Epidemiology and Health

COVID-19: Original Article

Risk of COVID-19 transmission in heterogeneous age groups and effective vaccination strategy in Korea: a mathematical modeling study: Youngsuk Ko, Jacob Lee, Yubin Seo, Eunok Jung; Epidemiol Health. 2021;43:e2021059. Published online September 8, 2021; DOI: https://doi.org/10.4178/epih.e2021059

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aims to analyze the possibility and conditions of maintaining an effective reproductive number below 1 using a mathematical model.

METHODS

The total population was divided into five age groups (0-17, 18-29, 30-59, 60-74, and ≥75 years). Maximum likelihood estimation (MLE) was used to estimate the transmission rate of each age group. Mathematical model simulation was conducted until December 31, 2021, by establishing various strategies for vaccination and social distancing without considering variants.

RESULTS

MLE results revealed that the group aged 0-17 years had a lower risk of transmission than other age groups, and the older age group had relatively high risks of infection. If 70% of the population will be vaccinated by the end of 2021, then simulations showed that even if social distancing was eased, the effective reproductive number would remain below 1 near August if it was not at the level of the third re-spreading period. However, if social distancing was eased and it reached the level of the re-spreading period, the effective reproductive number could be below 1 at the end of 2021.

CONCLUSIONS

Considering both stable and worsened situations, simulation results emphasized that sufficient vaccine supply and control of the epidemic by maintaining social distancing to prevent an outbreak at the level of the re-spreading period are necessary to minimize mortality and maintain the effective reproductive number below 1.

Summary

Korean summary
본 연구에서는 질병관리청에서 제공하는 개별 확진자 데이터에 확률통계적 방법을 적용하여 연령군 간의 감염전파 행렬을 추정하였으며 연령군을 고려한 수리모델에 적용되었다. 본 연구에서 우리는 2020년 10월부터 2021년 5월까지 한국에서의 코로나19 유행상황을 정책 구간에 따라 분석하였으며 이를 토대로 거리두기 완화 수준에 따라 거리두기 완화 상태에서도 지속적으로 유효감염재생산지수가 1보다 작아지는 시점이 달라질 수 있음을 보인다.

Key Message
In this research, we estimated age-group-specified transmission rate matrix by applying maximum likelihood estimation into individual based data which was provided by Korea Disease Control and Prevention Agency. Our model simulation showed the moment, when the effective reproductive number is consistently below 1 even the distancing is eased, is ranged from August to the end of 2021 depending on the intensity of the social distancing during eased phase.

Citations

Citations to this article as recorded by

Predictive models for health outcomes due to SARS-CoV-2, including the effect of vaccination: a systematic review
Oscar Espinosa, Laura Mora, Cristian Sanabria, Antonio Ramos, Duván Rincón, Valeria Bejarano, Jhonathan Rodríguez, Nicolás Barrera, Carlos Álvarez-Moreno, Jorge Cortés, Carlos Saavedra, Adriana Robayo, Oscar H. Franco
Systematic Reviews.2024;[Epub] CrossRef
Mathematical Modeling of COVID-19 Transmission and Intervention in South Korea: A Review of Literature
Hyojung Lee, Sol Kim, Minyoung Jeong, Eunseo Choi, Hyeonjeong Ahn, Jeehyun Lee
Yonsei Medical Journal.2023; 64(1): 1. CrossRef
Impact of vaccination and non-pharmacological interventions on COVID-19: a review of simulation modeling studies in Asia
Karan Thakkar, Julia Regazzini Spinardi, Jingyan Yang, Moe H. Kyaw, Egemen Ozbilgili, Carlos Fernando Mendoza, Helen May Lin Oh
Frontiers in Public Health.2023;[Epub] CrossRef
Effective vaccination strategies to control COVID-19 in Korea: a modeling study
Youngsuk Ko, Kyong Ran Peck, Yae-Jean Kim, Dong-Hyun Kim, Eunok Jung
Epidemiology and Health.2023; 45: e2023084. CrossRef
Quantifying the Effects of Non-Pharmaceutical and Pharmaceutical Interventions Against Covid-19 Epidemic in the Republic of Korea: Mathematical Model-Based Approach Considering Age Groups and the Delta Variant
Youngsuk Ko, Victoria May P. Mendoza, Yubin Seo, Jacob Lee, Yeonju Kim, Donghyok Kwon, Eunok Jung, E. Augeraud, M. Banerjee, J.-S. Dhersin, A. d'Onofrio, T. Lipniacki, S. Petrovskii, Chi Tran, A. Veber-Delattre, E. Vergu, V. Volpert
Mathematical Modelling of Natural Phenomena.2022; 17: 39. CrossRef
Dietary Behavior and Diet Quality in the Korean Adult Population by Income Level before and after the COVID-19 Pandemic: Using the Korean National Health and Nutrition Examination Survey (2019-2020)
Hye-Min Na, Bok-Mi Jung
The Korean Journal of Community Living Science.2022; 33(3): 397. CrossRef

COVID-19: Epidemiologic Investigation

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

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Abstract Summary 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.

Citations

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Evaluation of diagnostic performance of SARS-CoV-2 infection using digital droplet polymerase chain reaction in individuals with or without COVID-19 symptoms
Yoonjung Kim, Eunyoung Lee, Boyeon Kim, Jinhee Cho, Sook-Won Ryu, Kyung-A Lee
Clinica Chimica Acta.2024; 554: 117759. CrossRef
Trends in Confirmed COVID-19 Cases in the Korean Military Before and After the Emergence of the Omicron Variant
Dong Hoon Shin, Haebong Jang, Sangho Lee, Byung Seop Choi, Donghoon Kim, Hong Sang Oh
Journal of Korean Medical Science.2022;[Epub] CrossRef
Characteristics of COVID-19 outbreaks and risk factors for transmission at an army training center in South Korea from June to August 2021
U Jin Cho, Seongjin Wang, Seonju Yi, Yeon Hwa Choi, Eun-Young Kim, Jin A Kim, Sanghwan Bae, Jungyeon Yu, Jangkyu Choi, Young-Joon Park
Osong Public Health and Research Perspectives.2022; 13(4): 263. CrossRef

Original Articles

A hypertension risk score for adults: a population-based cross-sectional study from the Dubai Household Survey 2019: Ibrahim Mahmoud, Nabil Sulaiman, Amal Hussein, Heba Mamdouh, Wafa K. AL Nakhi, Hamid Y. Hussain, Gamal M. Ibrahim; Epidemiol Health. 2021;43:e2021064. Published online September 8, 2021; DOI: https://doi.org/10.4178/epih.e2021064

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Abstract Summary PDF: Abstract
OBJECTIVES
The aim of this study was to develop a risk score model for predicting hypertension specific to the population of Dubai in the United Arab Emirates (UAE) to facilitate prevention and early intervention.
METHODS
A retrospective analysis of data from the Dubai Household Health Survey 2019 was conducted. Demographic and physical parameters, as well as blood glucose levels, were included in the data. The risk factors for hypertension were identified using bivariate analysis. A risk score model was developed using the enter method, where all significant predictors of hypertension in bivariate analyses were entered in a single step with the primary outcome of hypertension status (yes/no). The model was validated internally by splitting the data into Emirati and non-Emirati populations.
RESULTS
A total of 2,533 subjects were studied. The significant risk factors for hypertension identified were male sex, older age (≥40 years), education level, body mass index, diabetes mellitus, and dyslipidaemia. The model showed a high discrimination ability between individuals with and without hypertension, with an area under the curve of 0.77 (95% confidence interval [CI], 0.75 to 0.79), excellent sensitivity (81.0%; 95% CI, 71.9 to 88.2) and moderate specificity (56.0%; 95% CI, 45.7 to 65.9).
CONCLUSIONS
The model developed by this study is simple, convenient, and based on readily available demographic and medical characteristics. This risk score model could support initial hypertension screening and provide an effective tool for targeted lifestyle counselling and prevention programs.; Summary

Key Message
To prevent hypertension in Dubai's adult population, primary health care physicians can use our risk score model to recommend preventative measures, with a focus on men over 40 years old, with a low educational level, who are obese, and who have other morbidities, such as diabetes mellitus and dyslipidemia.

Association between body temperature and leukocyte telomere length in Korean middle-aged and older adults: Carolina García-García, Chol Shin, Inkyung Baik; Epidemiol Health. 2021;43:e2021063. Published online September 8, 2021; DOI: https://doi.org/10.4178/epih.e2021063

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Data on associations between body temperature (BT) and leukocyte telomere length (LTL), which has been widely used as a biomarker of cellular senescence in recent epidemiological studies, are limited. Therefore, this study aimed to explore the associations between a normal BT range (35.0-37.5°C) and LTL via 6-year longitudinal observations of 2,004 male and female adults aged 50 or older.

METHODS

BT was obtained by measuring the tympanic temperature, and relative LTL was determined by real-time polymerase chain reaction. Robust regression analysis was used to evaluate the association between the baseline and follow-up LTL values and their differences.

RESULTS

A significant inverse association was found between BT and LTL at baseline. The regression coefficient estimate was -0.03 (95% confidence interval, -0.07 to -0.001; p<0.05). This association was stronger in participants with a body mass index >25 kg/m2 and males (p<0.01). However, there were no associations between BT and LTL at follow-up or BT and 6-year longitudinal differences in LTL.

CONCLUSIONS

These findings suggest that having a high BT between 35°C and 37.5°C (95°F and 99°F) may be detrimental for obese individuals in terms of biological aging.

Summary

Korean summary
본 역학 연구는 한국 성인 2,004명을 연구대상자로 하여 2011-2012년에 고막 체온을 측정하고 전혈을 채취하여 백혈구 텔로미어 길이를 분석하였으며 이러한 분석을 2017-2018년에 반복하여 6년 동안의 백혈구 텔로미어 길이 변화를 계산하였다. 고막 체온과 초기 텔로미어 길이의 관련성을 분석한 결과, 정상 체온 범위 내 체온이 높을수록 텔로미어 길이가 유의적으로 짧아지는 생리적 노화 상태와 관련된 것으로 나타났으며, 이러한 결과는 비만할 경우 더욱 분명하게 나타났다. 본 연구 결과를 통해 비만 시 체내 열발생과 관련된 노화 진행이 체중 감소를 통해 지연될 수 있는 가능성이 제시되었다.

Key Message
In an epidemiological study including Korean adults, a relatively higher normal body temperature between 35°C to 37.5°C was found to be associated with shorter leukocyte telomere length, a cellular senescence biomarker. In particular, this association was observed to be stronger among obese participants, suggesting that attaining normal body weight may be beneficial for anti-aging.

Citations

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Higher Daily Air Temperature Is Associated with Shorter Leukocyte Telomere Length: KORA F3 and KORA F4
Wenli Ni, Kathrin Wolf, Susanne Breitner, Siqi Zhang, Nikolaos Nikolaou, Cavin K. Ward-Caviness, Melanie Waldenberger, Christian Gieger, Annette Peters, Alexandra Schneider
Environmental Science & Technology.2022; 56(24): 17815. CrossRef

Associations of regional-level perceived stress and depression with health-related quality of life in Korean adults: a multilevel analysis of 2017 Korea Community Health Survey data: Eunsu Kim, Min-Ho Shin, Jung-Ho Yang, Soon-Ki Ahn, Baeg-Ju Na, Hae-Sung Nam; Epidemiol Health. 2021;43:e2021062. Published online September 8, 2021; DOI: https://doi.org/10.4178/epih.e2021062

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Abstract Summary PDF

Abstract

OBJECTIVES
We examined the associations of individual and regional-level perceived stress and depression with health-related quality of life (HRQOL) in Korean adults.

METHODS

We used data from the 2017 Korea Community Health Survey, which included 216,713 adults living within 254 municipal districts. As individual-level independent variables, perceived stress (higher vs. lower) and depression (Patient Health Questionnaire-9 ≥10) were defined. Regional-level age-adjusted rates of perceived stress (%) and depression (%) were created for 254 municipal districts and categorized into quartiles to generate regional levels of stress and depression. HRQOL was defined as the individual-level EuroQol 5-dimensional index×100. A multilevel analysis was performed to identify the relationship between individual or regional-level independent variables and individual HRQOL.

RESULTS

In the null model, the proportions of individual variation in the HRQOL explained by region were 1.7% and 2.7% for men and women, respectively. When adjusted with all individual-level variables, regional stress and depression, as well as individual-level perceived stress and depression, were significantly related to HRQOL for both genders. In the full model including all variables, the decrease in HRQOL from the first to the fourth quartile group of regional stress was greater in women (-1.09; 95% confidence interval [CI], -1.87 to -0.31) than in men (-0.65; 95% CI, -1.04 to -0.26).

CONCLUSIONS

Our results suggest that regional-level perceived stress and depression, as well as individual-level perceived stress and depression, are inversely associated with individual HRQOL.

Summary

Korean summary
시군구 단위 스트레스 인지율과 우울 유병률이 개인 단위 건강관련 삶의 질 수준과 연관성을 갖는지 파악하고자 지역사회건강조사 자료를 이용하여 다수준 분석을 수행하였다. 개인 수준에서 인지된 스트레스와 우울은 건강관련 삶의 질 감소와 관련이 있었다. 스트레스와 우울 수준이 높은 시군구일수록 개인의 건강관련 삶의 질은 낮아지는 관계를 보였는데, 이는 남성보다는 여성에서 더 저명하였다.

Key Message
This study examined the associations of regional-level perceived stress and depression with individual HRQOL measured in terms of the EQ-5D using a multilevel model. Individual-level perceived stress and depression were significantly related to individual HRQOL. Regional stress and depression were also significant factors and both had greater negative impacts on HRQOL among women than among men.

Citations

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Association between seafood intake and depression in Korean adults: analysis of data from the 2014–2020 Korea National Health and Nutrition Examination Survey
Hyemin Shin, Won Jang, Yangha Kim
Journal of Nutrition and Health.2023; 56(6): 702. CrossRef
Depression before and during-COVID-19 by Gender in the Korean Population
Won-Tae Cha, Hye-Jin Joo, Yu-Shin Park, Eun-Cheol Park, Soo-Young Kim
International Journal of Environmental Research and Public Health.2022; 19(6): 3477. CrossRef
Association Between Regional Levels of Particulate Matter and Recurrent Falls in Korea
Jung-Ho Yang, Ji-An Jeong, Sun-Seog Kweon, Min-Ho Shin
Journal of Korean Medical Science.2022;[Epub] CrossRef

The age-standardized incidence, mortality, and case fatality rates of COVID-19 in 79 countries: a cross-sectional comparison and their correlations with associated factors: Dongui Hong, Sohyae Lee, Yoon-Jung Choi, Sungji Moon, Yoonyoung Jang, Yoon-Min Cho, Hyojung Lee, Sukhong Min, Hyeree Park, Seokyung Hahn, Ji-Yeob Choi, Aesun Shin, Daehee Kang; Epidemiol Health. 2021;43:e2021061. Published online September 8, 2021; DOI: https://doi.org/10.4178/epih.e2021061

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
During the coronavirus disease 2019 (COVID-19) pandemic, crude incidence and mortality rates have been widely reported; however, age-standardized rates are more suitable for comparisons. In this study, we estimated and compared the age-standardized incidence, mortality, and case fatality rates (CFRs) among countries and investigated the relationship between these rates and factors associated with healthcare resources: gross domestic product per capita, number of hospital beds per population, and number of doctors per population.

METHODS

The incidence, mortality, and CFRs of 79 countries were age-standardized using the World Health Organization standard population. The rates for persons 60 years or older were also calculated. The relationships among the rates were analysed using trend lines and coefficients of determination (R2). Pearson correlation coefficients between the rates and the healthcare resource-related factors were calculated.

RESULTS

The countries with the highest age-standardized incidence, mortality, and CFRs were Czechia (14,253 cases/100,000), Mexico (182 deaths/100,000), and Mexico (6.7%), respectively. The R2 between the incidence and mortality rates was 0.852 for all ages and 0.945 for those 60 years or older. The healthcare resources-related factors were associated positively with incidence rates and negatively with CFRs, with weaker correlations among the elderly.

CONCLUSIONS

Compared to age-standardized rates, crude rates showed greater variation among countries. Medical resources may be important in preventing COVID-19-related deaths; however, considering the small variation in fatality among the elderly, preventive measures such as vaccination are more important, especially for the elderly population, to minimize the mortality rates.

Summary

Korean summary
국가별 발생률, 사망률, 치명률을 WHO 표준 인구로 연령표준화하였고, 의료자원과 관계된 지표와의 상관관계를 파악하였다. 2021년 4월 6일 기준, 연령표준화 발생률, 사망률, 치명률이 가장 높은 나라는 각각 체코 (10만명당 14,253명), 멕시코 (10만명당 182명), 멕시코 (6.7%)이며, 60세 이상 노인은 사망률과 치명률이 더 높은 것으로 나타났다. 1인당GDP, 인구당 의사 수, 인구당 병상 수는 발생률과 양의 상관관계가, 치명률과는 음의 상관관계가 있었고 노인에게서는 상관관계가 약하게 나타났다. 코로나바이러스감염증-19로 인한 피해를 최소화하기 위해서 의료자원의 투입과 더불어 노인의 감염예방이 중요할 것이다.

Key Message
The incidence, mortality, and case fatality rates of 79 countries were age-standardized using the WHO standard population. The correlations between the rates and the healthcare resource-related factors were investigated. As of April 6, 2021, the countries with the highest age-standardized incidence, mortality, and case fatality rates were Czechia (14,253 cases/100,000), Mexico (182 deaths/100,000), and Mexico (6.7%), respectively; the mortality and case fatality rates were higher among the elderly. GDP per capita, number of hospital beds per population, and number of doctors per population were associated positively with incidence rate, and negatively with case fatality rates: the correlations were weaker among the elderly. To minimize the burden caused by COVID-19, preventing the elderly from infection is important as well as supply of medical resources.

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Anna K. Porter, Sarah E. Kleinschmidt, Kara L. Andres, Courtney N. Reusch, Ryan M. Krisko, Oyebode A. Taiwo, Geary W. Olsen, Matthew P. Longnecker
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Y. Bodryzlova, A. J. Lemieux, A. Crocker
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Age-standardization and Standard Population
Dongui Hong, Sohyae Lee, Kyu-Won Jung, Aesun Shin
Journal of Health Informatics and Statistics.2023; 48(Suppl 1): S15. CrossRef
Topic and Trend Analysis of Weibo Discussions About COVID-19 Medications Before and After China’s Exit from the Zero-COVID Policy: Retrospective Infoveillance Study
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Rapid establishment of a dedicated COVID-19 hospital in Mexico city during a public health crisis
Roberto Tapia-Conyer, Rafael Ricardo Valdez-Vázquez, Julieta Lomelín-Gascón, Rodrigo Saucedo-Martínez, Luis Alberto Martinez-Juarez, Héctor Gallardo-Rincón
Hospital Practice.2022; 50(3): 183. CrossRef
Comparative epidemiology of five waves of COVID-19 in Mexico, March 2020–August 2022
Iván de Jesús Ascencio-Montiel, Oscar David Ovalle-Luna, Ramón Alberto Rascón-Pacheco, Victor Hugo Borja-Aburto, Gerardo Chowell
BMC Infectious Diseases.2022;[Epub] CrossRef
Global burden of calcific aortic valve disease and attributable risk factors from 1990 to 2019
Jiaye Yu, Zhuo Wang, Qinyi Bao, Shuxin Lei, Yayu You, Zhehui Yin, Xiaojie Xie
Frontiers in Cardiovascular Medicine.2022;[Epub] CrossRef
Is it possible to prepare for a pandemic?
Robert Tucker Omberg, Alex Tabarrok
Oxford Review of Economic Policy.2022; 38(4): 851. CrossRef
Time-series comparison of COVID-19 case fatality rates across 21 countries with adjustment for multiple covariates
Yongmoon Kim, Bryan Inho Kim, Sangwoo Tak
Osong Public Health and Research Perspectives.2022; 13(6): 424. CrossRef
Cause-specific mortality in Korea during the first year of the COVID-19 pandemic
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Bacillus of Calmette and Guérin (BCG) and the risk of leprosy in Ciudad del Este, Paraguay, 2016-2017: Nancy Carolina Cuevas, Victor M. Cardenas; Epidemiol Health. 2021;43:e2021060. Published online September 8, 2021; DOI: https://doi.org/10.4178/epih.e2021060

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Abstract Summary PDF

Abstract

OBJECTIVES
Paraguay has experienced a 35% reduction in the detected incidence of leprosy during the last ten years, as the vaccination coverage against tuberculosis (Bacillus of Calmette and Guérin [BCG] vaccine) reached ≥95% among infants. The objective of this case-control study was to evaluate the protective effect of BCG on the risk of leprosy.

METHODS

We used a population-based case-control study of 20 leprosy confirmed cases reported among residents of Ciudad del Este, Paraguay, diagnosed in 2016-2017. Three controls were selected from a random sample of households from the city. We assessed vaccine effectiveness using 1- odds ratio [OR], and confounding for age, gender, education, occupation, and marital status using stratified and exact logistic regression, and explored if there was effect modification calculating the synergy factor (SF) and relative excess risk due to interaction (RERI).

RESULTS

After controlling for age, gender, education, occupation and marital status, the OR of BCG scar on the risk of leprosy was 0.10 (95% confidence interval [CI], 0.02 to 0.45), for an estimate of vaccine effectiveness of 89.5% reduced risk of leprosy (95% CI, 55.2 to 98.1). There was evidence of heterogeneity by which the effectiveness of BCG seemed stronger among younger persons (Breslow-Day and Z-test of the SF had a p<0.05), and both the RERI and SF indicated a less then multiplicative and additive interaction of BCG and younger age.

CONCLUSIONS

BCG vaccination was associated with a decreased risk of leprosy in the study population, particularly in persons born after 1980.

Summary

Key Message
Paraguay had the second highest reported incidence in the Americas, but no previous study had investigated the topic of BCG for leprosy in Paraguay. We confirmed that BCG protected from leprosy, hence it may have contributed to the observed decline of leprosy.

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BCG and SARS-CoV-2—What Have We Learned?
Jakub Kulesza, Ewelina Kulesza, Piotr Koziński, Wojciech Karpik, Marlena Broncel, Marek Fol
Vaccines.2022; 10(10): 1641. CrossRef

Brief Communication

A comparison of meta-analysis results with and without adjustment for the healthy worker effect: cancer mortality among workers in the semiconductor industry: Sung-Ho Hwang, Moon-Young Park, Won Jin Lee, Inho Park, Kimyong Hong, Donguk Park, Kyoung-Mu Lee; Epidemiol Health. 2021;43:e2021057. Published online September 8, 2021; DOI: https://doi.org/10.4178/epih.e2021057

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Abstract Summary PDF

Abstract

OBJECTIVES
This study compared the results of meta-analysis with and without adjustment for the healthy worker effect on the association between working in the semiconductor industry and cancer mortality.

METHODS

Six studies that reported standardized mortality ratios (SMRs) for cancers were selected for meta-analysis. Using a random-effects model, the SMR results from each study were combined for all cancers and leukemias to estimate the summary SMRs (95% confidence interval, CI). To adjust for the healthy worker effect, the relative standardized mortality ratio (rSMR=SMRx/SMRnot x) were calculated using observed and expected counts for the specific cause of interest (i.e., all cancers and leukemias) and the observed and expected counts for all other causes of mortality. Then, the rSMR results were combined to estimate the summary rSMRs (95% CIs).

RESULTS

The SMRs for all causes of mortality among semiconductor industry workers ranged from 0.25 to 0.80, which reflects a significant healthy worker effect. A remarkable difference was found between the summary SMRs and the summary rSMRs. The summary SMR for all cancers was 0.70 (95% CI, 0.63 to 0.79) whereas the summary rSMR was 1.38 (95% CI, 1.20 to 1.59). The summary SMR for leukemia was 0.88 (95% CI, 0.72 to 1.07), and the summary rSMR was 1.88 (95% CI, 1.20 to 2.95).

CONCLUSIONS

Our results suggest that adjustment for the healthy worker effect (i.e., rSMR) may be useful in meta-analyses of cohort studies reporting SMRs.

Summary

Korean summary
본 연구에서는 반도체 근로자의 암사망률을 일반 인구와 비교하여 표준화사망비(SMR)를 제시한 연구를 대상으로 한 메타분석에서, summary SMR값(95% CI)과 건강근로자효과에 대해 보정한 rSMR을 산출한 후 종합한 summary rSMR값(95% CI)을 비교하였다. 모든 암의 경우 summary SMR=0.70 (0.63-0.79), summary rSMR=1.38(1.20-1.59)로 나타났으며, 백혈병의 경우 summary SMR=0.88 (0.72-1.07), summary rSMR=1.88(1.20-2.95)로 나타났다. 본 연구결과는 SMR 연구를 종합하는 메타분석 연구에서 rSMR과 같은 건강근로자효과에 대해 보정하는 방법론을 적용할 수 있음을 보여주는 사례이다.

Key Message
The relevance of epidemiological research reporting the standardized mortality ratios (SMRs) for workers in the semiconductor industry is often limited by the healthy worker effect. One of the simple correction methods in the relative standardized mortality ratio (rSMR). We observed significant rightward shift when the summary rSMRs were compared with the summary rSMRs, which suggest that adjustment for the healthy worker effect (i.e., rSMR) may be useful in meta-analyses of cohort studies reporting SMRs.

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Health risks, emergency preparedness and Norwegian-Russian cooperation on Svalbard. A systematic review
Turid Austin Wæhler, Tor Ingebrigtsen
International Journal of Circumpolar Health.2022;[Epub] CrossRef

Original Articles

Pain and mortality among older adults in Korea: Chiil Song, Wankyo Chung; Epidemiol Health. 2021;43:e2021058. Published online September 7, 2021; DOI: https://doi.org/10.4178/epih.e2021058

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
With the increasing elderly population with chronic disease, understanding pain and designing appropriate policy interventions to it have become crucial. While pain is a noted mortality risk factor, limited studies exist due to the various causes of pain and the subjectivity of pain expression. This study aimed to examine the relationship between pain and mortality, controlling for other diseases and socio-cultural factors.

METHODS

We analyzed 6,258 individuals aged 45 years or older, the population with the highest prevalence of pain, using the Korean Longitudinal Study of Aging (2006-2016) data and the Cox proportional-hazards model. Further subgroup analyses were conducted by sex and education level to examine differences in the relationship between pain and mortality.

RESULTS

The adjusted hazard ratios of mortality were 1.16 (95% confidence interval [CI], 1.00 to 1.34, model 1) and 1.12 (95% CI, 0.97 to 1.29, model 2) for the individuals in pain depending on the models used, where additional socio-cultural factors were accounted for in model 2. For individuals in severe pain, ratios were significantly higher with 1.23 (95% CI, 1.08 to 1.41, model 1) and 1.16 (95% CI, 1.02 to 1.32, model 2). Further subgroup analyses showed that severe pain was more associated with mortality for males and more educated individuals, with adjusted hazard ratios of 1.29 (95% CI, 1.08 to 1.55, model 2) and 1.62 (95% CI, 1.15 to 2.28, model 2), respectively.

CONCLUSIONS

Pain showed a statistically significant relationship with mortality risk. Family members or medical staff should pay proper attention to pain, particularly severe pain in males and highly educated individuals.

Summary

Korean summary
우리나라의 고령인구와 만성질환의 증가가 가속화됨에 따라, 통증의 문제를 겪는 인구가 증가하고 통증의 사회경제적 영향도 커지고 있어 통증에 대한 엄밀한 분석이 요구된다. 본 연구는 통증을 주로 겪는 중·고령층을 대상으로 생존분석을 통해, 통증이 객관적 지표인 사망위험과 유의미하게 관련이 있음을 보였다. 따라서 환자의 통증 표현은, 특히 남성과 고학력자의 심한 통증 표현은, 사망과 관련이 있는 중요한 지표로 관리될 필요가 있으며 적절한 정책적 접근이 요구된다.

Key Message
With the increasing elderly population with chronic disease, understanding pain and designing appropriate policy interventions to it have become crucial. This study showed that pain had a statistically significant relationship with mortality risk, thus proper attention should be paid to it.

Citations

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Sex-specific effects of neuropathic pain on long-term pain behavior and mortality in mice
Magali Millecamps, Susana G. Sotocinal, Jean-Sebastien Austin, Laura S. Stone, Jeffrey S. Mogil
Pain.2023; 164(3): 577. CrossRef
Spécificités de la prise en charge de la douleur chez la personne âgée
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Bulletin de l'Académie Nationale de Médecine.2023; 207(5): 661. CrossRef

Employment status and mortality among Korean men over a 13-year period: Dohee Lim, Kyoung Ae Kong, Hyesook Park, Kyunghee Jung-Choi; Epidemiol Health. 2021;43:e2021055. Published online August 18, 2021; DOI: https://doi.org/10.4178/epih.e2021055

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study explored the effect of employment status on mortality over a 13-year period in Korean men.
METHODS
Data were used from the Korean Labor and Income Panel Study from 1999 to 2012. This study started with 2,737 subjects and included employed men in good health, aged 30-69 years. Deaths were tracked for 13 years from 2000 to 2012. Employment status classifications were: (1) regular employees, (2) precarious employees, (3) petty bourgeoisie, and (4) employers. Hazard ratios (HRs) were calculated using a Cox proportional hazards model, and were adjusted for age, education, income, and occupation, with regular employees as the reference category. To examine the effect of employment status and include employment history, the risk ratios of mortality were measured using the Poisson regression model, considering the duration of each employment and using 0 years as the reference category.
RESULTS
Over the course of the 13-year study, being a precarious employee (HR, 1.84) or petty bourgeoisie (HR, 1.87) at a particular point in time had a negative effect on mortality when compared with regular employees. Furthermore, working as precarious employees or petty bourgeoisie had no positive effect on mortality. A positive effect was observed, however, on the overall mortality risk for regular employees.
CONCLUSIONS
These results suggest that a healthy social policy is needed for precarious employees and petty bourgeoisie to avoid disadvantages in the workplace and the social safety net.; Summary

Korean summary
13년간 추적한 결과, 비정규직 노동자와 고용원이 없는 자영업자가 정규직 노동자에 비해 사망위험이 유의하게 높았다. 정규직 노동자에서는 일하는 것이 사망위험을 낮추는 긍정적인 효과를 관찰할 수 있었으나, 비정규직 노동자나 고용원이 없는 자영업자에서는 일하는 것의 긍정적인 효과를 관찰할 수 없었다. 이는 비정규직 노동자와 고용원이 없는 자영업자에 대한 건강한 사회 정책이 필요함을 시사한다.

Key Message
Over the course of the 13-year study, being a precarious employee or petty bourgeoisie had a negative effect on mortality when compared with regular employees. No positive effect of working was found for precarious employees or petty bourgeoisie, whereas cumulative work as a regular employee was observed to have a positive effect on mortality. These results suggest that a healthy social policy is needed for precarious employees and petty bourgeoisie to avoid disadvantages in the workplace and the social safety net.

COVID-19: Perspective

Herd immunity: challenges and the way forward in Korea: Jiyoung Oh, Sohyun Kim, Boyeong Ryu, Minjoung Shin, Bryan Inho Kim; Epidemiol Health. 2021;43:e2021054. Published online August 18, 2021; DOI: https://doi.org/10.4178/epih.e2021054

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Abstract Summary PDF

Abstract

Vaccination is considered to be the most effective measure for preventing the spread of coronavirus disease 2019 (COVID-19). Many countries, including of Korea, are focusing on achieving herd immunity with the goal of reaching a vaccination rate of 70-80%. However, achieving herd immunity does not mean eradicating COVID-19, and the following challenges can occur in the process of achieving herd immunity. First, as the vaccination rate is likely to slow down over time, it is necessary to promote the benefits of vaccination through risk communication strategies and provide incentives for those who have been vaccinated. Second, a booster dose may be required depending on future studies on vaccine-induced immunity. Third, since variants capable of evading immunity and with higher transmissibility can emerge, rapid contract tracing and regular community genomic surveillance could help mitigate the impact of new variants. When the impact of COVID-19 is controlled to the level of seasonal influenza, the current public health measures that have been strictly imposed on society since the beginning of the pandemic will no longer be needed. The overall response strategy to COVID-19 will need to change accordingly, based on evaluations of the level of population immunity. These changes will include more efficient and targeted contact tracing and eased quarantine measures for vaccinated close contacts and travelers. Mask wearing and a minimum of social distancing will still be required in the journey towards the end of the pandemic. The COVID-19 pandemic will end, but the virus will not disappear.

Summary

Korean summary
한국을 포함한 많은 국가에서 예방접종률 70~80% 달성을 목표로 집단면역을 달성하는데 집중하고 있으나, 집단면역 달성은 코로나19 퇴치를 의미하지 않으며, 집단면역을 달성해 나가는 과정에서 여러 어려움이 발생할 수 있다. 코로나19의 전반적인 영향력이 계절성 인플루엔자와 같은 관리가능한 수준으로 낮아진다면 현재의 코로나19 대응조치들은 인구집단의 면역 수준을 고려하여 점차 완화될 것이지만 마스크 착용과 최소한의 사회적 거리두기는 당분간 지속될 것이며, 코로나19 대유행이 끝나더라도 바이러스는 사라지지 않을 것이다.

Key Message
Achieving herd immunity does not mean eradicating COVID-19, and some challenges can occur in the process of achieving herd immunity. When the impact of COVID-19 is controlled to the level of seasonal influenza, the current public health measures that have been strictly imposed on society since the beginning of the pandemic will no longer be needed. The overall response strategy to COVID-19 will need to change accordingly, based on evaluations of the level of population immunity. However, mask wearing and a minimum of social distancing will still be required in the journey towards the end of the pandemic. The COVID-19 pandemic will end, but the virus will not disappear.

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Towards a sustainable integrated management approach to uncertainty surrounding COVID‐19
Tiep Nguyen, Leonie Hallo, Nicholas Chileshe, Nghia Hoai Nguyen
Systems Research and Behavioral Science.2023; 40(6): 819. CrossRef
Evolution of Tourism Risk Communication: A Bibliometric Analysis and Meta-Analysis of the Antecedents of Communicating Risk to Tourists
Weina Liu, Chaonan Xu, Yajie Peng, Xinlong Xu
Sustainability.2023; 15(12): 9693. CrossRef
What Happens to the Immune System after Vaccination or Recovery from COVID-19?
Bruna T. Tiyo, Gabriela J. H. Schmitz, Marina M. Ortega, Laís T. da Silva, Alexandre de Almeida, Telma M. Oshiro, Alberto J. da S. Duarte
Life.2021; 11(11): 1152. CrossRef

Original Articles

Recent increase in pertussis incidence in Korea: an age-period-cohort analysis: Chanhee Kim, Seonju Yi, Sung-il Cho; Epidemiol Health. 2021;43:e2021053. Published online August 18, 2021; DOI: https://doi.org/10.4178/epih.e2021053

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Pertussis or whooping cough—one of the most contagious diseases—is caused by the Gram-negative bacterium Bordetella pertussis. Despite a high vaccination rate, Korea recently experienced a resurgence of pertussis. This study explores patterns and possible explanations for this resurgence through an age-period-cohort analysis.

METHODS

Using secondary data from the infectious disease portal of the Korea Disease Control and Prevention Agency and the Korea Statistical Information Service of Statistics Korea, this study analyzed the incidence of pertussis in Korea to determine which factors contributed to the recent increase using an age-period-cohort model.

RESULTS

Analysis of the age effect indicated that the age group most vulnerable to pertussis was 0-year to 2-year-olds. Analysis of the period effect showed a sharp increase in the incidence rate after 2016. Analysis of the cohort effect showed a significant decrease in incidence beginning with the 1955 birth cohort, with the risk increasing again with the 2000s birth cohort.

CONCLUSIONS

Previous studies have suggested 3 main possible explanations for our results. First, the increased incidence rate can be attributed to contact rates. Second, the rate of immunity through natural exposure has decreased due to the low number of circulating pathogens, in turn affecting the trend of infection. Lastly, variations in pathogens may have also contributed to the increase in incidence. Given that the most significant increase in incidence was observed among infants younger than 1 year old, sufficient maternal immunity must be prioritized to provide passive immunity to newborns via the placenta.

Summary

Korean summary
본 연구는 연령-기간-코호트 모델을 활용하여 예방접종률이 높은 국가들의 백일해 재출현에 기여하는 요인에 무엇이 있는지 살펴보았다. 연령에 따른 사회적 접촉률(contact rate)의 변화, 자연노출에 의한 면역 강화(natural boosting) 기회의 감소, 그리고 백일해 병원체의 변이가 백일해 재출현의 원인일 수 있다. 분석 결과 영아 집단에서 백일해 발병률이 가장 급격한 증가가 관찰되었으며, 이는 모성면역의 확보가 중요하다는 점을 시사한다.

Key Message
This study examined factors contribute to the re-emergence of pertussis in countries with high vaccination rates using the age-period-cohort model. Changes in social contact rates according to age, reduction in immune boosting opportunities by natural exposure, and variations in pertussis pathogens may be the cause of re-emergence. As a result of the analysis, the sharpest increase in the incidence of pertussis in the infant group was observed, suggesting that securing maternal immunity is important.

Citations

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Epidemiological Characteristics of Notifiable Respiratory Infectious Diseases in Mainland China from 2010 to 2018
Lele Deng, Yajun Han, Jinlong Wang, Haican Liu, Guilian Li, Dayan Wang, Guangxue He
International Journal of Environmental Research and Public Health.2023; 20(5): 3946. CrossRef
Incidence and Healthcare Burden of Pertussis among Older Adults with and without Pre-Existing Chronic Obstructive Pulmonary Disease or Asthma in South Korea
Jing Chen, Ju-Young Shin, Hyungwoo Kim, Ju Hwan Kim, Ahhyung Choi, Hee Jin Cheong, Yeon-Mok Oh, Adrienne Guignard, Sumitra Shantakumar
COPD: Journal of Chronic Obstructive Pulmonary Disease.2023; 20(1): 126. CrossRef
Pre-Pandemic Distribution of Bacterial Species in Nasopharyngeal Swab Specimens from Pediatric and Adult Patients Detected via RT-PCR Using the Allplex Respiratory Panel
Dong-Hyun Lee, Young-Jin Choi, Jieun Kim, Eunhee Han, Mi-Hyun Bae
Life.2023; 13(9): 1840. CrossRef
Bacterial Etiology in Subacute Cough
Ji-Yong Moon, Hyun Lee, Min-Hye Kim, Woo-Jung Song, Sang Min Lee, Sae-Hoon Kim, Sang-Heon Kim, Byung-Jae Lee, Ho Joo Yoon, Sang Hoon Kim
Allergy, Asthma & Immunology Research.2023; 15(5): 673. CrossRef
Post-Marketing Surveillance of Tetravalent Diphtheria-Tetanus-Acellular Pertussis and Inactivated Poliovirus (DTaP-IPV) Vaccine in South Korea, 2009 to 2015
Young June Choe, Emmanuel Vidor, Christine Manson
Infectious Diseases and Therapy.2022; 11(4): 1479. CrossRef
ARIMA and ARIMA-ERNN models for prediction of pertussis incidence in mainland China from 2004 to 2021
Meng Wang, Jinhua Pan, Xinghui Li, Mengying Li, Zhixi Liu, Qi Zhao, Linyun Luo, Haiping Chen, Sirui Chen, Feng Jiang, Liping Zhang, Weibing Wang, Ying Wang
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Ewa Szwejser-Zawislak, Mieszko M. Wilk, Piotr Piszczek, Justyna Krawczyk, Daria Wilczyńska, Daniela Hozbor
Vaccines.2022; 11(1): 1. CrossRef

Accelerometer-measured stepping cadence patterns in Korean adults: an analysis of data from the 2014-2015 Korea National Health and Nutrition Examination Survey: Geon Hui Kim, Hoyong Sung, Yeun Ryu, Jungjun Lim, Joon-Sik Kim, Hak Kyun Kim, Yeon Soo Kim; Epidemiol Health. 2021;43:e2021056. Published online August 17, 2021; DOI: https://doi.org/10.4178/epih.e2021056

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Abstract Summary PDF: Abstract
OBJECTIVES
The aim of this study was to identify the stepping cadence patterns in Korean adults by using objectively measured accelerometer data to analyze the time spent in each cadence category by sex and age.
METHODS
During the 2014-2015 Korean National Health and Nutrition Examination Survey, 1,703 males and females aged 19-64 years provided at least 1 valid day of data (wearing an accelerometer ≥ 10 hr/d). The mean cumulative time and percentage per day in 8 cadence categories (0, 1-19, 20-29, 30-59, 60-79, 80-99, 100-119, and ≥ 120 steps/min) by sex and age group were calculated.
RESULTS
Cumulative time and percentage per day decreased across the incremental cadence categories. Participants spent 360.08± 2.56 min/d in the non-movement cadence category and 361.50± 2.28 min/d in the incidental movement cadence category. However, they spent only about 18.1 min/d (2.1%) at ≥ 100 steps/min. Males spent significantly more time in the cadence categories of sporadic movement, purposeful steps, slow walking, and medium walking, but the other categories, except for brisk walking, had higher values in females (p< 0.001). The older age group spent less time in non-movement cadence categories, and the youngest and oldest groups spent more time at a higher cadence (≥ 100 steps/min) than the other age groups. Similar patterns were found in a subgroup analysis by sex.
CONCLUSIONS
Korean adults spent most of their time at a low cadence and only a few minutes at a high cadence (≥100 steps/min); this trend was consistent across sex and age groups.; Summary

Korean summary
본 연구에서는 2014-2015년도 국민건강영양조사자료의 가속도계 자료를 활용하여 한국 성인의 성별, 연령별 케이던스 패턴을 확인하였다. 한국 성인은 하루 평균 약 12시간(약 87%)을 분당 20보 이하의 낮은 케이던스에서 보냈고, 분당 100보 이상의 높은 케이던스에서는 하루 중 단지 약 18분 (약 2%)의 시간을 보냈다. 성별 및 연령대에 따라 약간의 차이는 있으나, 대부분 유사한 양상을 보였다.

Key Message
Korean adults spent approximately 12 hours per day (about 87%) at a low cadence (<20 steps per minute) while spending only about 18 minutes per day (about 2%) at a high cadence (≥ 100 steps per minute). Even though certain amount of differences between sex and age groups do exist, most have shown similar patterns.

Data Profile

Data resource profile: the Korea National Hospital Discharge In-depth Injury Survey: Yeon-Kyeng Lee, Sung Ok Hong, Soo-Jung Park, Mijin Park, Kyunghae Wang, Mini Jo, Jeongah Oh, Sin Ae Lee, Hyeon Ju Lee, Jungeun Oh, Dosang Lim, Sanghui Kweon, Youngtaek Kim; Epidemiol Health. 2021;43:e2021052. Published online August 17, 2021; DOI: https://doi.org/10.4178/epih.e2021052

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Abstract Summary PDF

Abstract

The Korea National Hospital Discharge In-depth Injury Survey (KNHDIS), which was started in 2005, is a national probability survey of general hospitals in Korea with 100 or more beds conducted by the Korea Disease Control and Prevention Agency (KDCA). The KNHDIS captures approximately 9% of discharged cases from sampled hospitals using a 2-stage stratified cluster sampling scheme, among which 13% are injury related cases, defined as S00-T98 (injury, poisoning, and certain other consequences of external causes) using International Classification of Diseases, 10th revision codes. The KNHDIS collects information on characteristics of injury-related discharges in order to understand the scale of injuries, identify risk factors, and provide data supporting prevention policies and intervention strategies. The types of data captured include the hospitals’ information, detailed clinical information, and injury-related codes such as the mechanism, activities undertaken when injured (sports, leisure activities, work, treatment, and education), external causes of the injury, and location of the occurrence of the injury based on the International Classification of External Causes of Injuries. Furthermore, the means of transportation, risk factors for suicide, and toxic substances are recoreded. Annual reports of the KNHDIS are publicly accessible to browse via the KDCA website (http://www.kdca.go.kr) and microdata are available free of charge upon request via email (kcdcinjury@korea.kr).

Summary

Korean summary
퇴원손상심층조사는 손상발생 규모 및 손상 퇴원환자의 발생 추이를 파악하고자 2005년 도입된국가 단위 통계를 산출하는 표본 조사 사업이다. 본 연구는 퇴원손상심층조사의 표본설계, 조사방법, 조사항목과 함께 그간의 조사결과의 활용도 등 성과에 대해 살펴보았다. 조사결과는 국가 손상예방관리를 위한 기초자료로 활용되고 있으며, 조사 원자료는 공개하고 있다.

Key Message
The Korea National Hospital Discharge In-depth Injury Survey (KNHDIS), started in 2005, is a national probability survey of general hospitals in Korea with 100 or more beds conducted by the Korea Disease Control and Prevention Agency. The KNHDIS collects information on characteristics of injury-related discharges to understand the scale of injuries, identify risk factors, and provide data supporting prevention policies. The data captured including the hospitals’ information, and injury-related codes based on the International Classification of External Causes of Injuries. Annual reports of the KNHDIS are publicly accessible from KDCA website and microdata are available upon request via email.

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COVID-19: Brief Communication

Hydrogen peroxide as an auxiliary treatment for COVID-19 in Brazil: a randomized double-blind clinical trial: Marielle Bazzo Di Domênico, Kauê Collares, Renan Brandenburg dos Santos, Ulysses Lenz, Vinícius Picoli Antunes, Vinicius Webber Godinho, Henrique Cesca, Thales Henrique Jincziwski Ponciano, Pedro Henrique Corazza; Epidemiol Health. 2021;43:e2021051. Published online August 3, 2021; DOI: https://doi.org/10.4178/epih.e2021051

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Abstract Summary PDF

Abstract

OBJECTIVES
This study evaluated the effectiveness of hydrogen peroxide (H2O2) as mouthwash and nasal spray on symptom relief in coronavirus disease 2019 (COVID-19) patients.

METHODS

Patients positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), who were treated in a hospital or at home, and patients’ family members (not positive for SARS-CoV-2), were randomized into 2 groups: experimental (1% H2O2 for gargling, 0.5% H2O2 for nasal wash), and control. Patients gargled the solution 3 times a day, and applied the nasal spray twice a day, for a 7-day period. Family members received the same treatment as the treated COVID-19 patient. The researchers contacted patients every 2 days over an 8-day period. An average post-treatment interval of 8 days passed before testing family members.

RESULTS

The most frequent symptoms on day 0 were cough, loss of taste, and hyposmia; there were no significant differences between groups, independent of the period. The symptom of dyspnea presented a significant difference between days 2 and 4 (p<0.05). Among family members, 86.0% had no antibodies, 2.3% had antibodies, and 11.6% had active infections (4 in the experimental group and 6 in the control group). The most frequent adverse effects in the H2O2 group were a burning throat and nose.

CONCLUSIONS

H2O2 was not effective for the relief of COVID-19 symptoms and was associated with reports of transient adverse effects.

Summary

Key Message
The hydrogen peroxide (H2O2) at low concentrations disrupts the lipid membranes of some viruses through the action of oxygen free radicals. Nevertheless, the data obtained in the present study demonstrated that the use of the H2O2 as mouthwash and nasal spray was not effective on symptom relief in patients with COVID-19. Moreover, it was associated with transient adverse effects such as burning sensations in the nose and throat. Thus, the authors of this study advise against the use of H2O2 as a mouthwash and nasal spray to relieve COVID-19 symptoms and transmission.

Citations

Citations to this article as recorded by

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