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Cohort profile: a nationwide retrospective cohort of mortality in people living with HIV in Korea, 1985-2020
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Taeyoung Kim, Yoonhee Jung, Koun Kim, Jung Wan Park, Jeonghee Yu, Sung-il Cho
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Epidemiol Health. 2025;47:e2025002. Published online January 2, 2025
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DOI: https://doi.org/10.4178/epih.e2025002
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Abstract
The increasing number of people living with human immunodeficiency virus (HIV) in Korea has prompted interest in using the national surveillance system as a database for studying their health. To investigate the relationships between socio-demographic and epidemiological characteristics and mortality rates, a nationwide retrospective cohort was formed by integrating surveillance data with the Cause of Death Statistics from Statistics Korea. This integration included incidence reports, epidemiological investigations, and death reports from the surveillance data, enriched with detailed mortality information from the Cause of Death data. The cohort comprised 17,199 adult Korean individuals diagnosed with HIV infection from 1985 to 2020. By the end of 2020, 2,721 of these individuals were confirmed deceased. The sex ratio of the study participants was 14.3:1.0 (male to female), with 78.2% being under 50 years old at the time of diagnosis. Sexual contact was identified as the primary transmission route, accounting for 75.7% of cases. HIV disease emerged as the predominant cause of death, representing two-thirds (1,817 of 2,721) of the fatalities, followed by injuries and trauma, malignancies, and cardiovascular diseases. Recommendations for further cohort studies may be submitted to the Korea Disease Control and Prevention Agency.
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Summary
Korean summary
- 인체면역결핍바이러스 감염인들의 사망과 연관된 요인의 파악을 위해, 질병관리청의 국가 감시체계 데이터와 통계청 사망원인통계를 결합하여 후향적 코호트를 구성하였다.
- 구성된 코호트에는 1985-2020년 중 발생이 보고된 대한민국 국적의 19세 이상 감염인 17,199명이 포함되었으며 이 중 2,721명의 사망이 감시체계와 사망원인통계에서 최종 확인되었고, 코호트 데이터는 이들의 사회인구학적 요인, 역학적 요인, 사망원인을 포함한 사망 관련 정보로 구성되어 있다.
- 본 코호트에 기반한 연구를 통해 국내 거주하는 한국인 감염인들의 건강을 전반적으로 확인할 수 있을 것으로 생각되며, 감염인 중 사망 위험이 높은 취약군을 확인하는 등 국가 정책의 기반이 되는 과학적 근거를 생산할 수 있기를 기대한다.
Key Message
- By merging KDCA’s national surveillance data and the national mortality statistics, our retrospective cohort data have been established for identifying people living with HIV (PLHIV) at higher risk of mortality.
- In the established cohort, incidence reports of 17,199 PLHIV aged 19 or older with Korean nationality and mortality reports of 2,721 were included. The cohort data were composed of their sociodemographic and epidemiologic characteristics, and mortality data including causes of death.
- We expect further research based on the cohort to explore Korean PLHIV’s health and mortality risk, and to generate scientific evidence for national policymaking.
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Epidemiological characteristics and risk factors of suspected and confirmed mpox cases during the 2022-2023 epidemic in the Capital Region, Korea
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Mingyeol Shim, Soo Hyeon Cho, Seung Eun Lee, Taeyoung Kim
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Epidemiol Health. 2024;46:e2024092. Published online November 24, 2024
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DOI: https://doi.org/10.4178/epih.e2024092
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OBJECTIVES
This study investigated the general characteristics of laboratory-confirmed mpox patients in the Capital Region of Korea, as well as the risk factors for mpox infection, particularly focusing on the characteristics of polymerase chain reaction (PCR)-positive and PCR-negative cases.
METHODS We investigated 160 adults, excluding 4 minors, from 164 suspected mpox patients reported in Seoul, Gyeonggi, Incheon, and Gangwon from June 21, 2022 to October 31, 2023. Data were collected via telephone and face-to-face interviews. A statistical analysis of the general characteristics of the infection was conducted using frequency analysis and logistic regression.
RESULTS Of the 160 suspected cases of mpox, 59.3% (n=95) tested positive via mpox-PCR. Among the confirmed cases, 97.9% (n=93) were male. PCR-positive patients typically presented with genital and anal skin rashes or mucosal lesions, accompanied by pain. Additionally, 35.5% (n=33) of the male patients had human immunodeficiency virus (HIV) infections. Most confirmed cases (94.7%, 90/95) were believed to have contracted mpox through sexual contact during the maximal incubation period of 21 days prior to symptom onset, with a significant number reporting same-sex or casual contact. The most commonly collected and highest-yielding specimens from PCR-positive patients were from skin or mucosal lesions, whereas blood samples demonstrated the lowest percent positivity.
CONCLUSIONS In the Capital Region, most PCR-positive cases were male patients in their 30s who had sexual contacts and exhibited symptoms, aligning with findings from previous studies. These results provide a foundation for the differential diagnosis concerning mpox infection and the selection of PCR-test samples in clinical settings.
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Summary
Korean summary
- 대한민국 수도권의 mpox 의심환자 160명 중 59.3%(n=95)가 mpox-PCR 검사에서 양성으로 확인되었다.
- 확진 환자 중 97.9%(n=93)는 남성이었고 35.5%(n=33)는 HIV에 감염되었으며 엠폭스 감염의 위험요인으로는 일회성 파트너와의 성적 접촉, 항문생식기 병변, 병변 부위의 통증이 포함되었다.
- 양성 환자의 검체 특성은 피부 및 점막 병변 샘플이 가장 높은 양성률을 보였고, 혈액 샘플은 가장 낮은 양성률을 보였다.
Key Message
- Of the 160 suspected mpox cases in the Capital Region of South Korea, 59.3% (n=95) were confirmed as PCR-positive.
- Among the confirmed cases, 97.9% were male and 35.5% were infected with HIV, and risk factors of mpox infection included sexual contact with casual partner, anogenital lesion, and pain on lesions.
- Skin and mucosal lesion samples had the highest positivity rate, while blood samples had the lowest.
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Detecting mpox infection in the early epidemic: an epidemiologic investigation of the third and fourth cases in Korea
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Taeyoung Kim, Eonjoo Park, Jun Suk Eun, Eun-young Lee, Ji Won Mun, Yunsang Choi, Shinyoung Lee, Hansol Yeom, Eunkyoung Kim, Jongmu Kim, Jihyun Choi, Jinho Ha, Sookkyung Park
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Epidemiol Health. 2023;45:e2023040. Published online March 23, 2023
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DOI: https://doi.org/10.4178/epih.e2023040
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Abstract
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Abstract
OBJECTIVES
As few mpox cases have been reported in Korea, we aimed to identify the characteristics of mpox infection by describing our epidemiologic investigation of a woman patient (index patient, the third case in Korea) and a physician who was infected by a needlestick injury (the fourth case).
METHODS We conducted contact tracing and exposure risk evaluation through interviews with these 2 patients and their physicians and contacts, as well as field investigations at each facility visited by the patients during their symptomatic periods. We then classified contacts into 3 levels according to their exposure risk and managed them to minimize further transmission by recommending quarantine and vaccination for post-exposure prophylaxis and monitoring their symptoms.
RESULTS The index patient had sexual contact with a man foreigner during a trip to Dubai, which was considered the probable route of transmission. In total, 27 healthcare-associated contacts across 7 healthcare facilities and 9 community contacts were identified. These contacts were classified into high (7 contacts), medium (9 contacts), and low (20 contacts) exposure risk groups. One high-risk contact was identified as a secondary patient: a physician who was injured while collecting specimens from the index patient.
CONCLUSIONS The index patient visited several medical facilities due to progressive symptoms prior to isolation. Although the 2022 mpox epidemic mainly affected young men, especially men who have sex with men, physicians should also consider mpox transmission in the general population for the timely detection of mpox-infected patients.
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Korean summary
국내 엠폭스 3번환자는 전파 가능 시기에 7곳의 의료기관을 방문했으며, 접촉자로 분류된 27명의 의료기관 접촉자와 9명의 지역사회 접촉자 중 주사침 자상을 입은 의료인 1명이 추가 확진되었다. 적시에 엠폭스 환자를 발견하기 위하여 의료인들은 전파위험이 낮은 일반 인구의 감염 가능성에 대한 고려가 필요하다.
Key Message
As a result of contact tracing of a mpox patient in the early phase of epidemic, she visited 7 healthcare facilities to be diagnosed which infers diagnosing those who are statistically not at high risk is challenging. Yet the risk of contracting mpox seems relatively low as only one of 36 contacts was infected; a healthcare personnel who sustained a needlestick injury.
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Citations
Citations to this article as recorded by  - Clinical Features of Mpox Patients in Korea: A Multicenter Retrospective Study
So Yun Lim, Hyeon Jae Jo, Su-Yeon Lee, Miyoung Ahn, Yeonjae Kim, Jaehyun Jeon, Eu Suk Kim, BumSik Chin, Jae-Phil Choi, Nam Joong Kim
Journal of Korean Medical Science.2024;[Epub] CrossRef - Transmission potential of mpox in mainland China, June-July 2023: estimating reproduction number during the initial phase of the epidemic
Andrei R. Akhmetzhanov, Pei-Hsuan Wu
PeerJ.2024; 12: e16908. CrossRef - Genomic Analysis of Monkeypox Virus During the 2023 Epidemic in Korea
Chi-Hwan Choi, Minji Lee, Sang Eun Lee, Jin-Won Kim, Hwachul Shin, Myung-Min Choi, Hwajung Yi, Min-Kyung Kim, Jaehyun Jeon, Jun-Sun Park, Yeonjae Kim, So Yun Lim, BumSik Chin, Yoon-Seok Chung
Journal of Korean Medical Science.2024;[Epub] CrossRef - Epidemiological characteristics and risk factors of suspected and confirmed mpox cases during the 2022-2023 epidemic in the Capital Region, Korea
Mingyeol Shim, Soo Hyeon Cho, Seung Eun Lee, Taeyoung Kim
Epidemiology and Health.2024; 46: e2024092. CrossRef - Mpox exposure and transmission in healthcare settings during the 2022 global outbreak
Kimon C Zachary, Lisa L Philpotts, Erica S Shenoy
Current Opinion in Infectious Diseases.2023; 36(4): 257. CrossRef
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