Epidemiology and Health

Epidemiologic Investigation

An outbreak of hepatitis A associated with salted clams in Busan, Korea: Hyunjin Son, Miyoung Lee, Youngduck Eun, Wonseo Park, Kyounghee Park, Sora Kwon, Seungjin Kim, Changhoon Kim; Epidemiol Health. 2022;44:e2022003. Published online December 29, 2021; DOI: https://doi.org/10.4178/epih.e2022003

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Abstract

OBJECTIVES
In July 2019, there were multiple reports on patients with hepatitis A among the visitors of a restaurant in Busan. The current study presents the results of an epidemiological investigation and outlines the supplementary measures that would help with hepatitis A control.

METHODS

A cohort study was conducted for all 2,865 customers who visited restaurant A from June to July. Using a standardized questionnaire, participants reported the presence of hepatitis A symptoms and whether they had consumed any of 19 food items. As for participants who had visited public health centers, their specimens were collected.

RESULTS

From the study cohort, 155 participants (5.4%) had confirmed hepatitis A. The epidemic curve was unimodal, and the median number of days from the restaurant visit to symptom onset was 31 days. A genotype analysis indicated that 89 of 90 tested patients had hepatitis A virus (HAV) genotype 1A. The results of a multivariate logistic regression analysis indicated that the ingestion of salted clams increased the risk of hepatitis A by 68.12 times (95% confidence interval [CI], 9.22 to 510.87). In an unopened package of salted clams found and secured through traceback investigation, HAV genotype 1A was detected.

CONCLUSIONS

To prevent people from ingesting uncooked clams, there needs to be more efforts to publicize the dangers of uncooked clams; the food sampling test standards for salted clams should also be expanded. Furthermore, a laboratory surveillance system based on molecular genetics should be established to detect outbreaks earlier.

Summary

Korean summary
2019년 7월, 부산시의 한 식당을 방문한 사람에서 다수의 A형간염 환자가 신고되었다. 2019년 6월 1일부터 7월 28일까지 해당 식당을 방문하여 카드 결제를 한 사람과 동반자 2,865명 전체를 대상으로 코호트 조사를 수행하였다. A형간염에 확진 된 사람은 총 155명으로 발병률은 5.4%였다. 다변량 로지스틱 회귀분석 결과 조개젓 섭취는 A형간염 발병 위험을 68.62배(95% CI, 9.22 to 510.87) 증가시키는 것으로 나타났다. 익히지 않은 조개류를 섭취하지 않도록 더욱 홍보를 강화해야 한다.

Key Message
In July 2019, there were multiple reports on patients with hepatitis A among the visitors of a restaurant in Bu¬san. A cohort study was conducted for all 2,865 customers who visited the restaurant from June to July. From the study cohort, 155 participants (5.4%) had confirmed hepatitis A. The results of a multivariate logistic regression analysis indicated that the ingestion of salted clams increased the risk of hepatitis A by 68.12 times. To prevent people from ingesting uncooked clams, there needs to be more efforts to publicize the dangers of uncooked clams.

Citations

Citations to this article as recorded by

Investigating the spatio-temporal variation of hepatitis A in Korea using a Bayesian model
Jaehong Jeong, Mijeong Kim, Jungsoon Choi
Frontiers in Public Health.2023;[Epub] CrossRef
A Study on the Detection Rate of Hepatitis A from Gastroenteritis Patients and the Genotype Analysis of Hepatitis A Virus in Busan
Sun Hee Park, Chanhee Kim, Summi Lee, Jihye Jeong, Junghye Choi, Seung Ju Lee
Journal of Bacteriology and Virology.2023; 53(2): 74. CrossRef
Influence of temperature and precipitation on the incidence of hepatitis A in Seoul, Republic of Korea: a time series analysis using distributed lag linear and non-linear model
Kiook Baek, Jonghyuk Choi, Jong-Tae Park, Kyeongmin Kwak
International Journal of Biometeorology.2022; 66(9): 1725. CrossRef

COVID-19: Brief Communication

Follow-up investigation of asymptomatic COVID-19 cases at diagnosis in Busan, Korea: Miyoung Lee, Youngduck Eun, Kyounghee Park, Jeonghun Heo, Hyunjin Son; Epidemiol Health. 2020;42:e2020046. Published online June 23, 2020; DOI: https://doi.org/10.4178/epih.e2020046

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Abstract

OBJECTIVES
The objective of the study was to conduct a follow-up investigation of 10 asymptomatic patients at diagnosis among the 98 confirmed coronavirus disease 2019 (COVID-19) cases reported in Busan between February 21, 2020 and March 13, 2020 to determine whether asymptomatic infection and transmission during asymptomatic period are possible.

METHODS

The study analyzed 10 asymptomatic, confirmed COVID-19 cases to determine whether asymptomatic infection is possible. We conducted in-depth interviews with patients and guardians; interviews with primary physicians; review of medical records and drug utilization review (DUR) reports; and base station-based location tracking.

RESULTS

Among the 98, confirmed COVID-19 cases reported in Busan, the study analyzed 10 (10.2%) asymptomatic patients at diagnosis. The results confirmed that two (2.0%) patients reported to be asymptomatic during the initial epidemiological investigation, but turned symptomatic before diagnosis as per the in-depth interview results. Four cases (4.0%) of early detection led to confirmed diagnosis during the incubation period and presentation of symptoms after diagnosis. In addition, the remaining four patients (4.0%), having no subjective symptoms nor specific findings on chest radiography and computed tomography, remained asymptomatic until the isolation order was lifted. With regard to whether transmission during the asymptomatic period is possible, it was found that one out of 23 household contacts of the confirmed patients was identified as an additional confirmed case after coming in close contact with an index patient during the presymptomatic period.

CONCLUSIONS

Among the 98 confirmed cases, asymptomatic infection was confirmed in four cases (4.0%). In addition, there was one additional confirmed case in which the patient was a family member who came in close contact with an index patient during the incubation period, thereby confirming that transmission during the asymptomatic period is possible. The possibility of transmission during the asymptomatic period has been confirmed; therefore, it is necessary to review the measures for expanding contact tracing that is currently being applied starting one day prior to the onset of symptoms.

Summary

Korean summary
본 연구는 부산광역시에서 무증상으로 COVID-19에 진단된 10명의 환자를 추적조사하여 무증상 감염이 가능한가, 무증상기에 전파가 가능한가에 대해 확인하였다. 조사결과 4명(4.0%)의 무증상 감염환자를 확인하였고, 환자의 무증상기에 밀접 접촉한 가족 중 1명의 추가 환자를 확인하여 무증상기 전파가 가능하다는 것을 확인하였다.

Citations

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COVID-19: Original Article

Epidemiological characteristics of and containment measures for COVID-19 in Busan, Korea: Hyunjin Son, Hyojung Lee, Miyoung Lee, Youngduck Eun, Kyounghee Park, Seungjin Kim, Wonseo Park, Sora Kwon, Byoungseon Ahn, Dongkeun Kim, Changhoon Kim; Epidemiol Health. 2020;42:e2020035. Published online June 1, 2020; DOI: https://doi.org/10.4178/epih.e2020035

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Abstract Summary PDF Supplementary Material

Abstract

Objectives
To describe and evaluate epidemiological investigation results and containment measures implemented in Busan, where 108 cases were confirmed with coronavirus disease 2019 (COVID-19) between February 21, 2020 and March 24, 2020.

Methods

Any individual who tested positive for COVID-19 was classified as a confirmed case. Measures were taken to identify the source of infection and trace and quarantine contacts. Serial intervals were estimated and the effective reproduction number was computed.

Results

Of the total 18,303 COVID-19 tests performed between January 16, 2020 and March 24, 2020 in Busan, 108 yielded positive results (positive test rate, 0.6%). All confirmed cases were placed in isolation at hospitals. Of the 108 confirmed cases, 59 (54.6%) were female. The most common age group was 20-29 years with 37 cases (34.3%). Regarding symptoms at the time of diagnosis, cough (n=38, 35.2%) and fever (n=34, 31.5%) were most common; 12 cases (11.1%) were asymptomatic. The source of infection was identified in 99 cases (91.7%). A total of 3,223 contacts were identified and quarantined. Household contacts accounted for 196, and the household secondary attack rate was 8.2% (95% confidence interval [CI], 4.7 to 12.9). The mean serial interval was estimated to be 5.54 days (95% CI, 4.08 to 7.01). After February 26, (R<sub>t</sub>) remained below 1 in Busan.

Conclusions

The early containment strategy implemented in Busan shows that control is possible if outbreaks are of limited scope. In preparation for future outbreaks, public health and healthcare systems should be re-examined and put in a ready state.

Summary

Korean summary
2월 21일부터 3월 24일까지 부산시에서 보고된 108명의 코로나바이러스감염증-19 (코로나19) 확진 환자의 역학 조사 결과와 관리 조치를 기술하고 평가하였다. 초기에는 A 교회 클러스터와 다른 지역에서 유입된 사례로 인해 급격한 환자 증가가 있었고 이후 접촉자를 중심으로 2차 유행을 보였다. 2월 26일 이후 부산 지역의 Rt가 1보다 낮은 값을 보여 전파가 통제되고 있음을 알 수 있었다. 부산에서 초기 containment 전략을 시행한 결과 제한된 발생 규모인 경우 통제가 가능하다는 점을 확인하였다. 이후 발생할 유행에 대비해 적극적으로 공중보건 및 보건의료 체계를 정비하고 준비해야 할 것으로 생각된다

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Original Article

A large outbreak of Salmonella enterica serovar Thompson infections associated with chocolate cake in Busan, Korea: Youngduck Eun, Hyesun Jeong, Seungjin Kim, Wonseo Park, Byoungseon Ahn, Dongkeun Kim, Eunhee Kim, Eunhee Park, Sunhee Park, Inyeong Hwang, Hyunjin Son; Epidemiol Health. 2019;41:e2019002. Published online January 9, 2019; DOI: https://doi.org/10.4178/epih.e2019002

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to reveal the epidemiologic characteristics of the outbreak of gastroenteritis caused by Salmonella enterica serovar Thompson in Busan Metropolitan City and to identify points for improvement to prevent of food-borne disease outbreak.

METHODS

This was a case-control study. The control group comprised asymptomatic students in the same classes of the cases. The presence or absence of symptoms, ingestion of each food provided by school meal service, and commonly ingested foods in addition to those foods in meal service were investigated. Moreover, specimens collected from rectal swab, preserved foods, and environmental surface were tested.

RESULTS

Of the 6,092 subjects, 1,111 (1,083 students, 22 school personnel, and 6 foodservice employees) were included in the case group; this corresponded to an 18.4% attack rate. Symptoms included diarrhea (n=1,051, 94.6%), abdominal pain (n=931, 83.8%), febrile sensation (n=502, 45.2%), and vomiting (n=275, 24.8%). The epidemic curves of each 10 schools were unimodal. Investigation of food intake showed a significantly high odds ratio for chocolate cake in 5 out of the 10 schools. Laboratory test detected Salmonella enterica serovar Thompson both in rectal swab specimens of 9 schools and in collected preserved chocolate cakes of 9 schools. Pulsed-field gel electrophoresis test result showed that Salmonella enterica seorvar Thompson isolated from human and foods were the same.

CONCLUSIONS

The source of infection for the Salmonella enterica serovar Thompson outbreak in the 10 schools of Busan Metropolitan City is chocolate cake. Traceback investigation for origin of contaminated food in food-borne disease outbreak and safety control during food production should be more enhanced.

Summary

Korean summary
이 연구는 2018년 9월 부산광역시 10개 학교에서 급식으로 제공된 초콜릿 케익으로 인해 발생한 살모넬라 톰슨 감염증 대규모 유행의 역학 조사 결과이다. 학교 급식과 같은 대규모 집단급식은 원재료에서 급식 제공까지 안전하게 관리되어야 하며 식품매개감염병 집단 발생 역학조사에 있어 오염원에 대한 체계적 역추적 조사와 기관 간 협업의 중요성을 강조하였다.

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