Epidemiology and Health

Original article

Effect of the human papillomavirus vaccine on the risk of genital warts: a nationwide cohort study of South Korean adolescent girls: Jaeyoung Cho, Eun Mi Kim, Jihye Kim, Ju-Young Shin, Eui Hyeok Kim, Jong Heon Park, Seunghyun Lewis Kwon, Geun-Yong Kwon, Soon-Ae Shin, Jaiyong Kim; Epidemiol Health. 2024;e2024040. Published online March 18, 2024; DOI: https://doi.org/10.4178/epih.e2024040 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
The purpose of this study was to assess the effectiveness of human papillomavirus (HPV) vaccination administered to adolescent girls through South Korea’s National Immunization Program.
METHODS
This retrospective cohort study included individuals who were 12 to 13 years old, whether vaccinated or unvaccinated, between July 2016 and December 2017. The incidence of genital warts (GWs) was monitored through 2021. Time-stratified hazard ratios (HRs) were estimated, adjusting for birth year, socioeconomic status, and the level of urbanization of the region, and were presented with 95% confidence intervals (CIs). Data were sourced from the Immunization Registry Integration System, linked with the National Health Information Database.
RESULTS
The study included 332,062 adolescent girls, with an average follow-up period of approximately 4.6 years. Except for the first year, the HRs for the vaccinated group were lower than those for the unvaccinated group. The HRs for specific cutoff years were as follows: year 2, 0.62 (95% CI, 0.31 to 1.13); year 3, 0.58 (95% CI, 0.35 to 0.96); and year 4 and beyond, 0.39 (95% CI, 0.28 to 0.52).
CONCLUSIONS
Our findings indicate that HPV vaccination was associated with a reduction in the risk of GWs among adolescent girls. Notably, this reduction became significant as the incidence of GWs increased with age.; Summary

COVID-19: Original Article

Risk of lymphadenopathy from SARS-CoV-2 vaccination in Korea: a self-controlled case series analysis: Mi-Sook Kim, Bongyoung Kim, Jeong Pil Choi, Nam-Kyong Choi, Jung Yeon Heo, Jun Yong Choi, Joongyub Lee, Sang Il Kim; Epidemiol Health. 2023;45:e2023090. Published online October 13, 2023; DOI: https://doi.org/10.4178/epih.e2023090

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
To assess the risk of lymphadenopathy following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination.
METHODS
A self-controlled case series design was used to determine whether the risk of lymphadenopathy was higher in the 1-day to 42-day risk interval after coronavirus disease 2019 (COVID-19) vaccination compared to the control period. In addition, subgroup analyses were conducted according to baseline characteristics, time since vaccination, and sensitivity analyses adjusted for the length of the risk interval.
RESULTS
The risk of developing lymphadenopathy in the risk interval (1-42 days) after COVID-19 vaccination compared to the control period was significantly increased, with a relative incidence (RI) of 1.17 (95% confidence interval [CI], 1.17 to 1.18) when the first, second, and third doses were combined. The RI was greater on the day of vaccination (1.47; 95% CI, 1.44 to 1.50). In subgroup analyses by baseline characteristics, a significantly increased risk or trend toward increased risk was observed in most subgroups except for those aged 70 years and older, with a significant increase in risk in younger individuals, those with a Charlson’s comorbidity index <5, and those who received mRNA vaccines (mRNA-1273>BNT162b2). Within the 1-day to 42-day post-dose risk period, the relative risk was highest during the 1-day to 7-day post-dose period (1.59; 95% CI, 1.57 to 1.60) compared to the control period, and then the risk declined. In the sensitivity analysis, we found that the longer the risk window, the smaller the RI.
CONCLUSIONS
SARS-CoV-2 vaccination is associated with a statistically significant increase in the risk of lymphadenopathy, and this risk was observed only with mRNA vaccines.; Summary

Korean summary
질병관리청의 코로나19 예방접종자료와 국민건강보험공단 자료를 이용하여 수행한 본 자기대조환자군 연구에서 코로나19 백신접종은 42일 내 림프절병증 발생위험을 1.17배 (95% 신뢰구간, 1.17-1.18) 증가시키는 것으로 나타났다. 이러한 위험의 증가는 mRNA 백신에 국한하여 관찰되었으며 연령이 낮을수록, 여성일수록 상대위험도가 높은 것으로 나타났다.

Key Message
This self-controlled case series study, using the Korea Disease Control and Prevention Agency COVID-19 vaccination database and the National Health Insurance Service database, showed an increased risk of developing lymphadenopathy following vaccination (RR 1.17; 95% CI, 1.17 to 1.18). The elevated risk of lymphadenopathy is specifically associated with mRNA platform vaccines, not viral vector vaccines, and is more pronounced in younger individuals and females.

COVID-19: Original Article

Effective vaccination strategies to control COVID-19 in Korea: a modeling study: Youngsuk Ko, Kyong Ran Peck, Yae-Jean Kim, Dong-Hyun Kim, Eunok Jung; Epidemiol Health. 2023;45:e2023084. Published online September 7, 2023; DOI: https://doi.org/10.4178/epih.e2023084

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
In Korea, as immunity levels of the coronavirus disease 2019 (COVID-19) in the population acquired through previous infections and vaccinations have decreased, booster vaccinations have emerged as a necessary measure to control new outbreaks. The objective of this study was to identify the most suitable vaccination strategy for controlling the surge in COVID-19 cases.
METHODS
A mathematical model was developed to concurrently evaluate the immunity levels induced by vaccines and infections. This model was then employed to investigate the potential for future resurgence and the possibility of control through the use of vaccines and antivirals.
RESULTS
As of May 11, 2023, if the current epidemic trend persists without further vaccination efforts, a peak in resurgence is anticipated to occur around mid-October of the same year. Under the most favorable circumstances, the peak number of severely hospitalized patients could be reduced by 43% (n=480) compared to the scenario without vaccine intervention (n=849). Depending on outbreak trends and vaccination strategies, the best timing for vaccination in terms of minimizing this peak varies from May 2023 to August 2023.
CONCLUSIONS
Our findings suggest that if the epidemic persist, the best timing for administering vaccinations would need to be earlier than currently outlined in the Korean plan. It is imperative to continue monitoring outbreak trends, as this is key to determining the best vaccination timing in order to manage potential future surges.; Summary

Korean summary
본 연구는 자연감염 혹은 백신으로 획득된 면역의 저하를 고려한 수리모델을 사용하여 COVID-19에 대한 백신 접종 전략 분석 결과를 보인다. 시뮬레이션 결과는 추가 백신 접종이 없을 경우 재유행의 정점이 800명을 넘을 것임을 나타내며, 적절한 시기에 백신을 접종하면 최대 재원 위중증환자수를 약 40%까지 줄일 수 있음을 보인다. 본 연구는 확진자 추세의 지속적인 모니터링이 백신 접종의 적정 시기를 결정하고 미래 COVID-19의 재유행을 효과적으로 관리하는 데 필요하다는 점을 강조한다.

Key Message
Our study analyzes strategies for COVID-19 through vaccination, using a mathematical model considering waning immunity from past infections and vaccinations. Results indicate that a resurgence peak would reach more than 800 without further vaccination, and suggest vaccination in proper timing can reduce the peak size of administered severe patients by up to approximately 40%. The study emphasizes the importance of ongoing monitoring of outbreak trends to manage vaccination timing and future COVID-19 surges effectively.

COVID-19: Original Article

Barriers to COVID-19 vaccine surveillance: the issue of under-reporting adverse events: Yunha Noh, Hwa Yeon Ko, Ju Hwan Kim, Dongwon Yoon, Young June Choe, Seung-Ah Choe, Jaehun Jung, Ju-Young Shin; Epidemiol Health. 2023;45:e2023054. Published online June 7, 2023; DOI: https://doi.org/10.4178/epih.e2023054

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study investigated the reporting rates of adverse events following immunization (AEFIs) to the spontaneous reporting system (SRS) and its predictors among individuals with AEFIs after coronavirus disease 2019 (COVID-19) vaccination.

METHODS

A cross-sectional, web-based survey was conducted from December 2, 2021 to December 20, 2021, recruiting participants >14 days after completion of a primary COVID-19 vaccination series. Reporting rates were calculated by dividing the number of participants who reported AEFIs to the SRS by the total number of participants who experienced AEFIs. We estimated adjusted odds ratios (aORs) using multivariate logistic regression to determine factors associated with spontaneous AEFIs reporting.

RESULTS

Among 2,993 participants, 90.9% and 88.7% experienced AEFIs after the first and second vaccine doses, respectively (reporting rates, 11.6 and 12.7%). Furthermore, 3.3% and 4.2% suffered moderate to severe AEFIs, respectively (reporting rates, 50.5 and 50.0%). Spontaneous reporting was more prevalent in female (aOR, 1.54; 95% confidence interval [CI], 1.31 to 1.81); those with moderate to severe AEFIs (aOR, 5.47; 95% CI, 4.45 to 6.73), comorbidities (aOR, 1.31; 95% CI, 1.09 to 1.57), a history of severe allergic reactions (aOR, 2.02; 95% CI, 1.47 to 2.77); and those who had received mRNA-1273 (aOR, 1.25; 95% CI, 1.05 to 1.49) or ChAdOx1 (aOR, 1.62; 95% CI, 1.15 to 2.30) vaccines versus BNT162b2. Reporting was less likely in older individuals (aOR, 0.98; 95% CI, 0.98 to 0.99 per 1-year age increment).

CONCLUSIONS

Spontaneous reporting of AEFIs after COVID-19 vaccination was associated with younger age, female sex, moderate to severe AEFIs, comorbidities, history of allergic reactions, and vaccine type. AEFIs under-reporting should be considered when delivering information to the community and in public health decision-making.

Summary

Korean summary
본 연구는 국내 19-49세 성인을 대상으로, 코로나19 예방 백신 접종 후 이상반응 경험에 대한 자발적 보고율을 조사하고, 자발적 보고와 관련된 요인을 파악하고자 하였다. 2021년 12월 2일부터 20일까지 온라인 설문조사를 통하여 자료를 수집하였으며, 연구대상자는 코로나19 예방 백신의 기초접종을 완료한 후 2주 경과한 19-49세 성인으로, 전국 대표성을 확보하기 위해 성별, 연령, 지역별로 층화하여 모집하였다. 이상반응 자발적 보고율은 1차 접종과 2차 접종 후 각각 약 11.6%, 12.7%로 나타났으며, 중등도에서 중증의 이상반응에 대한 자발적 보고율은 약 50.5%, 50.0%로 나타났다. 이상반응 자발적 보고율 관련 영향요인으로는 젊은 연령층, 여성, 이상반응의 중증도, 동반질환, 알러지 반응 이력, 기초접종 백신 종류가 포함되었다.

Key Message
Spontaneous reporting rates of adverse events following immunization (AEFIs) against coronavirus disease 2019 (COVID-19) were low, at around 12 % of any AEFIs and 50 % of moderate-to-severe AEFIs. Younger age, female sex, severe AEFIs, comorbidities, history of allergic reactions, and the type of COVID-19 vaccine were associated with the AEFIs reporting.

Citations

Citations to this article as recorded by

The effect of covid vaccination on menstruation and attitude to the vaccine among Indian women – Results of a prospective survey
Anbukkani Subbian, Jeevithan Shanmugam, Uma Ram
Indian Journal of Obstetrics and Gynecology Research.2024; 11(1): 70. CrossRef

COVID-19: Brief Communication

Self-reported adverse events after 2 doses of COVID-19 vaccine in Korea: Yunhyung Kwon, Insob Hwang, Mijeong Ko, Hyungjun Kim, Seontae Kim, Soon-Young Seo, Enhi Cho, Yeon-Kyeng Lee; Epidemiol Health. 2023;45:e2023006. Published online December 26, 2022; DOI: https://doi.org/10.4178/epih.e2023006

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Abstract Summary PDF

Abstract

OBJECTIVES
In Korea, a national coronavirus disease 2019 (COVID-19) vaccination program was implemented, including 4 vaccines against COVID-19. A text messaging-based survey, in addition to a passive adverse event reporting system, was launched to quickly report unusual symptoms post-vaccination. This study compared the frequency of adverse events after COVID-19 vaccination based on the vaccine type and the type of 2-dose regimen (homologous or heterologous).

METHODS

Self-reported adverse events were collected through a text-message survey for 7 days after each vaccination. This study included 50,950 vaccine recipients who responded to the survey at least once. Informed consent to receive surveys via text was obtained from the vaccine recipients on the date of first vaccination.

RESULTS

The recipients of mRNA vaccines reported local and systemic reactions 1.6 times to 2.8 times more frequently after dose 2 than after dose 1 (p<0.001), whereas ChAdOx1-S recipients reported significantly fewer local and systemic reactions after dose 2 than after dose 1 (p<0.001). Local and systemic reactions were approximately 2 times and 4 times more frequent for heterologous vaccination than for BNT162b2/BNT162b2 and ChAdOx1-S/ChAdOx1-S regimens, respectively. Young individuals, female, and those receiving heterologous vaccine regimens including ChAdOx1-S/BNT162b2 vaccines reported more adverse events than older participants, male, and those with homologous vaccine regimens.

CONCLUSIONS

Although a heterologous regimen, youth, and female sex were associated with a higher risk of adverse reactions after COVID-19 vaccination, no critical issues were noted. Active consideration of heterologous schedules based on the evidence of efficacy and safety appears desirable.

Summary

Korean summary
본 연구는 코로나19 백신 접종 후 7일 동안 문자 설문조사를 통해 50,950명이 자가 보고한 이상반응자료를 분석하였다. mRNA 백신 접종자는1회 접종 후보다 2회 접종 후 국소 이상반응 및 전신이상반응을 1.6~2.8배 더 자주 보고한 반면, ChAdOx1-S 백신 접종자는1회 접종 후 보다 2회 접종 후 이상반응을 더 적게 보고하였다. 동종 백신접종 보다 교차 접종의 경우 2-4배 더 많은 이상반응을 보고 하였다. COVID-19 백신 접종 후 교차접종, 젊은 연령, 여성의 경우 좀 더 많은 이상반응을 보고하였지만,중대한 문제는 보고되지 않았다.

Key Message
Self-reported adverse events were collected through a text-message survey from 50,950 recipients for 7 days after COVID-19 vaccination. The mRNA vaccine recipients reported local and systemic reactions 1.6 to 2.8 times more frequently after dose 2 than after dose 1, whereas ChAdOx1-S recipients reported significantly fewer local and systemic reactions after dose 2 than after dose 1. Local and systemic reactions were approximately 2 to 4 times more frequent for heterologous vaccination than for homologous regimens. Although a heterologous regimen, youth, and female were associated with a higher risk of adverse reac¬tions after COVID-19 vaccination, no critical issues were noted.

Citations

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Safety of a second homologous Ad26.COV2.S vaccine among healthcare workers in the phase 3b implementation Sisonke study in South Africa
Azwidihwi Takalani, Michelle Robinson, Phumeza Jonas, Annie Bodenstein, Vuyelo Sambo, Barry Jacobson, Vernon Louw, Jessica Opie, Jonny Peter, Pradeep Rowji, Ishen Seocharan, Tarylee Reddy, Nonhlanhla Yende-Zuma, Kentse Khutho, Ian Sanne, Linda-Gail Bekker
Vaccine.2024; 42(6): 1195. CrossRef
A Nationwide Survey of mRNA COVID-19 Vaccinee’s Experiences on Adverse Events and Its Associated Factors
Dongwon Yoon, Ha-Lim Jeon, Yunha Noh, Young June Choe, Seung-Ah Choe, Jaehun Jung, Ju-Young Shin
Journal of Korean Medical Science.2023;[Epub] CrossRef

COVID-19: Original Article

Parental concerns about COVID-19 vaccine safety and hesitancy in Korea: implications for vaccine communication: Hye-Kyung Cho, Hyunju Lee, Young June Choe, Shinkyeong Kim, Sujin Seo, Jiwon Moon, Eun Hwa Choi, Geun-Yong Kwon, Jee Yeon Shin, Sang-Yoon Choi, Mi Jin Jeong, Myoungsoon You; Epidemiol Health. 2023;45:e2023004. Published online December 13, 2022; DOI: https://doi.org/10.4178/epih.e2023004

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Abstract Summary PDF

Abstract

OBJECTIVES
Vaccination is one of the most important strategies to contain the spread of coronavirus disease 2019 (COVID-19). Vaccination in children is dependent on their parents, making it important to understand parents’ awareness and attitudes toward vaccines in order to devise strategies to raise vaccination rates in children.

METHODS

A web-based nationwide survey was conducted among Korean parents of 7-year-old to 18-year-old children in August 2021 to estimate parents’ intention to vaccinate their children against COVID-19 and identify key factors affecting parental acceptance and hesitancy through regression analysis.

RESULTS

Approximately 56.4% (575/1,019) were willing to vaccinate their children against COVID-19. Contributing factors to COVID-19 vaccine hesitancy were being a mother (adjusted odds ratio [aOR], 0.36; 95% confidence interval [CI], 0.25 to 0.52), a lower education level (aOR, 0.83; 95% CI, 0.70 to 0.97), hesitancy to other childhood vaccines (aOR, 0.78; 95% CI, 0.64 to 0.96), and refusal to vaccinate themselves (aOR, 0.08; 95% CI, 0.02 to 0.20). Having older children (aOR, 1.20; 95% CI, 1.13 to 1.28), trusting the child’s doctor (aOR, 1.19; 95% CI, 1.07 to 1.32), positive perceptions of the COVID-19 vaccine’s effectiveness (aOR, 2.60; 95% CI, 1.90 to 3.57) and perceiving the COVID-19 vaccine as low-risk (aOR, 1.68; 95% CI, 1.27 to 2.24) were associated with COVID-19 vaccine acceptance. Concerns about adverse reactions were the most common cause of hesitancy.

CONCLUSIONS

Providing parents with accurate and reliable information on vaccine effectiveness and safety is important to increase COVID-19 vaccine uptake in children. Differential or targeted approaches to parents according to gender, age, and their children’s age are necessary for effective communication about vaccination in children.

Summary

Korean summary
부모에게 백신 효과와 안전성에 대한 정확하고 믿을만한 정보를 제공하는 것이 소아 코로나19 백신 접종률을 높이는데 중요하다. 자녀의 백신 접종에 대한 의사소통을 효율적으로 하기 위해서는 부모의 성별과 연령, 자녀의 연령을 고려한 차별적인 접근 방법이 필요하다.

Key Message
To improve COVID-19 vaccine uptake in children, it's crucial to provide parents with reliable and precise information about vaccine safety and effectiveness. Targeted communication strategies that consider factors such as the age of the parents and their children, as well as gender, may be necessary to effectively convey this information.

Citations

Citations to this article as recorded by

Safety of BNT162b2 mRNA COVID-19 vaccine in children with chronic kidney disease: a national population study from South Korea
Young June Choe, Yo-Han Ahn, Eunsun Gwak, Eunseo Jo, Jinseob Kim, Seung-Ah Choe
Pediatric Nephrology.2024; 39(2): 625. CrossRef
Willingness and hesitancy of parents to vaccinate against COVID-19 their children ages 6 months to 4 years with frail conditions in Italy
Grazia Miraglia del Giudice, Giorgia Della Polla, Mario Postiglione, Italo Francesco Angelillo
Frontiers in Public Health.2023;[Epub] CrossRef

COVID-19: Original Article

Physical and mental health characteristics related to trust in and intention to receive COVID-19 vaccination: results from a Korean community-based longitudinal study: Ye Jin Jeon, Youngrong Lee, Ji Su Yang, Young Su Park, Sun Jae Jung; Epidemiol Health. 2022;44:e2022064. Published online August 3, 2022; DOI: https://doi.org/10.4178/epih.e2022064

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
The aim of this study was to explore factors affecting attitudes toward coronavirus disease 2019 (COVID-19) vaccination, including socio-demographic characteristics and mental health status during the pandemic.
METHODS
This study analyzed responses from 1,768 participants who were originally included in a community cohort study and responded to 3 online surveys related to COVID-19 (March 2020 to March 2021). The k-means method was used to cluster trust in and intention to receive COVID-19 vaccination. Baseline (2013-2018) socio-demographic characteristics, physical health status, and depressive symptoms were analyzed as exposure variables, and current mental health status was included in the analyses.
RESULTS
Almost half of all participants were classified into the moderate trust and high intention cluster (n=838, 47.4%); those with high trust and high intention accounted only for 16.9%. They tended to be older, had high-income levels, and engaged in regular physical activity at baseline (p<0.05), and their sleep quality and psychological resilience were relatively high compared to other groups.
CONCLUSIONS
Our results suggest that more efforts are required to enhance the perceived need for and trust in COVID-19 vaccination.; Summary

Korean summary
•본 연구는 코로나19 관련 온라인, 모바일 설문조사에 응답한 1,768명을 대상으로 코로나19 유행 동안의 정신건강 상태와 백신 접종에 대한 태도 (백신에 대한 믿음, 백신에 대한 접종 의사) 사이의 관련성을 파악하고자 하였다. •연구결과 우울, 불안, 외로움, 회복탄력성 등과 같은 정신건강 상태가 나쁜 사람은 백신에 대한 접종 의사가 높을 오즈가 그렇지 않은 사람에 비해 높았으며, 이는 통계적으로 유의하였다.

Key Message
In this community-based study including 1,768 participants who responded online survey related to COVID-19, we investigate the relationship between mental health during the pandemic and attitude toward COVID-19 vaccine (trust and intention). Each of the mental symptoms, including depression, anxiety, and loneliness, was significantly associated with higher intention to COVID-19 vaccine. Our results suggest that more efforts are required to enhance the perceived need for and trust in COVID-19 vaccination.

COVID-19: Original Article

Predictors of COVID-19 booster vaccine hesitancy among fully vaccinated adults in Korea: a nationwide cross-sectional survey: Yunha Noh, Ju Hwan Kim, Dongwon Yoon, Young June Choe, Seung-Ah Choe, Jaehun Jung, Sang-Won Lee, Ju-Young Shin; Epidemiol Health. 2022;44:e2022061. Published online July 22, 2022; DOI: https://doi.org/10.4178/epih.e2022061

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study explored predictors of coronavirus disease 2019 (COVID-19) booster hesitancy among fully vaccinated young adults and parental COVID-19 vaccine hesitancy for their children.

METHODS

This cross-sectional study administered an online survey from December 2 to December 20, 2021. We enrolled participants aged 18-49 years, for whom ≥2 weeks had passed after their initial COVID-19 vaccination. We estimated odds ratios (ORs) with 95% confidence intervals (CIs) using multivariate logistic regression to evaluate factors associated with booster/vaccine hesitancy.

RESULTS

Among the 2,993 participants, 48.8% showed hesitancy (wait and see: 40.2%; definitely not: 8.7%). Booster hesitancy was more common among women (OR, 1.25; 95% CI, 1.05 to 1.50), younger people (OR, 1.44; 95% CI, 1.17 to 1.77), those with a lower education level (OR, 2.05; 95% CI, 1.10 to 3.82), those who received the mRNA-1273 vaccine type (OR, 2.01; 95% CI, 1.65 to 2.45), and those who experienced serious adverse events following previous COVID-19 vaccination (OR, 2.03; 95% CI, 1.47 to 2.80). The main reasons for booster hesitancy were concerns about safety (54.1%) and doubts about efficacy (29.8%). Among the 1,020 respondents with children aged <18 years, 65.8% were hesitant to vaccinate their children against COVID-19; hesitancy was associated with younger parental age, education level, the type of vaccine the parent received, and a history of COVID-19 infection.

CONCLUSIONS

Concerns about the efficacy and safety of COVID-19 vaccines were the major barrier to booster acceptance. The initial COVID-19 vaccine type (mRNA-1273), young age, gender (women), a low education level, and adverse events after the first COVID-19 vaccine were key predictors of booster hesitancy.

Summary

Korean summary
본 연구는 국내 19-49세 성인을 대상으로, 코로나19 3차접종 의향과 그들의 18세 미만 자녀에 대한 코로나19 기초접종 의향을 조사하고, 코로나19 백신접종 기피와 관련된 요인을 파악하고자 하였다. 2021년 12월 2일부터 20일까지 온라인 설문조사를 통하여 자료를 수집하였으며, 연구대상자는 코로나19 기초접종을 완료한 후 2주 경과한 19-49세 성인으로, 전국 대표성을 확보하기 위해 성별, 연령, 지역별로 층화하여 모집하였다. 코로나19 3차접종 기피율은 약 48.8%로 나타났으며, 접종 기피 관련 영향요인으로는 젊은 연령층, 여성, 낮은 교육수준, 기초접종 백신 종류, 기초접종 후 중증 이상반응 경험이 포함되었으며, 18세 미만 자녀에 대한 코로나19 기초접종 기피율은 65.8%로, 관련 영향요인으로는 젊은 부모 연령, 교육수준, 부모의 기초접종 백신 종류, 코로나19 감염 과거력이 포함되었다.

Key Message
Concerns about the safety and efficacy of COVID-19 vaccines were the major barrier to booster acceptance; the initial COVID-19 vaccine type (mRNA-1273), younger age, gender (women), a low education level, and adverse events after the first COVID-19 vaccine were key predictors of booster hesitancy.

Citations

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Yam B. Limbu, Bruce A. Huhmann
Tropical Medicine and Infectious Disease.2023; 8(3): 159. CrossRef
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Kai Wei Lee, Sook Fan Yap, Hooi Tin Ong, Myo Oo, Kye Mon Min Swe
Vaccines.2023; 11(3): 638. CrossRef
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Theresia Santi, Badriul Hegar, Zakiudin Munasir, Ari Prayitno, Retno Asti Werdhani, Ivo Novita Sah Bandar, Juandy Jo, Ruswati Uswa, Ratna Widia, Yvan Vandenplas
Clinical and Experimental Vaccine Research.2023; 12(3): 240. CrossRef
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A. Takamatsu, H. Honda, T. Miwa, T. Tabuchi, K. Taniguchi, K. Shibuya, Y. Tokuda
Public Health.2023; 223: 72. CrossRef
Predictors of COVID-19 Vaccine Hesitancy Among Parents of Children Aged 5–11 Years in Korea
Ju Hwan Kim, Dongwon Yoon, Yunha Noh, Jaehun Jung, Young June Choe, Ju-Young Shin
Journal of Korean Medical Science.2023;[Epub] CrossRef
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Seong-Heon Wie, Jaehun Jung, Woo Joo Kim
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Epidemiology and Health.2022; 45: e2023004. CrossRef

COVID-19: Brief Communication

Dynamics of hospitalizations and in-hospital deaths from COVID-19 in northeast Brazil: a retrospective analysis based on the circulation of SARS-CoV-2 variants and vaccination coverage: Paulo Ricardo Martins-Filho, Adriano Antunes de Souza Araújo, Lucindo José Quintans-Júnior, Bárbara dos Santos Soares, Waneska de Souza Barboza, Taise Ferreira Cavalcante, Victor Santana Santos; Epidemiol Health. 2022;44:e2022036. Published online April 5, 2022; DOI: https://doi.org/10.4178/epih.e2022036

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Abstract Summary PDF

Abstract

This study investigated the dynamics of hospitalizations and in-hospital deaths from coronavirus disease 2019 (COVID-19) throughout the pandemic in northeast Brazil, the Brazilian region with the worst socioeconomic indicators. In total, 141,445 cases, 8,213 hospital admissions, and 1,644 in-hospital deaths from COVID-19 were registered from March 14, 2020 to February 5, 2022. The overall rates of hospitalization and in-hospital deaths were 5.8% and 20.0%, respectively. The hospitalization and death rates significantly decreased over time, which may have been related to progress in vaccination. During the spread of the Gamma variant (January to June 2021), most hospitalized individuals were young adults, and approximately 40% of deaths occurred in this age group. During the predominance of Delta (July to December 2021), over 75% of deaths occurred among the elderly and unvaccinated or partially vaccinated individuals. This rate decreased to 42.3% during the transmission of the Omicron variant (January to February 2022), during which 34.6% of deaths were recorded among fully vaccinated individuals (2 doses) and 23.1% among those who received full vaccination and a booster. The Omicron-driven third wave was associated with a rise in the proportion of deaths among vaccinated individuals, especially among those who had not received a booster dose.

Summary

Key Message
The Omicron-driven third wave in Brazil was associated with a rise in the proportion of deaths among vaccinated individuals, especially among those who had not received a booster dose

Citations

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Diego Gomes Teixeira, João Firmino Rodrigues-Neto, Dayse Caroline Severiano da Cunha, Selma Maria Bezerra Jeronimo
Infection, Genetics and Evolution.2024; 118: 105556. CrossRef
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Paulo Ricardo Martins-Filho, Jerocílio Maciel de Oliveira Júnior, Cliomar Alves dos Santos
Enfermedades Infecciosas y Microbiología Clínica.2023; 41(3): 199. CrossRef
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Pediatric Infectious Disease Journal.2023; 42(2): 136. CrossRef
Case-fatality rates and risk of death from COVID-19 and influenza A/H3N2 in Brazil: A nationwide ecological study
Paulo Ricardo Martins-Filho, Jerocílio Maciel de Oliveira Júnior, Cliomar Alves dos Santos
Enfermedades infecciosas y microbiologia clinica (English ed.).2023; 41(3): 199. CrossRef
Impact of inactivated vaccines on decrease of viral RNA levels in individuals with the SARS-CoV-2 Omicron (BA.2) variant: A retrospective cohort study in Shanghai, China
Peng Yang, Bianli Dang, Wen Kang, Xiaofeng Li, Tianping Wang, Ruijuan Li, Meijuan Peng, Yushen Liu, Linxu Wang, Yan Cheng, Suhuai Yu, Min Wei, Han Gao, Wenzhen Kang, Lei Shang
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Clinical Characteristics and Risk Factors for Mortality in Critical COVID-19 Patients Aged 50 Years or Younger During Omicron Wave in Korea: Comparison With Patients Older Than 50 Years of Age
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Epidemiology and Health.2023; 45: e2023025. CrossRef
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Perspective

Measles susceptibility of marriage migrant women in Korea: Sooyeon Kim, Sun A Kim, Hanbich Hong, Seong Ryeong Choi, Hae-Young Na, Sung Un Shin, Kyung-Hwa Park, Sook In Jung, Min-Ho Shin, Sun-Seog Kweon, Seung Ji Kang; Epidemiol Health. 2022;44:e2022031. Published online March 12, 2022; DOI: https://doi.org/10.4178/epih.e2022031

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Abstract Summary PDF: Abstract
International migrants could be considered a risk group susceptible to vaccine-preventable diseases. We conducted a measles seroprevalence study among 419 marriage migrant women living in Sinan-gun and Wando-gun, South Jeolla Province, located in the southwestern part of Korea. The overall seroimmunity was 92.8%. The seroimmunity varied considerably according to the country of origin and increased with age. Our current analysis could be valuable in the context of discussions concerning vaccination policies for immigrants in Korea.; Summary

Korean summary
전라남도 신안군과 완도군에 거주하는 결혼이주여성 419명을 대상으로 홍역항체 양성률을 조사하였다. 전체적 항체양성률은 92.8% 로 높았으나, 나이로 나누어 분석하였을 때, 30세 미만에서는 83.1% 로 30세 이상의 95.5% 에 비해 통계적으로 유의미하게 낮았다. 출신국가에 따른 분석에서는 캄보디아 출신의 경우 30세 미만에서 항체 양성률이 40.0 % 에 불과하여, 타국가 들에 비해 통계적으로 유의미하게 낮았다.

Key Message
To prevent measles resurgence, continuous monitoring of immunity in communities, including foreign-born populations who may have different serostatus, is essential.

Original Articles

Persistence of vaccine-induced antibodies to A/H5N1 at 30 months and 36 months after vaccination in Vietnam: Chien Vien Chinh, Viet Phu Quoc, Loc Huynh Tan, Duoc Nguyen Van, Thai Pham Quang, Be Le Van; Epidemiol Health. 2021;43:e2021076. Published online October 6, 2021; DOI: https://doi.org/10.4178/epih.e2021076

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Abstract Summary PDF: Abstract
OBJECTIVES
An A/H5N1 vaccine (IVACFLU-A/H5N1) was accepted for use in Vietnam; however, antibody persistence after vaccination has not been well characterized. We examined post-vaccination antibody persistence and related risk factors in individuals enrolled in the phase II IVACFLU-A/ H5N1 vaccine trial in Ninh Hoa, Vietnam, who received a 15-μg dose (2 injections 21 days apart).
METHODS
We used a longitudinal study design to follow 86 participants, without a control group. The participants tested as anti-A/H5N1 immunoglobulin G seronegative at baseline and received both doses of the vaccine. Blood was drawn at 30 months and 36 months after the complete vaccination to assess antibody status. Antibody persistence status was compared by demographic characteristics and exposure risk factors using univariate logistic regression.
RESULTS
In total, 84.9% and 52.3% of the population showed persistence of at least 1/10 of the A/H5N1 antibodies at 30 months and 36 months after IVACFLU-A/H5N1 vaccination, respectively. The odds of antibody persistence were higher in older people, but lower in people who had experienced flu-like symptoms in the past 18 months or between 2 visits. We recorded no differences between A/H5N1 antibody persistence and exposure risk factors, including having a poultry farm, coming into contact with poultry, and slaughtering and processing poultry.
CONCLUSIONS
This study demonstrated noteworthy antibody persistence, indicated by the seroconversion rate and geometric mean titer at 30 months and 36 months after the IVACFLU-A/H5N1 vaccine. Further studies should investigate older people and those who experienced flu-like symptoms to determine a suitable time for a booster shot.; Summary

Key Message
A longitudinal un-controlled study followed participants enrolled in the phase II IVACFLU-A/ H5N1 vaccine trial in Ninh Hoa, Vietnam. The participants tested for anti-A/H5N1 IgG at baseline, 30 months, and 36 months after the complete vaccination to assess antibody status. 84.9% and 52.3% of the population have persistence of at least 1/10 of the A/H5N1 antibodies at 30 months and 36 months, respectively. Antibody persistence was higher in older people but lower in people who had experienced flu-like symptoms in the past or between 2 visits. The result can interpret that remarkable antibody persistence long after vaccination.

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 (R2). 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 R2 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.

Citations

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Anna K. Porter, Sarah E. Kleinschmidt, Kara L. Andres, Courtney N. Reusch, Ryan M. Krisko, Oyebode A. Taiwo, Geary W. Olsen, Matthew P. Longnecker
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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
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Frontiers in Cardiovascular Medicine.2022;[Epub] CrossRef
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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
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Bacillus of Calmette and Guérin (BCG) and the risk of leprosy in Ciudad del Este, Paraguay, 2016-2017: Nancy Carolina Cuevas, Victor M. Cardenas; Epidemiol Health. 2021;43:e2021060. Published online September 8, 2021; DOI: https://doi.org/10.4178/epih.e2021060

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Abstract Summary PDF

Abstract

OBJECTIVES
Paraguay has experienced a 35% reduction in the detected incidence of leprosy during the last ten years, as the vaccination coverage against tuberculosis (Bacillus of Calmette and Guérin [BCG] vaccine) reached ≥95% among infants. The objective of this case-control study was to evaluate the protective effect of BCG on the risk of leprosy.

METHODS

We used a population-based case-control study of 20 leprosy confirmed cases reported among residents of Ciudad del Este, Paraguay, diagnosed in 2016-2017. Three controls were selected from a random sample of households from the city. We assessed vaccine effectiveness using 1- odds ratio [OR], and confounding for age, gender, education, occupation, and marital status using stratified and exact logistic regression, and explored if there was effect modification calculating the synergy factor (SF) and relative excess risk due to interaction (RERI).

RESULTS

After controlling for age, gender, education, occupation and marital status, the OR of BCG scar on the risk of leprosy was 0.10 (95% confidence interval [CI], 0.02 to 0.45), for an estimate of vaccine effectiveness of 89.5% reduced risk of leprosy (95% CI, 55.2 to 98.1). There was evidence of heterogeneity by which the effectiveness of BCG seemed stronger among younger persons (Breslow-Day and Z-test of the SF had a p<0.05), and both the RERI and SF indicated a less then multiplicative and additive interaction of BCG and younger age.

CONCLUSIONS

BCG vaccination was associated with a decreased risk of leprosy in the study population, particularly in persons born after 1980.

Summary

Key Message
Paraguay had the second highest reported incidence in the Americas, but no previous study had investigated the topic of BCG for leprosy in Paraguay. We confirmed that BCG protected from leprosy, hence it may have contributed to the observed decline of leprosy.

Citations

Citations to this article as recorded by

BCG and SARS-CoV-2—What Have We Learned?
Jakub Kulesza, Ewelina Kulesza, Piotr Koziński, Wojciech Karpik, Marlena Broncel, Marek Fol
Vaccines.2022; 10(10): 1641. CrossRef

Recent increase in pertussis incidence in Korea: an age-period-cohort analysis: Chanhee Kim, Seonju Yi, Sung-il Cho; Epidemiol Health. 2021;43:e2021053. Published online August 18, 2021; DOI: https://doi.org/10.4178/epih.e2021053

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Pertussis or whooping cough—one of the most contagious diseases—is caused by the Gram-negative bacterium Bordetella pertussis. Despite a high vaccination rate, Korea recently experienced a resurgence of pertussis. This study explores patterns and possible explanations for this resurgence through an age-period-cohort analysis.

METHODS

Using secondary data from the infectious disease portal of the Korea Disease Control and Prevention Agency and the Korea Statistical Information Service of Statistics Korea, this study analyzed the incidence of pertussis in Korea to determine which factors contributed to the recent increase using an age-period-cohort model.

RESULTS

Analysis of the age effect indicated that the age group most vulnerable to pertussis was 0-year to 2-year-olds. Analysis of the period effect showed a sharp increase in the incidence rate after 2016. Analysis of the cohort effect showed a significant decrease in incidence beginning with the 1955 birth cohort, with the risk increasing again with the 2000s birth cohort.

CONCLUSIONS

Previous studies have suggested 3 main possible explanations for our results. First, the increased incidence rate can be attributed to contact rates. Second, the rate of immunity through natural exposure has decreased due to the low number of circulating pathogens, in turn affecting the trend of infection. Lastly, variations in pathogens may have also contributed to the increase in incidence. Given that the most significant increase in incidence was observed among infants younger than 1 year old, sufficient maternal immunity must be prioritized to provide passive immunity to newborns via the placenta.

Summary

Korean summary
본 연구는 연령-기간-코호트 모델을 활용하여 예방접종률이 높은 국가들의 백일해 재출현에 기여하는 요인에 무엇이 있는지 살펴보았다. 연령에 따른 사회적 접촉률(contact rate)의 변화, 자연노출에 의한 면역 강화(natural boosting) 기회의 감소, 그리고 백일해 병원체의 변이가 백일해 재출현의 원인일 수 있다. 분석 결과 영아 집단에서 백일해 발병률이 가장 급격한 증가가 관찰되었으며, 이는 모성면역의 확보가 중요하다는 점을 시사한다.

Key Message
This study examined factors contribute to the re-emergence of pertussis in countries with high vaccination rates using the age-period-cohort model. Changes in social contact rates according to age, reduction in immune boosting opportunities by natural exposure, and variations in pertussis pathogens may be the cause of re-emergence. As a result of the analysis, the sharpest increase in the incidence of pertussis in the infant group was observed, suggesting that securing maternal immunity is important.

Citations

Citations to this article as recorded by

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Dynamics of the COVID-19 epidemic in the post-vaccination period in Korea: a rapid assessment: Kyung-Duk Min, Sangwoo Tak; Epidemiol Health. 2021;43:e2021040. Published online May 27, 2021; DOI: https://doi.org/10.4178/epih.e2021040

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Coronavirus disease 2019 (COVID-19) has had a tremendous impact on public health and socioeconomic conditions globally. Although non-pharmaceutical interventions (NPIs) such as social distancing effectively reduced the incidence of COVID-19, especially in Korea, demand for vaccination has increased to minimize the social costs of NPIs. This study estimated the potential benefits of COVID-19 vaccination in Korea.

METHODS

A mathematical model with vaccinated–susceptible–latent–infectious–recovered compartments was used to simulate the COVID-19 epidemic. The compartments were stratified into age groups of 0-19 years, 20-59 years, and 60 years or older. Based on the Korea Disease Control and Prevention Agency national vaccination plan for the second quarter of 2021, announced on March 15, we developed vaccination scenarios (with 150,000 dose/d and 100% compliance as the main scenario). Comparing scenarios without vaccination or with higher/lower vaccination rates and compliance, we estimated the numbers of COVID-19 cases that will be prevented by vaccination.

RESULTS

The results projected 203,135 cases within a year after April 2021 without vaccination, which would be reduced to 71,248 (64.9% decrease) by vaccination. Supposing a vaccination rate of 150,000 dose/d and 100% compliance, social distancing interventions for those aged 20 or more can be retracted after January 1, 2022.

CONCLUSIONS

We expect COVID-19 vaccination to be effective in Korea. Health authorities should minimize delays in vaccination and vaccine avoidance to maximize the effectiveness of vaccination and end social distancing early.

Summary

Korean summary
본 연구에서 국내 백신 접종 시작이후의 코로나19 유행 추이를 수학적 모형을 통하여 예측하였다. 연구 결과, 백신 접종이 전혀 진행되지 않을 경우, 2021년 4월부터 1년간 203,135 건의 확진 사례가 보고될 것으로 예측되었으나, 하루 15만 도즈의 접종이 진행될 경우 같은 기간의 확진자 수를 64.9% 감소시킬 수 있을 것으로 나타났으며, 20세 이상을 대상으로한 사회적 거리두기 정책은 2022년 1월에 중지될 수 있을 것으로 예상되었다.

Key Message
A mathematical model with vaccinated–susceptible–latent–infectious–recovered compartments was used to simulate the COVID-19 epidemic in Korea. The results projected 203,135 cases within a year after April 2021 without vaccination, which would be reduced to 71,248 (64.9% decrease) by vaccination (150,000 doses per day and 100% compliance). Supposing a vaccination rate of 150,000 doses per day and 100% compliance, social distancing intervention for those aged 20 or more can be retracted after January 1, 2022.

Citations

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