Osong Public Health and Research Perspectives

Articles in E-pub version are posted online ahead of regular printed publication.

Original Article

Factors associated with the timely diagnosis of malaria and the utilization of types of healthcare facilities: a retrospective study in the Republic of Korea: HyunJung Kim, Sangwoo Tak, So-dam Lee, Seongwoo Park, Kyungwon Hwang; Received November 20, 2023 Accepted January 18, 2024 Published online April 16, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0349 [Epub ahead of print]

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Abstract PDF: Objectives
This study aimed to analyze trends in the timely diagnosis of malaria cases over the past 10 years in relation to the utilization of different types of healthcare facilities.
Methods
The study included 3,697 confirmed and suspected cases of malaria reported between January 1, 2013, and December 31, 2022, in the national integrative disease and healthcare management system. Some cases lacking a case report or with information missing from the case report were excluded from the analysis. A generalized linear model with a Poisson distribution was constructed to estimate rate ratios and 95% confidence intervals adjusted for other variables, such as distance.
Results
When cases involving diagnosis >5 days after symptom onset in confirmed patients (5DD) were examined according to the type of healthcare facility, the rate ratio of 5DD cases was found to be higher for public health facilities than for tertiary hospitals. Specifically, the rate ratio was higher when the diagnosis was established at a tertiary hospital, even after a participant had visited primary or secondary hospitals. In an analysis adjusted for the distance to each participant’s healthcare facility, the results did not differ substantially from the results of the crude analysis.
Conclusion
It is imperative to improve the diagnostic capabilities of public facilities and raise awareness of malaria at primary healthcare facilities for effective prevention and control.

Brief Report

Gender differences in hepatitis A seropositivity rates according to the Republic of Korea’s vaccination policy: Hyunjin Son, Sunhyun Ahn, Wonseo Park, Gayoung Chun, Unyeong Go, Sang Gon Lee, Eun Hee Lee; Received September 18, 2023 Accepted January 22, 2024 Published online April 16, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0263 [Epub ahead of print]

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Abstract PDF: Objectives
This study aimed to investigate differences in the anti-hepatitis A (HAV) antibody seropositivity rate by age and gender.
Methods
We collected information on anti-HAV immunoglobulin G and immunoglobulin M status from samples submitted for HAV antibody testing in 2012–2022. A total of 1,333,615 cases were included in the analysis.
Results
By age, the seropositivity rate was represented by a U-shaped curve, such that the rate was low for the group aged 20 to 39 years and higher in those who were younger or older. Over time, the curve shifted rightward, and the seropositivity rate declined gradually in the group aged 35 to 39 years and older. A gender-based difference in antibody seropositivity rate was especially noticeable in the group aged 20 to 29 years. This difference between genders widened in the participants’ early 20s—when men in the Republic of Korea enlist in the military—and the divergence continued subsequently for older individuals.
Conclusion
These results indicate a higher risk of severe infection among older individuals and a gender-based difference in seroprevalence. Therefore, it is necessary to implement policies to promote vaccination in adults.

Special Article

The COVID-19 Vaccine Safety Research Center: a cornerstone for strengthening safety evidence for COVID-19 vaccination in the Republic of Korea: 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, Jaehun Jung, Joongyub Lee, Ju-Young Shin, Sun-Young Jung, Byung-Joo Park, Nam-Kyong Choi; Received November 16, 2023 Accepted February 22, 2024 Published online April 4, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0343 [Epub ahead of print]

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Abstract PDF: The COVID-19 Vaccine Safety Research Committee (CoVaSC) was established in November 2021 to address the growing need for independent, in-depth scientific evidence on adverse events (AEs) following coronavirus disease 2019 (COVID-19) vaccination. This initiative was requested by the Korea Disease Control and Prevention Agency and led by the National Academy of Medicine of Korea. In September 2022, the COVID-19 Vaccine Safety Research Center was established, strengthening CoVaSC’s initiatives. The center has conducted various studies on the safety of COVID-19 vaccines. During CoVaSC’s second research year, from September 29, 2022 to July 19, 2023, the center was restructured into 4 departments: Epidemiological Research, Clinical Research, Communication & Education, and International Cooperation & Policy Research. Its main activities include (1) managing CoVaSC and the COVID-19 Vaccine Safety Research Center, (2) surveying domestic and international trends in AE causality investigation, (3) assessing AEs following COVID-19 vaccination, (4) fostering international collaboration and policy research, and (5) organizing regular fora and training sessions for the public and clinicians. Causality assessments have been conducted for 27 diseases, and independent research has been conducted after organizing ad hoc committees comprising both epidemiologists and clinical experts on each AE of interest. The research process included protocol development, data analysis, interpretation of results, and causality assessment. These research outcomes have been shared transparently with the public and healthcare experts through various fora. The COVID-19 Vaccine Safety Research Center plans to continue strengthening and expanding its research activities to provide reliable, high-quality safety information to the public.

Review Article

Psychiatric adverse events associated with the COVID-19 vaccines approved in the Republic of Korea: a systematic review: Seungeun Ryoo, Miyoung Choi, Nam-Kyong Choi, Hyoung-Shik Shin, Jun Hee Woo, Byung-Joo Park, Sanghoon Oh; Received October 31, 2023 Accepted January 16, 2024 Published online March 28, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0325 [Epub ahead of print]

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Abstract PDF: This systematic review evaluated psychiatric adverse events (AEs) following vaccination against coronavirus disease 2019 (COVID-19). We included studies that reported or investigated psychiatric AEs in individuals who had received an approved COVID-19 vaccine in the Republic of Korea. Systematic electronic searches of Ovid-Medline, Embase, CENTRAL, and KoreaMed databases were conducted on March 22, 2023. Risk of bias was assessed using the Risk of Bias Assessment Tool for Non-randomized Studies 2.0. The study protocol was registered in the International Prospective Register of Systematic Reviews (CRD42023449422). Of the 301 articles initially selected, 7 were included in the final analysis. All studies reported on sleep disturbances, and 2 highlighted anxiety-related AEs. Sleep disorders like insomnia and narcolepsy were the most prevalent AEs, while depression was not reported. Our review suggests that these AEs may have been influenced by biological mechanisms as well as the broader psychosocial context of the COVID-19 pandemic. Although this study had limitations, such as a primary focus on the BNT162b2 vaccine and an observational study design, it offered a systematic, multi-vaccine analysis that fills a critical gap in the existing literature. This review underscores the need for continued surveillance of psychiatric AEs and guides future research to investigate underlying mechanisms, identify risk factors, and inform clinical management.

Original Articles

AI-powered COVID-19 forecasting: a comprehensive comparison of advanced deep learning methods: Muhammad Usman Tariq, Shuhaida Binti Ismail; Received October 13, 2023 Accepted January 26, 2024 Published online March 28, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0287 [Epub ahead of print]

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Abstract PDF: Objectives
The coronavirus disease 2019 (COVID-19) pandemic continues to pose significant challenges to the public health sector, including that of the United Arab Emirates (UAE). The objective of this study was to assess the efficiency and accuracy of various deep-learning models in forecasting COVID-19 cases within the UAE, thereby aiding the nation’s public health authorities in informed decision-making.
Methods
This study utilized a comprehensive dataset encompassing confirmed COVID-19 cases, demographic statistics, and socioeconomic indicators. Several advanced deep learning models, including long short-term memory (LSTM), bidirectional LSTM, convolutional neural network (CNN), CNN-LSTM, multilayer perceptron, and recurrent neural network (RNN) models, were trained and evaluated. Bayesian optimization was also implemented to fine-tune these models.
Results
The evaluation framework revealed that each model exhibited different levels of predictive accuracy and precision. Specifically, the RNN model outperformed the other architectures even without optimization. Comprehensive predictive and perspective analytics were conducted to scrutinize the COVID-19 dataset.
Conclusion
This study transcends academic boundaries by offering critical insights that enable public health authorities in the UAE to deploy targeted data-driven interventions. The RNN model, which was identified as the most reliable and accurate for this specific context, can significantly influence public health decisions. Moreover, the broader implications of this research validate the capability of deep learning techniques in handling complex datasets, thus offering the transformative potential for predictive accuracy in the public health and healthcare sectors.

Effect of Paxlovid in COVID-19 treatment during the periods of SARS-CoV-2 Omicron BA.5 and BN.1 subvariant dominance in the Republic of Korea: a retrospective cohort study: Dong-Hwi Kim, Min-Gyu Yoo, Na-Young Kim, So Young Choi, Minjeong Jang, Misuk An, Se-Jin Jeong, Jungyeon Kim; Received August 16, 2023 Accepted January 18, 2024 Published online March 28, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0230 [Epub ahead of print]

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Abstract PDF: Objectives
This study was conducted to assess the efficacy of nirmatrelvir/ritonavir treatment in patients with coronavirus disease 2019 (COVID-19), particularly those aged 60 years and older. Using real-world data, the period during which the BN.1 Omicron variant was dominant was compared to the period dominated by the BA.5 variant.
Methods
In this retrospective cohort study, data were collected regarding 2,665,281 patients infected with severe acute respiratory syndrome coronavirus 2 between July 24, 2022, and March 31, 2023. Propensity score matching was utilized to match patients who received nirmatrelvir/ritonavir in a 1:4 ratio between BN.1 and BA.5 variant groups. Multivariable logistic regression analysis was employed to assess the effects of nirmatrelvir/ritonavir within these groups.
Results
Compared to the prior period, the efficacy of nirmatrelvir/ritonavir did not significantly differ during the interval of Omicron BN.1 variant dominance in the Republic of Korea. Among patients treated with nirmatrelvir/ritonavir, a significantly lower risk of mortality was observed in the BN.1 group (odds ratio [OR], 0.698; 95% confidence interval [CI], 0.557–0.875) compared to the BA.5 group. However, this treatment did not significantly reduce the risk of severe or critical illness, including death, for those in the BN.1 group (OR, 0.856; 95% CI, 0.728–1.007).
Conclusion
Nirmatrelvir/ritonavir has maintained its effectiveness against COVID-19, even with the emergence of the BN.1 Omicron subvariant. Consequently, we strongly recommend the administration of nirmatrelvir/ritonavir to patients exhibiting COVID-19-related symptoms, irrespective of the dominant Omicron variant or their vaccination status, to mitigate disease severity and decrease the risk of mortality.

COVID-19 infection among people with disabilities in 2021 prior to the Omicron-dominant period in the Republic of Korea: a cross-sectional study: Seul-Ki Kang, Bryan Inho Kim; Received July 11, 2023 Accepted January 16, 2024 Published online March 28, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0194 [Epub ahead of print]

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Abstract PDF: Objectives
This study investigated the characteristics of coronavirus disease 2019 (COVID-19) among individuals with disabilities on a nationwide scale in the Republic of Korea, as limited research has examined this population.
Methods
Between January 1 and November 30, 2021, a total of 5,687 confirmed COVID-19 cases among individuals with disabilities were reported through the Korea Disease Control and Prevention Agency’s COVID-19 web reporting system. Follow-up continued until December 24, and demographic, epidemiological, and clinical characteristics were analyzed.
Results
Individuals with disabilities represented approximately 1.5% of confirmed cases, with a mean age of 58.1 years. Most resided in or near metropolitan areas (86.6%) and were male (60.6%). Frequent sources of infection included home (33.4%) and contact with confirmed cases (40.7%). Many individuals (75.9%) had underlying conditions, and 7.7% of cases were severe. People with disabilities showed significantly elevated risk of severe infection (adjusted odds ratio [aOR], 1.63; 95% confidence interval [CI], 1.47–1.81) and mortality (aOR, 1.65; 95% CI, 1.43–1.91). Vaccination against COVID-19 was associated with significantly lower risk of severe infection (aORs for the first, second, and third doses: 0.6 [95% CI, 0.42–0.85], 0.28 [95% CI, 0.22–0.35], and 0.16 [95% CI, 0.05–0.51], respectively) and death (adjusted hazard ratios for the first and second doses: 0.57 [95% CI, 0.35–0.93] and 0.3 [95% CI, 0.23–0.40], respectively).
Conclusion
Individuals with disabilities showed higher risk of severe infection and mortality from COVID-19. Consequently, it is critical to strenghthenCOVID-19 vaccination initiatives and provide socioeconomic assistance for this vulnerable population.

Commentary

Challenges in capacity building of national immunization programs and emergency or pandemic vaccination responses in the Global Health Security Agenda member countries: Sookhyun Lee, Jung Ju Oh, Sang Hyun Park, Dasol Ro, Ye Jin Jeong, So Yoon Kim; Received June 14, 2023 Accepted January 16, 2024 Published online March 28, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0159 [Epub ahead of print]

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