Osong Public Health and Research Perspectives

Original Articles

The effect of the COVID-19 pandemic on the trends and characteristics of natural and unnatural deaths in an urban Sri Lankan cohort viewed through retrospective analysis of forensic death investigations from 2019 to 2022: Sameera Anuruddha Gunawardena, Nishani Dassanayake, Buddhika Indeewarie Keerawelle, Shivasankarie Kanthasamy, Hasini Ranganatha, Jayani Wathsala Gunawardana; Received June 25, 2023 Accepted October 24, 2023 Published online November 23, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0175 [Epub ahead of print]

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Abstract PDF: Objectives
The coronavirus disease 2019 (COVID-19) pandemic has had a severe impact on global health. Apart from the disease itself, the strict restrictions and lockdowns enforced to minimize its spread have also substantially disrupted personal and public health.
Methods
An analysis of forensic autopsy investigations was conducted between 2019 and 2022 on a selected urban population in Colombo, Sri Lanka, assessing the effects of the COVID-19 pandemic on mortality within these communities.
Results
During the COVID-19 restrictions, there was a 2.5-fold increase in the total number of deaths, with a significantly higher percentage of female deaths than before. The majority of these deaths were due to cardiovascular causes, while COVID-19-related deaths ranked third overall. The highest proportion of COVID-19 deaths occurred among unvaccinated females. The monthly frequency of deaths from traffic accidents, poisoning, and asphyxiation decreased, while deaths from blunt trauma, sharp trauma, burns, and immersion increased. There was also a rise in blunt homicides and a greater number of femicides during the COVID-19 restrictions than in the pre-pandemic period. A significantly higher percentage of males who received the COVID-19 vaccine died from cardiovascular causes compared to those in the unvaccinated group.
Conclusion
The significant changes in mortality demographics and causes of death within this community during the COVID-19 restrictions underscore the disruption in healthcare, health-seeking behavior, and social interactions during this period. The vulnerability of individuals residing in highly urbanized areas with lower socioeconomic status, particularly women, is brought into sharp focus.

Estimation of the onset time of diabetic complications in type 2 diabetes patients in Thailand: a survival analysis: Natthanicha Sauenram, Jutatip Sillabutra, Chukiat Viwatwongkasem, Pratana Satitvipawee; Received March 31, 2023 Accepted October 11, 2023 Published online November 23, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0084 [Epub ahead of print]

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Abstract PDF: Objectives
This study aimed to identify factors associated with the onset time of diabetic complications in patients with type 2 diabetes mellitus (T2DM) and determine the best-fitted survival model.
Methods
A retrospective cohort study was conducted among T2DM patients enrolled from October 1, 2016 to July 15, 2020 at the National Health Security Office (NHSO). In total, 388 T2DM patients were included. Cox proportional-hazard and parametric models were used to identify factors related to the onset time of diabetic complications. The Akaike information criterion, Bayesian information criterion, and Cox-Snell residual were compared to determine the best-fitted survival model.
Results
Thirty diabetic complication events were detected among the 388 patients (7.7%). A 90% survival rate for the onset time of diabetic complications was found at 33 months after the first T2DM diagnosis. According to multivariate analysis, a duration of T2DM ≥42 months (time ratio [TR], 0.56; 95% confidence interval [CI], 0.33–0.96; p=0.034), comorbid hypertension (TR, 0.30; 95% CI, 0.15–0.60; p=0.001), mildly to moderately reduced levels of the estimated glomerular filtration rate (eGFR) (TR, 0.43; 95% CI, 0.24–0.75; p=0.003) and an eGFR that was severely reduced or indicative of kidney failure (TR, 0.38; 95% CI, 0.16–0.88; p=0.025) were significantly associated with the onset time of diabetic complications (p<0.05).
Conclusion
Patients with T2DM durations of more than 42 months, comorbid hypertension, and decreased eGFR were at risk of developing diabetic complications. The NHSO should be aware of these factors to establish a policy to prevent diabetic complications after the diagnosis of T2DM.

Factors affecting depression and health-related quality of life in the elderly during the COVID-19 pandemic: Deok-Ju Kim; Received June 21, 2023 Accepted September 22, 2023 Published online November 16, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0166 [Epub ahead of print]

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Abstract PDF: Objectives
This study investigated changes in the health behaviors of the elderly due to coronavirus disease 2019 (COVID-19), concerns due to COVID-19, depression, and health-related quality of life (HRQOL), and aimed to identify factors that affect depression and HRQOL in the elderly.
Methods
This study was conducted using data from the 2021 Community Health Survey of the Korea Disease Control and Prevention Agency. From a total sample size of 229,242 individuals, 74,376 elderly people aged 65 or older were selected as subjects, and changes in health behaviors, concerns due to COVID-19, depression, and HRQOL were measured and analyzed.
Results
The level of depression associated with sleep and fatigue was high. The lowest HRQOL was related to physical pain and discomfort, while the most common concerns were related to economic difficulties. Factors influencing depression included worries about infection and economic harm, while factors impacting HRQOL encompassed concerns about infection, economic harm, and criticism from others.
Conclusion
If an infectious disease situation such as COVID-19 reoccurs in the future, it will be necessary to encourage participation in hybrid online and offline programs at senior welfare centers. This should also extend to community counseling institutions like mental health welfare centers. Additionally, establishing connections with stable senior job projects can help to mitigate the effects of social interaction restrictions, physical and psychological health issues, and economic difficulties experienced by the elderly.

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.

Brief Report

JYNNEOS vaccine safety monitoring in the Republic of Korea, 2022: a cross-sectional study: Jaeeun Lee, Seunghyun Lewis Kwon, Jinhee Park, Hyuna Bae, Hyerim Lee, Geun-Yong Kwon; Osong Public Health Res Perspect. 2023;14(5):433-438. Published online October 18, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0182

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Graphical Abstract Abstract PDF: Objectives
With the recent global mpox outbreak, the JYNNEOS vaccine (Modified Vaccinia Ankara-Bavarian Nordic) was developed as a third-generation smallpox vaccine and initially favored for mpox immunization. Vaccine-associated side effects contribute to vaccine hesitancy. Consequently, tracking adverse events post-immunization is crucial for safety management. This study used data from the national active vaccine safety surveillance conducted in Korea from August 25 to November 24, 2022 to detect potential safety signals and adverse events. Methods: Data on health conditions following vaccination were gathered from web-based surveys and reported via active surveillance through the Immunization Registry Information System. This follow-up system functioned via a text message link, surveying adverse events and health conditions beginning on the second day post-vaccination. Information about specific adverse events, including both local and systemic reactions, was collected. Results: The study included 86 healthcare workers who had received at least 1 dose of the JYNNEOS vaccine. Among the respondents, 79.1% reported experiencing at least 1 adverse event, with the majority being local reactions at the injection site. The incidence of adverse events was higher following the first dose (67.9%) than after the second dose (34.4%). The most frequently reported adverse event for both doses was mild pain at the injection site. Conclusion: The study provides crucial information on the safety of the JYNNEOS vaccine, demonstrating that most adverse events were manageable and predominantly localized to the injection site. Nonetheless, additional research is needed on the safety of various vaccine administration techniques and the vaccine’s effects on broader demographics.

Original Articles

The risk associated with psychiatric disturbances in patients with diabetes in Indonesia (2018): a cross-sectional observational study: Siti Isfandari, Betty Roosihermiatie, Sulistyowati Tuminah, Laurentia Konadi Mihardja; Osong Public Health Res Perspect. 2023;14(5):368-378. Published online October 18, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0144

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Graphical Abstract Abstract PDF: Objectives
The global prevalence of psychiatric disturbances is rising, detrimentally affecting the quality of care and treatment outcomes for individuals, particularly those with diabetes.This study investigated the association of risk factors for psychiatric disturbances among productive-age patients with diabetes (ages 30−59 years), considering sociodemographic characteristics and co-existing diseases. The risk factors considered included sociodemographic factors (e.g., residence, age, sex, marital status, education, and occupation) and co-existing diseases (e.g., hypertension, heart disease, stroke, renal failure, rheumatism, asthma, and cancer). Methods: This cross-sectional study utilized data from the 2018 Indonesian National Health Survey (Riskesdas). The study population comprised respondents aged between 30 and 59 years who had diabetes and had completed the 20-question self-reporting questionnaire (SRQ-20). After the exclusion of incomplete SRQ-20 data, the sample included 8,917 respondents. Data were analyzed using logistic regression. Results: Approximately 18.29% of individuals with diabetes displayed symptoms indicative of psychiatric disturbances. After adjusting for sociodemographic factors such as age, sex, education level, occupation, marital status, and place of residence, patients with diabetes who had co-existing conditions such as hypertension, heart diseases, rheumatic disorders, asthma, or cancer had a higher risk for developing psychiatric disturbances than those with diabetes alone (adjusted odds ratio, 6.67; 95% confidence interval, 4.481−9.928; p<0.001). Conclusion: The elevated risk of psychiatric disturbances among patients with diabetes who had comorbidities underscores the importance of addressing mental health issues in the management of diabetes, especially in patients with concurrent disease conditions.

Drug resistance and the genotypic characteristics of rpoB and katG in rifampicin- and/or isoniazid-resistant Mycobacterium tuberculosis isolates in central Vietnam: Thi Binh Nguyen Nguyen, Thi Kieu Diem Nguyen, Van Hue Trương, Thi Tuyet Ngoc Tran, van Bao Thang Phan, Thi Tuyen Nguyen, Hoang Bach Nguyen, Viet Quynh Tram Ngo, Van Tuan Mai, Paola Molicotti; Osong Public Health Res Perspect. 2023;14(5):347-355. Published online October 18, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0124

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Graphical Abstract Abstract PDF: Objectives
Tuberculosis (TB) and drug-resistant TB (DR-TB) are national health burdens in Vietnam. In this study, we investigated the prevalence of rifampicin (RIF) and/or isoniazid (isonicotinic acid hydrazide, INH) resistance in patients with suspected TB, and applied appropriate techniques to help rapidly target DR-TB. Methods: In total, 1,547 clinical specimens were collected and cultured using the BACTEC MGIT system (Becton Dickinson and Co.). A resazurin microtiter assay (REMA) was used to determine the proportions of RIF and/or INH resistance. A real-time polymerase chain reaction panel with TaqMan probes was employed to identify the mutations of rpoB and katG associated with DR-TB in clinical isolates. Genotyping of the identified mutations was also performed. Results: A total of 468 Mycobacterium tuberculosis isolates were identified using the REMA. Of these isolates, 106 (22.6%) were found to be resistant to 1 or both antibiotics. Of the resistant isolates, 74 isolates (69.8%) were resistant to isoniazid (INH) only, while 1 isolate (0.94%) was resistant to RIF only. Notably, 31 isolates (29.24%) were resistant to both antibiotics. Of the 41 phenotypically INH-resistant isolates, 19 (46.3%) had the Ser315Thr mutation. There were 8 different rpoB mutations in 22 (68.8%) of the RIF-resistant isolates. The most frequently detected mutations were at codons 531 (37.5%), 526 (18.8%), and 516 (6.3%). Conclusion: To help prevent new cases of DR-TB in Vietnam, it is crucial to gain a comprehensive understanding of the genotypic DR-TB isolates.

Review Article

Strategies to combat Gram-negative bacterial resistance to conventional antibacterial drugs: a review: Priyanka Bhowmik, Barkha Modi, Parijat Roy, Antarika Chowdhury; Osong Public Health Res Perspect. 2023;14(5):333-346. Published online October 18, 2023; DOI: https://doi.org/10.24171/j.phrp.2022.0323

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Graphical Abstract Abstract PDF: The emergence of antimicrobial resistance raises the fear of untreatable diseases. Antimicrobial resistance is a multifaceted and dynamic phenomenon that is the cumulative result of different factors. While Gram-positive pathogens, such as methicillin-resistant Staphylococcus aureus and Clostridium difficile, were previously the most concerning issues in the field of public health, Gram-negative pathogens are now of prime importance. The World Health Organization’s priority list of pathogens mostly includes multidrug-resistant Gram-negative organisms particularly carbapenem-resistant Enterobacterales, carbapenem-resistant Pseudomonas aeruginosa, and extensively drug-resistant Acinetobacter baumannii. The spread of Gram-negative bacterial resistance is a global issue, involving a variety of mechanisms. Several strategies have been proposed to control resistant Gram-negative bacteria, such as the development of antimicrobial auxiliary agents and research into chemical compounds with new modes of action. Another emerging trend is the development of naturally derived antibacterial compounds that aim for targets novel areas, including engineered bacteriophages, probiotics, metal-based antibacterial agents, odilorhabdins, quorum sensing inhibitors, and microbiome-modifying agents. This review focuses on the current status of alternative treatment regimens against multidrug-resistant Gram-negative bacteria, aiming to provide a snapshot of the situation and some information on the broader context.

Short Communication

Perceptions of older adults and generativity among older citizens in Japan: a descriptive cross-sectional study: Yuho Shimizu, Tomoya Takahashi, Kenichiro Sato, Susumu Ogawa, Daisuke Cho, Yoshifumi Takahashi, Daichi Yamashiro, Yan Li, Keigo Hinakura, Ai Iizuka, Tomoki Furuya, Hiroyuki Suzuki; Osong Public Health Res Perspect. 2023;14(5):427-432. Published online October 10, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0063

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Graphical Abstract Abstract PDF: Objectives
As the population ages worldwide, including in Japan, there is a growing expectation for older adults to remain active participants in society. The act of sharing one’s experiences and knowledge with younger generations through social engagement not only enriches the lives of older individuals, but also holds significant value for our society. In this study, we examined both positive and negative perceptions of older adults and investigated the correlation between these perceptions and generativity among older citizens. Additionally, we evaluated the impact of life satisfaction on these factors. Methods: We conducted a survey of 100 older adults in Japan (mean age, 71.68 years) and utilized multiple regression analyses, using positive and negative perceptions of older adults, life satisfaction, and demographic factors as independent variables. The sub-categories of generativity—namely, generative action, concern, and accomplishment—were used as dependent variables. Results: Participants who held a more positive perception of older adults demonstrated a higher level of generative actions and concerns. Additionally, participants who reported higher levels of life satisfaction also exhibited more generative actions, concerns, and accomplishments. Conversely, those who held a more negative perception of older adults were found to have higher levels of generative actions. Conclusion: Enhancing positive perceptions of older adults among them can boost the sub-categories of generativity. This study, which was conducted from an exploratory perspective, has several limitations, including a potential sampling bias. A more comprehensive examination of the relationship between perceptions of older adults and generativity is anticipated in future research.

Original Articles

The associations of health behaviors and working hours with high-sensitivity C-reactive protein levels in Korean wage workers: a cross-sectional study: Choong-Won Seo, Eun-A Park, Tae-Hyung Yoon; Osong Public Health Res Perspect. 2023;14(5):356-367. Published online September 21, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0052

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Graphical Abstract Abstract PDF: Objectives
We investigated differences in high-sensitivity C-reactive protein (hs-CRP) levels by age group according to working hours, socioeconomic level, health behavior and status, and occupational class, and aimed to identify factors affecting hs-CRP levels in various age groups using data from the Korean National Health and Nutrition Examination from 2016 to 2018. Methods: The study included a total of 4,786 male wage workers across the nation, aged between 19 and 65. Data from 4,674 workers were analyzed using multiple logistic regression analysis. Results: Obesity, metabolic syndrome, and weekly working hours were associated with hs-CRP, a biomarker of inflammation. Participants with a body mass index (BMI) ≥25.0 kg/m2 showed significantly higher hs-CRP levels than those with a BMI 23.0 to 25.0 kg/m2. Workers with high-risk drinking and metabolic syndrome showed significantly higher hs-CRP levels in the 50 to 65 years group. Obesity, walking 0 to 149 min/wk, and working ≥61 hours a week were associated with significantly higher hs-CRP levels in the 35 to 49 years group. The factors that significantly affected hs-CRP levels were different among age groups. Conclusion: Plans to adjust working hours should be considered health behaviors, such as drinking and physical activity, and health conditions, such as metabolic syndrome and obesity, according to workers’ age.

Factors associated with the combination of general and abdominal obesity in middle-aged and older Korean women: a cross-sectional study: Jin Suk Ra; Osong Public Health Res Perspect. 2023;14(5):379-387. Published online September 20, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0089

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Graphical Abstract Abstract PDF: Objectives
To identify factors associated with general and abdominal obesity in middle-aged and older Korean women based on the biopsychosocial model. Methods: Data from 4,076 women aged ≥45 years who participated in the Korea National Health and Nutrition Examination Survey from 2015 to 2020 were analyzed. Complex sampling analysis was performed using IBM SPSS ver. 26.0. Results: The combination of general and abdominal obesity was positively associated with age ≥65 years, postmenopausal status, and without breastfeeding experience among biomedical factors; depressive symptoms and prolonged (≥8 hours a day) sedentary behavior among psychosocial factors; and an educational level lower than middle or high school graduation and the first and second income quantiles among biosocial factors. Conclusion: Healthcare providers in communities and public societies should screen for risk factors for the combination of general and abdominal obesity while considering non-modifiable biomedical (e.g., age) and biosocial factors (e.g., educational level). In addition, intervention strategies should be developed by considering modifiable psychosocial factors such as sedentary behavior.

Living arrangements and metabolic syndrome: a national cross-sectional study in the Republic of Korea: Junghyun Kim, Aeree Sohn; Received February 8, 2023 Accepted May 25, 2023 Published online September 20, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0036 [Epub ahead of print]

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Abstract PDF: Objectives
This study investigated the relationship between living arrangements and metabolic syndrome (MetS) risk in the adult population in the Republic of Korea. Methods: The samples were derived from the data collected during the second year of the seventh Korea National Health and Nutrition Examination Survey. The study targeted a total of 6,265 adults who were aged 20 years and above, and multiple logistic regression analysis was conducted. Living arrangements were classified into 4 categories: single-person households, 1-generation households, 2-generation households, and other family types. MetS was identified by the presence of at least 3 out of the 5 National Cholesterol Education Program Adult Treatment Panel III criteria. Results: For men, the odds ratio (ORs) for MetS in 1- and 2-generation households, compared to single-person households, were 0.92 (95% confidence interval [CI], 0.55–1.54) and 0.97 (95% CI, 0.58–1.62), respectively. The OR for other types of households was 0.96 (95% CI, 0.79–1.17). For women, the OR for MetS in 1- and 2-generation households, compared to single-person households, were 1.52 (95% CI, 1.15–2.01) and 1.29 (95% CI, 1.01–1.67), respectively. Conclusion: Our study suggests that a national strategy involving tailored interventions for women living in high-risk conditions is necessary to reduce the risk of MetS in Korean women.

Estimating the prevalence of oral manifestations in COVID-19 patients: a systematic review: Ankita Gupta, Kriti Shrivastav, Amit Agrawal, Abhishek Purohit, Roshan Chanchlani; Osong Public Health Res Perspect. 2023;14(5):388-417. Published online September 19, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0033

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Graphical Abstract Abstract PDF: Objectives
Patients with coronavirus disease 2019 (COVID-19) present with a variety of oral manifestations. Therefore, we conducted a systematic review to estimate the prevalence of oral lesions among COVID-19 patients. Methods: An extensive literature search of several electronic bibliographic databases (PubMed, Scopus, Science Direct, Litcovid) was conducted to retrieve all articles published in the English language from January 1, 2020 to March 31, 2023 that reported the prevalence of oral manifestations among COVID-19 patients. A meta-analysis of pooled prevalence was performed using Jamovi ver. 2.3 (2022). The I2 and Q statistics were used to assess heterogeneity between studies, and p-values <0.01 were considered statistically significant. Results: In total, 79 studies with data from 13,252 patients were included. The articles were predominantly published in 2020 (n=33), and Italy was the most common country (n=14). Most of the affected patients more than 50 years old and women (56.6%). The most common sites of involvement were the tongue (n=65), followed by the oral mucosa (n=37) and lips (n=19). High heterogeneity was found between studies. The most common oral manifestation was taste alteration, followed by xerostomia and ulceration, showing pooled prevalence rates of 48%, 35%, and 21%, respectively. Conclusion: COVID-19 patients show various oral manifestations that may help clinicians identify the disease promptly. Recognition of the signs and symptoms of COVID-19 is critical for an early diagnosis and better prognosis.

Short Communications

Trends of legionellosis reported in Jeju Province, Republic of Korea, 2015–2022: Juyoung Park, Jong-Myon Bae; Osong Public Health Res Perspect. 2023;14(4):321-327. Published online August 21, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0145

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Graphical Abstract Abstract PDF: Objectives
The number of reported cases of Legionnaires’ disease (LD) in the Republic of Korea surged nationally in 2016; however, in 2022, this number was higher in Jeju Province than the previous national peak. A descriptive epidemiological study was conducted to analyze trends in the incidence of reported LD cases in Jeju Island from 2015 to 2022.
Methods
The data for this study were obtained from case reports submitted to the Korea Disease Control and Prevention Agency through its Disease and Health Integrated Management System. The selection criteria were cases or suspected cases of LD reported among Jeju residents between 2015 and 2022. The 95% confidence interval of the crude incidence rate was calculated using the Poisson distribution.
Results
Since 2020, the incidence rate of LD in Jeju has risen sharply, showing a statistically significant difference from the national incidence rate. A particular medical institution in Jeju reported a significant number of LD cases. Screening with the urine antigen test (UAT) also increased significantly.
Conclusion
Our findings indicate that the rapid increase in cases of LD in Jeju Province since 2020 was due to the characteristics of medical-care use among Jeju residents, which were focused on a specific medical institution. According to their clinical practice guidelines, this medical institution conducted UATs to screen patients suspected of pneumonia.

Epidemiological characteristics of carbapenemase-producing Enterobacteriaceae outbreaks in the Republic of Korea between 2017 and 2022: Hyoseon Jeong, Junghee Hyun, Yeon-Kyeng Lee; Osong Public Health Res Perspect. 2023;14(4):312-320. Published online August 21, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0069

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Graphical Abstract Abstract PDF: Objectives
We aimed to describe the epidemiological characteristics of carbapenemase-producing Enterobacteriaceae (CPE) outbreaks in healthcare settings in the Republic of Korea between 2017 and 2022.
Methods
Under the national notifiable disease surveillance system, we obtained annual descriptive statistics regarding the isolated species, carbapenemase genotype, healthcare facility type, outbreak location and duration, and number of patients affected and recommended interventions. We used epidemiological investigation reports on CPE outbreaks reported to Korea Disease Control and Prevention Agency from June 2017 to September 2022.
Results
Among the 168 reports analyzed, Klebsiella pneumoniae (85.1%) was the most frequently reported species, while K. pneumoniae carbapenemase (KPC, 82.7%) was the most common carbapenemase genotype. Both categories increased from 2017 to 2022 (p<0.01). General hospitals had the highest proportion (54.8%), while tertiary general hospitals demonstrated a decreasing trend (p<0.01). The largest proportion of outbreaks occurred exclusively in intensive care units (ICUs, 44.0%), and the frequency of concurrent outbreaks in ICUs and general wards increased over time (p<0.01). The median outbreak duration rose from 43.5 days before the coronavirus disease 2019 (COVID-19) pandemic (2017–2019) to 79.5 days during the pandemic (2020–2022) (p=0.01), and the median number of patients associated with each outbreak increased from 5.0 to 6.0 (p=0.03). Frequently recommended interventions included employee education (38.1%), and 3 or more measures were proposed for 45.2% of outbreaks.
Conclusion
In the Republic of Korea, CPE outbreaks have been consistently dominated by K. pneumoniae and KPC. The size of these outbreaks increased during the COVID-19 pandemic. Our findings highlight the need for continuing efforts to control CPE outbreaks using a multimodal approach, while considering their epidemiology.

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