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Cholera in Korea, 1991: models of transmission.
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Han Joong Kim, Il Suh, Hee Choul Oh, Kyoo Sang Kim, Sun Ha Jee, Soon Young Lee, Sun Hee Lee
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Korean J Epidemiol. 1991;13(2):123-139.
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Abstract
In August-September 1991，Korea had a cholera epidemic caused by Vibrio El Tor Ogawa with 92 bacteriologically confirmed cases and 8 deaths.
Seochun-gun Choongnam, Kunsan-si and Okgu-gun Chunbuk area, which are located near the mid-west coast of the country, were mainly affected. Vibrio cholerae were isolated from sewage water, sea water, squid and shell-fish tested during the epidemic, and an epidemiologic study found that consumption of raw shellfish or fish was the most probable source of cholera infection.
Vibrio cholerae were thought to have spread from foreign countries and there were some evidence that an environmental reservoir of cholera might play a role in the transmission of cholera in this epidemic.
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Epidemiological characteristics of cholera epidemic in Korea, 1991.
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Hee Choul Oh, Jong Ku Park, Mook Shik Kim, Kyoo Sang Kim, Sun Ha Jee, Soon Young Lee, Sun Hee Lee
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Korean J Epidemiol. 1991;13(2):112-122.
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From July 30th through September 9th, 1991, 188 cases of cholera were reported throughout most provinces in Korea. Of the cases 92 were bacteriologically confirmed and 96 were diagnosed by clinical symptoms. Through screening of the cholera epidemic area residents 58 inapparent infections were discovered and 8 deaths occurred.
A population interview survey was conducted to the people inhabiting the five villages at the two epidemic foci, Sochon and Okgu. Other various information sources such as reported cases to health centers or quarantine stations, medical records of some hospitals, and laboratory findings of National Institute of Health were used to describe the cholera epidemic. Data from these sources were rearranged and analysed on an individual bases. Epidemiological characteristics of the 1991 cholera epidemic of Korea are as follows:
1. Vibrio cholerae biotype El Tor, sero type Ogawa was the causitive agent.
2. The epidemic duration was 25 days from August 13th to September 7th.
3. Epidemiological investigation of the two epidemic foci-Sochon, and Okgu counties-in the west coastal regions of the Korean penisula-revealed that 155 cases occurred in explosive outbreaks amounting to 82.5% of the total 188 noted cholera cases.
4. The epidemic curve of the 1991 cholera epidemic showed that of a typical point-source outbreak suggesting that there were few secondary infected cases.
5. Lower incidence rates among younger age groups and higher incidence rates among older age groups were noted. These findings support that this cholera outbreak was epidemic not endemic.
These findings suggest that epidemiological characteristecs of the 1991 cholera epidemic differ from those of 1980 or before, in number of patients, duration of epidemic and the epidemic curve pattern. The authors suspect that improved national and personal hygiene might explain the difference.
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A study on time-series changes of visual acuity and related factorsfor high school students in Seoul.
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Jiyeon Park, Il Soon Kim, Hee Choul Oh
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Korean J Epidemiol. 1991;13(1):52-62.
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The purpose of this study was to observe the ten-year changes of visual acuity and to determine the factors of reducing visual acuity-especially learning musical instrument-. For the study, data from ten-years health record of one high school in Seoul that checked by school yearly and self-written questionnaire was analysed. The subject of study were 314 (150 : male, 164 : female).
The results of study were summarized as follows.
1. The average visual scuity of female was more reduced than male by aging during past ten years. The oneset of low average visual acuity that defined less than 1.0 in this study was third grade of elemantary school in femals and second grade of middle school in male. In male, the rate of low visual acuity increased by aging but in female the rate fluctuated.
2. The propotion of low visual acuity at third grade of high school was 54.0% in male, 74.0% in female.
3. The performance of middle and high school was associated with low visual acuity but not statistically significant in female, other general factors of visual acuity were statistically insignificant.
4. In family history of visual acuity, low visual acuity were associated with putting on mother’s and brother’s glasses but not statistically significant.
5. The group of low visual acuity at third grade of high school was longer in learning musical instrument than group of normal visual acuity but not statistically significant.
6. The average visual acuity of group learning musical instrument was lower than group not learnig. The onset of low average visual acuity of group learning musical instrument was earlier than group not learning.
7. By the period of learning musical instrument, rate of low visual acuity were increased and statistically significant, but by the level of operating instrument was not statistically significant.
To sum up the results, visual acuity was gradually reduced by aging and the onset of low visual acuity of female was earlier than male. At all age the average of female’s visual acuity was lower than male’s.
The onset of low visual acuity of group learning musical instrument was earlier than group not learning musical instrument and the average visual acuity of group learning musical instrument was lower than group not learning musical instrument.
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Mortality of Koreans in the fourth decade of age
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Il Soon Kim, Sun Ha Jee, Hee Choul Oh, Il Suh
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Korean J Epidemiol. 1990;12(2):191-210.
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The Mortality experience among Koreans in their forties during the past eight yeasrs was compared to the countries, of Singapore, Czechoslovakia, Hungary, Poland, U.S.A.，U.K., Japan, and Germany in order to determine the mortality status and structure of Koreans in the fifth decade of age.
The major findings are as follows ；
1. The age — specific and sex — specific death rates of Koreans showed a continuous decrease during the past eight years. When compared to other countries, the death rate among males in Korea was similar to or lower than the rate in the developing countries but higher than the rate in the developed countries. On the other hand, there was no significant difference in death rates among females compared with the developed countries.
2. When comparing the causes of death among Koreans with the Japanese, infections disease was 3.4 — 4.5 times greater and chronic non—infectious desease was 1.5 — 2.1 times greater, for both sexes. Pulmonary tuberculosis was 30 times higher for males in their twenties to fities, and hepatic carcinoma and gastric carcinoma were 4 一 7 times and 1.5 — 2 times higher, respectively, for males in their thirties to forties.
The higher death rates among Koreans compared with the developed countries are attributed to infectious disease, hepatic carcinoma, and gastric carcinoma, which have decreased in recent years. In conclusion, the death rates of Koreans in their forties are higher compared with the developed countries but lower compared to the developing countries, along the lines of socioeconomic achievement.
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A study on the effect of regional health insurance upon the appendectomy rate
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Yo Hwan Yang, Il Soon Kim, Hee Choul Oh
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Korean J Epidemiol. 1988;10(1):109-123.
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The objective of this study is to identify the change of the incidence and patterns of appendectomy due to the introduction of regional health insurance.
In order to compare the appendectomy rate before and after the introduction of regional health insurance, survey was performed in Kangwha county were the regional health insurance has implemented for all residents since July 1, 1982.
Seventy risidents from 3 townships (Seonwon, Buleun and Naega Myun) had received appendectomy from July 1, 1977 to June 30, 1982 and 790 people among all residents in the county had received appendectomy for the next 5 years(1982. 7.1-1987. 6.30).
The results are as follows:
1. The appendectomy rate before insurance was 8.7/10,000, but it was increased significantly to 22.4/10,000 after the insurance.
2. The appendectomy rate among young age group was increased remarkably, especially, the rate was increased by 12.4 times for female teen age group.
3. While the percentage of perforated appendicitis among appendectomy cases was decreased after the insurance, the rate of perforated appendicitis per 10,000 population was increased to only 1.9 times.
4. The appendectomy rate was increased more in the high economic group than that in low economic group.
5. During the 5 years after insurance, while the appendectomy rate had been increased steadily, complicated appendicitis rate had not been increased annually. Perforated appendicitis rate was slightly increased, but it was not statistically significant.
6. Higher levels of appendectomy rates in all clinical types were noted in high economic group compared with the low economic group.
7. Appendectomy rates and perforated appendicitis rate among the residents in islands (the lowest accessibility group) were higher than those of Myun and Eup. But it was not statistically significant.
From this result it was found that there are remarkable increase in appendectomy rate and appendicitis rate in Korean rural area after the implementation of regional health insurance. The reason for such increase may be due to the spontaneous remissions of appendicitis before insurance without surgery. To understand this phenomenon, there is a need to study the natural history of appendicitis in population for the further study.
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Prevalence and changes of HBsAg and Anti-HBs for one year period in natural status and after hepatitis B vaccination
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Il Soon Kim, Hee Choul Oh, Yoon Lee, Joo Duck Kim, Won Yong Lee
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Korean J Epidemiol. 1987;9(1):40-48.
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Familial aggregation and intrafamilial transmission of hepatitis B
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Hee Choul Oh, Il Soon Kim
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Korean J Epidemiol. 1987;9(1):49-56.
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This study was carried out in a rural area, Kangwha County to investigate familial aggregation of hepatitis B infection and to obtain knowledge on relative importance of vertical and horizontal transmission of hepatitis B within family members. Eight hundred and twenty eight persons from 391 households were examined for hepatitis B surface antigen(HBsAg)and antibody( anti — HBs)tested by ELISA method in 1984 and 1985. Results are as follows.
1. Strong familial aggregation of hepatitis B infection was observed.
2. Spouse concordance rate of HBsAg positive and both HBsAg and anti-HBs positive were 43.6% and 53.3% repectively, and these rates did not show statistical difference from those of total study population.
3. Mother with positive HBsAg was important to determine their children's HBV infection.
4. Horizontal transmission of hepatitis B between spouses seemed to take minor part of total hepatitis B infection among adults.
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Changes in mortality rates and cause of death in Kangwha county for the past 10 years (1975-1985)
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Hee Choul Oh, Yong Ho Lee, Il Soon Kim
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Korean J Epidemiol. 1987;9(1):87-95.
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To identify the changes in trends of death rates and causes of death for the population of Kangwha County for the past 10 years from 1975 to 1985, the total 652 death occurred during the study period(1981-1985) in three townships(Sunwon, Naega，Buleon Myuns)were analysed and compared with the previous five-year data(1975-1980).
All death with causes of death were identified and confirmed by health project team consisted of a family health worker, Myun health workers, a public health nurse and field project director.
The major findings of this study were as below:
1. Age adjusted death rate in average for the five-year period(1981-1985) was 5.6 per 1,000 population, 6.9 in male and 4.3 in female respectively which are about 20% reduction in death rate compared with the previous 5 years.
2. In general, age specific death rates revealed an U shaped curve for the past 10 year periods(1975-1985). The age specific death rates particularly for ages under 20 have markedly for both sexes for the study period.
3. Infant and neonatal death rates were markedly decreased from 18.8 and 12.9 per 1,000 live births in the previous period to 8.9 and 4.5 per 1,000 live births in average for the study period. The prematurity was the most common cause of neonatal death both the two study periods one case of neonatal tetanus was found during the 5 year study period.
4. The most common cause of death was cerebrovascular diseases with the magnitude of 139.1 per 100,000 population, in 5 year average, 148.9 in male and 122.5 in female. However, it showed a decreasing trend in comparing with the previous period(180.8 per 100,000:1975-1980)
5. The next leading cause of death was malignant neoplasms with magnitude of 120.7 per 100,000 population, 143.9 in male and 87.5 in female. However, an increasing trend in comparing with the previous period(94.5 per 100,000:1975-1980). All types of accidents rose to the 3rd from the 4th leading causes of death.
6. 84.4% of all deaths were due to any type of disease entities and suicide and poisoning/accidents comprised 5.7% and 5.4% respectively.
7. The proportion of treatment received from health care facilities(including drug stores, herb clinics, hospitals) prior to death increased, from 57.0% in 1975 to 68.1% in 1985. The most common place of death occurred was residence of their own(with 86.7%) and only 5.0% of deaths were occurred in hospital. This pattern persisted without changes for the past 10 years.
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A case-control study for risk factors of peptic ulcer
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Hee Choul Oh, Il Soon Kim
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Korean J Epidemiol. 1986;8(2):221-232.
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A case-control study was conducted to identify risk factors for peptic ulcer with the cases composed of patients who were endoscopically diagnosed from May 1, 1983 to June 30, 1986 in the Kang-wha Community Hospital. A total of 173 duodenal ulcer and a total of 103 benign gastric ulcer cases were studied and the control groups were twice matched by sex and age. Statistically significant variables were screened by X2-test, which were entered to the multiple logistic model to calculate the odds ratios for risk factors.
The results were as follows:
1) Odds ratios of three main effects were preference of spicy food 5.6, salty food 5.6, and presence of life event 2.0 for duodenal ulcer respectively. The interaction term between preference of spicy food and salty food was 7.4 whereas odds ratio of drinking alcohol for duodenal ulcer was 0.5.
2) Although preference of spicy food and smoking were statistically significant respectively, their odds ratios could not be determined for benign gastric ulcer because the multiple logistic model was statistically rejected.
3) A multiple logistic analysis showed that the risk factors for duodenal and gastric ulcer were different in composition of risk factors studied here.
4) As in implication for further study, some objective methods to measure preference for spicy and salty food are needed to confirm them to be risk factors of peptic ulcer and new approaches are also needed to understand the effects of stress on peptic ulcer in terms of interactions with stress relieving factors.
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A study on the anti-HBs prevalence between occupationally risk and non-risk groups in terms of hepatitis B virus exposure
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Hee Choul Oh, Il Soon Kim
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Korean J Epidemiol. 1985;7(2):259-264.
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This study was performed to find HBsAg and Anti-HBs prevalence between the two groups. One group, defined as occupationally risk group, consists of persons who treat patients personally or who deal with blood as their daily activity. The other group, defined as occupationally non-risk group, consists of remaining persons in the study. The data were collected from the annual screening physical check-up which was performed in 1984 for 2,631 teaching, clerical and other personnel of Y university. RPHA method was used for the detection of HBsAg and Anti-HBs.
The results from the analysis are summarized as follows:
1) No difference was observed in HBsAg positive rate between occupationally risk (6.9%) and non-risk group(7.1%) but showed significant difference in HBsAg or Anti-HBs positive rate between the two groups(24.2% and 19.4%, P<0.01). This finding suggests that there is higher risk to expose to Hapatitis B Virus(HBV) in occupationally risk group than in non-risk one.
2) Difference in HBsAg or Anti-HBs positive rate between occupationally risk and non-risk group was statistically significant for the 20~29 age group but not for the remaining age groups. This finding suggests that vaccination against hepatitis B(HB) is highly recomrmanded to this age group especially for those who take this highly risk occupation.
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Mortality in Kang Wha county, 1975-1980
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Yong Ho Lee, Hee Choul Oh, Il Soon Kim
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Korean J Epidemiol. 1981;3(1):65-70.
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To identify mortality pattern of a rural community, the total death, 711 occurred in three townships (Sunwon, Naega, Buleon Myuns) in Kang Wha County during 1975-1980 were studied.
All death was reported weekly to health workers by 37 family health workers of villages. Causes of death was identified by one public health nurse & three public physicians using questionnaries.
This study focuses on death rates & causes of death.
The following is brief summary of results of the study.
1) Crude death rates
The trend in the crude death rates showed slowly downward tendency & especially male. 5-year (1976-1980) average crude death rates was 7.9 per 1,000 and 8.6 in male & 7.2 in female.
2) Age-specific death rates revealed a U-shape & similiar patterns were shown during the study period.
3) The trend in the infant death rates showed also downward tendency. 5-year average infant death rate was 12.9 per 1,000 live births and the neonatal death rate 18.8. The most common cause of neonatal deaths was prematurity.
4) Proportional Mortality Indicators ranged between 71%-83%.
5) The most common cause of deaths was cerebrovascular diseases (180.8 per 100,000) and was followed by malignant neoplasms (94.5 per 100,000).
The death due to pulmonay tuberculosis ranked 5 with a death rate of 47.2 per 100,000 and the death due to pneumonia & respiratory diseases ranked 10 with a death rates of 11.5 per 100,000.
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