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Analysis of Transmission Mode of Confirmed Shigellosis in Gyeongju, Korea.
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Cheoll Jung, Hyun Sul Lim, Gyoung Yim Ha, Hee Su Kim
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Korean J Epidemiol. 2004;26(1):1-16.
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PURPOSE
This study was carried out to investigate the sources of infection and modes of transmission of an 107 (54males, 53 females) confirmed shigellosis in Gyeongju from Sept. 24 to Oct. 24, 1998.METHODS We reviewed hospital records of all confirmed shigellosis. Thirty-two strains of Shigella sonnei isolated were analyzed in order to trace the source of infections by plasmid profile, antimicrobial drug resistance pattern, biotyping and pulsed-field gel electrophoresis (PFGE).RESULTS The first source of infection was estimated to be contaminated underground water and simple piped water caused by leakage from the cess pool. Antimicrobial drug resistance pattern showed that all strains were multi-resistant. All isolates had the same XbaI and SfiI PFGE patterns, indicating the epidemiological relationship of the outbreaks strains in this area. The major characteristics of diarrhea were watery (84.2%) in nature.
The clinical symptoms among the diarrheal cases included abdominal pain (86.1%), fever (83.2%), headache (78.2%), chill (45.5%) and tenesmus (41.6%). Six cases were asymptomatic. From initial manifestation to admission were 6.2+/-1.6 (median 6) days, so it could be transmitted to others in this infective period. Duration of admission were 5.5 +/-2.4 (median 6) days. We can find familial mean secondary attack rate were 38.5%.CONCLUSION It's transmission to other areas were certified by contaminated water and contact with shigellosis, and unknown cases were estimated to be transmitted by contacts with inapparent infection. By plasmid profile and PFGE, the epidemiological relationship of the outbreaks strains in this area seemed to be the same micro-organisms.
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An Epidemiologic Study on Sudden Deaths of Cattle Occurred in Kyongju.
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Hyun Sul Lim, Hae Kwan Cheong, Jung Ran Kim, Ik Jung Kim, Gyoung Yim Ha
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Korean J Epidemiol. 2001;23(1):59-68.
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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.
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An Epidemiological Investigation of an Outbreak of Rubella Occurred in a Male High School in Kyongju.
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Hae Kwan Cheong, Hyun Sul Lim, Cheol Jung, Gyoung Yim Ha
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Korean J Epidemiol. 1998;20(2):202-211.
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This epidemiological study was carried out to investigate the sources of infection and modes of transmission of an outbreak of rubella that occurred among male high school students in Kyongju in march, 1996. 770 male students(286 third grade, 262 second grade, 222 first grade students) were selected as the study subjects. A questionnaire was completed by the subjects. The anti-Rubella antibodies IgM and IgG were examined and tested by ELISA on all sera from 770 students and the environmental status of class rooms, the dormitory conditions and study rooms were tested. The positive IgM result rate was 17.8% and when the IgM negative was combined with IgG positive the results was 74.9%. IgM IgG negative rates were 7.3%, however, out of a total 770 students. Amongst the older students, the IgM positive rate showed an increase(p<0.01). Out of 137 cases(with a cummulative incidence rate of 71.0%), there were 97 apparant cases(cummulative incidence rate 50.3%) and 40 inapparent cases(cummulative incidence rate 20.7%). Again, the cummulative incidence rate showed an increase in the older students(p<0.04). In the apparent cases, major symptoms included eruption(96.9%), fever(85.6%), lymphadenitis(82.5%), generalized aches and muscle tenderness(76.3%), and a sore throat(61.9%). These symptoms lasted anywhere from 2 degrees =/ 13 days, the average duration being 4 days in length. Initially, there were 9 people on third grade and suspected origin was from more than 2 external sources. It progressed from the upper grades down to the lower grades. In dormitory students, the cummulative incidence ratio was 1.70 and 1.78 amongst study room students.
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An Epidemiological Survey on a Salmonella enteritidis Outbreak in Kyongju, Korea.
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Mee Kyung Kim, Hyun Sul Lim, Cheol Jung, Gyoung Yim Ha
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Korean J Epidemiol. 1998;20(2):187-201.
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This study was conducted to investigate the cause and magnitude of food poisoning among residents and visitors for a birthday party in a rural area of Kyongju city in september, 1996. The total subjects were 137 persons, 119 residents(53 males, 66 females), including 7 hospitalixed patients and 18 visitors(8 males, 10 females). The investigation consisted of an interview survey, a study on clinical characteristics for the patients hospitalized, bacteriological examinations of the underground water and microbiologic examinations on microbes isolated from the patients. The population at risk was 59 persons(24 males, 35 females). The attack rate was 50.0%(12 cases) for males, 48.6% for females(17 cases). The cases were distributed evenly for all age groups. The attack rates for each party-food and possible fooe groups were not significantly different. Most clinical symptoms were significantly more frequent among cases than non-ases: abdominal pain(73.1%), diarrhea(73.1%), chilliness(69.2%), fever(65.4%), anorexia(61.5%), nausea(53.8%), general weakness(50.0%) and dizziness(50.0%) were the major symptoms among the cases.
The admission rate among the cases was 24.1%(1 male, 6 females). In the stool cultures, Salmonella species group D was isolated from 6 persons of 85 examinees. It was identified as Salmonella enteritidis by serological diagnosis. The samples of underground water were assessed Enon-compatible for drinking in 10 wells(83.3%) of this rural area and it was suggested that it could have been contaminated from cattle feces. There were two wells in the party house, one of them was contaminated by bacterias including E. coli. The contaminated water was stored in a water tank located on the rooftop. This water was used for dish washing and cooking. Wd concluded that the cause of this epidemic was the underground water contaminated by Salmonella enteritidis from guman carriers or domestic animal carriers.
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