Osong Public Health and Research Perspectives

Original Articles

A Mycobacterium bovis outbreak among exhibition animals at a zoo in the Republic of Korea: the first contact investigation of zoonotic tuberculosis: Hye Young Lee, Yunhyung Kwon, Sang-Eun Lee, Jieun Kim, Hoyong Choi; Osong Public Health Res Perspect. 2024;15(3):248-259. Published online May 17, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0228

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Graphical Abstract Abstract PDF: Objectives
Between July 2, 2021, and September 20, 2022, a Mycobacterium bovis outbreak occurred among exhibition animals at a zoo in the Republic of Korea. This study was conducted to assess the likelihood of M. bovis transmission to human contacts through a contact investigation and to implement preventive treatment for latent tuberculosis infection (LTBI). Methods: In this descriptive study, the Korea Disease Control and Prevention Agency conducted a contact investigation, which included interviews, interferon-gamma release assay (IGRA) tests, and chest X-rays. Contacts underwent IGRA testing on 2 occasions: initial testing of 29 contacts (15 in the first cluster of infection and 14 in the second cluster) and follow-up testing of the 15 contacts in the first cluster. Results: The study included 29 participants, 18 of whom were male (62.1%) and 11 female (37.9%). The mean participant age was 37.3 years (standard deviation, 9.6 years). In the initial IGRA tests, 6 of the 29 participants tested positive, indicating a prevalence of 20.7%. Following prolonged exposure, 1 additional positive case was detected in follow-up testing, raising the prevalence of LTBI to 24.1%. None of the contacts had active tuberculosis. Among the 7 individuals with positive results, 2 (28.6%) underwent treatment for LTBI. Conclusion: This study faced challenges in confirming the transmission of M. bovis infection from infected animals to humans in the Republic of Korea. Nevertheless, adopting a One Health approach necessitates the implementation of surveillance systems and infection control protocols, particularly for occupational groups at high risk of exposure.

Risk factors for SARS-CoV-2 transmission during a movie theater outbreak in Incheon in the Republic of Korea, November 2021: a retrospective study: Hye Young Lee, Young-Joon Park, Sang-Eun Lee, Han-Na Yoo, Il-Hwan Kim, Jin Sun No, Eun-Jin Kim, Jungyeon Yu, Sanghwan Bae, Mi Yu; Osong Public Health Res Perspect. 2024;15(1):45-55. Published online January 31, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0269

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Graphical Abstract Abstract PDF: Objectives
We examined factors contributing to the transmission of an acute respiratory virus within multi-use facilities, focusing on an outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a movie theater in the Republic of Korea. Methods: This retrospective cohort study involved a descriptive analysis of 48 confirmed cases. Logistic regression was applied to a cohort of 80 theater attendees to identify risk factors for infection. The infection source and transmission route were determined through gene sequencing data analysis. Results: Of the 48 confirmed cases, 35 were theater attendees (72.9%), 10 were family members of attendees (20.8%), 2 were friends (4.2%), and 1 was an employee (2.1%). Among the 80 individuals who attended the 3rd to 5th screenings of the day, 35 became infected, representing a 43.8% attack rate. Specifically, 28 of the 33 third-screening attendees developed confirmed SARSCoV-2, constituting an 84.8% attack rate. Furthermore, 11 of the 12 cases epidemiologically linked to the theater outbreak were clustered monophyletically within the AY.69 lineage. At the time of the screening, 35 individuals (72.9%) had received 2 vaccine doses. However, vaccination status did not significantly influence infection risk. Multivariate analysis revealed that close contacts had a 15.9-fold higher risk of infection (95% confidence interval, 4.37–78.39) than casual contacts. Conclusion: SARS-CoV-2 transmission occurred within the theater, and extended into the community, via a moviegoer who attended the 3rd screening during the viral incubation period after contracting the virus from a family member. This study emphasizes the importance of adequate ventilation in theaters.

Evaluation of COVID-19 vaccine effectiveness in different high-risk facility types during a period of Delta variant dominance in the Republic of Korea: a cross-sectional study: Min Jei Lee, Myung-Jae Hwang, Dong Seob Kim, Seon Kyeong Park, Jihyun Choi, Ji Joo Lee, Jong Mu Kim, Young-Man Kim, Young-Joon Park, Jin Gwack, Sang-Eun Lee; Osong Public Health Res Perspect. 2023;14(5):418-426. Published online October 19, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0188

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Graphical Abstract Abstract PDF: Objectives
We evaluated the effectiveness of coronavirus disease 2019 vaccination in high-risk facilities in the Republic of Korea during the period when the highly transmissible Delta variant was prevalent. Additionally, we aimed to explore any disparities in vaccine effectiveness (VE) across various types of institutions, specifically distinguishing between non-medical and medical establishments. Methods: We examined 8 outbreak clusters covering 243 cases and 895 contacts from 8 high-risk facilities divided into 2 groups: group A (4 non-medical institutions) and group B (4 medical institutions). These clusters were observed from July 27, 2021 to October 16, 2021 for the attack rate (AR) and VE with respect to disease severity. A generalized linear model with a binomial distribution was used to determine the odds ratio (OR) for disease severity and death. Results: AR was notably lower in group B (medical institutions). Furthermore, VE analysis revealed that group A exhibited higher effectivity for disease severity and death than group B. The OR for disease severity was 0.24 (95% confidence interval [CI], 0.03–2.16) for group A and 0.27 (95% CI, 0.12–0.64) for group B, with the OR for death at 0.12 (95% CI, 0.01–1.32) in group A and 0.34 (95% CI, 0.14–0.87) in group B. Conclusion: Although VE may vary across institutions, our findings underscore the importance of implementing vaccinations in high-risk facilities. Customized vaccination programs, tailored response plans, and competent management personnel are essential for effectively addressing and mitigating public health challenges.

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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Graphical Abstract 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.

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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Graphical Abstract 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.

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Detection of a cluster of Omicron's BA.4 sublineage in Northern Senegal and identification of the first XAS recombinant variant in Senegal
Martin Faye, Modeste Name Faye, Babacar Ndiaye, Moussa Moïse Diagne, Safietou Sankhe, Ndeye Marième Top, Amadou Diallo, Cheikh Loucoubar, Ndongo Dia, Amadou Alpha Sall, Ousmane Faye
Virus Research.2024; 339: 199259. CrossRef

Results of contact tracing for SARS-CoV-2 Omicron sub-lineages (BA.4, BA.5, BA.2.75) and the household secondary attack risk: Mi Yu, Sang-Eun Lee, Hye Young Lee, Hye-jin Kim, Yeong-Jun Song, Jian Jeong, Ae Kyung Park, Il-Hwan Kim, Eun-jin Kim, Young-Joon Park; Osong Public Health Res Perspect. 2023;14(3):173-179. Published online June 22, 2023; DOI: https://doi.org/10.24171/j.phrp.2022.0285

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Graphical Abstract Abstract PDF

Objectives
This study aimed to assess the contact tracing outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron sub-lineages BA.4, BA.5, and BA.2.75 within Republic of Korea, and to generate foundational data for responding to future novel variants.
Methods
We conducted investigations and contact tracing for 79 confirmed BA.4 cases, 396 confirmed BA.5 cases, and 152 confirmed BA.2.75 cases. These cases were identified through random sampling of both domestically confirmed and imported cases, with the goal of evaluating the pattern of occurrence and transmissibility.
Results
We detected 79 instances of Omicron sub-lineage BA.4 across a span of 46 days, 396 instances of Omicron sub-lineage BA.5 in 46 days, and 152 instances of Omicron sub-lineage BA.2.75 over 62 days. One patient with severe illness was confirmed among the BA.5 cases; however, there were no reports of severe illness in the confirmed BA.4 and BA.2.75 cases. The secondary attack risk among household contacts were 19.6% for BA.4, 27.8% for BA.5, and 24.3% for BA.2.75. No statistically significant difference was found between the Omicron sub-lineages.
Conclusion
BA.2.75 did not demonstrate a higher tendency for transmissibility, disease severity, or secondary attack risk within households when compared to BA.4 and BA.5. We will continue to monitor major SARS-CoV-2 variants, and we plan to enhance the disease control and response systems.

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Replication kinetics and infectivity of SARS-CoV-2 Omicron variant sublineages recovered in the Republic of Korea
Jeong-Min Kim, Dongju Kim, Jee Eun Rhee, Cheon Kwon Yoo, Eun-Jin Kim
Osong Public Health and Research Perspectives.2024; 15(3): 260. CrossRef

Analysis of pregnant women with critically severe COVID-19 in Republic of Korea from February 2020 and December 2021: Ji Joo Lee, Sang-Eun Lee, Yeonjung Kim, Young-Joon Park; Osong Public Health Res Perspect. 2023;14(2):129-137. Published online April 5, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0025

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Graphical Abstract Abstract PDF: Objectives
This study aimed to describe the characteristics and risk factors for severe disease in pregnant women infected with coronavirus disease 2019 (COVID-19) from the early days of the COVID-19 epidemic in Korea to the predominant period of the Delta variant.
Methods
A retrospective cohort study was conducted among pregnant women diagnosed with COVID-19 between February 2020 and December 2021. Logistic regression analysis was performed to compare severe and mild cases after adjusting for pregnant women’s age, nationality, infection route, outbreak area, infection period, symptoms, underlying disease, smoking status, trimester, and COVID-19 vaccination status.
Results
In total, 2,233 pregnant women were diagnosed with COVID-19 by December 2021. Among these, 96.7% had mild symptoms, 3.3% had severe symptoms, and 0.04% died. The risk factors for severe disease in pregnant women with confirmed COVID-19 were being in the age group of 35 to 45 years, having hyperlipidemia, being in the second or third trimester of pregnancy at the time of COVID-19 diagnosis, being infected during the Delta-predominant period, and having a fever (≥38 °C) at diagnosis. Furthermore, 47.1% of patients in the mild group and 84.9% of patients in the severe group had 3 or more risk factors.
Conclusion
Pregnant women with COVID-19 mainly experienced mild symptoms, but those with risk factors were at a higher risk of developing severe symptoms. Therefore, treatment and follow-up management should be thoroughly implemented.

Brief Report

Early countermeasures to COVID-19 at long-term care facilities in Gwangju Metropolitan City, Republic of Korea: Hye-Jin Kim, Jieun Kim, Yoon Suk Jang, Hanul Park, Jong Mu Kim, Young Joon Park, So-Yeon Ryu, Jun Hwi Cho, So Yeong Park, Sang-Eun Lee; Osong Public Health Res Perspect. 2023;14(1):59-65. Published online February 1, 2023; DOI: https://doi.org/10.24171/j.phrp.2022.0293

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Graphical Abstract Abstract PDF: Objectives
The coronavirus disease 2019 (COVID-19) pandemic has continued since its first detection in the Republic of Korea on January 20, 2020. This study describes the early countermeasures used to minimize the risk of COVID-19 outbreaks during cohort quarantine and compares the epidemiological characteristics of 2 outbreaks in long-term care facilities (LTCFs) in Gwangju Metropolitan City in summer 2020. Methods: An epidemiological investigation was conducted via direct visits. We investigated epidemiological characteristics, including incidence, morbidity, and mortality rates, for all residents and staff members. Demographic characteristics were analyzed using a statistical program. Additionally, the method of managing infection in LTCFs is described. Results: Residents and caregivers had high incidence rates in LTCF-A and LTCF-B, respectively. LTCF-B had a longer quarantine period than LTCF-A. The attack rate was 20.02% in LTCF-A and 27.9% in LTCF-B. The mortality rate was 2.3% (1/43) in LTCF-B, the only facility in which a COVID-19 death occurred. Conclusion: Extensive management requires contact minimization, which involves testing all contacts to mitigate further transmission in the early stages of LTCF outbreaks. The findings of this study can help inform and prepare public health authorities for COVID-19 outbreaks, particularly for early control in vulnerable facilities.

Original Article

2019 Tabletop Exercise for Laboratory Diagnosis and Analyses of Unknown Disease Outbreaks by the Korea Centers for Disease Control and Prevention: Il-Hwan Kim, Jun Hyeong Jang, Su-Kyoung Jo, Jin Sun No, Seung-Hee Seo, Jun-Young Kim, Sang-Oun Jung, Jeong-Min Kim, Sang-Eun Lee, Hye-Kyung Park, Eun-Jin Kim, Jun Ho Jeon, Myung-Min Choi, Boyeong Ryu, Yoon Suk Jang, Hwami Kim, Jin Lee, Seung-Hwan Shin, Hee Kyoung Kim, Eun-Kyoung Kim, Ye Eun Park, Cheon-Kwon Yoo, Sang-Won Lee, Myung-Guk Han, Gi-Eun Rhie, Byung Hak Kang; Osong Public Health Res Perspect. 2020;11(5):280-285. Published online October 22, 2020; DOI: https://doi.org/10.24171/j.phrp.2020.11.5.03

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Abstract PDF: Objectives
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.
Methods
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.
Results
Since September 9^th, 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.
Conclusion
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.

Short Communication

Detection of Novel Coronavirus on the Surface of Environmental Materials Contaminated by COVID-19 Patients in the Republic of Korea: Sang-Eun Lee, Deog-Yong Lee, Wook-Gyo Lee, ByeongHak Kang, Yoon Suk Jang, Boyeong Ryu, SeungJae Lee, Hyunjung Bahk, Eungyu Lee; Osong Public Health Res Perspect. 2020;11(3):128-132. Published online May 8, 2020; DOI: https://doi.org/10.24171/j.phrp.2020.11.3.03

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Abstract PDF

This study aimed to determine the presence of SARS-CoV-2 on surfaces frequently touched by COVID-19 patients, and assess the scope of contamination and transmissibility in facilities where the outbreaks occurred. In the course of this epidemiological investigation, a total of 80 environmental specimens were collected from 6 hospitals (68 specimens) and 2 “mass facilities” (6 specimens from a rehabilitation center and 6 specimens from an apartment building complex). Specific reverse transcriptase-polymerase chain reaction targeting of RNA-dependent RNA polymerase, and envelope genes, were used to identify the presence of this novel coronavirus. The 68 specimens from 6 hospitals (A, B, C, D, E, and G), where prior disinfection/cleaning had been performed before environmental sampling, tested negative for SARS-CoV-2. However, 2 out of 12 specimens (16.7%) from 2 “mass facilities” (F and H), where prior disinfection/cleaning had not taken place, were positive for SARS-CoV-2 RNA polymerase, and envelope genes. These results suggest that prompt disinfection and cleaning of potentially contaminated surfaces is an effective infection control measure. By inactivating SARS-CoV-2 with disinfection/cleaning the infectivity and transmission of the virus is blocked. This investigation of environmental sampling may help in the understanding of risk assessment of the COVID-19 outbreak in “mass facilities” and provide guidance in using effective disinfectants on contaminated surfaces.

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Original Article

Prevalence of Clonorchis sinensis Infections Along the Five Major Rivers in Republic of Korea, 2007: Hyun-Kyung Kim, Hyeng-Il Cheun, Byung-Suk Cheun, Ki-Yeon Lee, Tong-Soo Kim, Sang-Eun Lee, Won-ja Lee, Shin-Hyeong Cho; Osong Public Health Res Perspect. 2010;1(1):43-49. Published online December 31, 2010; DOI: https://doi.org/10.1016/j.phrp.2010.12.010

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Abstract PDF

Objectives
The prevalence of Clonorchis sinensis infection was investigated among residents of the five major river basins, that is, Hangang, Nakdonggang, Seomjingang, Yeongsangang, and Geumgang River basins in Korea.
Methods
From January to December 2007, a total of 31,268 stool samples were collected from 29 localities and examined by the formalin-ether sedimentation technique.
Results
Intestinal parasite eggs and/or protozoan cysts were detected from 2957 (9.5%) inhabitants. Number of residents harbouring helminth eggs in the faeces was 2542 (8.1%) for C. sinensis, 255 (0.8%) for Heterophyes spp., 36 (0.1%) for Echinostoma spp., 30 (0.1%) for Trichuris trichiura, 8 (0.03%) for Ascaris lumbricoides, 7 (0.02%) for Gymnophalloide seoi, and 50 (0.02%) for Trichostrongylus orientalis. Number of residents harbouring protozoan cysts in the faeces was 133 (1.3%) for Entamoeba spp. and 50 (0.2%) for Giardia lamblia. The positive rates of C. sinensis in Nakdonggang, Seomjingang, Yeongsangang, Geumgang, and Hangang River basins were 12.2%, 9.5%, 3.3%, 3.0%, and 1.0%, respectively. The egg positive rate of C. sinensis was higher in male (10.6%) than in female (6.1%), and the age group of 50s had the highest positive rate (10.4%).
Conclusion
The result of this study revealed little decrease in positive rate of C. sinensis compared with the result of southern endemic areas of Korea in 2006.

Citations

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Infection characteristics of Metagonimus species (Digenea: Heterophyidae) metacercariae in fish from major rivers of Korea
Woon-Mok Sohn
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Infection Characteristics of Clonorchis sinensis Metacercariae in Fish from Republic of Korea
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