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Epidemiologic investigation
Salmonellosis outbreaks linked to eggs at 2 gimbap restaurants in the Republic of Korea
Jun Suk Eun, Joohyun Han, Ji-Hyun Lim, Eunkyung Shin, Junyoung Kim, Da-Jung Ko, Jaeil Yoo, Sungil Kim, Jin Sook Kim, JungSub Park, Ji-Hyuk Park
Epidemiol Health. 2024;e2024036.   Published online March 7, 2024
DOI: https://doi.org/10.4178/epih.e2024036    [Accepted]
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  • 22 Download
AbstractAbstract PDF
Abstract
OBJECTIVES
Salmonellosis outbreaks occurred at 2 restaurants 2 days apart, and an epidemiological investigation was conducted to determine whether the outbreaks were connected.
METHODS
Case studies were conducted for both outbreaks. Stool samples were collected from individuals, and food samples were collected from the restaurants. Pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing analyses were performed on outbreak-related Salmonella enterica serovar Enteritidis (Salmonella Enteritidis) isolates. Traceback investigations were also conducted for the ingredients from gimbap restaurants A and B.
RESULTS
In total, 106 people from gimbap restaurant A and 5 from gimbap restaurant B met the case definition. Salmonella Enteritidis was detected in samples from 2 food handlers, 22 patients, and 1 food (iceberg lettuce) at gimbap restaurant A and from 1 patient at gimbap restaurant B. According to PFGE, all isolates were identified as SEGX01.089. The molecular typing of all isolates showed the same pattern, and the genetic distance was close according to phylogenetic analysis. Eggs were the only food ingredient that was supplied to both gimbap restaurants.
CONCLUSIONS
The outbreaks were caused by Salmonella Enteritidis, and the source of infections was suspected to be contaminated eggs. To prevent foodborne outbreaks of Salmonella, restaurants should heat eggs sufficiently, and egg farms need to establish management systems that prevent Salmonella infections.
Summary
Epidemiologic Investigations
Epidemiological investigation of a food-borne outbreak in a kindergarten, Jeju Province, Korea
Kyoung Mi Kim, Eun Suk Cho, Seong Bae Ahn, Eun Ok Kang, Jong-Myon Bae
Epidemiol Health. 2023;45:e2023047.   Published online April 17, 2023
DOI: https://doi.org/10.4178/epih.e2023047
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
On Monday, September 6, 2021, at a kindergarten in Jeju Province, a large number of children vomited and developed food poisoning symptoms, and this necessitated an epidemiological investigation.
METHODS
The team surveyed symptoms and food intake history of kindergarten children, teachers, and workers who ate lunch between September 2 (Thursday) and September 6 (Monday), excluding weekends. In addition to rectal swabs, environmental samples from preserved foods, cooking utensils, drinking water, and refrigerator handles were collected. Pulsed field gel electrophoresis (PFGE) for genetic fingerprint analysis was also performed.
RESULTS
There were 19 cases among 176 subjects, which indicated an attack rate of 10.8%. The epidemic curve showed a unimodal shape, and the average incubation period was 2.6 hours. While no food was statistically significant in food intake history, the analysis of 35 rectal smear samples detected Bacillus cereus in 7 children, 4 teachers, and 1 cooking staff. Enterotoxins were also detected in 12 samples. Out of 38 environmental samples, B. cereus and enterotoxins were detected in the morning snack cereal, lunch bean sprouts, and afternoon snack steamed potatoes on Monday, September 6th. The result of the PFGE test on 10 isolates of B. cereus showed that there was no genetic homology.
CONCLUSIONS
Our results indicated that this outbreak was simultaneously caused by various strains of B. cereus from the environment.
Summary
Korean summary
모 유치원에서 제공한 급식 취식아동에서 발열이 없고 구토형의 주증상인 식중독이 발생되었다. 평균 잠복기 2.6시간 (최소 0.8, 최대 4.5시간)이며, 인체 및 환경 검체에서 바실러스 세레우스 균이 분리되었다. 이에 해당 집단발생은 구토형 바실러스 세레우스 감염증에 의한 식중독을 결론지었다.
Key Message
A large number of children in a kindergarten vomited suddenly. The average incubation period was 2.6 hours (min 0.8, max 4.5 hours) with uni-modal shape in the epidemic curve. Bacillus cereus and entertoxin were detected in rectal smear and environmental samples.
Detecting mpox infection in the early epidemic: an epidemiologic investigation of the third and fourth cases in Korea
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
Epidemiol Health. 2023;45:e2023040.   Published online March 23, 2023
DOI: https://doi.org/10.4178/epih.e2023040
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  • 2 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDF
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.
Summary
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.

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
  • 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
An outbreak of neurologic symptoms among patients exposed to an unknown stench in a high school near an industrial complex: an epidemiological investigation
Kiook Baek, Seongmin Jo, Chulyong Park, Joon Sakong
Epidemiol Health. 2022;44:e2022105.   Published online November 9, 2022
DOI: https://doi.org/10.4178/epih.e2022105
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Seven students at a high school in Korea visited the emergency room with non-specific neurological symptoms after a stench was noticed during a school entrance ceremony. In relation to this incident, 105 patients visited medical institutions over 5 days. A team of environmental and epidemiological experts was assembled to investigate the incident.
METHODS
Our team of experts participated in the investigation 1 month post-incident. Previously, only air samples had been analyzed. We received results of air samples analyzed by other investigators, medical records of some students, and data from police interviews of patients. Additional investigation and interviews were conducted, and the events were reconstructed in spatial and temporal order.
RESULTS
A cluster of patients was observed on the south side and parts of the north side of the upper floor. A stench like that reported during the incident had been noticed for about 2 years near the school. Students consistently described a similar stench occurring frequently in the vicinity of the school. According to student statements, the odor mainly resembled something burning. The carboxyhemoglobin levels of some students were observed to be >1.5%.
CONCLUSIONS
In the investigation, 2 suspected sources were identified: a science room storing chemicals downstairs from the auditorium and various industrial facilities near the school. Combining the scattered evidence, we considered a toxic puff of gas, perhaps from brief incineration or leakage in a specific area, to be the likely cause of the incident. We describe our approach and the limitations encountered during the investigation.
Summary
Korean summary
본 논문은 일개 고등학교에서 원인미상의 악취와 함께 100명 이상의 환자가 발생한 사건에 대한 조사과정을 담은 문헌이다. 본 연구진은 사건 발생 후 약 1달 후에 조사진에 합류하였으며, 발생 당시 환자 분포 점지도 작성, 인근 지역 사업장 및 악취발생 장소 점지도 작성, 사건 전후 시계열적 사건분석, 기상자료, 관계자 인터뷰 자료 분석 등의 역학적 기법을 동원하여 원인을 인근 지역에서 발생한 퍼프 가스의 유입으로 추정하였다. 본 사건의 원인은 결국 미제로 종결되었지만 추후 유사 사례 발생시 본 조사의 방법론을 참고할 수 있을 것이며, 의료진의 조기 개입을 수행하지 못함으로 인한 초기 상세 인터뷰 자료 확보, 생체 시료 수집 등이 이루어지지 못한 본 조사 과정의 한계점을 반면교사로 삼을 수 있을 것이다.
Key Message
This paper presents an investigation of an outbreak of over 100 patients experiencing an unexplained odor in a high school. The research team utilized epidemiological methods, including dot mapping, temporal analysis of events, and interview data analysis. The source of the odor was estimated to be the inflow of puff gas from surrounding areas. Although the toxic puff gas discharge facility was not identified, sharing the experience from this investigation could help with future investigations of similar incidents.
Analysis of the on-ship transmission of the COVID-19 mass outbreak on the Republic of Korea Navy amphibious warfare ship
Soo Hyeon Cho, Young-Man Kim, Gyeongyong Seong, Sunkyun Park, Seoncheol Park, Sang-Eun Lee, Young Joon Park
Epidemiol Health. 2022;44:e2022065.   Published online August 11, 2022
DOI: https://doi.org/10.4178/epih.e2022065
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  • 432 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This investigation was conducted to determine the size and pattern, source, and transmission route of the coronavirus disease 2019 (COVID-19) outbreak on the Republic of Korea Navy (ROKN) amphibious warfare ship.
METHODS
We investigated the characteristics of all crew members and tracked the medical records of the confirmed cases. Fourteen essential ship operation personnel were interviewed. The study design was a retrospective cohort study, and the incidence rate ratio was through a statistical program.
RESULTS
The COVID-19 incidence on the ROKN amphibious warfare ship was 44.7% (38/85). It was estimated that the main propagation route started from the 1st floor worker, which spread to the same floor, and then to other floors. In the case of the working area, the incidence rate of crew members below the 1st floor without ventilation was higher than those on the 2nd or higher floors with natural ventilation.
CONCLUSIONS
This case is the first case of a COVID-19 outbreak on the ROKN amphibious warfare ship, and it is estimated that the incidence rate is high because of the closed and dense environment. To prevent the spread of various respiratory diseases including COVID-19, unified mitigation such as vaccination, observing personal quarantine rules, periodic ventilation, preemptive testing, and blocking transmission through prompt contact management is necessary.
Summary
Korean summary
본 조사는 국내 첫 해군 상륙함 내 코로나19 집단발생의 규모 및 양상, 감염원과 전파경로를 규명하기 위해 수행되었다. 해군 상륙함에서의 발생률은 44.7%였으며 자연 환기가 가능한 2층 이상 근무자에 비해 환기가 불가능한 1층 이하 근무자의 발생률이 높았고 이는 통계적으로 유의했다. 밀폐된 환경에서 밀접한 생활을 하는 해군 상륙함의 특성을 고려하여 개인방역수칙 준수, 주기적 환기, 선제적 검사, 신속한 접촉자 관리 등을 통한 전파 차단이 필요할 것으로 판단된다.
Key Message
This investigation was conducted to determine the size and pattern of the outbreak of the COVID-19 infection, the source of infection and the transmission route on the ROK Navy Amphibious Warfare ship. The incidence on ROKN Amphibious Warfare ship was 44.7% (38/85) and the incidence rate of crew members below the first floor without ventilation was higher than those on the second floor or higher with natural ventilation. To prevent various respiratory diseases including COVID-19, unified mitigation such as vaccination, observing personal quarantine rules, periodic ventilation, preemptive testing, and blocking transmission through prompt contact management is necessary.

Citations

Citations to this article as recorded by  
  • Indoor Air Quality and COVID-19: A Scoping Review
    Axelle Braggion, Adeline Dugerdil, Olwen Wilson, Francesca Hovagemyan, Antoine Flahault
    Public Health Reviews.2024;[Epub]     CrossRef
Investigation of a human brucellosis outbreak in Douz, Tunisia, 2018
Nejib Charaa, Rabaa Ghrab, Aicha Ben Othman, Mohamed Makhlouf, Hejer Ltaief, Nissaf Ben Alaya, Mohamed Chahed
Epidemiol Health. 2022;44:e2022048.   Published online May 18, 2022
DOI: https://doi.org/10.4178/epih.e2022048
  • 6,473 View
  • 319 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
In 2017, the incidence of human brucellosis in Tunisia was 9.8 per 100,000 population. In the Douz district, 2 cases were reported in March 2018. Prior to that date, the last indigenous cases to be reported in Douz had been in 2015. This study aimed to identify the source of this new contamination and recommend control interventions.
METHODS
This case-control study included residents of Douz who presented with clinical symptoms of brucellosis and had a subsequent Wright test antibody titer ≥ 1/160. The controls were neighbors of the infected cases who had a negative Rose Bengal test. Univariate and multivariate analyses were performed to estimate the odds ratios of risk factors. Goats belonging to the cases and controls were actively screened.
RESULTS
Twenty-five infected cases and 52 uninfected controls were enrolled. All infected cases had consumed goat milk and 92% had purchased it from the same breeder. Consumption of goat milk from this breeder (adjusted odds ratio [aOR], 30.78; 95% confidence interval [CI], 6.47 to 235.91) and overall consumption of raw goat milk (aOR, 14.84; 95% CI, 2.04 to 310.44) were independent risk factors for brucellosis. The breeder had 18 goats, 5 of which were smuggled from a neighboring country. Three of those goats were diagnosed with brucellosis.
CONCLUSIONS
Consumption of raw milk from smuggled sick goats was the main risk factor in this outbreak. The sick goats were slaughtered and an education campaign was conducted. Vaccination, control of cross-border animal movements, and control of goat milk sales must be strengthened to prevent the spread of brucellosis in southwestern Tunisia.
Summary
Key Message
Human brucellosis, despite being a major economic and health problem and the availability of proven control methods, is still endemic in North African countries. The scarcity of epidemiological data, under-reporting, certain weaknesses in surveillance systems and the lack of well-conducted outbreak investigations, contribute to this endemic state. This field epidemiological investigation of a human brucellosis outbreak highlighted the importance of serological surveillance, the slaughter of infected animals, vaccination, control of animal movements across borders and pasteurization of milk in the fight against this disease.

Citations

Citations to this article as recorded by  
  • Long ignored but making a comeback: a worldwide epidemiological evolution of human brucellosis
    Zhiguo Liu, Liping Gao, Miao Wang, Min Yuan, Zhenjun Li
    Emerging Microbes & Infections.2024;[Epub]     CrossRef
  • Native circulating Brucella melitensis lineages causing a brucellosis epidemic in Qinghai, China
    Hongmei Xue, Zhijun Zhao, Jianling Wang, Li Ma, Jiquan Li, Xuxin Yang, Lingling Ren, Liqing Xu, Zhiguo Liu, Zhenjun Li
    Frontiers in Microbiology.2023;[Epub]     CrossRef
An outbreak of hepatitis A associated with salted clams in Busan, Korea
Hyunjin Son, Miyoung Lee, Youngduck Eun, Wonseo Park, Kyounghee Park, Sora Kwon, Seungjin Kim, Changhoon Kim
Epidemiol Health. 2022;44:e2022003.   Published online December 29, 2021
DOI: https://doi.org/10.4178/epih.e2022003
  • 11,198 View
  • 567 Download
  • 2 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
In July 2019, there were multiple reports on patients with hepatitis A among the visitors of a restaurant in Busan. The current study presents the results of an epidemiological investigation and outlines the supplementary measures that would help with hepatitis A control.
METHODS
A cohort study was conducted for all 2,865 customers who visited restaurant A from June to July. Using a standardized questionnaire, participants reported the presence of hepatitis A symptoms and whether they had consumed any of 19 food items. As for participants who had visited public health centers, their specimens were collected.
RESULTS
From the study cohort, 155 participants (5.4%) had confirmed hepatitis A. The epidemic curve was unimodal, and the median number of days from the restaurant visit to symptom onset was 31 days. A genotype analysis indicated that 89 of 90 tested patients had hepatitis A virus (HAV) genotype 1A. The results of a multivariate logistic regression analysis indicated that the ingestion of salted clams increased the risk of hepatitis A by 68.12 times (95% confidence interval [CI], 9.22 to 510.87). In an unopened package of salted clams found and secured through traceback investigation, HAV genotype 1A was detected.
CONCLUSIONS
To prevent people from ingesting uncooked clams, there needs to be more efforts to publicize the dangers of uncooked clams; the food sampling test standards for salted clams should also be expanded. Furthermore, a laboratory surveillance system based on molecular genetics should be established to detect outbreaks earlier.
Summary
Korean summary
2019년 7월, 부산시의 한 식당을 방문한 사람에서 다수의 A형간염 환자가 신고되었다. 2019년 6월 1일부터 7월 28일까지 해당 식당을 방문하여 카드 결제를 한 사람과 동반자 2,865명 전체를 대상으로 코호트 조사를 수행하였다. A형간염에 확진 된 사람은 총 155명으로 발병률은 5.4%였다. 다변량 로지스틱 회귀분석 결과 조개젓 섭취는 A형간염 발병 위험을 68.62배(95% CI, 9.22 to 510.87) 증가시키는 것으로 나타났다. 익히지 않은 조개류를 섭취하지 않도록 더욱 홍보를 강화해야 한다.
Key Message
In July 2019, there were multiple reports on patients with hepatitis A among the visitors of a restaurant in Bu¬san. A cohort study was conducted for all 2,865 customers who visited the restaurant from June to July. From the study cohort, 155 participants (5.4%) had confirmed hepatitis A. The results of a multivariate logistic regression analysis indicated that the ingestion of salted clams increased the risk of hepatitis A by 68.12 times. To prevent people from ingesting uncooked clams, there needs to be more efforts to publicize the dangers of uncooked clams.

Citations

Citations to this article as recorded by  
  • Investigating the spatio-temporal variation of hepatitis A in Korea using a Bayesian model
    Jaehong Jeong, Mijeong Kim, Jungsoon Choi
    Frontiers in Public Health.2023;[Epub]     CrossRef
  • A Study on the Detection Rate of Hepatitis A from Gastroenteritis Patients and the Genotype Analysis of Hepatitis A Virus in Busan
    Sun Hee Park, Chanhee Kim, Summi Lee, Jihye Jeong, Junghye Choi, Seung Ju Lee
    Journal of Bacteriology and Virology.2023; 53(2): 74.     CrossRef
  • Influence of temperature and precipitation on the incidence of hepatitis A in Seoul, Republic of Korea: a time series analysis using distributed lag linear and non-linear model
    Kiook Baek, Jonghyuk Choi, Jong-Tae Park, Kyeongmin Kwak
    International Journal of Biometeorology.2022; 66(9): 1725.     CrossRef
Experience of a COVID-19 outbreak response in a general hospital in Gyeonggi Province, Korea
Chanhee Kim, Gawon Choi, Shin Young Park, Jieun Kim, Young Joon Park, Kyungnam Kim
Epidemiol Health. 2021;43:e2021083.   Published online October 18, 2021
DOI: https://doi.org/10.4178/epih.e2021083
  • 7,730 View
  • 138 Download
  • 3 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Coronavirus disease 2019 (COVID-19) outbreaks in general hospitals are particularly risky because they not only overburden the regional healthcare delivery system, but also increase the possibility of community transmission. This study shares an experience of a COVID-19 outbreak response in a general hospital in Gyeonggi Province, Korea.
METHODS
Since the first COVID-19 confirmed case was recognized in Hospital A on March 29, 2020, the Immediate Response Team of Gyeonggi Province and Korea Disease Control and Prevention Agency devised a plan to conduct an epidemiological investigation and minimize the paralysis of hospital functions. Apart from the epidemiological investigation, a risk assessment of the hospital and management of contacts, including patients and workers, were also undertaken.
RESULTS
In total, 72 confirmed cases were identified, including 26 hospitalized patients, 16 healthcare personnel, 7 visitors, and 22 cases identified externally. The majority of the confirmed cases were exposed in Ward B or were contacts of people exposed in Ward A (58.3% of 72 cases). Among healthcare personnel, caregivers were found to be the most vulnerable to COVID-19 in this outbreak.
CONCLUSIONS
Preparation for all possible situations in medical facilities is important because it is difficult to find alternative resources. The findings of this study provide information on controlling the further transmission of COVID-19 and furnish evidence of the importance of ordinary management skills to be prepared for COVID-19.
Summary
Korean summary
본 연구에서는 2020년 경기도 소재 한 종합병원에서 발생한 코로나19 유행 대응 사례 경험을 공유한다. 병원 외 지역사회 전파 사례를 포함하여 총 72명의 확진자가 이 유행에서 확인되었다. 종합병원은 지역 의료전달체계에서 중요한 역할을 하고 있기 때문에 코로나19로 인해 그 기능이 마비되지 않도록 예방하는 것이 가장 바람직하며, 이를 위해서는 평상 시에 적절한 대비 체계를 갖추어 두어야 한다.
Key Message
This study shares the experience of responding to the COVID-19 outbreak at a general hospital in Gyeonggi-do, 2020. A total of 72 confirmed cases were identified, including cases of community based transmission outside the hospital. Since general hospitals play an important role in the medical delivery system, it is most desirable to prevent the function from being paralyzed by COVID-19 situation, and for this, and appropriate preparedness should be established.

Citations

Citations to this article as recorded by  
  • Vaccine effectiveness and the epidemiological characteristics of a COVID-19 outbreak in a tertiary hospital in Republic of Korea
    Seonhee Ahn, Tae Jong Son, Yoonsuk Jang, Jihyun Choi, Young Joon Park, Jiseon Seong, Hyun Hee Kwon, Muk Ju Kim, Donghyok Kwon
    Osong Public Health and Research Perspectives.2023; 14(3): 188.     CrossRef
  • Effect of changes in the hearing aid subsidy on the prevalence of hearing loss in South Korea
    Chul Young Yoon, Junhun Lee, Tae Hoon Kong, Young Joon Seo
    Frontiers in Neurology.2023;[Epub]     CrossRef
COVID-19 outbreak in a military unit in Korea
Chanhee Kim, Young-Man Kim, Namwoo Heo, Eunjung Park, Sojin Choi, Sehyuk Jang, Nayoung Kim, Donghyok Kwon, Young-Joon Park, Byeongseop Choi, Beomman Ha, Kyounghwa Jung, Changbo Park, Sejin Park, Heeyoung Lee
Epidemiol Health. 2021;43:e2021065.   Published online September 8, 2021
DOI: https://doi.org/10.4178/epih.e2021065
  • 9,662 View
  • 205 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study presents the response of a military unit to an outbreak of coronavirus disease 2019 (COVID-19) in Gyeonggi Province. As soon as 2 soldiers were identified as index cases, the infectious disease investigators of the Gyeonggi Provincial Government, Korea Disease Control and Prevention Agency, and the Armed Forces Epidemiologic Investigation Center discussed the investigation and response plan for an imminent massive outbreak.
METHODS
The joint immediate response team (IRT) conducted interviews with confirmed COVID-19 patients, reviewed their medical records, performed contact tracing using global positioning system data, and undertook a field investigation. For risk assessment, the joint IRT visited all 8 sites of the military units and the army chaplain’s church to evaluate the transmission risk at each site. The evaluation items included the size of the site, the use of air conditioning, whether windows were opened, and whether masks were worn. Pooled testing was used for the low-risk population to quickly detect the spread of COVID-19 in the military base.
RESULTS
One day before the symptom onset of the index case, the lecturer and >50% of the attendees were infected with COVID-19 while attending a lecture that lasted 2 hours and 30 minutes. Attendees were not wearing masks and were in a poorly ventilated room.
CONCLUSIONS
Since COVID-19 can be spread before symptom onset, contact tracing must be performed to investigate potential exposures prior to symptom onset and to manage any exposed persons.
Summary
Korean summary
본 연구는 경기도 군부대에서 발생한 코로나19 대응 경험을 공유하는 국내 최초의 연구 결과이다. 본 연구를 통해 정리된 역학조사 과정은 군부대, 기숙사, 교정시설 등 집단 시설의 방역 대책 수립에 도움이 될 것으로 기대한다. 또한, 이번 사례는 집단 감염 발생 시 여러 유관 기관의 협조 체계가 신속한 대응과 추가 전파 예방에 중요하다는 점을 시사한다.
Key Message
This study is the first research in South Korea to share the experience of responding to COVID-19 at the military unit in Gyeonggi-do. The epidemiological investigation process organized through this study is expected to help establish response measures for group facilities such as military units, dormitories, and correctional facilities. In addition, this case suggests that the cooperative system of various related organizations in the event of a mass infection is important for rapid response and prevention of further transmission.

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    Yoonjung Kim, Eunyoung Lee, Boyeon Kim, Jinhee Cho, Sook-Won Ryu, Kyung-A Lee
    Clinica Chimica Acta.2024; 554: 117759.     CrossRef
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How to improve the human brucellosis surveillance system in Kurdistan Province, Iran: reduce the delay in the diagnosis time
Meysam Olfatifar, Seyed Mehdi Hosseini, Payam Shokri, Soheila Khodakarim, Naghmeh Khadembashi, Sajjad Rahimi Pordanjani
Epidemiol Health. 2020;42:e2020058.   Published online August 10, 2020
DOI: https://doi.org/10.4178/epih.e2020058
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AbstractAbstract PDF
Abstract
OBJECTIVES
Spatial information makes a crucial contribution to enhancing and monitoring the brucellosis surveillance system by facilitating the timely diagnosis and treatment of brucellosis.
METHODS
An exponential scan statistic model was used to formalize the spatial distribution of the adjusted delay in the diagnosis time of brucellosis (time between onset and diagnosis of the disease) in Kurdistan Province, Iran. Logistic regression analysis was used to compare variables of interest between the clustered and non-clustered areas.
RESULTS
The spatial distribution of clusters of human brucellosis cases with delayed diagnoses was not random in Kurdistan Province. The mean survival time (i.e., time between symptom onset and diagnosis) was 4.02 months for the short spatial cluster, which was centered around the city of Baneh, and was 4.21 months for spatiotemporal clusters centered around the cities of Baneh and Qorveh. Similarly, the mean survival time for the long spatial and spatiotemporal clusters was 6.56 months and 15.69 months, respectively. The spatial distribution of the cases inside and outside of clusters differed in terms of livestock vaccination, residence, sex, and occupational variables.
CONCLUSIONS
The cluster pattern of brucellosis cases with delayed diagnoses indicated poor performance of the surveillance system in Kurdistan Province. Accordingly, targeted and multi-faceted approaches should be implemented to improve the brucellosis surveillance system and to reduce the number of lost days caused by delays in the diagnosis of brucellosis, which can lead to long-term and serious complications in patients.
Summary

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  • Asymmetric Effects of Weather-Integrated Human Brucellosis Forecasting System Using a New Nonlinear Autoregressive Distributed Lag Model
    Yongbin Wang, Chenlu Xue, Bingjie Zhang, Yuchun Li, Chunjie Xu, Daniel Diaz
    Transboundary and Emerging Diseases.2024; 2024: 1.     CrossRef
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    Sajjad Rahimi Pordanjani, Maryam Mohammadian, Somayeh Derakhshan, Fatemeh Hadavandsiri, Seyed Saeed Hashemi Nazari, Mohammad Hossein Panahi
    Middle East Journal of Rehabilitation and Health Studies.2023;[Epub]     CrossRef
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    Jingbo Zhai, Ruihao Peng, Ying Wang, Yuying Lu, Huaimin Yi, Jinling Liu, Jiahai Lu, Zeliang Chen
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A foodborne outbreak of gastroenteritis caused by Vibrio parahaemolyticus associated with cross-contamination from squid in Korea
Sun-Wha Jung
Epidemiol Health. 2018;40:e2018056.   Published online November 13, 2018
DOI: https://doi.org/10.4178/epih.e2018056
  • 14,176 View
  • 245 Download
  • 21 Web of Science
  • 23 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Water-borne diseases caused by Vibrio parahemolyticus are often known to cause gastritis when raw or undercooked seafood is eaten. It is very rare that Vibrio gastritis caused by ingesting non-seafood products occurs on a large scale. On September 19, 2017, a large-scale Vibrio gastritis occurred after the city residents consumed food at a bazaar held in a welfare center in Jungnang-gu, Seoul.
METHODS
The total number of visitors was approximately 299, and 237 (79.3%) of them showed symptoms. Among those who showed symptoms, 116 (48.9%) consulted the hospital, and 53 (45.6%) were hospitalized. Among the 299 exposed individuals, 174 (58.1%) responded to this survey: 163 (93.6%) with and 11 (6.4%) without symptoms. This study was retrospectively conducted by investigating the exposed individuals. To investigate the spread of infection, medical staff of hospitals in the epidemic area were interviewed, exposed individuals surveyed, microbiological testing conducted, and ingredient handling and cooking processes investigated.
RESULTS
A total of 237 individuals, including 6 food handlers, were affected (prevalence, 79.2%). During the microbiological testing, V. parahemolyticus was found in 34 patients and 4 food handlers. In the consumption analysis, the relative risk of kimbap was 6.79 (confidence interval 1.10 to 41.69). In-depth investigation found that squid, an ingredient of Korean pancake, and egg sheets, an ingredient of kimbap, were prepared using the same cutting board and knife, which were thought to be the cause of cross-contamination that led to a large-scale outbreak of Vibrio gastritis.
CONCLUSIONS
A recent large-scale outbreak of Vibrio gastritis occurred due to the cross-contamination with kimbap during the preparation process of squid rather than the actual consumption of seafood. Thus, a more stringent hygiene management is necessary during the processing and management of food to prevent infections associated with V. parahemolyticus.
Summary
Korean summary
비브리오 장염은 흔히 날 것이나 덜 익힌 해산물을 섭취하였을 경우 잘 생기는 것으로 알려져 있다. 그러나 해산물을 처리하는 과정에서 생긴 교차 감염에 의해서도 비브리오 장염이 생길 수 있으며 이로 인하여 대규모의 유행이 발생할 수 있다. 이에 보다 철저한 위생관리와 교육이 필요하다

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Vaccination history in elementary school children enrolled in the varicella epidemic investigations held in Jeju-si, Korea in the first half of 2017
Hyun-Suk Oh, Jong-Myon Bae
Epidemiol Health. 2017;39:e2017053.   Published online November 13, 2017
DOI: https://doi.org/10.4178/epih.e2017053
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The reported incidence rate of varicella infection in Jeju-do is higher compared with the national average. This study aimed to examine varicella vaccination history and evaluate clinical manifestation of varicella cases in Jeju-do.
METHODS
Based on the guideline suggested by the Korea Centers for Disease Control and Prevention (KCDC), two epidemic investigations for varicella infection were conducted in the first half of 2017. The history of varicella vaccination was confirmed using the Integrated Control System for Diseases and Health operated by the KCDC.
RESULTS
Out of a total of 60 elementary school children as the study subjects, all had been previously vaccinated against varicella. Twenty cases (33%) showed mild clinical manifestations and no complications.
CONCLUSIONS
As the government of Jeju-do has supplied a single-labeled vaccine since 2011, there is a need to evaluate the type of vaccination failure such as primary or secondary.
Summary
Korean summary
수두 발생 신고률에 있어 제주도는 전국에 비해 높은 수준을 보이고 있지만, 수둑접종률은 전국과 유사한 수준이다. 이에 2017년 상반기 수두 집단발생에 대응한 2건의 역학조사를 수행한 결과, 33%에서 돌발수두 임상 증상을 보였고 모두 백신 접종력이 있었다. 높은 발생 신고률은 지역사회 소아 개원의들의 높은 신고에 의한 것으로 유추할 수 있으며, 수두 백신 실패에 대한 추후 조사가 필요하다.

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  • Seroprevalence and molecular characteristics of varicella-zoster virus infection in Chinese children
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Healthcare worker infected with Middle East Respiratory Syndrome during cardiopulmonary resuscitation in Korea, 2015
Hae-Sung Nam, Mi-Yeon Yeon, Jung Wan Park, Jee-Young Hong, Ji Woong Son
Epidemiol Health. 2017;39:e2017052.   Published online November 12, 2017
DOI: https://doi.org/10.4178/epih.e2017052
  • 17,358 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
During the outbreak of the Middle East Respiratory Syndrome (MERS) in Korea in 2015, the Korea Centers for Disease Control and Prevention (KCDC) confirmed a case of MERS in a healthcare worker in Daejeon, South Korea. To verify the precise route of infection for the case, we conducted an in-depth epidemiological investigation in cooperation with the KCDC.
METHODS
We reviewed the MERS outbreak investigation report of the KCDC, and interviewed the healthcare worker who had recovered from MERS. Using the media interview data, we reaffirmed and supplemented the nature of the exposure.
RESULTS
The healthcare worker, a nurse, was infected while performing cardiopulmonary resuscitation (CPR) for a MERS patient in an isolation room. During the CPR which lasted for an hour, a large amount of body fluid was splashed. The nurse was presumed to have touched the mask to adjust its position during the CPR. She suggested that she was contaminated with the MERS patient’s body fluids by wiping away the sweat from her face during the CPR.
CONCLUSIONS
The possible routes of infection may include the following: respiratory invasion of aerosols contaminated with MERS-coronavirus (MERS-CoV) through a gap between the face and mask; mucosal exposure to sweat contaminated with MERS-CoV; and contamination during doffing of personal protective equipment. The MERS guidelines should reflect this case to decrease the risk of infection during CPR.
Summary
Korean summary
2015년 한국의 Middle East respiratory syndrome (MERS) 유행 기간 중 질병관리본부는 MERS 환자 심폐소생술(cardio–pulmonary resuscitation, CPR)에 참여한 간호사에서 MERS를 확진하였다. 이 사례에 대해 대전광역시 메르스 대응 민간역학조사지원단에서 심층역학조사를 실시한 결과 (1) CPR 수행 중 MERS-CoV에 오염된 에어로졸의 호흡기 침투, (2) MERS-CoV에 오염된 땀의 점막 침투, (3) 보호구 탈의 과정에서 MERS-Cov에 오염 등이 가능한 감염 경로로 파악되었다. 본 사례는 MERS 환자에 대한 CPR 수행 및 수행자의 보호구 착용과 관련하여 MERS 관리 지침의 개정이 필요함을 시사한다.

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Analysis of Kudoa septempunctata as a cause of foodborne illness and its associated differential diagnosis
Sung Uk Lee
Epidemiol Health. 2017;39:e2017014.   Published online March 31, 2017
DOI: https://doi.org/10.4178/epih.e2017014
  • 14,645 View
  • 272 Download
  • 6 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Recently <i>kudoa septempuctata</i> in olive flounders is suggested as a cause of food poisoning, however whether <i>kudoa septempuctata</i> can affect human gastrointestinal systems is controversial and its pathogenecity remains unclear. In view of the field epidemiology, food poisonings caused by <i>kudoa septempuctata</i> should be distinguished from those caused by staphylococcus aureus and bacillus cereus.
METHODS
The statistics of food poisoning investigations published by Korea Centers for Disease Control and Prevention in 2013-2015 were reviewed. The characteristics of <i>kudoa septempuctata</i> food poisoning reported by Korea Centers for Disease Control and Prevention were reviewed. Information regarding clinical symptoms or epidemiology was extracted.
RESULTS
Total eleven <i>kudoa septempuctata</i> food poisoning cases were analyzed. Food poisonings caused by <i>kudoa septempuctata</i>, staphylococcus aureus and bacillus cereus have clinical and epidemiological similarities. Forty five percent of food poisoning outbreaks occurred in Korea was concluded as unknown. The food poisoning caused by staphylococcus aureus and bacillus cereus accounted for 4.5% (50/1,092) of all food poisoning outbreaks in Korea between 2013 and 2015.
CONCLUSIONS
This study suggests the possibilities of misdiagnosis in the investigations of food poisoning by staphylococcus aureus and bacillus cereus with <i>kudoa septempuctata</i>.
Summary
Korean summary
최근 광어 섭취 후 발생한 식중독의 한 원인으로 쿠도아충이 지목되고 있다. 하지만 쿠도아충에 의한 식중독은 인체 감염에 대한 근거가 부족하고, 황색포도알균이나 바실루스 세레우스 식중독과 감별이 어려워 진단에 있어 주의를 요한다.

Citations

Citations to this article as recorded by  
  • Molecular detection and genotype analysis of Kudoa septempunctata from food poisoning outbreaks in Korea
    Gyung-Hye Sung, In-Ji Park, Hee-Soo Koo, Eun-Hee Park, Mi-Ok Lee
    Parasites, Hosts and Diseases.2023; 61(1): 15.     CrossRef
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  • Foodborne Illness Outbreaks in Gyeonggi Province, Korea, Following Seafood Consumption Potentially Caused by <italic>Kudoa septempunctata</italic> between 2015 and 2016
    Joon Jai Kim, Sukhyun Ryu, Heeyoung Lee
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  • Analysis of Kudoa septempunctata as a cause of foodborne illness and its associated differential diagnosis
    Ji-Hyuk Park
    Epidemiology and Health.2017; 39: e2017037.     CrossRef
  • Relationship between shipping amounts of olive flounder aquacultured from Jejudo and the reported events of acute food poisoning by Kudoa septempunctata in 2015, South Korea: an ecological study
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Epidemiologic research on lung damage caused by humidifier disinfectants
Moo-Song Lee, Hwa Jung Kim
Epidemiol Health. 2016;38:e2016031.   Published online July 20, 2016
DOI: https://doi.org/10.4178/epih.e2016031
  • 15,911 View
  • 276 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
In April 2011 a tertiary hospital located in Seoul, Korea reported several cases of severe respiratory distress of unknown origin in young adults. To find the route of transmission, causative agent and patient risk factors of the outbreak, an investigation of the epidemic was initiated. A hospital based case-control study was conducted to indicate that humidifier detergent use was the cause of the outbreak. This information led the Ministry of Health and Welfare of Korea issued an order that humidifier detergents should be withdrawn from the market. Here, we describe the major events of planning, execution, and interpretation of the study, and discussions between researchers and public authorities following the decision to perform an epidemiologic study, chronologically.
Summary
Korean summary
본 역학조사는 일개 병원에서 신고한 질병 유행에 대해 다학제적 연구 결과로써, 질병의 임상적 특성과 역학적 원인 파악 후 정책적 대책으로 이어진 사례이다. 향후 가습기 살균제 이외에도 일반국민의 건강에 영향을 미칠 수 있는 다양한 생활환경요인에 관심을 가지고, 필요 시 적극적인 조사와 대응이 필요할 것이다.

Citations

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