Osong Public Health and Research Perspectives

Short Communication

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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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.

Original Articles

Risk factors for COVID-19 outbreaks in livestock slaughtering and processing facilities in Republic of Korea: Seongju Choi, Tae Jong Son, Yeon-Kyung Lee; Osong Public Health Res Perspect. 2023;14(3):207-218. Published online June 8, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0035

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Graphical Abstract Abstract PDF: Objectives
The goal of this study was to help prevent and control the spread of coronavirus disease 2019 (COVID-19) by identifying transmission routes and risk factors in livestock slaughtering and processing facilities (SPFs) and establishing an optimal intervention strategy for outbreaks.
Methods
This case series study was a demographic analysis of patients with confirmed COVID-19 associated with 5 SPFs in Korea between January and June 2021. Additionally, in a retrospective cohort study, the association between COVID-19 infection and risk factors was analyzed for SPFs at which outbreaks occurred.
Results
The COVID-19 attack rates were 11.2%, 24.5%, and 6.8% at 3 poultry SPFs (PSPFs) and 15.5% and 25.2% at 2 mammal SPFs (MSPFs). Regarding spatial risk factors, the COVID-19 risk levels were 12.1-, 5.2-, and 5.0-fold higher in the refrigeration/ freezing, by-product processing, and carcass cutting areas, respectively, than in the office area. The risk of COVID-19 infection was 2.1 times higher among employees of subcontractors than among employees of contractors. The COVID-19 risk levels were 5.3- and 3.0-fold higher in foreign workers than in native Korean workers in the PSPFs and MSPFs, respectively.
Conclusion
As the COVID-19 pandemic continues, a detailed policy for infectious disease prevention and control intervention is needed, without interrupting economic activities. Thus, we propose an ideal intervention plan to prevent COVID-19 through disinfection and preemptive testing and to block its transmission through effective contact management during outbreaks at SPFs.

COVID-19 outbreak in a religious village community in Republic of Korea and risk factors for transmission: Jiae Shim, Eunju Lee, Eunyoung Kim, Yeonhwa Choi, Giseok Kang, Bryan Inho Kim; Osong Public Health Res Perspect. 2023;14(2):110-118. Published online April 5, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0002

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Graphical Abstract Abstract PDF: Objectives
This study aimed to assess the scale and transmission patterns of coronavirus disease 2019 (COVID-19) in a religious village community in South Korea, to determine the risk factors of transmission, and to evaluate vaccine effectiveness.
Methods
An epidemiological survey was conducted, and data were collected and analyzed from 602 villagers in the religious village community. Multivariate logistic regression analysis was used to identify the risk factors for COVID-19 transmission and to evaluate vaccine effectiveness.
Results
The outbreak attack rate was 72.1% (434/602). The attack rate was high among women in their 60s, the unemployed, residents living near religious facility (<500 m), and the unvaccinated. Age, the distance between religious facility and residences, and the absence of vaccination were identified as risk factors for transmission. Vaccine effectiveness was 49.0%, and the highest effectiveness was seen in the age group of 59 years or younger (65.8%).
Conclusion
This village community was isolated, with little communication with the outside world. However, the frequency of close contact between residents was relatively high, contributing to the spread of COVID-19 in the village even with relatively short exposure. Vaccination rates in the village community were also lower than those in the general public. Public health authorities should consider the potential impact of cultural factors, including religion, that could lead to the exponential spread of COVID-19 in closed village communities.

The first reported hepatitis E outbreak in a food manufacturing factory: Korea, 2022: Hansol Yeom, Soonryu Seo, Youngsil Yoon, Jaeeun Lee, Myung-Guk Han, Deog-Yong Lee, Sun-Whan Park, Song A Park, Sook-Hyang Jeong, Jin Gwack; Osong Public Health Res Perspect. 2023;14(1):15-22. Published online February 22, 2023; DOI: https://doi.org/10.24171/j.phrp.2022.0305

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Graphical Abstract Abstract PDF: Objectives
On February 16, 2022, 12 cases of hepatitis E virus (HEV) infection were reported in a food manufacturing factory in Korea. The aim of this study was to identify additional cases and to determine the source of this HEV outbreak. Methods: This study was an in-depth investigation of 12 HEV immunoglobulin M (IgM)-positive cases and their demographic, clinical, and epidemiological characteristics. On-site specimens were collected from the environment and from humans, and a follow-up investigation was conducted 2 to 3 months after the outbreak. Results: Among 80 production workers in the factory, 12 (15.0%) had acute HEV infection, all of whom were asymptomatic. The follow-up investigation showed that 3 cases were HEV IgMpositive, while 6 were HEV IgG-positive. HEV genes were not detected in the HEV IgM-positive specimens. HEV genes were not detected in the food products or environmental specimens collected on-site. HEV was presumed to be the causative pathogen. However, it could not be confirmed that the source of infection was common consumption inside the factory. Conclusion: This was the first domestic case of an HEV infection outbreak in a food manufacturing factory in Korea. Our results provide information for the future control of outbreaks and for the preparation of measures to prevent domestic outbreaks of HEV infection.

COVID-19 outbreak response at a nursing hospital in South Korea in the post-vaccination era, including an estimation of the effectiveness of the first shot of the Oxford-AstraZeneca COVID-19 vaccine (ChAdOx1-S): Chanhee Kim, Geon Kang, Sun Gu Kang, Heeyoung Lee; Osong Public Health Res Perspect. 2022;13(2):114-122. Published online April 26, 2022; DOI: https://doi.org/10.24171/j.phrp.2021.0262

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Abstract PDF

Objectives
We descriptively reviewed a coronavirus disease 2019 (COVID-19) outbreak at a nursing hospital in Gyeonggi Province (South Korea) and assessed the effectiveness of the first dose of the Oxford-AstraZeneca vaccine in a real-world population. Methods: The general process of the epidemiological investigation included a public health intervention. The relative risk (RR) of vaccinated and unvaccinated groups was calculated and compared to confirm the risk of severe acute respiratory syndrome coronavirus-2 (SARSCoV-2) infection, and vaccine effectiveness was evaluated based on the calculated RR. Results: The population at risk was confined to ward E among 8 wards of Hospital X, where the outbreak occurred. This population comprised 55 people, including 39 patients, 12 nurses, and 4 caregivers, and 19 cases were identified. The RR between the vaccinated and unvaccinated groups was 0.04, resulting in a vaccine effectiveness of 95.3%. The vaccination rate of the nonpatients in ward E was the lowest in the entire hospital, whereas the overall vaccination rate of the combined patient and non-patient groups in ward E was the third lowest. Conclusion: The first dose of the Oxford-AstraZeneca vaccine (ChAdOx1-S) was effective in preventing SARS-CoV-2 infection. To prevent COVID-19 outbreaks in medical facilities, it is important to prioritize the vaccination of healthcare providers.

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COVID-19 Vaccination in Korea: Past, Present, and the Way Forward
Eliel Nham, Joon Young Song, Ji Yun Noh, Hee Jin Cheong, Woo Joo Kim
Journal of Korean Medical Science.2022;[Epub] CrossRef

Short Communication

COVID-19 outbreak and risk factors for infection in a taekwondo gym in the Republic of Korea: Seung Hwan Shin, Eonjoo Park, Sookhyun Kim, Minji Jang, Subin Park, Dong-Hwi Kim, Tae Jong Son, Ji-Hyuk Park; Osong Public Health Res Perspect. 2022;13(2):162-170. Published online March 31, 2022; DOI: https://doi.org/10.24171/j.phrp.2021.0295

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Abstract PDF

Objectives
Relatively few studies have assessed risk factors for coronavirus disease 2019 (COVID-19) in public facilities used by children and adolescents. This study presents an analysis of a COVID-19 outbreak that occurred in a taekwondo gym in Korea, predominantly among children and adolescents, with the aim of providing insights on managing COVID-19 outbreaks in similar facilities. Methods: All 108 taekwondo gym students and staff received COVID-19 tests. A survey and closed-circuit television analyses were used to identify risk factors. A univariate analysis was conducted, followed by multivariate logistic regression analysis with backward elimination for variables with a significance level <0.10 in the univariate analysis. Results: COVID-19 was confirmed in 30 of 108 subjects at the taekwondo gym (attack rate, 27.8%). The outbreak started in an adult class student. This student transmitted the virus to the staff, who consequently transmitted the virus to adolescent students. In the univariate analysis, the relative risk for younger age (≤9 years) was 2.14 (95% confidence interval [CI], 1.01–4.54; p=0.054), and that for food consumption inside the gym was 2.12 (95% CI, 1.04–4.30; p=0.048). In the multivariate logistic regression analysis, the odds ratio for younger age was 2.96 (95% CI, 1.07–8.20; p=0.036), and that for food consumption inside the gym was 3.00 (95% CI, 1.10–8.17; p=0.032). Conclusion: Food consumption inside the facility and young age were significant risk factors for COVID-19 transmission in this taekwondo gym. Food consumption should be prohibited in sports facilities, and infection prevention education for young students is also required.

Citations

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SARS-CoV-2 transmission modes: Why and how contamination occurs around shared meals and drinks?
Aure Saulnier, Jean-Michel Wendling, Benoit Hermant, Didier Lepelletier
Food Microbiology.2023; 114: 104297. CrossRef
Risk factors for COVID-19 outbreaks in livestock slaughtering and processing facilities in Republic of Korea
Seongju Choi, Tae Jong Son, Yeon-Kyung Lee
Osong Public Health and Research Perspectives.2023; 14(3): 207. CrossRef
The First outbreak of coronavirus disease (COVID-19) at outdoor camping site in South Korea, 2020
Na-Young Kim, Seonhee Ahn, GwangJin Kim, Donghyok Kwon, Young-Joon Park, Sang-Eun Lee
Journal of Epidemiology.2023;[Epub] CrossRef

Original Articles

Delays in the diagnosis and treatment of tuberculosis during the COVID-19 outbreak in the Republic of Korea in 2020: Jiyeon Yang, Yunhyung Kwon, Jaetae Kim, Yoojin Jang, Jiyeon Han, Daae Kim, Hyeran Jeong, Hyekyung Park, Eunhye Shim; Osong Public Health Res Perspect. 2021;12(5):293-303. Published online September 23, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0063

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Graphical Abstract Abstract PDF

Objectives
We investigated the impact of the coronavirus disease 2019 (COVID-19) pandemic on tuberculosis (TB) management in the Republic of Korea (ROK).
Methods
This retrospective cross-sectional study used nationwide ROK TB notification data (98,346 cases) from 2017 to 2020. The median time from the onset of TB symptoms to treatment initiation and the compliance rates with the required timing for notification and individual case investigations were measured and compared across periods and regions affected by the COVID-19 epidemic.
Results
TB diagnosis during the COVID-19 pandemic was delayed. The median time to TB treatment initiation (25 days) in 2020 increased by 3 days compared to that of the previous 3 years (22 days) (p<0.0001). In the outbreak in Seoul, Incheon, and Gyeonggi province during August, the time to TB diagnosis was 4 days longer than in the previous 3 years (p=0.0303). In the outbreak in Daegu and Gyeongbuk province from February to March 2020, the compliance rate with the required timing for individual case investigations was 2.2%p points lower than in other areas in 2020 (p=0.0148). For public health centers, the rate was 13%p lower than in other areas (80.3% vs. 93.3%, p=0.0003).
Conclusion
TB diagnoses during the COVID-19 pandemic in the ROK were delayed nationwide, especially for patients notified by public-private mix TB control hospitals. TB individual case investigations were delayed in regional COVID-19 outbreak areas (Daegu and Gyeongbuk province), especially in public health centers. Developing strategies to address this issue will be helpful for sustainable TB management during future outbreaks.

Citations

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Tuberculosis: Republic of Korea, 2021
Jinsoo Min, Hyung Woo Kim, Ju Sang Kim
Tuberculosis and Respiratory Diseases.2023; 86(1): 67. CrossRef
Prevalence and associated factors of diabetes mellitus among patients with tuberculosis in South Korea from 2011 to 2018: a nationwide cohort study
Dawoon Jeong, Jeongha Mok, Doosoo Jeon, Hee-Yeon Kang, Hee Jin Kim, Hee-Sun Kim, Jeong Mi Seo, Hongjo Choi, Young Ae Kang
BMJ Open.2023; 13(3): e069642. CrossRef
Increased Healthcare Delays in Tuberculosis Patients During the First Wave of COVID-19 Pandemic in Korea: A Nationwide Cross-Sectional Study
Jinsoo Min, Yousang Ko, Hyung Woo Kim, Hyeon-Kyoung Koo, Jee Youn Oh, Yun-Jeong Jeong, Hyeon Hui Kang, Kwang Joo Park, Yong Il Hwang, Jin Woo Kim, Joong Hyun Ahn, Yangjin Jegal, Ji Young Kang, Sung-Soon Lee, Jae Seuk Park, Ju Sang Kim
Journal of Korean Medical Science.2022;[Epub] CrossRef
Time trend prediction and spatial–temporal analysis of multidrug-resistant tuberculosis in Guizhou Province, China, during 2014–2020
Wang Yun, Chen Huijuan, Liao Long, Lu Xiaolong, Zhang Aihua
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Real-world association of adherence with outcomes and economic burden in patients with tuberculosis from South Korea claims data
Sun-Hong Kwon, Jin Hyun Nam, Hye-Lin Kim, Hae-Young Park, Jin-Won Kwon
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The Impact of the COVID-19 Pandemic on Tuberculosis Case Notification and Treatment Outcomes in Eswatini
Hloniphile Victory Masina, I-Feng Lin, Li-Yin Chien
International Journal of Public Health.2022;[Epub] CrossRef
Trends in incidences of newly notified tuberculosis in Jeju Province, Korea, 2017-2021
Jinhee Kim, Nam-Hun Kang, Jong-Myon Bae
Journal of Medicine and Life Science.2022; 19(3): 103. CrossRef

Trends in recent waterborne and foodborne disease outbreaks in South Korea, 2015–2019: Sang Hyuk Lee, Jae-Won Yun, Ji Hee Lee, Yeon Haw Jung, Dong Han Lee; Osong Public Health Res Perspect. 2021;12(2):73-79. Published online April 29, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.12.2.04

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Abstract PDF

Objectives
This study analyzed trends in foodborne and waterborne diseases in South Korea between 2015 and 2019.
Methods
The data consisted of information on outbreaks of waterborne and foodborne infectious diseases reported through the Korea Centers for Disease Control and Prevention (KCDC) system. We analyzed the trends and epidemiological aspects of outbreaks by month, place of occurrence, and causative pathogens in this observational study.
Results
The number of outbreaks has steadily increased over the last 5 years, but the number of cases per outbreak has followed a decreasing trend. Incidence at daycare centers and preschools has been steadily increasing over consecutive years.
Conclusion
The steady number of patients and decreasing number of cases per outbreak, even as the number of outbreaks has been increasing, suggest that the KCDC’s professional management system is operating effectively. It is necessary to continue improving the objectivity and efficiency of the management system and to carefully examine the increasing number of outbreaks in smaller-scale group catering facilities, such as daycare centers and preschools. Outbreaks can be prevented by closely examining those caused by unidentified pathogens and group outbreaks caused by other diseases, identifying problems, and supplementing the management system.

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Yuhua Yan, Tao Yang, Zisheng Luo, Dong Li, Li Li, Xingyu Lin
Food Chemistry.2023; 408: 135226. CrossRef
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다슬 김, 인호 김, 형준 김, 지애 심, 지수 원, 진 곽
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Namwoo Heo, Jihee Lee, Yeonkyung Kim, Donghan Lee, Seok-Jae Heo, Yoon Soo Park, Jae-Won Yun, Yong Chan Kim
Journal of Korean Medical Science.2023;[Epub] CrossRef
Novel next generation sequencing panel method for the multiple detection and identification of foodborne pathogens in agricultural wastewater
Dong-Geun Park, Joon-Gi Kwon, Eun-Su Ha, Byungcheol Kang, Iseul Choi, Jeong-Eun Kwak, Jinho Choi, Woojung Lee, Seung Hwan Kim, Soon Han Kim, Jeongwoong Park, Ju-Hoon Lee
Frontiers in Microbiology.2023;[Epub] CrossRef
Survival of murine norovirus and hepatitis A virus in bottled drinking water, strawberries, and oysters
Ziwei Zhao, Md Iqbal Hossain, Soontag Jung, Zhaoqi Wang, Daseul Yeo, Mengxiao Song, Ae Min, Sunho Park, Changsun Choi
Food Control.2022; 133: 108623. CrossRef
Trends in gastrointestinal infections before and during non-pharmaceutical interventions in Korea in comparison with the United States
Soyeoun Kim, Jinhyun Kim, Bo Youl Choi, Boyoung Park
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Md-Mafizur Rahman, Sang-Jin Lim, Yung-Chul Park
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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.

Brief Report

Enhancing ‘Whole-of-Government’ Response to Biological Events in Korea: Able Response 2014: Sangwoo Tak, Anton Jareb, Suon Choi, Marvin Sikes, Yeon Hwa Choi, Hyeong-wook Boo; Osong Public Health Res Perspect. 2018;9(1):32-35. Published online December 31, 2017; DOI: https://doi.org/10.24171/j.phrp.2018.9.1.06

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3 Citations

Abstract PDF

Since 2011, the Republic of Korea (ROK) and United States (U.S.) have been collaborating to conduct inter- and intra-governmental exercises to jointly respond to biological events in Korea. These exercises highlight U.S. interest in increasing its global biosurveillance capability and the ROK’s interest in improving cooperation among ministries to respond to crises. With Able Response (AR) exercises, the ROK and U.S. have improved coordination among US and ROK government and defense agencies responding to potential bio-threats and identified additional areas on which to apply refinements in policies and practices. In 2014, the AR exercise employed a Biosurveillance Portal (BSP) to facilitate more effective communication among participating agencies and countries including Australia. In the present paper, we seek to provide a comprehensive assessment of the AR 2014 (AR14) exercise and make recommendations for future improvements. Incorporating a more realistic response in future scenarios by integrating a tactical response episode in the exercise is recommended.

Citations

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Artificial intelligence in public health: the potential of epidemic early warning systems
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Original Article

Emerging Pathogens and Vehicles of Food- and Water-borne Disease Outbreaks in Korea, 2007–2012: Shinje Moon, Il-Woong Sohn, Yeongseon Hong, Hyungmin Lee, Ji-Hyuk Park, Geun-Yong Kwon, Sangwon Lee, Seung-Ki Youn; Osong Public Health Res Perspect. 2014;5(1):34-39. Published online February 28, 2014; DOI: https://doi.org/10.1016/j.phrp.2013.12.004

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16 Citations

Abstract PDF

Objectives
Food- and water-borne disease outbreaks (FBDOs) are an important public health problem worldwide. This study investigated the trends in FBDOs in Korea and established emerging causal pathogens and causal vehicles.
Methods
We analyzed FBDOs in Korea by year, location, causal pathogens, and causal vehicles from 2007 to 2012. Information was collected from the FBDOs database in the Korean Centers for Disease Control and Prevention.
Results
During 2007–2012, a total of 1794 FBDOs and 48,897 patients were reported. After 2007, FBDOs and patient numbers steadily decreased over the next 2 years and then plateaued until 2011. However, in 2012, FBDOs increased slightly accompanied by a large increase in the number of affected patients. Our results highlight the emergence of norovirus and pathogenic Escherichia coli other than enterohemorrhagic E. coli (EHEC) in schools in 2012. We found that pickled vegetables is an emerging causal vehicle responsible for this problem.
Conclusion
On the basis of this study we recommend intensified inspections of pickled vegetable manufacturers and the strengthening of laboratory surveillance of relevant pathogens.

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Invited Original Article

Incubation Period of Ebola Hemorrhagic Virus Subtype Zaire: Martin Eichner, Scott F. Dowell, Nina Firese; Osong Public Health Res Perspect. 2011;2(1):3-7. Published online June 30, 2011; DOI: https://doi.org/10.1016/j.phrp.2011.04.001

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44 Citations

Abstract PDF

Objectives
Ebola hemorrhagic fever has killed over 1300 people, mostly in equatorial Africa. There is still uncertainty about the natural reservoir of the virus and about some of the factors involved in disease transmission. Until now, a maximum incubation period of 21 days has been assumed.
Methods
We analyzed data collected during the Ebola outbreak (subtype Zaire) in Kikwit, Democratic Republic of the Congo, in 1995 using maximum likelihood inference and assuming a log-normally distributed incubation period.
Results
The mean incubation period was estimated to be 12.7 days (standard deviation 4.31 days), indicating that about 4.1% of patients may have incubation periods longer than 21 days.
Conclusion
If the risk of new cases is to be reduced to 1% then 25 days should be used when investigating the source of an outbreak, when determining the duration of surveillance for contacts, and when declaring the end of an outbreak.

Citations

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