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Volume 27 (1); June 2005
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Original Articles
Smoking and cause of death in Korea: 11 years follow-up prospective study.
Sun Ha Jee, Ji Eun Yun, Jung Yong Park, Jae Woong Sull, Il Soon Kim
Korean J Epidemiol. 2005;27(1):182-190.
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Abstract
OBJECTIVE: In Korea, male smoking prevalence is among the world's highest and mortality rates from smoking-caused cancers, particularly lung cancer, are escalating. This cohort study examined the effects of cigarette smoking on the risk of mortality from all causes, cancers and cardiovascular diseases(CVD), and characterized the relationship of the risk with the amount and duration of cigarette smoking.
METHOD
A eleven-year prospective cohort study was carried out of on 1,207,592 Koreans, 30 to 95 years of age. The study population includes participants in a national insurance program, who completed a questionnaire on smoking and other risk factors. The main outcome measures were death from all causes, cancer and CVD, obtained through record linkage. At baseline, 482,997 men(60.0%) and 19,755(5.3%) women were current cigarette smokers.
RESULTS
In multivariate Cox proportional hazards models, controlling for age, alcohol drinking, exercise, and obesity, current smoking among men increased the risks of mortality from all cause death (relative risk[RR], 1.56; 95% confidence interval[CI], 1.52~1.59), all cancer (1.75, 1.68~1.82), and CVD(1.46, 1.38~1.55). Similar results were found for mortality among women. Smoking also increased the risks of mortality for cancer of the lung(4.60, 4.09~5.33) and other cancers, including larynx, bile duct, esophagus, liver, stomach, pancreas, bladder, and also leukemia. Current smoking among women increased the risk of lung cancer mortality(RR=2.83, 95% CI 2.38~3.36).
CONCLUSION
In Korea, smoking is an independent risk factor for death from all causes, CVD and a number of major cancers. The findings affirm the need for aggressive tobacco control in Korea in order to minimize the epidemic of smoking-caused disease.
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Accidents Status of Freshmen for 2 Months before Entrance University.
Young Sun Min, Hyun Sul Lim
Korean J Epidemiol. 2005;27(1):173-181.
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Abstract
OBJECTIVES
In recent years, Korea has experienced a loss of manpower and economy due to accidents. The consequences have been comprehensive. Nevertheless, there have been few recent Korean studies on adult accidents. Therefore, this study was carried out to examine the incidence pattern of accidents for 2 months before entering university among university freshmen.
METHODS
The subjects were 1,920 university freshmen who visited the university health center for health examination from March 8 to 12, 2004, and self-reported questionnaire was given to the subjects. The authors developed a questionnaire including age, gender, place and type of high school, experience of accidents, occurrence time and type of accidents and so on.
RESULTS
The monthly incidence of accident was 9.9 per 1,000 population. The accident cases were 28 in male and 10 in female, and the incidence of males was significantly higher than females. The frequent accident states were 15 cases in 'Ordinary life' (39.8%), 10 in 'Sports activities' (26.3%), 9 in 'Walking' (23.7%) and so on. The accident types were 13 cases of 'Tumbling over' (34.2%), 12 of 'Crash' (31.6%), 8 of 'Traffic accident' (21.0%) and so on. The frequent injury types were 19 cases of 'Sprain' (50.0%), 15 of 'Contusion' (38.4%) and 2 of 'Laceration' (5.3%). One's own carelessness was the most frequent cause of accident (65.8%). After the accident, 28 cases(73.7%) visited the hospital, 7 (18.4%) were hospitalized, and 3 (7.9%) underwent surgery.
CONCLUSIONS
Because the most frequent cause of accidents was one's own carelessness, self-consciousness and attention are needed. The authors expect that this study will go far toward increasing concern of researchers and administrators for the accidents among adults.
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Long-term prediction of gastric cancer mortality in Korea.
Jin Gwack, Yunhee Choi, Hai Rim Shin, Yun Chul Hong, Keun Young Yoo
Korean J Epidemiol. 2005;27(1):163-172.
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Abstract
PURPOSE
This study was carried out to predict the mortality rate for gastric cancer up to 2020 in Korea with forecasting model.
METHODS
The trends of the age-adjusted mortality rate was calculated from 1983 to 2003 using the mortality data of the past 20 years in Korea, and projected up to the year of 2020 with log-linear models for each gender. The number of deaths from gastric cancer was calculated from the predicted mortality rate.
RESULTS
Age-adjusted mortality rates for gastric cancer per 100,000 persons were 32.13 in 1983, 23.95 in 1990, and 15.99 in 2003 for women, and 70.37, 58.74, 41.04 for men, respectively. The expected age-adjusted mortality rates for gastric cancer were 16.50 in 2005, 14.27 in 2010, and 10.66 in 2020 for women, and 39.14, 33.83, 25.28 for men, respectively. In contrast to this decreasing trend, it is predicted that mortality rates for those aged 75 or over would increase steadily. The predicted number of deaths from gastric cancer was 6,519 for women and 13,743 for men in 2020.
CONCLUSIONS
This study suggests that gastric cancer mortality rate would decrease continuously except for some aged groups. The declining trends in gastric cancer mortality are regarded as a result of lifestyle changes, improvements in screening methods and treatments. Strategies for aged groups should be developed in order to control increasing mortality rates.
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Mortality Trends in Colorectal Cancer and Breast Cancer in Korea: Birth Cohort Effects?.
Jae Kwan Jun, Yeon Ju Kim, Jin Gwack, Yunhee Choi, Yun Chul Hong, Keun Young Yoo
Korean J Epidemiol. 2005;27(1):154-162.
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Abstract
PURPOSE
Cancer has been the leading cause of deaths since 1980s in Korea. Among them, colorectal cancer and breast cancer shows steadily increasing pattern, being the fourth and the fifth common site of cancer death in Korea, respectively. This analysis aimed to evaluate potential contribution of birth cohort effects to the recent increases in mortality of colorectal cancer and breast cancer since 1983 in Korea.
METHODS
Mortality statistics on deaths of both cancers for the past 20 years of 1983~2002 were obtained from the National Statistical Office. The age-standardized mortality rates were calculated based on the census population of 1992 as a standard.
RESULTS
Age-standardized mortality rate for colorectal cancer increased 4.7-fold in men and 3.6-fold in women, whereas 2.1-fold increase in breast cancer mortality during 1983~2002. Age-specific mortality rates for colorectal cancer were steadily increasing by age before 1991 in both genders. However, the mortality rates showed an exponentially increasing pattern for the age group of 70 and over during 1993~2001, which was more prominent in female. The birth cohort curves showed that there were 2- to 3-fold increases in the mortality rates of people who were born in 1931 for colorectal cancer compared to those of people who were born in 1921. Differences in mortality for breast cancer by birth cohort were 1.7-fold among age group of 45~49 and 50~54 between 1936 and 1946.
CONCLUSIONS
This analysis suggests that recent increases in mortality of colorectal cancer and breast cancer could potentially be due to birth cohort effects, i.e. rapid changes in life-style in younger generation. The quantitative approach using age-period-cohort model should be pursued.
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A study on the addicted use of mobile phone among the high school students.
Jin young Jeong, Dong Hyun Kim
Korean J Epidemiol. 2005;27(1):140-153.
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Abstract
BACKGROUND
As there are many teenagers being addicted to the Internet ever since the computer became one of the communication channels, similar addictive phenomena are expected to occur for mobile phone usage as it rapidly positions itself as a means of communication among teenagers. OBJECTIVE: This study was performed to describe the pattern of mobile phone usage among high school students and to examine the association with psychological characteristics related to addiction such as depression, self-esteem and impulsiveness.
METHOD
OLOGY: A survey was conducted for 501 high school students(254 males and 247 females), currently using mobile phones, in the Metropolitan Seoul area. The Questionnaire by Young for the evaluation of internet addiction was modified and supplemented incorporating the circumstances in Korea. For the psychological characteristics, following were used: Korean translation of the depression scale CES-D, the self-esteem scale and Barratt Impulsiveness Scale. Based on the total score on the mobile phone survey, the top 25% were categorized as the addicted user group (n=129) and the bottom 25% as the non-addicted user group(n=126).
RESULTS
The addicted user group started using the mobile phone earlier, used their phones for longer durations and displayed higher purchasing frequencies than the non-addicted user group. Furthermore, the addicted group members scored higher in terms of average daily usage time, voice call duration, SMS exchanges, the number of contacts stored in the phone, experiences of using the phone during classes, and average monthly charges. Multiple logistic regression analysis was performed to assess associated factors of addicted mobile phone use. In terms of psychological characteristics, addicted mobile phone use was 10.2 times(OR=10.2, 95% CI 2.1~49.2) greater if the depression point is 51 or higher compared to 35 or less, and 6.3 times(OR=6.4, 95% CI 2.0~20.5) greater if the impulsiveness point is 61 or higher compared to 50 or less.
CONCLUSION
These finding showed that there were differences between the addicted mobile phone user group and the non-addicted counterpart in terms of mobile phone usage patterns and psychological characteristics such as depression and impulsiveness. Further studies on the association between addicted use of mobile phone and psychological factors are needed.
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Prevalence and Risk Factors of Green Tobacco Sickness among Korean Tobacco Harvesters, 2003.
Kwan Lee, Hyun Sul Lim
Korean J Epidemiol. 2005;27(1):129-139.
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Abstract
OBJECTIVES
This study was carried out to understand the prevalence and risk factors of green tobacco sickness (GTS) among Korean tobacco harvesters.
METHODS
The authors conducted a questionnaire among the tobacco harvesters (842 persons from 449 out of 500 tobacco harvesting households) in Cheongsong-gun for 4 days from Sep 1 to 4, 2003.
RESULTS
The study subjects contained 440 males and 402 females. The prevalence of GTS in 2003 was 39.2%, and was significantly higher in females (53.4%) than in males (25.6%, p<0.01). The incidence density of GTS according to the number of workdays in 2003 was 11.5 spells/100 person-days. The GTS symptoms reported by the tobacco harvesters in 2003 were nausea in 320 cases (97.0%), dizziness in 311 cases (94.2%), headache in 264 cases (80.0%) and vomiting in 209 cases (63.3%) etc. Through multiple logistic regression, the factors significantly associated with GTS were found. Odds ratio for smoking, age over sixty(compared with under forties), and working over 10 hours(compared with under 10 hours) were respectively 0.23 (95% CI: 0.16~0.33), 0.46 (95% CI: 0.23~0.93), and 1.53 (95% CI: 1.12~2.10).
CONCLUSIONS
Our studies before this, there were significant recall bias by time lag between harvesting period and survey time. We tried to study promptly after harvesting tobacco leaves to solve this recall bias. More extensive epidemiologic studies, and educations for harvesters are expected.
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Relationship among risk factors related to Human Papillomavirus infection among youth.
Jin Kyoung Oh, Young Hee Ju, Dong Young Yoon, Kap Yeol Jung, Se Il Jung, Hai Rim Shin
Korean J Epidemiol. 2005;27(1):118-128.
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Abstract
PURPOSE
To investigate the prevalence and related risk factors of infection with human papillomavirus(HPV) in young adults, and the interrelationships among the risk factors, school-based survey was conducted in Busan.
METHODS
A total of 1,430 male and female students(aged 16~25) participated in the survey that included self-administered questionnaire and, for males, physician-performed collection of exfoliated genital cells, for females, self-collection of vaginal cells. The prevalences of 25 HPV types were evaluated by a polymerase chain reaction-based assay.
RESULTS
HPV DNA detected more frequently in female students(15.2%) than in male students(8.7%). In female students, currently smoking cigarettes(OR=3.8, 95% CI=1.7~8.3) and having had penetrative sexual intercourse(OR=12.7, 95% CI=7.2~22.2) were the significant risk factors for HPV infection; in male students, there was nothing to show statistical significance. Smoking rate was 53.8% in males and 17.7% in females, and 55.6% of male students and 25.9% of female students reported having had a sexual intercourse. Smokers were more likely to have had a sexual intercourse than nonsmokers(OR=4.0, 95% CI=2.5~6.2, males; OR=9.1, 95% CI=5.6~14.7, females).
CONCLUSIONS
According to the strong interrelationship between sexual intercourse and smoking, multilateral behavioral intervention is needed to prevent infection with HPV.
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The Factors Associated with the Abnormal Eating Behavior in University Hospital's Nurses.
Young Geon Ji, Su Jin Kim, Hyung Gon Kang
Korean J Epidemiol. 2005;27(1):108-117.
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Abstract
OBJECTIVES
To compare eating behavior according to the shift work and to find the factors associated with the abnormal eating behavior in university hospital's nurses.
METHODS
For this assessment, a cross-sectional study was conducted with 300 university hospital's nurses. Nurses were questioned with self-reported questionnaire forms. After excluding cases with incomplete data, 276 cases are enrolled in the study. To find the factors associated with the abnormal eating behavior, we conducted multiple logistic regression analysis.
RESULTS
The proportions of shift work nurses were 63.77%(176 cases). The proportions of abnormal eating behavior among shift work nurses were 22.73%(40 cases), but only 6.00%(6 cases) among non-shift work nurses had the abnormal eating behavior. Considering the shift work period, the proportions of abnormal eating behavior were 31.25%, 22.92% and 17.50% in case of shift work period were less than 1 year, 1~3 years and more than 3 years, respectively. The abnormal eating behavior was associated with having shift work, doing exercise, more weekly working hours, being on a diet and having perception of overweight. But age and body mass index were not influenced the abnormal eating behavior.
CONCLUSIONS
In this study, we found that the factors associated with the abnormal eating behavior are the shift work, exercise, weekly working hours, perception of overweight and diet.
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Reviews
Epidemiology and Prevention Strategies of Avian Influenza.
Byung chul Chun, Jae hong Kim, Yoon jung Lee, Kang Chun, Hyun mee Kim, Young kuk Kwon, Jun gu Choi, Eun kyoung Lee, Choi kyu Park, Sung hwan Wee, Soon ja Choi
Korean J Epidemiol. 2005;27(1):90-107.
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Abstract
Natural infections with influenza A viruses have been reported in a variety of animal species including humans, pigs, horses, sea mammals, and birds. Although viruses of relatively few haemagglutinin(HA) and neuraminidase(NA) subtype combinations have been isolated from mammalian species, all subtypes, in most combinations, have been isolated from birds. During the past few years, several subtypes of avian influenza A have been shown to cross the species barrier and infect humans. During an outbreak of a highly pathogenic influenza A(H5N1) virus among poultry in Hong Kong in 1997, 6 of 18 people with confirmed infection died. And a total of 89 human infections with influenza A(H7N7), including 1 resulting in the death of a Dutch veterinarian, occurred during the extensive outbreak in 2003. During late 2003 and early 2004, there were reports of large outbreaks of H5N1 among poultry throughout Asia (including Korea, Japan, Indonesia, Vietnam, Thailand, Laos, Cambodia, and China). In Korea, we had also highly pathogenic avian influenza(HPAI) outbreak in 2003~2004 with a first suspected case reported on 10 December 2003. The case was reported at a parent stock farm for broilers, which was located in Chungbuk province, and the farm was immediately placed under movement restrictions. Laboratory tests confirmed the outbreak of HPAI on 12 December 2003. Up to 20 March 2004, a total of 19 farms were confirmed as having been infected with HPAI virus. No further outbreaks occurred after that date. Fortunately there were no human cases founded in this epidemic in Korea. In January 2004, there was confirmation that influenza A(H5N1) virus had been isolated from patients who had died of a respiratory illness in Vietnam. Total 107 human confirmed cases were reported until June 2005 to WHO, threatening new pandemic outbreak. We reviewed our prevention and control strategies of avian influenza and preparedness to the pandemic outbreak.
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Development of Policy and Strategy for the Control of Creutzfeldt-Jakob Disease in Korea.
Seung Il Choi, Byung Hoon Jeong, Yong Sun Kim
Korean J Epidemiol. 2005;27(1):81-89.
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Abstract
PURPOSE
Through the understanding of the current status of transmissible spongiform encephalopathy(TSE), this study was conducted to contribute to the development of policy and strategy for the control of TSE in Korea in order to keep Korea as a bovine spongiform encephalopathy(BSE)- and variant Creutzfeldt-Jakob disease(vCJD)-free country. BSE and vCJD cases have not been found in Korea. During 2001-2004, the number of patients who have been diagnosed as a definite or probable CJD was 121, which are consisted of 62 male and 59 female(average age: 63 years old). The occurrence of the patients was 5-59 people per year until 2003 and has been gradually increasing due to the recent increase in the diagnostic rate rather than the increase of the incidence. In 2004, the annual occurrence of sporadic CJD(sCJD) in Korea was 1 people per million, which is similar to the average occurrence rate of the world. Two cases of chronic wasting disease(CWD) in deer were found in Chungcheongbuk-do, one in August 2001 and one in October 2001. After that, 4 more CWD-affected deer have been reported in Kyungsangnam-do area in November 2004. We have also examined the possibility that Korean CJD occurred as a result of dietary exposure to BSE. Fortunately, all of Korean CJD patients were not vCJD cases. However, if BSE occurs in Korea, there is a great potential for most of the Korean population to be easily infected with BSE due to their highly susceptible genotype to BSE infection as well as their traditional food habit. In 2003, the total number of people who left Korea was almost identical with the total number of people who entered Korea. However, we could not analyze the number of people who visited or stayed in the UK and Europe during 1980s~1990s, in which BSE was prevalent in Europe, because there was no statistical data available.
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An epidemiologic review of Japanese Encephalitis with a special focus on incidence and methods of control for South Korea.
Hee choul Ohrr, Sang Wook Lee, Jae Seok Hong
Korean J Epidemiol. 2005;27(1):69-80.
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Abstract
Japanese encephalitis(JE) is the leading viral cause of encephalitis and disability in Asia. The disease primarily infects children under the age of 15, leaving up to 70% of these who develop illness either dead or with a long-term neurological disability. We reviewed not only JE disease burden, etiology, vector, mode of transmission, reservoir but also geographic distribution and incidence of the disease in Asia, with a focus on the South Korea. A special comment on the methods of control JE and perspective for South Korea also included.
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Epidemiology and Prevention Strategies of Rabies in Korea.
Joong Bok Lee, Hun Jae Lee, Bang Hun Hyun, Ji Hwan Bang, Kyung Ok Nam, Young Eui Jeong, Young Hack Shin
Korean J Epidemiol. 2005;27(1):53-68.
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Abstract
Rabies is a uniformly fatal encephalitis and cannot be treated, therefore efforts must be focused on preventing the disease. The incidence of rabies in humans and animals has decreased with the introduction of rabies vaccination for animals since the early 1950s in Korea. There was no rabies occurrence either in human or animal for 8 years from 1985 to 1992. However, a case of animal rabies recurred in 1993. Since then, rabies endemic areas were expanded into 17 counties near the demilitarized zone, and 6 human cases were reported from the endemic areas of animal rabies. According to epidemic studies, wild raccoon dogs were suspected to be the transmission source of rabies in dogs, domestic animals, and other wild animals, which resulted in human rabies. Rabies prevention strategies were aimed at the animals capable of transmitting rabies or vaccination for the high risk group and postexposure prophylaxis for the bitten patients. Unfortunately, these activities were not conducted appropriately and substantially. All rabies victims were either not treated or did not receive timely and appropriate postexposure treatment. Prevention of rabies can only be achieved by securing political and financial support for an effective rabies program. Key activities for rabies prevention should include changing current public perception regarding rabies, strengthening surveillance for the exposed person to suspected rabid animals, and laboratory-based rabies surveillance.
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A study on epidemiological characteristics and control methods of EHEC infection in Korea.
Sang Won Lee, Bok Kwon Lee, Yong Jae Lee, Hee Soo Lee, Suk Chan Jung, Kwak Hyo Sun, Bo Youl Choi
Korean J Epidemiol. 2005;27(1):37-52.
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Abstract
E. coli is a bacterium that is commonly found in the gut of humans and warm-blooded animals. Most strains of E. coli are harmless. But some strains such as Enterohaemorrhagic E. coli(EHEC), can cause severe food borne disease. It is transmitted to humans primarily through consumption of contaminated foods, such as raw or undercooked ground meat. There is no widely agreed definition of when a shiga-toxin producing E. coli is considered to be an EHEC. But in Korea, the word "EHEC", "STEC", "VTEC" are often used as same meaning, which refer to the E.coli those producing shiga-toxin. We suggest the term STEC refers to those E. coli produce one or more shiga-toxins(stx), and the term EHEC refers only to STEC that cause a clinical illness. EHEC infection were designated as the class 1 notifiable disease in Korea in 2000. Although EHEC/STEC cases were not common in Korea, the number of STEC infection cases reported has increased since 2001. From 2001 to 2004, the number of STEC infection cases in Korea were 11, 8, 52, 118 respectively. These cases included 17 due to E. coli O157, 136 due to E. coli, serogroup non-O157, and 15 due to E. coli that were not serogrouped. The most common serotype implicated is E. coli O91 without virulent factor and clinical symptoms. But those cases involve in one epidemic in primary school in 2004. STEC infections in Korea occur in all age groups, with the highest frequencies in children less than 5 years old. Healthy cattle are the main animal reservoir for STEC and they harbor the organism as part of the bowel flora. The proportion of STEC in E. coli in animal feces was examined by using stool samples from 283 Korean beef cattle on 27 farms, 169 milk cattle on 28 frams, 455 swine on 50 farms. As determined by culture and toxin assay, the proportion of STEC was 25.8%(16 STEC/62 E. coli) in milk cattle, 18.8%(19 STEC/101 E.coli) in Korean beef cattle, 14.0%(25 STEC/178 E. coli) in swine. Effective surveillance of EHEC/STEC in humans is essential in order to protect the public health. EHEC infection is notifiable in many countries including USA, Japan, and Belgium, Finland, Italy, Netherlands, and the United Kingdom(UK), have sentinel systems. England, Wales, and Scotland have comprehensive national laboratory reporting schemes for STEC. And there has been an increase in the number of reported cases and outbreaks during the past decades in many countries Prevention of STEC infection requires control measures at all stages of surveillace, investigations and special pathogen tracing such as PulseNet.
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Brucellosis: An Overview.
Hyun Sul Lim, Young Goo Song, Han Sang Yoo, Mi Yeoun Park, Jong Wan Kim
Korean J Epidemiol. 2005;27(1):26-36.
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Abstract
Brucellosis is zoonotic disease of worldwide distribution and still remains endemic in some developing countries. The main pathogenic species worldwide are B. abortus, responsible for bovine brucellosis, B. melitensis. The B. abortus is most common in Korea. Each Brucella spp. has a preferred natural host that serves as a reservoir of infection. The incubation period varies between 5 and 60 days, and Brucella infection may be asymptomatic or symptomatic. The majority of patients complained of fever (undulating fever), sweats, malaise, anorexia, and arthralgia. The diagnosis of brucellosis requires the isolation of Brucella from blood or body tissues, or the combination of suggestive clinical presentation and positive serology. There were first patients in 2002, thereafter 16 patients in 2003, and 47 patients in 2004, the human brucellosis are increasing more gradually in Korea. Brucellosis is an occupational risk for farmers, veterinarians, and abattoir workers. The main sources of Brucella are infected animals or their products, such as milk, blood, carcasses, and abortion products. Routes of transmission of the infection to humans include direct contact with infected animals and their secretions through cuts and abrasions in the skin, by way of infected aerosols inhaled or via the ingestion of unpasteurized dairy products. A combination of doxycycline and streptomycin has been used widely in brucellosis. Prevention of brucellosis in human still depends on the eradication or control of the disease in animal hosts, the exercise of hygienic precautions to limit exposure to infection through occupational activities and the effective heating of dairy products, and other potentially contaminated foods. Also, physicians and veterinarians must be concerned about specific environments and clinical patterns of brucellosis.
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Anthrax: An Overview.
Hyun Sul Lim, Young Goo Song, Han Sang Yoo, Seong Won Keun, Jong Wan Kim
Korean J Epidemiol. 2005;27(1):12-25.
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Abstract
Human anthrax has been a zoonotic disease affecting those who have close contact with animals or animal products contaminated with the spore-forming bacterium Bacillus anthracis. Now the incidence of anthrax in herbivores and human are rare, but it remains an important health problem in Korea because anthrax is seen as one of the most likely biological weapon. The B. anthracis forms a spore, which is resistant to drought, heat and numerous disinfectants, and the spore can remain viable and infective in the environment for decades. There are three major forms of human disease depending on how infection is contracted, cutaneous, inhalation and ingestion. Inhalational anthrax is the most common form, but the events in the Korea show that gastrointestinal anthrax is the most common. Several cases of anthrax have been reported in Korea. In recent years, 2 cases of bovine anthrax and 5 cases of human anthrax occurred in Changnyeong-gun, 2000, but it haven't occurred any more so far. The most useful microbiological test remains the standard blood culture. Confirmatory diagnostic tests such as polymerase chain reaction can also be used and may help in early diagnosis. Prompt clinical suspicion and rapid administration of effective antimicrobials are essential for treatment of anthrax. Ciprofloxacin or doxycycline should be used for initial intravenous therapy until antimicrobial susceptibility results are known. The best measure to eliminate human anthrax is control in domestic animals by effective surveillance and by immunization of animals in endemic areas. Also, the government must establish countplan for knowledge and rational policies in dealing with potential bioterrorism attacks.
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