Epidemiology and Health

COVID-19: Original Article

The association between tobacco or nicotine product use behaviors and non-compliance with mask-wearing during the COVID-19 pandemic: a cross-sectional study in Korea: Da-eun Lee, Heewon Kang, Sung-il Cho; Epidemiol Health. 2022;44:e2022087. Published online October 7, 2022; DOI: https://doi.org/10.4178/epih.e2022087

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
It is necessary to investigate tobacco or nicotine product (TNP) use which acts as a risk factor for coronavirus disease 2019 (COVID-19) infection. Especially, wearing a mask is difficult to practice while using TNP. Therefore, this study aimed to examine the association between TNP use behaviors and non-compliance with mask-wearing during the COVID-19 pandemic.
METHODS
The samples of 208,618 Korean adults from 2020 Community Health Survey in Korea were used. As an independent variable, TNP use behaviors such as TNP use status, changes in TNP use after the COVID-19 outbreak, TNP types, and attempt to quit were analyzed. Logistic regression was performed on gender-stratified participants.
RESULTS
Among men, the odds ratio (OR) of current and former TNP users were 2.00 (95% confidence interval [CI], 1.66 to 2.40) and 1.32 (95% CI, 1.09 to 1.60), respectively, compared to never users. In women, OR was 1.50 (95% CI, 1.00 to 2.26) for former users. Cigarette use was more associated with not wearing a mask than non-cigarette tobacco or nicotine product (NCTNP) use (OR, 1.53; 95% CI, 1.12 to 2.08). Men whose TNP use decreased had lower non-compliance (OR, 0.52; 95% CI, 0.36 to 0.74); while women whose TNP use increased had lower non-compliance (OR, 0.13; 95% CI, 0.07 to 0.26).
CONCLUSIONS
Current and former users were less likely to wear masks. Cigarette use was more associated with not wearing a mask than NCTNP use. Changes in TNP use showed association for men and women; however, in the opposite direction. Therefore, more attention should be paid to TNP use prevention and cessation support during the epidemic of respiratory infectious diseases. Moreover, it is necessary to identify risk factors of cigarette users in compliance with mask-wearing.; Summary

Korean summary
담배 또는 니코틴 제품 (Tobacco or Nicotine Products, TNPs) 현재사용자와 과거사용자는 비사용자 대비 마스크 미착용 연관성이 높고, 비궐련 담배 또는 니코틴 제품 (Non-Cigarette Tobacco or Nicotine Products, NCTNPs) 사용자보다는 일반담배 사용자의 마스크 미착용 연관성이 높다. 남성에서는 코로나19 유행 이전 대비 TNPs 사용이 감소했을 때, 여성에서는 증가했을 때 마스크 미착용 연관성이 낮았다. 따라서 호흡기 감염병 유행 시기에는 더욱 TNPs 사용 예방과 금연 지원에 관심을 가질 것을 제안한다.

Key Message
During the epidemic of respiratory infectious diseases, more attention should be paid to tobacco or nicotine products (TNPs) use prevention and cessation support.

COVID-19: Original Article

The age-standardized incidence, mortality, and case fatality rates of COVID-19 in 79 countries: a cross-sectional comparison and their correlations with associated factors: Dongui Hong, Sohyae Lee, Yoon-Jung Choi, Sungji Moon, Yoonyoung Jang, Yoon-Min Cho, Hyojung Lee, Sukhong Min, Hyeree Park, Seokyung Hahn, Ji-Yeob Choi, Aesun Shin, Daehee Kang; Epidemiol Health. 2021;43:e2021061. Published online September 8, 2021; DOI: https://doi.org/10.4178/epih.e2021061

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
During the coronavirus disease 2019 (COVID-19) pandemic, crude incidence and mortality rates have been widely reported; however, age-standardized rates are more suitable for comparisons. In this study, we estimated and compared the age-standardized incidence, mortality, and case fatality rates (CFRs) among countries and investigated the relationship between these rates and factors associated with healthcare resources: gross domestic product per capita, number of hospital beds per population, and number of doctors per population.

METHODS

The incidence, mortality, and CFRs of 79 countries were age-standardized using the World Health Organization standard population. The rates for persons 60 years or older were also calculated. The relationships among the rates were analysed using trend lines and coefficients of determination (R<sup>2</sup>). Pearson correlation coefficients between the rates and the healthcare resource-related factors were calculated.

RESULTS

The countries with the highest age-standardized incidence, mortality, and CFRs were Czechia (14,253 cases/100,000), Mexico (182 deaths/100,000), and Mexico (6.7%), respectively. The R<sup>2</sup> between the incidence and mortality rates was 0.852 for all ages and 0.945 for those 60 years or older. The healthcare resources-related factors were associated positively with incidence rates and negatively with CFRs, with weaker correlations among the elderly.

CONCLUSIONS

Compared to age-standardized rates, crude rates showed greater variation among countries. Medical resources may be important in preventing COVID-19-related deaths; however, considering the small variation in fatality among the elderly, preventive measures such as vaccination are more important, especially for the elderly population, to minimize the mortality rates.

Summary

Korean summary
국가별 발생률, 사망률, 치명률을 WHO 표준 인구로 연령표준화하였고, 의료자원과 관계된 지표와의 상관관계를 파악하였다. 2021년 4월 6일 기준, 연령표준화 발생률, 사망률, 치명률이 가장 높은 나라는 각각 체코 (10만명당 14,253명), 멕시코 (10만명당 182명), 멕시코 (6.7%)이며, 60세 이상 노인은 사망률과 치명률이 더 높은 것으로 나타났다. 1인당GDP, 인구당 의사 수, 인구당 병상 수는 발생률과 양의 상관관계가, 치명률과는 음의 상관관계가 있었고 노인에게서는 상관관계가 약하게 나타났다. 코로나바이러스감염증-19로 인한 피해를 최소화하기 위해서 의료자원의 투입과 더불어 노인의 감염예방이 중요할 것이다.

Key Message
The incidence, mortality, and case fatality rates of 79 countries were age-standardized using the WHO standard population. The correlations between the rates and the healthcare resource-related factors were investigated. As of April 6, 2021, the countries with the highest age-standardized incidence, mortality, and case fatality rates were Czechia (14,253 cases/100,000), Mexico (182 deaths/100,000), and Mexico (6.7%), respectively; the mortality and case fatality rates were higher among the elderly. GDP per capita, number of hospital beds per population, and number of doctors per population were associated positively with incidence rate, and negatively with case fatality rates: the correlations were weaker among the elderly. To minimize the burden caused by COVID-19, preventing the elderly from infection is important as well as supply of medical resources.

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Age-standardization and Standard Population
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Iván de Jesús Ascencio-Montiel, Oscar David Ovalle-Luna, Ramón Alberto Rascón-Pacheco, Victor Hugo Borja-Aburto, Gerardo Chowell
BMC Infectious Diseases.2022;[Epub] CrossRef
Global burden of calcific aortic valve disease and attributable risk factors from 1990 to 2019
Jiaye Yu, Zhuo Wang, Qinyi Bao, Shuxin Lei, Yayu You, Zhehui Yin, Xiaojie Xie
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Robert Tucker Omberg, Alex Tabarrok
Oxford Review of Economic Policy.2022; 38(4): 851. CrossRef
Time-series comparison of COVID-19 case fatality rates across 21 countries with adjustment for multiple covariates
Yongmoon Kim, Bryan Inho Kim, Sangwoo Tak
Osong Public Health and Research Perspectives.2022; 13(6): 424. CrossRef
Cause-specific mortality in Korea during the first year of the COVID-19 pandemic
Jinwook Bahk, Kyunghee Jung-Choi
Epidemiology and Health.2022; 44: e2022110. CrossRef

COVID-19: Systematic Review

Clinical outcomes of COVID-19 amongst HIV patients: a systematic literature review: Thomas Massarvva; Epidemiol Health. 2021;43:e2021036. Published online May 17, 2021; DOI: https://doi.org/10.4178/epih.e2021036

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The global pandemic coronavirus disease 2019 (COVID-19) emerged in the city of Wuhan, China around December 2019. Since then, the virus has caused severe morbidity and mortality worldwide and has put pressure on the global medical system. Still, there are limited data regarding the clinical impact of COVID-19 on people living with human immunodeficiency virus (HIV). The primary aim of this study was, therefore, to systematically review up-to-date studies reporting the clinical outcomes of COVID-19 amongst HIV patients.

METHODS

A thorough literature search was carried out using MEDLINE, Embase, Scopus, and the Cochrane Library Databases in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

A total of 22 studies were identified. Amongst 730 HIV/COVID-19-coinfected patients, 79.4% were males, the median age was 51.5 years, and the number of reported patients receiving antiretroviral drugs was 708 (97.2%). Most coinfected patients had mild to moderate symptoms, including cough (37.7%), fever (37.5%), and dyspnoea (24.7%). Among pre-existing comorbidities, hypertension (26.3%) was the most prevalent in HIV/COVID-19 coinfected patients, and 87% of coinfected patients recovered.

CONCLUSIONS

Based on the existing data in this systematic literature review, HIV patients with pre-existing comorbidities, obesity, and older age should be considered as a high-risk group for COVID-19. Furthermore, coinfected patients appear to have marginally comparable clinical outcomes with the general population. The study’s findings highlight the need for further investigation to elucidate the impact of COVID-19 infection on HIV patients.

Summary

Key Message
In this systematic literature review, various aspects of COVID-19 outcomes amongst HIV patients are identified and quantified, including the proportion of different symptoms, severity, pre-existing comorbidities, recovery, death, and the most commonly prescribed antiretroviral drugs in HIV patients with COVID-19 coinfection.

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Double Trouble Co-Infections: Understanding the Correlation Between COVID-19 and HIV Viruses
Sassi Ashraf Ali Abbasi, Tarika Noor, Maneeth Mylavarapu, Monika Sahotra, Hunmble A Bashir, Rakshita Ramesh Bhat, Urmi Jindal, Uzma Amin, Anushree V, Humza F Siddiqui
Cureus.2023;[Epub] CrossRef

Original Article

Impact of early-life weight status on urinary tract infections in children: a nationwide population-based study in Korea: Hyung Eun Yim, Kyung Do Han, Bongseong Kim, Kee Hwan Yoo; Epidemiol Health. 2021;43:e2021005. Published online December 29, 2020; DOI: https://doi.org/10.4178/epih.e2021005

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Abstract Summary PDF

Abstract

OBJECTIVES
We aimed to evaluate the association between early-life weight status and urinary tract infection (UTI) risk in children.

METHODS

A nationwide study was conducted using Korean National Health Screening (NHS) data and National Health Insurance Service data. A sample cohort was selected using data from the 2014 and 2015 NHS for infants and children (4-71 months) and followed up until the end of 2017. Participants were divided into 4 groups (underweight, normal weight, overweight, and obese) based on the weight-for-age (< 2 years) or body mass index (≥ 2 years). Hazard ratios (HRs) with 95% confidence intervals (CIs) for developing UTIs, cystitis, and acute pyelonephritis (APN) were calculated using a Cox proportional hazard model.

RESULTS

Of 1,653,106 enrolled children, 120,142 (7.3%) developed UTIs, cystitis, and APN during follow-up. The underweight, overweight, and obese groups had higher risks of UTIs than the reference group after adjusting for age, sex, birth weight, and preterm birth. Between 2 years and 6 years of age, boys with underweight had a high risk of UTI and APN, while girls with overweight and obesity revealed elevated risks of UTIs, cystitis, and APN. The HRs for APN in boys with underweight and in girls with obesity were 1.46 (95% CI, 1.03 to 2.07) and 1.41 (95% CI, 1.13 to 1.75), respectively, after adjusting for age, sex, birth weight, and preterm birth. The incidence of APN did not decrease with age in underweight and obese children aged 2-6 years.

CONCLUSIONS

Children with underweight, overweight, and obesity may be at high risk for UTIs.

Summary

Korean summary
1. 영유아 및 소아에서 과소체중, 과체중 및 비만은 요로감염 발생 증가와 관련이 있다. 2. 본 전국적인 인구 기반 연구에서 2-6세 남아에서 과소체중을 보인 경우 요로감염과 신우신염 발생빈도가 증가하였으며, 2-6세 여아에서 과체중 및 비만을 보이는 경우 요로감염, 방광염, 신우신염 발생이 증가하였다. 3. 소아에서 적정체중을 유지하는 것이 요로감염, 방광염, 신우신염의 발생을 예방함에 있어서 중요하다.

Key Message
1. Being underweight, overweight, or obese can be associated with an increased risk of urinary tract infection in infants and children. 2. The underweight boys aged 2–6 years had a high risk of urinary tract infection and acute pyelonephritis, while the overweight and obese girls aged 2–6 years revealed increased risks of urinary tract infection, cystitis, and acute pyelonephritis in our nationwide population-based study on urinary tract infections. 3. Body weight control would be significant for the primary prevention of urinary tract infections, cystitis, and acute pyelonephritis in children.

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Risk factors for recurrent urinary tract infections in young infants under the age of 24 months
Min Hwa Son, Hyung Eun Yim
Childhood Kidney Diseases.2024; 28(1): 35. CrossRef
Childhood Body Mass Index (BMI) and the Risk of Infection: A Narrative Review
Houman Hashemian, Mohammad Ali Esfandiari, Setila Dalili
Journal of Comprehensive Pediatrics.2023;[Epub] CrossRef
Kidney Considerations in Pediatric Obesity
Alexandra Sawyer, Evan Zeitler, Howard Trachtman, Petter Bjornstad
Current Obesity Reports.2023; 12(3): 332. CrossRef
Association of body weight and urinary tract infections during infancy: a nationwide comparative matched cohort study
Peong Gang Park, Ji Hyun Kim, Yo Han Ahn, Hee Gyung Kang
Childhood Kidney Diseases.2023; 27(2): 111. CrossRef
Obesity and chronic kidney disease: prevalence, mechanism, and management
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COVID-19: Methods

Individual-based simulation model for COVID-19 transmission in Daegu, Korea: Woo-Sik Son, RISEWIDs Team; Epidemiol Health. 2020;42:e2020042. Published online June 15, 2020; DOI: https://doi.org/10.4178/epih.e2020042

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The aims of this study were to obtain insights into the current coronavirus disease 2019 (COVID-19) epidemic in the city of Daegu, which accounted for 6,482 of the 9,241 confirmed cases in Korea as of March 26, 2020, to predict the future spread, and to analyze the impact of school opening.

METHODS

Using an individual-based model, we simulated the spread of COVID-19 in Daegu. An individual can be infected through close contact with infected people in a household, at work/school, and at religious and social gatherings. We created a synthetic population from census sample data. Then, 9,000 people were randomly selected from the entire population of Daegu and set as members of the Shincheonji Church. We did not take into account population movements to and from other regions in Korea.

RESULTS

Using the individual-based model, the cumulative confirmed cases in Daegu through March 26, 2020, were reproduced, and it was confirmed that the hotspot, i.e., the Shincheonji Church had a different probability of infection than non-hotspot, i.e., the Daegu community. For 3 scenarios (I: school closing, II: school opening after April 6, III: school opening after April 6 and the mean period from symptom onset to hospitalization increasing to 4.3 days), we predicted future changes in the pattern of COVID-19 spread in Daegu.

CONCLUSIONS

Compared to scenario I, it was found that in scenario III, the cumulative number of patients would increase by 107 and the date of occurrence of the last patient would be delayed by 92 days.

Summary

Korean summary
신천지 교인 집단이 hotspot이 되어 지역사회로 전파된 대구의 COVID-19 확산을 시뮬레이션하였다. Individual based model을 이용하여 신천지 교인 집단, 즉 hotspot과 non-hotspot이 서로 다른 감염 확률을 갖고 있음을 확인하였으며, 4월 6일로 예정된 개학이 대구 지역 COVID-19 확산에 어떤 영향을 미칠지 분석하였다.

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Mathematical Modeling of COVID-19 Transmission and Intervention in South Korea: A Review of Literature
Hyojung Lee, Sol Kim, Minyoung Jeong, Eunseo Choi, Hyeonjeong Ahn, Jeehyun Lee
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Hamid Khataee, Jack Kibble, Istvan Scheuring, Andras Czirok, Zoltan Neufeld
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A Full-Scale Agent-Based Model to Hypothetically Explore the Impact of Lockdown, Social Distancing, and Vaccination During the COVID-19 Pandemic in Lombardy, Italy: Model Development
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Mina Kim, In-Hoo Park, Young-Shin Kang, Honey Kim, Min Jhon, Ju-Wan Kim, Seunghyong Ryu, Ju-Yeon Lee, Jae-Min Kim, Jonghun Lee, Sung-Wan Kim
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Original Articles

Factors associated with in-hospital death in patients with nosocomial infections: a registry-based study using community data in western Iran: Salman Khazaei, Erfan Ayubi, Ensiyeh Jenabi, Saeid Bashirian, Masud Shojaeian, Leili Tapak; Epidemiol Health. 2020;42:e2020037. Published online June 1, 2020; DOI: https://doi.org/10.4178/epih.e2020037

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Abstract PDF Supplementary Material

Abstract

Objectives
Determining the predictors of in-hospital death related to nosocomial infections is an essential part of efforts made in the overall health system to improve the delivery of health care to patients. Therefore, this study investigated the predictors of in-hospital death related to nosocomial infections.

Methods

This registry-based, longitudinal study analyzed data on 8,895 hospital-acquired infections (HAIs) in Hamadan Province, Iran from March 2017 to December 2019. The medical records of all patients who had been admitted to the hospitals were extracted from the Iranian Nosocomial Infections Surveillance Software. The effects of the type and site of infection, as well as age group, on in-hospital death were estimated using univariate and multivariable Cox regression models.

Results

In total, 4,232 (47.8%) patients with HAIs were males, and their mean age was 48.25±26.22 years. In both sexes, most nosocomial infections involved Gram-negative bacteria and the most common site of infection was the urinary tract. Older patients had a higher risk of in-hospital death (adjusted hazard ratio [aHR], 2.26; 95% confidence interval [CI], 1.38 to 3.69 for males; aHR, 2.44; 95% CI, 1.29 to 4.62 for females). In both sexes, compared with urinary tract infections, an increased risk of in-hospital death was found for ventilator-associated events (VAEs) (by 95% for males and 93% for females) and bloodstream infections (BSIs) (by 67% for males and 82% for females).

Conclusion

We found that VAEs, BSIs, and fungal infections were independently and strongly associated with increased mortality.

Summary

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Predictors of In-ICU Mortality Among Older Patients with Healthcare-Associated Infection: A Cohort Study
Fereshteh Rezaie, Farahnaz Mohammadi-Shahboulaghi, Reza Fadayevatan, Mohsen Shati, Gholamreza Ghaedamini Harouni
Journal of Kermanshah University of Medical Sciences.2023;[Epub] CrossRef
Barriers to hand hygiene compliance in intensive care units to prevent the spread of healthcare-associated infections
Gurjeet Singh, Raksha Singh, Ranga Reddy Burri
MGM Journal of Medical Sciences.2023; 10(4): 667. CrossRef
Prevalence of Nosocomial Infections During the COVID-19 Pandemic: A Systematic Review and Meta-analysis
Sima Rafiei, Zahra Nejatifar, Rana Soheylirad, Samira Raoofi, Fatemeh Pashazadeh Kan, Ahmad Ghashghaee
Journal of Health Reports and Technology.2022;[Epub] CrossRef
Prevalence of Nosocomial Infections During the COVID-19 Pandemic: A Systematic Review and Meta-analysis
Sima Rafiei, Zahra Nejatifar, Rana Soheylirad, Samira Raoofi, Fatemeh Pashazadeh Kan, Ahmad Ghashghaee
Journal of Health Reports and Technology.2022;[Epub] CrossRef
The Impact of COVID-19 Outbreak on Nosocomial Infection Rate: A Case of Iran
Maryam Jabarpour, Mahlagha Dehghan, Giti Afsharipour, Elham Hajipour Abaee, Parvin Mangolian Shahrbabaki, Mehdi Ahmadinejad, Mahboobeh Maazallahi, Aseer Manilal
Canadian Journal of Infectious Diseases and Medical Microbiology.2021; 2021: 1. CrossRef
Survival rate in patients with ICU-acquired infections and its related factors in Iran’s hospitals
MEDSKorosh Etemad, Yousef Khani, Seyed-Saeed Hashemi-Nazari, Neda Izadi, Babak Eshrati, Yadollah Mehrabi
BMC Public Health.2021;[Epub] CrossRef

Epidemiological characteristics of HIV infected Korean: Korea HIV/AIDS Cohort Study: Yunsu Choi, Bo Youl Choi, Soo Min Kim, Sang Il Kim, June Kim, Jun Young Choi, Shin-Woo Kim, Joon Young Song, Youn Jeong Kim, Dae Won Park, Hyo Youl Kim, Hee-Jung Choi, Mee-Kyung Kee, Young Hyun Shin, Myeongsu Yoo; Epidemiol Health. 2019;41:e2019037. Published online September 3, 2019; DOI: https://doi.org/10.4178/epih.e2019037

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
To manage evidence-based diseases, it is important to identify the characteristics of patients in each country.

METHODS

The Korea HIV/AIDS Cohort Study seeks to identify the epidemiological characteristics of 1,442 Korean individuals with human immunodeficiency virus (HIV) infection (12% of Korean individuals with HIV infection in 2017) who visited 21 university hospitals nationwide. The descriptive statistics were presented using the Korea HIV/AIDS cohort data (2006-2016).

RESULTS

Men accounted for 93.3% of the total number of respondents, and approximately 55.8% of respondents reported having an acute infection symptom. According to the transmission route, infection caused by sexual contact accounted for 94.4%, of which 60.4% were caused by sexual contact with the same sex or both males and females. Participants repeatedly answered the survey to decrease depression and anxiety scores. Of the total participants, 89.1% received antiretroviral therapy (ART). In the initial ART, 95.3% of patients were treated based on the recommendation. The median CD4 T-cell count at the time of diagnosis was 229.5 and improved to 331 after the initial ART. Of the patients, 16.6% and 9.4% had tuberculosis and syphilis, respectively, and 26.7% had pneumocystis pneumonia. In the medical history, sexually transmitted infectious diseases showed the highest prevalence, followed by endocrine diseases. The main reasons for termination were loss to follow-up (29.9%) and withdrawal of consent (18.7%).

CONCLUSIONS

Early diagnosis and ART should be performed at an appropriate time to prevent the development of new infection.

Summary

Korean summary
국내 감염인은 대부분 성 접촉으로 인해 감염되었고, 감염인의 약 90%가 치료를 경험하였다. 하지만 여전히 결핵, 매독, 주폐포자충 폐렴 등과 같은 HIV 관련 질환의 유병률이 높았고, 치료를 통해 수명이 연장되어 노화 혹은 치료 약제 부작용과 관련된 HIV 비 관련 만성 질환의 유병률도 높았다. 향후 감염인의 HIV/AIDS 비 관련 질환에 대한 연구 및 사망 원인 등에 대한 후속 연구가 필요하겠다.

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Smoothed quantile residual life regression analysis with application to the Korea HIV/AIDS cohort study
Soo Min Kim, Yunsu Choi, Sangwook Kang, Korea HIV/AIDS cohort study
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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.

Citations

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Rapid identification and absolute quantitation of zero tolerance-Salmonella enterica subsp. enterica serovar Thompson using droplet digital polymerase chain reaction
Eiseul Kim, Chang Hun Choi, Seung-Min Yang, Min-Ki Shin, Hae-Yeong Kim
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Pengfei Zhang, Panpan Wang, Xueting Fu, Xu Xu, Fuqian Ruan, Ting Wang, Guanhong Chang, Yangli Wan, Yao Zhang, Xin Wang
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Rapid detection of Salmonella enterica subsp. enterica serovar Thompson by real-time fluorescence loop-mediated isothermal amplification (LAMP) and colorimetric LAMP combined without DNA extraction in the field
Eiseul Kim, Seung-Min Yang, Hae-Yeong Kim
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Asymptomatic Middle East Respiratory Syndrome coronavirus infection using a serologic survey in Korea: Yeong-jun Song, Jeong-Sun Yang, Hee Jung Yoon, Hae-Sung Nam, Soon Young Lee, Hae-Kwan Cheong, Woo-Jung Park, Sung Han Park, Bo Youl Choi, Sung Soon Kim, Moran Ki; Epidemiol Health. 2018;40:e2018014. Published online April 15, 2018; DOI: https://doi.org/10.4178/epih.e2018014

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Abstract Summary PDF

Abstract

OBJECTIVES
The rates of asymptomatic infection with Middle East Respiratory Syndrome (MERS) coronavirus vary. A serologic study was conducted to determine the asymptomatic MERS infection rate in healthcare workers and non-healthcare workers by exposure status.

METHODS

Study participants were selected from contacts of MERS patients based on a priority system in 4 regions strongly affected by the 2015 MERS outbreak. A sero-epidemiological survey was performed in 1,610 contacts (average duration from exposure to test, 4.8 months), and the collected sera were tested using an enzyme-linked immunespecific assay (ELISA), immunofluorescence assay (IFA), and plaque reduction neutralization antibody test (PRNT). Among the 1,610 contacts, there were 7 ELISA-positive cases, of which 1 exhibited positive IFA and PRNT results.

RESULTS

The asymptomatic infection rate was 0.060% (95% confidence interval, 0.002 to 0.346). The asymptomatic MERS case was a patient who had been hospitalized with patient zero on the same floor of the hospital at the same time. The case was quarantined at home for 2 weeks after discharge, and had underlying diseases, including hypertension, angina, and degenerative arthritis.

CONCLUSIONS

The asymptomatic infection was acquired via healthcare-associated transmission. Thus, it is necessary to extend serologic studies to include inpatient contacts who have no symptoms.

Summary

Korean summary
2015년 국내 MERS 유행시에 자가격리를 시행하였던 접촉자 약 15,000명 (의료인과 비의료인 포함) 중에서 주요 유행지역, 노출 강도 등을 고려하여 선별된 3,291명을 대상으로 무증상 감염여부를 확인하기 위한 혈청 역학조사를 수행하였다. 최종 검사에 참여한 1,610명 중에서 7명이 ELISA 양성 반응을 보였고, 그 중 1명이 IFA와 PRNT에서도 양성 반응을 보여 무증상 감염률은 0.060%(95% CI: 0.002-0.346)로 기존 연구에 비하여 낮았다. 최종 양성을 보인 1명은 노출 당시 1번환자와 가까운 병실에 입원하였던 환자였다.

Citations

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MERS-Epidemiologic Investigation

Epidemiological investigation of the 119th confirmed Middle East Respiratory Syndrome coronavirus case with an indefinite mode of transmission during the Pyeongtaek outbreak in Korea: Jong Hyuk Choi, Byoungin Yoo, Soon Young Lee, Eun Gyu Lee, Moran Ki, Woncheol Lee, Jong Rak Jung, Kyujin Chang; Epidemiol Health. 2015;37:e2015054. Published online December 10, 2015; DOI: https://doi.org/10.4178/epih/e2015054

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224 Download
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Abstract Summary PDF Supplementary Material

Abstract

Since the first case was diagnosed on May 20, 2015, there were 186 confirmed cases of Middle East Respiratory Syndrome (MERS) until the end of outbreak in South Korea. Although medical institutions were the most identifiable sources of MERS transmission in South Korea, similar to other countries, in-depth epidemiological investigation was required for some confirmed cases with indefinite contact history or hospital visit records. The subject of epidemiological investigation in the present study was a 35 year-old male patient diagnosed with MERS (#119) who lived in Asan-city and worked in Pyeongtaek-city. Various potential sources of transmission were carefully investigated. While he could have been exposed to MERS through a friend from Saudi Arabia or confirmed MERS cases in his workplace, neighboring areas, and medical institutions, as well as contacts in his home, the chances of transmission were low; however, the potential for transmission through his local community could not be excluded. Practically, it was difficult to determine the modes of transmission for all outbreak cases in communicable disease that occurred in this short period of time. The investigation to identify the mode of transmission in this case was ultimately unsuccessful. However, the various data collected and analyzed to reveal modes of transmission provided detailed information that could not be collected using only interview surveys.

Summary

Korean summary
2015년 한국에서 유행한 메르스 환자들 중, 감염 경로가 불분명한 119번째 환자에 대한 심층 역학조사를 통해 다양한 감염경로의 가능성을 검토하였다. 감염경로를 명확하게 밝혀내지 못한 한계점이 있지만, 지역사회 전파에 대한 가능성을 제시하였다. 감염병 대유행시 효율적인 감염경로 파악을 위해서는 다방면의 자료에 대한 확보체계와 이를 신속히 분석하고 판단할 수 있는 전문 인력 확충이 필요하다.

Citations

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A database of geopositioned Middle East Respiratory Syndrome Coronavirus occurrences
Rebecca E. Ramshaw, Ian D. Letourneau, Amy Y. Hong, Julia Hon, Julia D. Morgan, Joshua C. P. Osborne, Shreya Shirude, Maria D. Van Kerkhove, Simon I. Hay, David M. Pigott
Scientific Data.2019;[Epub] CrossRef

MERS-Perspective

Strengthening epidemiologic investigation of infectious diseases in Korea: lessons from the Middle East Respiratory Syndrome outbreak: Changhwan Lee, Moran Ki; Epidemiol Health. 2015;37:e2015040. Published online September 16, 2015; DOI: https://doi.org/10.4178/epih/e2015040

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Abstract Summary PDF Supplementary Material

Abstract

The recent outbreak of Middle East Respiratory Syndrome (MERS) coronavirus infection in Korea resulted in large socioeconomic losses. This provoked the Korean government and the general public to recognize the importance of having a well-established system against infectious diseases. Although epidemiologic investigation is one of the most important aspects of prevention, it has been pointed out that much needs to be improved in Korea. We review here the current status of the Korean epidemiologic service and suggest possible supplementation measures. We examine the current national preventive infrastructure, including human resources such as Epidemic Intelligence Service officers, its governmental management, and related policies. In addition, we describe the practical application of these resources to the recent MERS outbreak and the progress in preventive measures. The spread of MERS demonstrated that the general readiness for emerging infectious diseases in Korea is considerably low. We believe that it is essential to increase society’s investment in disease prevention. Fostering public health personnel, legislating management policies, and establishing research centers for emerging infectious diseases are potential solutions. Evaluating international preventive systems, developing cooperative measures, and initiating improvements are necessary. We evaluated the Korean epidemiologic investigation system and the public preventive measures against infectious diseases in light of the recent MERS outbreak. We suggest that governmental authorities in Korea enforce preventive policies, foster the development of highly qualified personnel, and increase investment in the public health domain of infectious disease prevention.

Summary

Korean summary
2015년 한국의 메르스 유행시 실제 시행되었던 역학조사 내용을 기술하고, 단계별로 문제점을 검토하였다. 또한 향후 역학조사 강화방안으로 1)관련 법령 수정, 2)역학조사 전문인력 강화, 3) 신종 감염병 연구센터 필요성 등을 제시하였다. 이번 메르스 위기를 기회로 삼아 한국 감염병 대비대응체계를 굳건히 하여야 할 것이다.

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Identifying determinants of heterogeneous transmission dynamics of the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea, 2015: a retrospective epidemiological analysis
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Review

Tularemia, a re-emerging infectious disease in Iran and neighboring countrie: Afsaneh Zargar, Max Maurin, Ehsan Mostafavi; Epidemiol Health. 2015;37:e2015011. Published online February 22, 2015; DOI: https://doi.org/10.4178/epih/e2015011

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Abstract PDF

Abstract

OBJECTIVES
Tularemia is a zoonotic disease transmitted by direct contact with infected animals and through arthropod bites, inhalation of contaminated aerosols, ingestion of contaminated meat or water, and skin contact with any infected material. It is widespread throughout the northern hemisphere, including Iran and its neighbors to the north, northeast, and northwest.

METHODS

In this paper, the epidemiology of tularemia as a re-emerging infectious disease in the world with a focus on Iran and the neighboring countries is reviewed.

RESULTS

In Iran, positive serological tests were first reported in 1973, in wildlife and domestic livestock in the northwestern and southeastern parts of the country. The first human case was reported in 1980 in the southwest of Iran, and recent studies conducted among at-risk populations in the western, southeastern, and southwestern parts of Iran revealed seroprevalences of 14.4, 6.52, and 6%, respectively.

CONCLUSIONS

Several factors may explain the absence of reported tularemia cases in Iran since 1980. Tularemia may be underdiagnosed in Iran because Francisella tularensis subspecies holarctica is likely to be the major etiological agent and usually causes mild to moderately severe disease. Furthermore, tularemia is not a disease extensively studied in the medical educational system in Iran, and empirical therapy may be effective in many cases. Finally, it should be noted that laboratories capable of diagnosing tularemia have only been established in the last few years. Since both recent and older studies have consistently found tularemia antibodies in humans and animals, the surveillance of this disease should receive more attention. In particular, it would be worthwhile for clinical researchers to confirm tularemia cases more often by isolating F. tularensis from infected humans and animals.

Summary

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Original Articles

Prevalence of fungal infections using National Health Insurance data from 2009-2013, South Korea: Hee Jung Yoon, Hwa Young Choi, Young Kwon Kim, Yeong Jun Song, Moran Ki; Epidemiol Health. 2014;36:e2014017. Published online September 11, 2014; DOI: https://doi.org/10.4178/epih/e2014017

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The symptoms of fungal infections vary from minor to severe. According to recent reports, fungal infection prevalence is increasing due to increases in the aging population and in patients with compromised immune systems. However, the total prevalence of fungal infections in South Korea is unknown. We investigated the recent 5-year prevalence of each type of fungal infection in South Korea across age, sex, and regional groups.

METHODS

Nationwide data from the National Health Insurance of South Korea were used. The target population included patients who had received treatment for a fungal infection that was listed as the main disease. For each patient, multiple treatments were counted as one case per year in the data analysis.

RESULTS

The annual prevalence of all-type mycoses increased from 6.9% in 2009 to 7.4% in 2013. Among the specific groups, the prevalence of dermatophytosis was highest (5.2%), followed by that of opportunistic mycoses (1.7%) and superficial mycoses (0.2%). The prevalence of subcutaneous mycoses and generalized mycoses was very low (8 cases per 100,000 persons and 3 cases per 1 million persons, respectively).

CONCLUSIONS

Every year, approximately 7.1% of the Korean population receives treatment for fungal diseases. Cases of opportunistic mycoses are assumed to increase each year. Therefore, further research is needed to understand and monitor the prevalence of mycoses to establish management policies to reduce the burden of fungal diseases.

Summary

Korean summary
2009-2013년도 한국의 건강보험자료를 활용하여 진균 종류별로 연령별, 성별, 지역별 유병률을 검토하였다. 그 결과 한국 인구의 약 7.1%가 매년 진균 질환으로 치료를 받고 있는 것으로 나타났다. 특히 기회감염 진균증의 연도별 증가 양상이 관찰되었다. 진균증 유병률에 대한 이해와 관심이 필요하며 이를 토대로 진균 질환 관리 정책 수립이 필요하다.

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Outbreak of Salmonellosis Misdiagnosed with Amebiasis in Gumi City and Chilgok County, Korea.: Hyun Sul Lim, Geun Ryang Bae, Tai Soon Yong; Korean J Epidemiol. 2002;24(1):54-62.

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Abstract PDF: Abstract
PURPOSE
S: In May 29, 1999, the health department in Gumi city received a report from a local pediatrician that three children who attended a kindergarten were diagnosed with amebic dysentery. By May 31, fifteen more children from the same kindergarten were diagnosed with amebic dysentery. We conducted an investigation in order to verify the diagnosis, and to implement appropriate control measures.
METHODS
We conducted a questionnaire survey on 264 children in 3 kindergarten in Gumi city. Furthermore, 726 children in 4 kindergarten and 13 academies in Chilgok county whose lunch is supplied by the same unlicensed catering company were monitored for diarrheal symptoms.
RESULTS
Of 264 children in Gumi city, 74 children fitted the case definition (attack rate, 28%). Of 726 children in Chilgok county, 50 children were reported to have diarrheal symptoms. The clinical picture was dominated by the following symptoms; abdominal pain (85.1%), fever (83.8%), headache (50.0%), chilling (45.9%), vomiting (28.4%). The median duration of diarrhea was 2 days, and the median frequency of diarrhea was 3 times/day. Salmonella Typhimurium of the same antibiogram pattern were isolated from fifteen cases. However, no evidence of amebiasis was found from laboratory results or epidemiologic pattern.
CONCLUSIONS
: This epidemic was caused by Salmonella Typhimurium, which were present in lunch supplied by the unlicensed catering company. Improvement of the diagnostic ability in local health centers as well as public health centers and reinforcement of strict protocols regarding appropriate management of catering services should be emphasized; Summary

An Epidemiologic Study on Sudden Deaths of Cattle Occurred in Kyongju.: Hyun Sul Lim, Hae Kwan Cheong, Jung Ran Kim, Ik Jung Kim, Gyoung Yim Ha; Korean J Epidemiol. 2001;23(1):59-68.

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Abstract PDF: Abstract
PURPOSE
This study was conducted to provide the baseline data for the epidemiologic and microbiologic investigation for the etiology of sudden deaths of cattle in Sara-Ri, Seo Myun, Kyongju.
METHODS
This survey was performed between April 11 and 22, 1994. Epidemiologic investigation consisted of interview of the residents, as well as pathologic and microbiologic test on tissues and blood samples from cardiac puncture.
RESULTS
The dead numbers of cattle were 149 in 35 households during about 20 years. The cows(63.9%) were more than bulls(36.1%) and most of them were raised in playpen(95.7%). The first death occurred in 1974, and then number of deaths increased until 1994. Besides the age of cattle at death was over two years old (88.3%), most of them(69.4%) died within one hour after onset of noticeable symptom by the farmers. The most common symptom of cattle at death was 'sudden death after screaming(71.1%)' and 'seizure (33.3%)'. Colonies from blood of case 3 showed double hemolysis in blood agar plate. The microbiologic test results in the culture of Clostridium perfringens. The pathological features were characterized as most of renal tubules revealed coagulative necrosis. Some gram-positive bacilli are scattered in interstitium.
CONCLUSIONS
Above results suggest C. perfringens as a possible pathogen of this ourbreak in livestock. The possibility of human infection, although nonfatal, and lack of vaccination against C. perfringens raises a need for stronger preventive action toward this communicable disease of cattle on this village.; Summary

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