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HOME > Osong Public Health Res Perspect > Volume 15(5); 2024 > Article
Editorial
Which infectious diseases are currently posing problems in the Republic of Korea? One out of every two tuberculosis patients is over 65 years old
Jong-Koo Leeorcid
Osong Public Health and Research Perspectives 2024;15(5):383-384.
DOI: https://doi.org/10.24171/j.phrp.2024.0301
Published online: October 31, 2024

National Academy of Medicine of Korea, Seoul, Republic of Korea

Corresponding author: Jong-Koo Lee National Academy of Medicine of Korea, 51 Seochojungang-ro, Seocho-gu, Seoul 06654, Republic of Korea E-mail: docmohw@snu.ac.kr
• Received: October 23, 2024   • Accepted: October 26, 2024

© 2024 Korea Disease Control and Prevention Agency.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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In this month’s issue, we have published papers highlighting the importance of focusing on tuberculosis, the resurgence of coronavirus disease 2019 (COVID-19), and the post-COVID-19 increase in measles cases.
First, it is essential to evaluate whether the goal of eradicating tuberculosis by 2030 can be achieved. Our country has made significant strides in tuberculosis management compared to other countries globally. However, as of 2023, there are still 20,000 new cases and 1,000 deaths annually. The national tuberculosis management system, initiated in 1962, led to a dramatic decrease in the number of patients through nationwide screenings, early detection and treatment, and ongoing management via health centers. The effectiveness of these strong vertical health programs began to diminish when, following the expansion of national health insurance, private medical institutions increasingly assumed the role of treating patients, necessitating a new management model. As the prevalence dropped to less than 1%, the nationwide tuberculosis survey was replaced by patient reporting. However, it took 10 years to generate accurate statistics until the tuberculosis management infrastructure in the private sector, including reporting of patient treatment outcomes, was established. Fortunately, after a pilot project in 2007, accurate statistics became available by promoting the Private-Public Mix program starting in 2011. Consequently, the incidence of new cases in 2011 was confirmed to be 78.9 per 100,000 population, decreasing to 30.6 in 2023. The total number of patients is decreasing at an annual average of 7.6%. With this rate of decrease, achieving the 2030 Goal, elimination of tuberculosis, appears challenging. Notably, the proportion of patients over 65 years old has risen to 57.9%, and there is a need for targeted measures for groups with high incidence rates, such as those with chronic diseases, low income, and coexisting conditions. Additionally, there is a need to enhance early detection programs for latent tuberculosis. One global challenge is resistance to anti-tuberculosis drugs. Fortunately, the number of patients with multidrug-resistant/rifampicin-resistant tuberculosis was 551 in 2023, representing 2.8% of the total reported tuberculosis cases of 19,540, a slight increase from 2.7% in 2022, but the situation remains relatively well-managed. However, while only 1.8% of new patients are drug-resistant, the proportion among retreatment cases is 6.8%, which is 3.8 times higher, underscoring the importance of continuous management and prevention of treatment dropout. Additionally, the proportion of imported cases among total tuberculosis cases continues to rise, reaching 5.7%, highlighting the need for focused prevention and early detection of imported cases [1].
Second, the possibility of a resurgence of COVID-19 in the 2024–2025 season remains a concern. Recent World Health Organization data indicates that the global number of new weekly COVID-19 cases rose by 10% during the 28-day period from August 19 to September 15, 2024, compared to the preceding 28 days, with over 270,000 new cases reported. Similarly, the number of new weekly deaths increased by 11%, totaling 5,700 fatalities. However, these reported cases may not accurately reflect the true infection rates due to a global reduction in testing and reporting. Currently, the variant of interest JN.1 is the most reported globally, identified in 140 countries and accounting for 16.0% of sequences in week 37, down from 19.4% in week 34 [2]. Despite these figures, it seems unlikely that we will experience a surge on the scale of 2022. Nevertheless, it is crucial to prepare for a potential resurgence this winter by addressing previously neglected policies—enhancing primary care, home care, critical patient treatment in intensive care units, and addressing excess mortality and collateral damage among patients. Recommendations include stockpiling treatments and increasing vaccination rates for those over 65 years old, along with promoting simultaneous vaccination for influenza. Although current vaccination rates are 1.7 times higher and simultaneous influenza vaccinations are 3.3 times higher than during the same period last year, it is still too early in the vaccination period to be fully reassured [3].
Lastly, It is important to note that there have been worldwide outbreaks of vaccine-preventable diseases (VPDs) following the COVID-19 pandemic. Specifically, from 2021 to 2022, global coverage for the first dose of the diphtheria-tetanus-pertussis–containing vaccine increased from 86% to 89%, and for the first dose of the measles-containing vaccine from 81% to 84%. However, these figures have not returned to the pre-pandemic coverage levels of 90% and 86%, respectively, recorded in 2019. The recovery in vaccination coverage has been uneven across different regions and countries, with low-income countries experiencing slower progress. In response, implementing strategies to provide catch-up vaccinations throughout childhood could effectively mitigate the increased risk of VPD outbreaks due to years of reduced vaccination coverage [4].
In particular, outbreaks of VPDs such as measles and pertussis were addressed at the 33rd WPRO Technical Advisory Group on Immunization Programmes. Fortunately, in our country (the Republic of Korea), neither economic nor geographic barriers disrupted access to the healthcare system during the COVID-19 pandemic, and vaccination rates remained stable, supported by the recall-reminder information technology program. However, despite implementing routine immunization programs and supplementary immunization activities, along with the surveillance and detection of measles virus genotypes, there has been a resurgence in endemic measles virus transmission in countries such as the Philippines and Malaysia, as well as large-scale import-related measles outbreaks in countries such as the Republic of Korea and Japan, which recently declared measles elimination, due to overseas influx. Additionally, endemic measles virus transmission has continued in countries such as Mongolia and Cambodia, where measles is prevalent. Overall, however, a report stated: "Notable progress towards measles and rubella elimination has been made in the Western Pacific Region in the last 10 years, despite the region-wide measles resurgence in 2013–2016, the global measles resurgence in 2018–2019, and the COVID-19 pandemic in 2020–2023 [5].

Ethics Approval

Not applicable.

Conflicts of Interest

Jong-Koo Lee has been the editor-in-chief of Osong Public Health and Research Perspectives since October 2021.

Funding

None.

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      Which infectious diseases are currently posing problems in the Republic of Korea? One out of every two tuberculosis patients is over 65 years old
      Which infectious diseases are currently posing problems in the Republic of Korea? One out of every two tuberculosis patients is over 65 years old

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