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Epidemiological characteristics of and containment measures for COVID-19 in Busan, Korea
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Hyunjin Son, Hyojung Lee, Miyoung Lee, Youngduck Eun, Kyounghee Park, Seungjin Kim, Wonseo Park, Sora Kwon, Byoungseon Ahn, Dongkeun Kim, Changhoon Kim
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Epidemiol Health. 2020;42:e2020035. Published online June 1, 2020
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DOI: https://doi.org/10.4178/epih.e2020035
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 Abstract
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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.
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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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Citations
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A large outbreak of Salmonella enterica serovar Thompson infections associated with chocolate cake in Busan, Korea
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Youngduck Eun, Hyesun Jeong, Seungjin Kim, Wonseo Park, Byoungseon Ahn, Dongkeun Kim, Eunhee Kim, Eunhee Park, Sunhee Park, Inyeong Hwang, Hyunjin Son
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Epidemiol Health. 2019;41:e2019002. Published online January 9, 2019
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DOI: https://doi.org/10.4178/epih.e2019002
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18,641
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420
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34
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36
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Abstract
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PDFSupplementary Material
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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.
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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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