Objectives Scrub typhus, an acute disease caused by Orientia tsutsugamushi and transmitted by larval chigger mites, is a representative autumn febrile illness in the Republic of Korea. We examined epidemiological characteristics underlying spatial heterogeneity in Busan Metropolitan City to inform region-specific prevention and control policies. Methods: We analyzed 1,645 confirmed and suspected scrub typhus cases reported in Busan from 2019 to 2023. Crude incidence rates and age-standardized incidence rates (ASIRs) per 100,000 population were calculated using the 2021 mid-year population. The chi-square test assessed associations between disease occurrence and exposure activities within the preceding 30 days. Correlation analyses examined the relationships of ASIR with environmental indicators, including per capita urban forest area, and epidemiological indicators, including prior infectious disease education. Results: The overall mean ASIR in Busan was 8.35 per 100,000 population, below the national average. However, incidence was higher in peri-urban districts, including Gijang-gun (26.12/100,000) and Gangseo-gu (15.02/100,000), than in central urban districts such as Junggu (2.20/100,000). Higher incidence was observed among women and older adults (≥60 years). ASIR correlated strongly with per capita urban forest area (r=0.92; 95% confidence interval, 0.79–0.97; p<0.001). Regional differences were significant for agriculture/forestry, gardening, and general outdoor activities (p<0.001). Districts with higher incidence also displayed higher rates of infectious disease education, although this may reflect reverse causation. Conclusion: In Busan, scrub typhus incidence was concentrated in peri-urban districts. These findings support region-specific prevention strategies, evaluation of infectious disease education, enhanced mite surveillance, and practical protective measures during fieldwork.
Objectives This study aimed to strengthen the core capabilities of epidemiological investigation and response teams (ERTs) at the Korea Disease Control and Prevention Agency, drawing on lessons learned from the Middle East respiratory syndrome and coronavirus disease 2019 pandemics. The primary objectives were to facilitate rapid and accurate data collection and analysis, improve communication skills, and simulate real-world on-site responses. Methods: The training program was developed using a scenario involving a novel infectious disease from the World Health Organization priority list entering a community. ERTs collected and analyzed epidemiological data and implemented control measures as they addressed the missions of the scenario. Improvement in competencies was assessed through self-evaluation surveys completed before and after training. Results: A total of 49 participants, including disease control officers, epidemiological investigation officers, researchers, and administrative officials, attended the training. Participant satisfaction with the training was high, scoring 6.4 out of 7, and the improvement in competency was statistically significant (pre-training score, 5.2; post-training score, 6.2; p<0.001). Conclusion: Scenario-based training can effectively enhance the capabilities of ERTs. Such training is essential, as emerging and re-emerging infectious diseases can exhibit unpredictable spread and potentially severe impacts. Therefore, developing diverse scenarios and conducting regular training sessions are necessary to improve the capacities of ERTs.
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.
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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
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.
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<sec>
<title>Objectives</title>
<p>The Korea Centers for Disease Control and Prevention has published “A Guideline for Unknown Disease Outbreaks (UDO).” The aim of this report was to introduce tabletop exercises (TTX) to prepare for UDO in the future.</p></sec>
<sec>
<title>Methods</title>
<p>The UDO Laboratory Analyses Task Force in Korea Centers for Disease Control and Prevention in April 2018, assigned unknown diseases into 5 syndromes, designed an algorithm for diagnosis, and made a panel list for diagnosis by exclusion. Using the guidelines and laboratory analyses for UDO, TTX were introduced.</p></sec>
<sec>
<title>Results</title>
<p>Since September 9<sup>th</sup>, 2018, the UDO Laboratory Analyses Task Force has been preparing TTX based on a scenario of an outbreak caused by a novel coronavirus. In December 2019, through TTX, individual missions, epidemiological investigations, sample treatments, diagnosis by exclusions, and next generation sequencing analysis were discussed, and a novel coronavirus was identified as the causal pathogen.</p></sec>
<sec>
<title>Conclusion</title>
<p>Guideline and laboratory analyses for UDO successfully applied in TTX. Conclusions drawn from TTX could be applied effectively in the analyses for the initial response to COVID-19, an ongoing epidemic of 2019 – 2020. Therefore, TTX should continuously be conducted for the response and preparation against UDO.</p></sec>
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<sec><title>Objectives</title>
<p>In this pandemic situation caused by a novel coronavirus disease in 2019 (COVID-19), an electronic support system that can rapidly and accurately perform epidemic investigations, is needed. It would systematically secure and analyze patients’ data (who have been confirmed to have the infection), location information, and credit card usage.</p></sec>
<sec><title>Methods</title>
<p>The “Infectious Disease Prevention and Control Act” in South Korea, established a legal basis for the securement, handling procedure, and disclosure of information required for epidemic investigations. The Epidemic Investigation Support System (EISS) was developed as an application platform on the Smart City data platform.</p></sec>
<sec><title>Results</title>
<p>The EISS performed the function of inter-institutional communication which reduced the processing period of patients’ data in comparison to other methods. This system automatically marked confirmed cases’ tracking data on a map and hot-spot analysis which lead to the prediction of areas where people may be vulnerable to infection.</p></sec>
<sec><title>Conclusion</title>
<p>The EISS was designed and implemented for use during an epidemic investigation to prevent the spread of an infectious disease, by specifically tracking confirmed cases of infection.</p></sec>
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Objectives
This study extended and updated a meta-analysis of the association between exposure to dichlorodiphenyltrichloroethane (DDT) and the risk of breast cancer. Methods
We reviewed the published literature on exposure to DDE and breast cancer risk to update a meta-analysis from 2004. The total of 35 studies included 16 hospital-based case–control studies, 11 population-based case–control studies, and 10 nested case–control studies identified through keyword searches in the PubMed and EMBASE databases. Results
The summary odds ratio (OR) for the identified studies was 1.03 (95% confidence interval 0.95–1.12) and the overall heterogeneity in the OR was observed (<i>I</i><sup>2</sup> = 40.9; <i>p</i> = 0.006). Subgroup meta-analyses indicated no significant association between exposure to DDE and breast cancer risk by the type of design, study years, biological specimen, and geographical region of the study, except from population-based case–control studies with estimated DDE levels in serum published in 1990s. Conclusion
Existing studies do not support the view that DDE increases the risk of breast cancer in humans. However, further studies incorporating more detailed information on DDT exposure and other potential risk factors for breast cancer are needed.
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Objectives
The epidemiological patterns of endemic hepatitis A virus (HAV) are unclear in northeastern Asia depending on the ethnicity of the country in question. The purpose of this study was to investigate the seroprevalence of HAV in northeastern China, South Korea, and Japan. Methods
A total of 1,500 serum samples were collected from five groups of inhabitants (300 each) who were over 40 years of age (Korean Chinese, indigenous Chinese, South Korean, Korean living in Japan, and indigenous Japanese). The samples were screened for antibodies to HAV using an enzyme-linked immunosorbent assay. Results
Positivity for HAV antibodies was 93.7% (95% confidence interval [CI]: 90.9–96.4) in Koreans living in northeastern China, 99.7% (95% CI: 99.0–100.3) in indigenous Chinese, 98.0% (95% CI: 96.4–99.6) in indigenous Koreans, 33.3% (95% CI: 28.0–38.7) in Koreans living in Japan, and 20.4% (95% CI: 15.8–25.0) in indigenous Japanese persons. The overall anti-HAV prevalence was not significantly different between northeastern China and South Korea, but it was different in Japan. Conclusions
These results indicate that differences in seroprevalence can be attributed to geological, environmental, and socioeconomic conditions rather than ethnicity.
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Objectives
The purpose of this study was to investigate the seroprevalence of hepatitis A virus (HAV) and hepatitis E virus (HEV) in Korea during 2005. Methods
Study subjects were selected from across Korea using a stratified multistage probability sampling design, and HAV and HEV seroprevalence was compared on the basis of sex, age, and residency. A total of 497 rural and urban people aged 10–99 years of age (mean ± SD age = 28.87 ± 17.63 years) were selected by two-stage cluster sampling and tested serologically for anti-HAV and anti-HEV IgG using an enzyme-linked immunosorbent assay. Results
Among this population, the overall seroprevalence of HAV was 63.80% (55.21% aged in their 20s and 95.92% in their 30s, <i>p</i> < 0.01) and that of HEV was 9.40% (5.21% aged in their 20s and 7.14% in their 30s, <i>p</i> < 0.01). Seroprevalence also varied according to area of residence. HEV prevalence in rural areas was higher than that of urban regions based on the anti-HEV antibody, odds ratio 3.22 (95% confidence interval: 1.46–7.10, <i>p</i> < 0.01). There were no significant differences between male and female against anti-HAV/HEV antibodies. Conclusion
Our study suggested that the seropositive rates of HAV and HEV might be related to age and environmental conditions.
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Objectives
In Korea, every outbreak of acute gastroenteritis in two or more patients who are epidemiologically related is investigated by local public health centres to determine causative agents and control the outbreak with the support of the Korean Centers for Disease Control and Prevention. The findings and conclusions of each outbreak investigation have been summarized annually since 2007 to make reports and statistics of water- and foodborne disease outbreaks. Methods
All outbreaks reported to Korean Centers for Disease Control and Prevention from 2007 to 2009 were included in the study. We analysed the trends and epidemiologic aspects of outbreaks by month, year, and location. Results
The total number of outbreaks decreased steadily each year for the period the study covered, whereas the number of patients per outbreak continued to increase resulting from a dramatic increase in the number of patients per outbreak in food service establishments. The outbreaks occurred in the period of June to September, when temperature and humidity are relatively high, which accounted for 44.3% of total outbreaks. The monthly number of outbreaks decreased steadily until November after peaking in May 2009. The most common causative agent was norovirus (16.5%) followed by pathogenic <i>Escherichia coli</i>. The rate of causative agent identification was 60.1%, with higher identification rates in larger outbreaks. Conclusions
Although a decreasing trend of outbreaks by year was observed in the study, the food services in schools and companies require more attention to hygiene and sanitation to prevent large outbreaks. The ability to establish the cause of an outbreak should be further improved.
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