave of the pandemic. The reasons why some countries were more strongly affected than others remain unknown. We identified the most-affected and less-affected countries and states and explored environmental, host, and infrastructure risk factors that may explain differences in the SARS-CoV-2 mortality burden.
Methods
We identified the top 10 countries/US states with the highest deaths per population until May 2020. For each of these 10 case countries/states, we identified 6 control countries/states with a similar population size and at least 3 times fewer deaths per population. We extracted data for 30 risk factors from publicly available, trusted sources. We compared case and control countries/states using the non-parametric Wilcoxon rank-sum test, and conducted a secondary cluster analysis to explore the relationship between the number of cases per population and the number of deaths per population using a scalable EM (expectation–maximization) clustering algorithm.
Results
Statistically significant differences were found in 16 of 30 investigated risk factors, the most important of which were temperature, neonatal and under-5 mortality rates, the percentage of under-5 deaths due to acute respiratory infections (ARIs) and diarrhea, and tuberculosis incidence (p<0.05)
Conclusion
Countries with a higher burden of baseline pediatric mortality rates, higher pediatric mortality from preventable diseases like diarrhea and ARI, and higher tuberculosis incidence had lower rates of coronavirus disease 2019-associated mortality, supporting the hygiene hypothesis.

Health-Related Quality of Life Based on Comorbidities Among Patients with End-Stage Renal Disease: Jieun Cha, Dallong Han; Osong Public Health Res Perspect. 2020;11(4):194-200. Published online August 31, 2020; DOI: https://doi.org/10.24171/j.phrp.2020.11.4.08

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Abstract PDF: Objectives
The aim of this study was to investigate comorbidities in patients with end-stage renal disease, and to compare health-related quality of life (HRQOL) according to the type, and number of comorbidities.
Methods
A total of 250 adults undergoing hemodialysis were recruited at local clinics. HRQOL was measured using the 12-item Medical Outcomes Study Short Form questionnaire. Data were analyzed using descriptive statistics, analysis of variance, and t test.
Results
Around 70.8% of patients with end stage renal disease had 1 or more comorbidities, and the most common comorbidities were hypertension, diabetes, and cardiovascular disease. HRQOL was significantly different based on the number of comorbidities (F = 9.83, p < 0.001). The effect of comorbidities on the scores for mental health domains of the HRQOL questionnaire was not conclusive compared with the scores for the physical domain which were conclusive. Among the comorbidities, diabetes was associated with a lower quality of life.
Conclusion
The customized management of diabetic and hypertensive patients is necessary for the early detection and prevention of chronic kidney disease, and slowing the progression of renal disease and managing cardiovascular risk factors is essential.

COVID-19 in Nursing Facilities: Experience in Republic of Korea: Rok Song, Hee-Sook Kim, Seok-Ju Yoo, Kwan Lee, Ji-Hyuk Park, Joon Ho Jang, Gyoung-Sook Ahn, Jun-Nyun Kim; Osong Public Health Res Perspect. 2020;11(4):164-169. Published online August 31, 2020; DOI: https://doi.org/10.24171/j.phrp.2020.11.4.04

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Abstract PDF: Objectives
Coronavirus disease 2019 (COVID-19) outbreaks in nursing facilities can easily lead to a high rate of infection and fatality. A surge in newly infected cases in the first quarter of 2020 in Gyeongsan-si, in the Republic of Korea, was followed by several outbreaks in nursing facilities in the same area. The aim of this study is to report on the epidemiological investigation and the management to reduce the infection rate in nursing facilities for older adults.
Methods
The municipal government and the Korea Centers for Disease Control and Prevention performed an epidemiological investigation into 5 nursing facilities that reported a high number of COVID-19 infection cases from February to May 2020. COVID-19 infected cases in the facilities were investigated to identify the infection routes, and the fatality rate of the 5 facilities.
Results
The 5 facilities had a combined fatality rate of 12.2% (9 deceased among the 74 infected cases). The median age of the deceased was 87 years old (range: 82–91). The infection was first identified on February 27^th, 2020, peaked on March 6^th, and was last detected on March 24^th, 2020.
Conclusion
Difficulties specific to such facilities included the delay in the recognition of symptoms and limitation in distancing. Tailored strategies such as daily monitoring of symptoms and proactive COVID-19 screening of quarantined residents, contributed to a decline in the infections in the facilities.

The Effects of Laughter Therapy for the Relief of Employment-Stress in Korean Student Nurses by Assessing Psychological Stress Salivary Cortisol and Subjective Happiness: Ji-Soo Lee, Soo-Kyoung Lee; Osong Public Health Res Perspect. 2020;11(1):44-52. Published online February 28, 2020; DOI: https://doi.org/10.24171/j.phrp.2020.11.1.07

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Abstract PDF: Objectives
Korean student nurses may be exposed to stress caused by their future employment (employment stress). The aim of this study was to investigate the effects of a Laughter Program on psychological stress, by assessing salivary cortisol and the subjective happiness of student nurses in order to relieve employment stress.
Methods
A quasi-experimental, non-equivalent, control-group, and pre-test/post-test was conducted in 4^th year student nurses (n = 48) from 2 universities in Korea at a time when participants’ final exams and job searches were simultaneously occurring. Physiological stress (salivary cortisol), and psychological stress measured using modified Cornell Medical Index questionnaire and the Subjective Happiness Scale were used to determine the effects of the program.
Results
The results of the study showed that the Laughter Program was effective in relieving employment stress and increasing the subjective well-being of student nurses. Psychological stress (p < 0.001), salivary cortisol levels (p < 0.001), and subjective happiness (p < 0.001) were statistically significantly improved after the intervention compared with before the Laughter Program.
Conclusion
This study is an effective evidence-based intervention to reduce student nurses employment stress and improve subjective happiness.

Editorial

How to deal with the Delta variant this fall: Jong-Koo Lee; Osong Public Health Res Perspect. 2021;12(4):201-202. Published online August 26, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0217

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Brief Report

COVID-19 vaccine safety monitoring in the Republic of Korea: February 26, 2021 to April 30, 2021: Hyun-kyung Oh, Eun Kyeong Kim, Insob Hwang, Tae Eun Kim, Yeon-kyeong Lee, Eunju Lee, Yeon-Kyeng Lee; Osong Public Health Res Perspect. 2021;12(4):264-268. Published online August 13, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0157

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Abstract PDF: Objectives
On February 26, 2021, coronavirus disease 2019 (COVID-19) vaccination was started for high-priority groups based on the recommendation of the Advisory Committee on Immunization Practices with 2 available COVID-19 vaccines (AstraZeneca and Pfizer-BioNTech) in Korea. This report provides a summary of adverse events following COVID-19 vaccination as of April 30, 2021.
Methods
Adverse events following immunization are notifiable by medical doctors to the Korea Immunization Management System (KIMS) under the national surveillance system. We analyzed all adverse events reports following COVID-19 vaccination to the KIMS from February 26 to April 30, 2021.
Results
In total, 16,196 adverse events following 3,586,814 administered doses of COVID-19 vaccines were reported in approximately 2 months (February 26 to April 30, 2021). Of these, 15,658 (96.7%) were non-serious adverse events, and 538 (3.3%) were serious adverse events, including 73 (0.5%) deaths. The majority of adverse events (n=13,063, 80.7%) were observed in women, and the most frequently reported adverse events were myalgia (52.2%), fever (44.9%), and headache (34.9%). Of the 73 deaths following the COVID-19 vaccination, none were related to the vaccines.
Conclusion
By April 30, 3.6 million doses of the COVID 19 vaccine had been given in Korea, and the overwhelming majority of reports were for non-serious events. The Korea Disease Control and Prevention Agency continues to monitor the safety of COVID-19 vaccination.

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