Osong Public Health and Research Perspectives

Original Article

Design and evaluation of a multi-epitope subunit vaccine against human norovirus using an immunoinformatics approach: Zxcy L. Nonog, Edward C. Banico, Ma. Easter V. Sajo, Pablo V. Serrano, Fredmoore L. Orosco; Received December 16, 2024 Accepted March 18, 2025 Published online April 25, 2025; DOI: https://doi.org/10.24171/j.phrp.2024.0349 [Epub ahead of print]

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Abstract PDF Supplementary Material: Objectives
This study aimed to identify safe, conserved, and highly immunogenic epitopes from all proteins of human-infecting norovirus (NoV) and to design a multi-epitope subunit vaccine construct from these epitopes using an immunoinformatics approach. Additionally, the vaccine construct was evaluated using both sequence- and structure-based assessments.
Methods
Conserved fragments were identified from all proteins of human-infecting NoV, and B and T lymphocyte epitopes were subsequently predicted using multiple epitope prediction tools. The selected epitopes were linked to form a multi-epitope construct, incorporating various adjuvants in the design. Vaccine constructs with different adjuvants were analyzed for their physicochemical properties and immune simulation profiles, and the optimal combination was selected as the final vaccine candidate for further study. Finally, molecular docking and dynamics simulations were performed to visualize the interaction between the construct and a host immune receptor.
Results
Twenty-two safe, conserved, and highly immunogenic epitopes were identified from all human-infecting NoV proteins. The construct adjuvanted with 50S ribosomal protein L7/L12 (50SrpL7/L12) was chosen as the final vaccine candidate due to its optimal physicochemical properties and favorable immune simulation profile. Furthermore, the construct exhibited high binding affinity and a stable interaction with toll-like receptor 4).
Conclusion
The multi-epitope subunit vaccine designed in this study shows promise as a potential NoV vaccine candidate for human immunization. Further in vitro and in vivo experiments are warranted to validate these findings.

Data Profile

Synthetic data production for biomedical research: Yun Gyeong Lee, Mi-Sook Kwak, Jeong Eun Kim, Min Sun Kim, Dong Un No, Hee Youl Chai; Received December 9, 2024 Accepted March 4, 2025 Published online April 22, 2025; DOI: https://doi.org/10.24171/j.phrp.2024.0335 [Epub ahead of print]

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Abstract PDF Supplementary Material: Synthetic data, generated using advanced artificial intelligence (AI) techniques, replicates the statistical properties of real-world datasets while excluding identifiable information. Although synthetic data does not consist of actual data points, it is derived from original datasets, thereby enabling analyses that yield results comparable to those obtained with real data. Synthetic datasets are evaluated based on their utility—a measure of how effectively they mirror real data for analytical purposes. This paper presents the generation of synthetic datasets through the Healthcare Big Data Showcase Project (2019–2023). The original dataset comprises comprehensive multi-omics data from 400 individuals, including cancer survivors, chronic disease patients, and healthy participants. Synthetic data facilitates efficient access and robust analyses, serving as a practical tool for research and education. It addresses privacy concerns, supports AI research, and provides a foundation for innovative applications across diverse fields, such as public health and precision medicine.

Short Communication

First report of human Mycobacterium bovis infection in a veterinary laboratory worker in the Republic of Korea: Ji-Yeon Lee, Seong Wook Pyo, Jieun Kim, Young-Joon Park; Received December 24, 2024 Accepted March 9, 2025 Published online April 16, 2025; DOI: https://doi.org/10.24171/j.phrp.2024.0343 [Epub ahead of print]

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Abstract PDF: Objectives
In the Republic of Korea, the previous surveillance system for zoonotic tuberculosis (TB) involved the X-ray testing of humans in contact with Mycobacterium bovis-infected livestock. In contrast, the updated surveillance system incorporates the genotyping of cultured Mycobacterium isolates for high-risk occupational groups. This study aimed to systematically document the detection, diagnosis, assessment, and response in the epidemic investigation of zoonotic TB in a laboratory worker in the Republic of Korea.
Methods
M. bovis was confirmed using spoligotyping and whole genome sequencing. Clinical characteristics were reviewed through epidemiological investigation and interviews with the affected individual. Transmission routes and secondary spread were assessed via field epidemiological investigations and contact evaluations using chest X-ray and interferon gamma release assay for latent TB infection.
Results
A 56-year-old laboratory worker presented with chest X-ray findings compatible with TB and subsequently tested positive for M. bovis. She had no clinical or family history of TB and remained asymptomatic. She completed a 6 month treatment regimen of isoniazid, rifampin, ethambutol, and pyrazinamide without hospitalization. Although no direct transmission pathways for zoonotic TB were identified, her work in a laboratory, processing specimens for zoonotic TB, indicated potential laboratory related exposure.
Conclusion
This case underscores the importance of stringent use of personal protective equipment among high-risk occupational groups and the implementation of an enhanced surveillance system to report zoonotic TB. These findings highlight the need for a One Health approach and proactive surveillance, emphasizing the necessity of refining and strengthening surveillance systems for precise monitoring and an effective response.

Brief Report

Standardizing the approach to clinical-based human microbiome research: from clinical information collection to microbiome profiling and human resource utilization: Jung Wook Kim, Eun Chae Choi, Kwang Jun Lee; Received November 14, 2024 Accepted March 6, 2025 Published online April 11, 2025; DOI: https://doi.org/10.24171/j.phrp.2024.0319 [Epub ahead of print]

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Abstract PDF: Objectives
This study presents the standardized protocols developed by the Clinical-Based Human Microbiome Research and Development Project (cHMP) in the Republic of Korea.
Methods
It addresses clinical metadata collection, specimen handling, DNA extraction, sequencing methods, and quality control measures for microbiome research.
Results
The cHMP involves collecting samples from healthy individuals and patients across various body sites, including the gastrointestinal tract, oral cavity, respiratory system, urogenital tract, and skin. These standardized procedures ensure consistent data quality through controlled specimen collection, storage, transportation, DNA extraction, and sequencing. Sequencing encompasses both amplicon and whole metagenome methods, followed by stringent quality checks. The protocols conform to international guidelines, ensuring that the data generated are both reliable and comparable across microbiome studies.
Conclusion
The cHMP underscores the importance of methodological standardization in enhancing data integrity, reproducibility, and advancing microbiome-based research with potential applications for improving human health outcomes.

Review Article

Global health security in the post-COVID-19 era: threats, preparation, and response: Chaeshin Chu; Received February 3, 2025 Accepted March 6, 2025 Published online April 4, 2025; DOI: https://doi.org/10.24171/j.phrp.2025.0037 [Epub ahead of print]

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Abstract PDF: Global health security threats in the post-coronavirus disease 2019 era include dense urban populations, increased human–animal proximity, migration driven by political or economic instability, climate change, humanitarian crises, antimicrobial resistance (AMR), and the misuse of biological research—including the accidental or intentional release of high-risk pathogens. The foundational preparation for these threats is to establish a robust, resilient public health system based on universal health coverage. The World Health Organization’s International Health Regulations must continue to promote global solidarity by maintaining core capacities such as surveillance, national laboratories, and epidemiological investigations of emerging infectious diseases, with timely reporting and information sharing within the global health security community. A One Health approach is essential for addressing AMR. Infection prevention and control must be enhanced to reduce healthcare-associated infections in medical facilities. Additionally, regulations concerning biosafety and biosecurity should address dual-use research of concern as well as the accidental or intentional release of high-risk pathogens from laboratories. Global health security is a collective responsibility because these threats know no borders and require coordinated action.

Original Articles

The first report of antibiotic resistance and virulence factor profiles in multidrug-resistant clinical isolates of Klebsiella pneumoniae from Pontianak, Indonesia: Mardhia Mardhia, Delima Fajar Liana, Mahyarudin Mahyarudin, Hariyanto Ih; Received August 31, 2024 Accepted January 23, 2025 Published online April 4, 2025; DOI: https://doi.org/10.24171/j.phrp.2024.0242 [Epub ahead of print]

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Abstract PDF: Objectives
Klebsiella pneumoniae is known as one of the most common causes of hospital-acquired infections. Its prevalence poses substantial challenges to both hospital and public health systems, particularly due to the rise of multidrug‐resistant strains. Understanding the epidemiology and resistance properties of K. pneumoniae can inform antimicrobial stewardship and infection control programs. A cross-sectional study was employed from November 2021 to November 2023.
Methods
A total of 24 isolates underwent antimicrobial susceptibility testing using the disk diffusion method, an extended-spectrum beta-lactamase (ESBL) production test, and molecular gene detection.
Results
The study found that 95.8% of clinical isolates were classified as multidrug-resistant. All isolates were resistant to ampicillin (100%). A high percentage of isolates were resistant to cefazolin (91.7%), ceftriaxone (87.5%), cefotaxime (87.5%), cefepime (87.5%), ciprofloxacin (83.3%), and sulfamethoxazole-trimethoprim (83.3%). Of the 24 isolates, 87.5% harbored ESBL genes, while the frequencies for GES, NDM, SIM, and OXA-48 were 16.7%, 20.8%, 8.3%, and 41.7%, respectively. Notably, the OXA-23 and OXA-51 genes, which are typically associated with Acinetobacter baumannii, were detected in 16.7% and 20.8% of isolates, respectively. Moreover, the prevalence of virulence genes rmpA, acrAB, and tolC was 0%, 95.8%, and 87.5%, respectively.
Conclusion
This study demonstrated a high level of antibiotic resistance and a significant presence of virulence genes among K. pneumoniae isolates. Consequently, these findings represent a critical public health issue that requires heightened awareness among all stakeholders, including health workers.

A comparison of health-related quality of life using the World Health Organization Quality of Life–BREF and 5-Level EuroQol-5 Dimensions in the Malaysian population: Andrian Liem, Hui Jun Chih, Vithya Velaithan, Richard Norman, Daniel Reidpath, Tin Tin Su; Received March 14, 2024 Accepted February 16, 2025 Published online March 31, 2025; DOI: https://doi.org/10.24171/j.phrp.2024.0076 [Epub ahead of print]

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Abstract PDF Supplementary Material: Objectives
This study aimed to describe and compare health-related quality of life (QoL) as measured by the World Health Organization Quality of Life–BREF (WHOQoL-BREF) and the EuroQol-5 Dimensions (EQ-5D) among the Malaysian population, examining differences by sociodemographic characteristics including age, income, sex, ethnicity, educational level, and occupation.
Methods
This cross-sectional study used data from 19,402 individuals collected as part of a health and demographic surveillance system survey conducted in the Segamat district of Malaysia in 2018–2019. Descriptive statistics and measures of central tendency were produced. Differences in QoL among demographic sub-groups were examined using the t-test and analysis of variance, while the correlations between the WHOQoL-BREF and EQ-5D were evaluated using Pearson correlation coefficients.
Results
Based on complete case analysis (n=19,129), the average scores for the 4 WHOQoL-BREF domains were 28.2 (physical), 24.1 (psychological), 12.0 (social relationships), and 30.4 (environment). The percentages of participants not in full health for each EQ-5D dimension were 12.8% (mobility), 3.1% (self-care), 6.9% (usual activities), 20.9% (pain/discomfort), and 6.8% (anxiety/depression). Correlations between the 4 WHOQoL-BREF domains and the 5 EQ-5D dimensions were relatively weak, ranging from –0.06 (social relationships with self-care and pain/discomfort; p<0.001) to –0.42 (physical with mobility; p<0.001).
Conclusion
Although health-related QoL as measured by the WHOQoL-BREF and the EQ-5D are correlated, these 2 measures should not be considered interchangeable. The choice between them should be guided by the specific research questions and the intended use of the data.

Review Article

The contribution of dietary total antioxidant capacity to type 2 diabetes risk and levels of glycemic biomarkers: a systematic review: Sorayya Kheirouri, Hamed Alizadeh; Received December 10, 2024 Accepted February 24, 2025 Published online March 27, 2025; DOI: https://doi.org/10.24171/j.phrp.2024.0337 [Epub ahead of print]

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Abstract PDF Supplementary Material: Objectives
This study systematically reviewed and analyzed epidemiological evidence regarding the association between dietary total antioxidant capacity (DTAC) and both the risk of developing diabetes and glycemic biomarker levels.
Methods
We searched the PubMed, Scopus, ScienceDirect, and Google Scholar databases through July 2024 without imposing any date restrictions. Original studies that examined the relationship between DTAC and either the risk of developing diabetes or glycemic biomarker levels—specifically fasting blood glucose (FBG), hemoglobin A1C (HbA1C), insulin, and the homeostatic model assessment for insulin resistance (HOMA-IR)—were eligible for inclusion. After eliminating duplicates and irrelevant records, relevant studies were selected, and data were extracted through rigorous critical analysis.
Results
A total of 32 articles were included in the review. Of the 19 studies that evaluated diabetes risk, 15 reported a lower risk among subjects with higher DTAC values. All 4 studies examining prediabetes risk found lower risk in participants with high DTAC scores. Additionally, significant inverse relationships were observed between DTAC values and FBG (9/15 studies), HbA1C (1/6 studies), insulin (5/6 studies), and HOMA-IR (8/9 studies).
Conclusion
The majority of evidence indicates that high adherence to an antioxidant-rich diet may reduce diabetes risk and improve glycemic biomarkers, including FBG, insulin, and HOMA-IR.

Original Articles

A retrospective study on blood microbiota as a marker for cognitive decline: implications for detecting Alzheimer’s disease and amnestic mild cognitive impairment in Republic of Korea: Youngchan Park, Jong-Young Lee, Eek-Sung Lee; Received December 5, 2024 Accepted February 12, 2025 Published online March 24, 2025; DOI: https://doi.org/10.24171/j.phrp.2024.0329 [Epub ahead of print]

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Abstract PDF: Objectives
This study aimed to investigate the relationship between blood microbiota, specifically bacterial DNA, and cognitive decline in individuals with subjective cognitive decline (SCD) and amnestic mild cognitive impairment (aMCI). The objective was to identify potential microbial signatures that could serve as biomarkers for cognitive deterioration.
Methods
Forty-seven participants were recruited, including 13 with aMCI, 20 with SCD, and 14 normal cognition (NC). Blood samples were collected, and microbial DNA was analyzed using 16S rRNA sequencing on the Illumina MiSeq platform. Bioinformatics analyses—including α- and β-diversity measures and differential abundance testing (using edgeR)—were employed to assess microbial diversity and differences in bacterial composition among groups. Logistic regression models were used to evaluate the predictive impact of the microbiota on cognitive decline.
Results
Microbial diversity differed significantly between groups, with NC exhibiting the highest α-diversity. Both the aMCI and SCD groups showed reduced diversity. Taxa such as Bacteroidia, Alphaproteobacteria, and Clostridia were significantly decreased in the aMCI group compared to NC (p<0.05). In contrast, Gammaproteobacteria increased significantly in the aMCI group compared to both NC and SCD, indicating progressive microbial changes from SCD to aMCI. No significant differences were found between the NC and SCD groups.
Conclusion
Distinct bacterial taxa—particularly the increase in Gammaproteobacteria along with decreases in Bacteroidia, Alphaproteobacteria, and Clostridia—are associated with the progression of cognitive decline. These findings suggest that blood microbiota could serve as potential biomarkers for the early detection of aMCI. However, the small sample size and the lack of control for confounding factors such as diet and medication limit the findings. Larger studies are needed to validate these results and further explore the role of microbiota in neurodegeneration.

Factors influencing satisfaction with medical services in medically underserved populations: an analytical cross-sectional study at a free medical clinic in the Republic of Korea: Joo Hyun Kim, Yeon Jeong Heo, Jae Bok Kwak, Samil Park, Curie Ahn, So Hee Ahn, Bumjo Oh, Jung Sik Lee, Jun Hyun Lee, Ho Young Lee; Received November 30, 2024 Accepted February 23, 2025 Published online March 17, 2025; DOI: https://doi.org/10.24171/j.phrp.2024.0325 [Epub ahead of print]

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Abstract PDF: Objectives
This study aimed to explore factors influencing satisfaction with medical services among medically underserved populations at the free medical clinic, providing data to improve free medical services for these populations.
Methods
We employed a descriptive correlational study design involving 112 individuals (aged 19 years and older) from medically underserved populations who visited the clinic. Data were collected through face-to-face surveys from September to October 2023, and statistical analyses (t-tests, analysis of variance, Pearson correlation, and hierarchical multiple regression) were used to identify key predictors of satisfaction.
Results
Perceived support from healthcare providers emerged as the strongest predictor of satisfaction with medical services, demonstrating a significant positive association. While social support was positively correlated with perceived support from healthcare providers, it did not independently predict satisfaction.
Conclusion
These findings underscore the importance of healthcare provider and social support in increasing satisfaction with medical services among medically underserved populations. Developing tailored healthcare programs and specialized healthcare provider training are essential strategies to improve healthcare access and outcomes for these vulnerable groups.

SWOT strategy for future global health security: insights from Indonesia, Cambodia, Vietnam, Dominican Republic, Ghana, and the Republic of Korea using the World Health Organization International Health Regulations monitoring tool: Moonsoo Yoon, Nuha Fairusya, Thao Le Nhu Nguyen, Diomarys Ishaura Jimenez-Baez, Vichuta Prak, Osei Kuffour Afreh, Chaeshin Chu; Received November 11, 2024 Accepted February 16, 2025 Published online March 12, 2025; DOI: https://doi.org/10.24171/j.phrp.2024.0314 [Epub ahead of print]

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Abstract PDF: Objectives
The study aimed to analyze the core capacities to implement World Health Organization International Health Regulations (IHR) in 6 countries: Indonesia, Cambodia, Vietnam, the Dominican Republic, Ghana, and the Republic of Korea.
Methods
Secondary data from relevant databases and reports, including the electronic State Party Self-Assessment Annual Reporting mechanism and global health security index, were used to assess health security in these countries. Descriptive statistics summarized the basic features of the scores, and a strengths, weaknesses, opportunities, and threats (SWOT) analysis was subsequently performed to identify factors affecting health security scores while highlighting key similarities and differences between countries.
Results
Early warning and event management emerged as the primary strength in most countries. Common opportunities included international commitments and immunization programs. In contrast, many countries shared weaknesses related to the policy, legal, and normative frameworks for IHR implementation, as well as challenges in human resources, chemical event management, and radiation emergency preparedness. Recurring threats involved issues such as biosafety, biosecurity, dual-use research and the culture of responsible science, infection control practices, coordination between public health and security authorities, laboratory supply chain vulnerabilities, and communication with healthcare workers during public health emergencies.
Conclusion
In order to counter future global health threats, countries should prioritize enhancing surveillance capacity (early warning and event management) as well as the immunization indicator (vaccination rates for human and animal diseases, including the national vaccine delivery system).

Editorial

It is time to hold discussions with policymakers: Jong-Koo Lee; Osong Public Health Res Perspect. 2025;16(1):1-2. Published online February 27, 2025; DOI: https://doi.org/10.24171/j.phrp.2025.0057

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Original Article

Multilevel analysis of individual, household, and community factors influencing COVID-19 vaccination intention: evidence from the 2021 Korea Community Health Survey: Ji-seon Seong, Jong-Yeon Kim; Received September 22, 2024 Accepted January 22, 2025 Published online February 21, 2025; DOI: https://doi.org/10.24171/j.phrp.2024.0254 [Epub ahead of print]

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Abstract PDF: Objectives
This study aimed to investigate the combined effects of individual, household, and community-level factors on coronavirus disease 2019 (COVID-19) vaccination intention using a multilevel analysis.
Methods
This cross-sectional study analyzed raw data from the 2021 Korea Community Health Survey and regional statistics from 255 health centers, with a final sample of 229,216 individuals. Multilevel analysis was conducted, focusing on individual, household, and community-level factors. Individual-level factors included demographics, health status, and COVID-19 concerns; household-level factors included income and marital status; and community-level factors included city type and vaccination rates.
Results
At the individual level, significant differences were observed across all variables. At the household level, higher vaccination intention was associated with households of 4 or more members and a monthly income of 4 million Korean won or more. At the community level, higher flu vaccination rates, greater concern about COVID-19 infection, and higher COVID-19 vaccination rates were linked to increased vaccination intention.
Conclusion
This study highlights that COVID-19 vaccination intention is influenced by factors at the individual, household, and community levels. Vaccination strategies that integrate household and community-level approaches may be more effective. Policymakers should consider both individual and social health factors when designing vaccination policies.

Commentary

Polycystic ovary syndrome, cardiovascular risk, and coffee: a complex interplay: Anna Vittoria Mattioli; Osong Public Health Res Perspect. 2025;16(1):89-90. Published online February 17, 2025; DOI: https://doi.org/10.24171/j.phrp.2025.0004

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Original Article

Effectiveness of a brain exercise program using game-based cognitive enhancement to reduce mild cognitive impairment among older adults in Pathum Thani Province, Thailand: a quasi-experimental study: Panida Kunrit, Phannathat Tanthanapanyakorn, Nonlapan Khantikulanon, Sootthikarn Mungkhunthod, Chaninan Praserttai, Sasipa Rungrungrueang, Wanwisa Phonmamuang; Osong Public Health Res Perspect. 2025;16(1):59-71. Published online February 17, 2025; DOI: https://doi.org/10.24171/j.phrp.2024.0267

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Graphical Abstract Abstract PDF: Objectives
Mild cognitive impairment (MCI) is prevalent among older adults and may progress to dementia. This study evaluated the effectiveness of a game-based brain exercise program in reducing MCI among older adults.
Methods
A quasi-experimental study was conducted with 2 groups of older participants in Pathum Thani Province, Thailand. A total of 96 individuals with Thai mental state examination (TMSE) scores between 12 to 23, indicating MCI but no dementia diagnosis, were recruited. Using multi-stage sampling, participants were divided into an intervention group (n=48) and a control group (n=48). The intervention group participated in a 6-week game-based brain exercise program, while the control group received a self-administered brain exercise manual. Face-to-face interviews assessed outcomes at baseline, post-intervention, and 3-month follow-up. Data were analyzed using descriptive statistics and repeated-measures analysis of variance.
Results
Significant differences were observed in mean TMSE scores and MCI knowledge between the intervention and control groups at the 3-month follow-up (p<0.001). The intervention group showed significant increases in TMSE scores and MCI knowledge post-intervention and at 3-month follow-up (p<0.001).
Conclusion
The findings suggest that a game-based brain exercise program can improve cognitive function in older adults. Healthcare professionals can implement such programs to reduce MCI by addressing planning, management, and related issues in the future.

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