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HOME > Osong Public Health Res Perspect > Volume 5(Suppl); 2014 > Article
Brief Report
Activities of the Korean Institute of Tuberculosis
Sungweon Ryoo, Hee Jin Kim*
Osong Public Health and Research Perspectives 2014;5(Suppl):S43-S49.
DOI: https://doi.org/10.1016/j.phrp.2014.10.007
Published online: November 3, 2014
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The Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Korea

∗Corresponding author. hachingbird@gmail.com
• Received: October 13, 2014   • Revised: October 27, 2014   • Accepted: October 27, 2014

© 2014 Published by Elsevier B.V. on behalf of Korea Centers for Disease Control and Prevention.

This is an Open Access article distributed under the terms of the CC-BY-NC License (http://creativecommons.org/licenses/by-nc/3.0).

  • The Korean National Tuberculosis Association (KNTA) set up the Korean Institute of Tuberculosis (KIT) in 1970 to foster research and technical activities pertaining to tuberculosis (TB). The KNTA/KIT had successfully conducted a countrywide TB prevalence survey from 1965 to 1995 at 5-year intervals. The survey results (decline in TB rates) established Korea as a country that had successfully implemented national control programs for TB. The KIT developed the Korea Tuberculosis Surveillance System and the Laboratory Management Information System, both of which were transferred to the Korea Centers for Disease Control and Prevention after its establishment. The KIT functions as a central and supranational reference TB laboratory for microbiological and epidemiological research and provides training and education for health-care workers and medical practitioners. Recently, the KIT has expanded its activities to countries such as Ethiopia, Laos, and Timor-Leste to support TB control and prevention. The KIT will continue to support research activities and provide technical assistance in diagnosing the infection until it is completely eliminated in Korea.
The Korean National Tuberculosis Association (KNTA) was established on November 6, 1953, to fight against tuberculosis (TB), which was the most serious public health problem during and after the Korean War. The KNTA was formed by the integration of pre-existing organizations such as the Chosun Anti-Tuberculosis Association, Anti-Tuberculosis Association, Missionary Doctor Committee, and Committee for Tuberculosis Prevention (Ministry of Health). At present, the KNTA has 12 branches and four specialized TB clinics known as the Double Cross Clinic.
The KNTA joined The International Union Against Tuberculosis and Lung Disease in 1954, and from then onward, it started developing into an international organization.
Since then, the KNTA has successfully conducted seven countrywide TB prevalence surveys from 1965 to 1995 at 5-year intervals and carried out campaigns and active TB case-finding activities, while also providing laboratory services to the national TB control program (NTP) to improve treatment for TB patients and supporting TB-related studies for improving the services of the NTP.
The KNTA decided to set up the Korean Institute of Tuberculosis (KIT) in 1970 to foster TB-related research and technical activities. The KIT included a bacteriology department (formerly known as the Central TB Laboratory Department), a training department for TB health-care workers, and an epidemiology department (formerly known as the Medical Department). Since its inception, the KIT has improved consistently and is now a leading institute for TB research in Korea that provides a scientific basis for TB control.
2.1 Domestic achievements
Under the NTP, the KIT has provided laboratory diagnostic services as well as training and education for health-care workers. In addition, it played an active role in policy development for TB control and eradication before the establishment of the Korea Centers for Disease Control and Prevention (KCDC). The KIT also conducts microbiological, epidemiological, and operational research.
Laboratory diagnosis is essential for the confirmation and treatment of TB. The KIT carried out 2831 microbiological examinations in 1962 and this number increased to 363,089 in 2012, including 9040 cases of drug-susceptibility testing (DST) and 163,121 culture examinations (Table 1) [1]. The KIT has provided laboratory technical support and reagents for microscopic examinations to public health centers in Korea. In addition, the KIT also provides laboratory services to the private sector. The KIT performed 108,706 microbiological examinations for the private sector, including 17,826 cases of DST. The KIT conducted almost two thirds of DST in 2013.
To provide technical support to the NTP, staff at the KIT performed supervisory visiting to public health centers until 2007. The KIT developed and constructed the Korea Tuberculosis Surveillance System and the Tuberculosis Laboratory Management Information System, which were transferred to the KCDC following its establishment. In addition, the KIT operates web-PACS, a web-based healthcare service developed by the KIT that supports radiological diagnosis of TB in public health centers. The number of public health centers that participated in the web-PACS was 202 in 2013 and 176,201 radiographic images were read by central and regional reading centers.
The number of research articles published reflects the research activities carried out and scientific achievement. So far, the KIT has published 163 articles in 48 Science Citation Index journals.
2.2 International part
Since 1979, the KIT has been organizing international TB training courses sponsored by the World Health Organization (WHO), the Korea International Cooperation Agency (KOICA), and other organizations. In 1984, the KIT joined as a member of the Tuberculosis Surveillance and Research Unit, which was founded by the WHO and the International Union Against Tuberculosis, and hosted two annual meetings in Korea. A total of 728 health workers, mainly medical doctors, participated in the 73 training courses conducted until 2013 [1].
In 1995, the KIT was designated as a WHO collaborating center and joined with the Supranational Reference Laboratory Network in 1994. The KIT also played a vital role in overseeing quality assurance activities for TB laboratory services and technical support to countries such as Vietnam, China, and the Philippines.
Since 2010, the KIT has expanded its activity globally under the official development assistance (ODA) projects for directly and indirectly supporting TB control and elimination in countries such as Ethiopia, Timor-Leste, Laos, and the Philippines.
3.1 Laboratory service
The Department of Laboratory Medicine provides microbiological laboratory services for the NTP and quality assurance as the TB reference laboratory in Korea (Table 1).
The KIT and various branches of the KNTA conduct microbiological examinations such as smears, cultures, strain identification, DST for Mycobacterium tuberculosis, and nontuberculous mycobacteria detection. In addition, for the rapid diagnosis and identification of drug resistance among the various strains of Mycobacterium, the KIT carries out molecular testing methods such as real-time polymerase chain reaction and Xpert MTB/RIF assay (Xpert assay; Cepheid, Sunnyvale, CA). The KIT also produces media for culture, strain differentiation, and DST, and provides the materials to public and private laboratories.
3.2 Research and development
The Department of Research and Development (Taiwan) actively studies molecular epidemiology, maintains data on various Mycobacterium species, develops new diagnostic tools for early detection of TB, and carries out other academic studies related to TB.
  • Molecular epidemiology: Molecular epidemiological studies for TB started out as a laboratory research project in the late 1990s. A database of the various epidemiological study results was established in 2005. The initial purpose of the study was to verify the transmission link among TB patients in schools by DNA typing of the strains. Nowadays, these molecular epidemiological technologies have become an essential part of the investigation on TB outbreaks in Korea. The molecular epidemiology studies helped in identifying the transmission link during a TB outbreak and improved the procedures for the treatment of latent TB infection (LTBI).

The Department of Research and Development has also built a database for M. tuberculosis strains using IS6110-based restriction fragment-length polymorphism typing of clinical isolates, which is a gold standard method for strain typing. In addition, the department recently established a database for variable number tandem repeat typing of M. tuberculosis strains. The department gives an effort to other countries such as China, Japan, Philippines, Vietnam and Mongolia for establishing a molecular technology like RFLP and VNTR typing. It is expected that the molecular epidemiology research will play a vital role in various aspects of TB control in the future.
  • Korea Mycobacterium Resource Center: Biospecimens are fundamental for microbiological research. The Korea Mycobacterium Resource Center (KMRC) has collected TB biological specimens from public health centers (M. tuberculosis and various nontuberculous mycobacterial strains), during TB outbreaks, from TB patients born outside South Korea, including North Korea defectors, and from various research groups. At present, the center contains more than 20,000 mycobacterial strains, including drug-resistant and nontuberculous mycobacteria (Table 2) [2]. In 2007, the KMRC officially opened a Mycobacterium strain bank, and in the same year, it signed a memorandum of understanding with the Korean Collection of Type Culture in the Korea Research Institute of Bioscience and Biotechnology. The KMRC was designated as a national cooperation bank with the National Culture Collection for Pathogens in the KCDC in 2009 and it adopted the ISO 9001 quality management standard to acquire reliability as a biological resource bank. The KMRC has distributed TB resources to many research groups.

  • Exploring useful antigens for the immunological diagnostics of LTBI: Identifying new antigens for the early diagnosis of LTBI has recently been explored to accelerate TB prevention and control. Until now, tuberculin skin testing (TST) and interferon gamma-releasing assay have been used for the diagnosis of LTBI. The Department of Research and Development has dedicated its efforts to identify new antigens that can be useful for the early diagnosis of LTBI or biomarkers to predict TB progression.

  • Projects supported by external funds: The KIT also coworks with other academic institutions that are supported by external funds. The projects currently handled by the KIT are as follows: Study on M. tuberculosis catalase and peroxidase activities and isoniazid resistance, Culturing TB bacteria in microfluidic system and verification of possibility in applying DST. In addition, KIT performs screening of new anti-TB drugs by in vitro assessment and also identifies and evaluates useful biomarkers for the diagnosis of LTBI. The Engineering College of Seoul National University has partnered with the KIT for the development of the microfluid system. This system can reduce the period of culture and provide DST results within a few days.

3.3 Domestic cooperation
The KIT has provided technical support and updated training programs for health-care workers. In addition, it provides training programs for newly appointed army doctors and medical officers in public health centers (Table 3) [1]. In Korea, doctors in private and public health centers are recommended to attend these training courses, because such courses help them stay up-to-date on the guidelines for the management, control, and prevention of TB. The KIT has also partnered with educational institutions through the public–private mix collaboration program. This project aims to provide specialized training on TB care and control for nurses from general hospitals. The KIT provides training on TST for nurses participating in epidemiological investigations, because TST is still an important method for contact or outbreak investigations.
3.4 Epidemiological investigations
To fight against a public health problem such as TB, it is essential to understand the size of the problem. In this regard, the KIT has conducted various activities and surveys to evaluate the epidemiological status of TB such as prevalence, incidence, and infection rates. The last countrywide prevalence survey was carried out in 1995. Since then, the KIT has analyzed the prevalence rate through the Korean National Health and Nutritional Examination survey, which revealed an age-adjusted prevalence rate of 208/105 (age ≥ 15 years) in 2010 [3]. The prevalence rate was 173/105 in 2006 and 98/105 in 2011 based on the analysis of national health screening data [4]. The incidence rate was 117/105 in 2006–2008 and 110/105 in 2008–2010 [5]. Tuberculin surveys were carried out to estimate the prevalence of TB infections and the annual risk of tuberculosis infections in school children and new entrants into military service, who are considered to be vulnerable groups [6,7]. Operational epidemiological studies were also carried out to improve the NTP [8]. A pilot study for the implementation of modified directly-observed treatment projects was also carried out (2012–2013). Drug taking was monitored either directly by health-care workers or indirectly by smart phone or digital pillbox. A total of 546 patients were enrolled for the study from 29 public health centers and 11 private clinics, including a clinic for the homeless [2].
3.5 International cooperation
The international cooperation division is responsible for international fellowship training, technical assistance, and ODA.
  • International fellowship training: The division has facilitated invitational fellowship training since 1971 in coordination with the WHO. In addition, the division coordinates with various organizations such as the KOICA, the Korea Foundation for International Healthcare, and the Ministry of Health and Welfare in developing countries in providing training as required. Training is provided on improving knowledge about NTP, microbiological examinations (e.g., smear, culture, and DST), and quality assurance. Participants of the KIT cipants of insurance. nations al Heawere health-care workers (doctors, nurses, laboratory technician, radiologists, etc.) come from high TB-burden countries such as Ethiopia, the Philippines, Timor-Leste, Myanmar, Laos, Cambodia, Vietnam.

  • Technical assistance: Technical assistance was provided to the Philippines and Laos for both the programmatical and technical development of TB laboratory services. In addition, external quality assurance for DST was provided to some countries in accordance with the TB Supranational Reference Laboratory Network's terms of reference.

  • ODA: Since the Republic of Korea joined the Organization for Economic Cooperation and Development, Development Assistance Committee in 2009, the budget for official development is continuously increasing to fulfill the demands from the international society. The experience with successful NTP activities is shared with the high TB-burden countries through agreements with organizations such as the KOICA. The KIT expects to meet the Millennium Development Goals through the various ODA projects.

At present, two ODA projects have been implemented by the KIT: Project for TB Prevention and Control in Ethiopia and Project for Capacity Building on TB Control in Timor-Leste.
The KIT and the KNTA have significantly contributed to the decrease in TB cases in Korea though various activities such as campaigns, systematically supporting the laboratory system, the development of guidelines, active screening of TB with mobile X-ray machines, research, training, and education. However, at present, the environment surrounding the KIT/KNTA is changing. The burden of TB is continuously decreasing due to economic development and various activities undertaken by the NTP. With the development of a health insurance system, many people prefer to visit private health centers than public health centers. In addition, the establishment of the KCDC has changed the role played by the KIT to a great extent. Previous the roles of the KIT such as policy development, operation and management of the surveillance system, epidemiological investigation, and training programs are now handled by the KCDC. Expanding TB control/maintenance activities to other countries that require international assistance, providing assistance to decrease TB burden in North Korea, and strengthening multi-institutional research activities are areas that require further improvements.
As a specialized and unique TB research institution in Korea, the KIT will continue to provide technical support to the NTP and be a linchpin that supports other academic institutions for research until complete elimination of TB in Korea. In addition, the KIT has strong plans to further expand its role globally and to eliminate TB in North Korea. These mottos will help to realize the vision of the KIT—Leading institute in the world to stop TB.
All contributing authors declare no conflicts of interest.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Table 1
Accomplishments of laboratory examinations for public health centers (1962–2013).
Year No. of examination cases Direct smear microscopy Culture
DST
Strain identification
Quality control for smear examination NAAT DNA Finger printing
Solid media Liquid media Conventional Molecular Conventional Molecular
1962 2,831 1,462 1,369
1963 16,157 5,437 4,664 1,233 4,823
1964 18,973 6,886 6,885 1,744 3,458
1965 74,146 34,757 30,112 7,079 2,198
1966 177,120 74,386 71,204 15,114 16,416
1967 171,898 81,926 76,091 3,448 10,433
1968 218,631 102,257 93,428 2,339 8,296 12,311
1969 235,464 106,437 101,212 4,490 11,168 12,157
1970 236,674 112,828 92,152 2,598 13,915 15,181
1971 325,301 130,146 117,386 3,192 8,110 66,467
1972 200,624 70,294 65,353 2,075 6,512 56,390
1973 280,733 114,322 109,364 4,330 1,793 50,924
1974 258,419 103,111 98,347 1,133 2,343 53,485
1975 268,019 117,478 104,491 1,281 2,461 42,308
1976 287,999 133,835 113,528 3,074 3,771 33,791
1977 325,713 153,335 134,445 9,876 3,631 24,426
1978 309,805 141,816 129,998 12,097 1,036 24,858
1979 314,312 143,229 132,126 10,304 5,230 23,423
1980 317,886 148,400 136,383 9,895 3,965 19,243
1981 346,006 147,797 139,365 10,210 3,864 44,770
1982 333,229 144,155 137,318 10,310 4,231 37,215
1983 334,248 141,683 136,178 8,121 4,042 44,224
1984 349,539 148,356 143,686 8,836 4,192 44,469
1985 401,816 169,063 164,728 7,240 4,290 56,495
1986 432,281 183,295 178,292 6,162 4,346 60,186
1987 411,647 173,994 169,868 6,538 4,413 56,884
1988 365,386 160,337 157,024 4,903 4,376 38,746
1989 369,626 162,618 159,632 3,554 4,301 39,521
1990 358,740 159,807 157,606 3,471 4,153 33,703
1991 353,737 156,313 156,313 3,627 3,960 33,524
1992 321,877 140,482 140,482 3,224 3,693 33,996
1993 320,447 137,696 137,696 3,068 4,074 37,913
1994 294,817 127,372 127,372 2,914 3,417 33,742
1995 260,902 110,953 110,953 2,852 5,023 31,121
1996 239,508 101,284 101,284 2,483 5,004 29,453
1997 219,132 89,917 89,917 2,616 4,716 31,966
1998 220,942 96,558 96,558 2,845 5,451 19,530
1999 217,976 94,864 94,864 2,771 5,454 20,023
2000 199,748 87,416 87,416 2,459 5,172 17,285
2001 191,701 81,640 81,640 2,169 5,063 21,189
2002 181,202 78,820 78,820 2,105 5,181 16,276
2003 176,211 83,993 83,993 2,268 5,253 704
2004 185,620 86,576 86,576 5,200 5,643 1,125
2005 240,590 113,330 113,330 7,375 5,511 1,044
2006 271,069 127,209 127,209 6,461 994 6,089 1,210 1,897
2007 320,957 152,522 152,522 6,292 932 5,987 1,174 1,528
2008 318,531 147,455 147,455 5,536 445 5,977 1,139 1,715
2009 328,192 152,089 152,089 5,884 408 7,208 1,302 1,625 1,940
2010 307,367 140,392 140,392 4,209 4,807 2,141 6,526 1,170 1,312 1,453
2011 343,148 154,009 154,009 9,112 5,333 2,916 5,727 1,197 2,407 5796 1,360
2012 363,089 164,478 164,478 9,040 5,275 2,824 6,201 1,283 871 7269 1,370
2013 351,385 159,477 159,477 10,921 4,759 1,567 6,807 1,445 920 4574 1,438
Total 13,971,371 6,158,292 5,947,080 33,282 256,970 12,227 274,904 6,397 1,230,726 17,639 12,701

DST = drug-susceptibility testing; NAAT = Nucleic Acid Amplification Tests.

Table 2
Resources in the Korea Mycobacterium Resource Center (2013).
Resources No. of strains
NTM Reference strains (ATCC, JCM, KCTC) 124
Clinical isolates 330
Mycobacterium tuberculosis
 RFLP Recurrent TB cases 91
North Korean patients 220
Gangwon province and outbreaks 1,919
The Philippines 138
 DST Pan susceptible 58
Monodrug resistant 449
Multidrug resistant 240
Extensively drug resistant 218
DST low-level resistant 320
DST high-level resistant 82
 Non-DST New smear-positive patients from public health centers 11,076
Drug-resistance surveys among new patients 5,632
National TB prevalence surveys 270
Quality assurance program for DST 412
Strains requested from abroad 1,031
Total 22,610

ATCC = American Type Culture Collection; DST = drug-susceptibility testing; JCM = Japan Collection of Microorganisms; KCTC = Korean Collection for Type Cultures; NTM = nontuberculous mycobacteria; RFLP = restriction fragment length polymorphisms; TB = tuberculosis.

Table 3
Annual achievements of domestic training and education.
Year Participants Place Number of training times Number of trainees
1954–1959 Doctors in general hospitals, medical college, doctors, nurses, radiologists, microscopists, and health-care workers Unclassified 4,301
1960–1969 Doctors, nurses, laboratory technicians, health-care workers, TB nurse officers, and others Central 84 2,089
Local 202 3,786
Unclassified 2,683
1970–1979 TB medical officers, TB health-care workers, laboratory technicians, TB nurse officers, and others Central 260 6,721
Local 406 22,007
1980–1989 TB doctors, directors/officers of public health centers, public medical doctors, other doctors, TB nurse officers, health-care workers, laboratory technicians, and TB volunteers in Korea Catholic Church Central 121 3,298
Local 187 5,389
1990–1999 TB doctors, public health doctors, doctors in public health centers in Seoul, TB health-care workers, doctors in national TB hospitals, Doctors in the National Institutes of Health, TB nurse officers, and others Central 96 4,084
Local 49 2,392
2000–2009 TB doctors, public health doctors, doctors in public health centers, practitioners, TB health-care workers, and TB nurse officers Central 199 16,682
Local 66 3,880
2010–2013 TB doctors, public health doctors, doctors in public health centers, practitioners, TB health-care workers, and TB nurse officers Central 61 8,942
Local 53 1,208

Training and education were provided by the Korean Institute of Tuberculosis and the Korean National Tuberculosis Association.

TB = tuberculosis.

Figure & Data

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