Epidemiology and Health

COVID-19: Original Article

Clinical symptom profile of hospitalized COVID-19 Brazilian patients according to SARS-CoV-2 variants: Natália Satchiko Hojo-Souza, Vander Luis de Souza Freitas, Daniel Ludovico Guidoni, Fernanda Sumika Hojo de Souza; Epidemiol Health. 2023;45:e2023079. Published online August 28, 2023; DOI: https://doi.org/10.4178/epih.e2023079

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Abstract

OBJECTIVES
The aim of this study was to investigate the prevalence of the main symptoms in Brazilian coronavirus disease 2019 (COVID-19) patients hospitalized during 4 distinct waves, based on their infection with different severe acute respiratory disease coronavirus 2 (SARS-CoV-2) variants.

METHODS

This study included hospitalized patients who tested positive for SARS-CoV-2 during 15 weeks around the peak of each of 4 waves: W1, ancestral strain/B.1 lineage (May 31 to September 12, 2020); W2, Gamma/P.1 variant (January 31 to May 15, 2021); W3, Omicron variant (December 5, 2021 to March 19, 2022); and W4, BA.4/BA.5 subvariants (May 22 to September 3, 2022). Symptom data were extracted from the Brazilian Severe Acute Respiratory Syndrome Database. Relative risks were calculated, and an analysis of symptom networks was performed.

RESULTS

Patients who were hospitalized during the prevalence of the Gamma/P.1 variant demonstrated a higher risk, primarily for symptoms such as fatigue, abdominal pain, low oxygen saturation, and sore throat, than patients hospitalized during the first wave. Conversely, patients who were hospitalized during the predominance of the Omicron variant exhibited a lower relative risk, particularly for symptoms such as loss of smell, loss of taste, diarrhea, fever, respiratory distress, and dyspnea. Similar results were observed in COVID-19 patients who were hospitalized during the wave of the Omicron subvariants BA.4/BA.5. A symptom network analysis, conducted to explore co-occurrence patterns among different variants, revealed significant differential profiles across the 4 waves, with the most notable difference observed between the W2 and W4 networks.

CONCLUSIONS

Overall, the relative risks and patterns of symptom co-occurrence associated with different SARS-CoV-2 variants may reflect disease severity.

Summary

Key Message
The study highlights the varying prevalence and distinct symptom profiles among Brazilian COVID-19 patients hospitalized during different waves linked to specific SARS-CoV-2 variants. It suggests that the manifestation of symptoms differs significantly across variant-driven waves, signifying potential shifts in disease severity. Specifically, patients during the Gamma/P.1 variant wave showed higher risks for symptoms like fatigue, abdominal pain, and respiratory impairment, while those during the Omicron wave exhibited lower risks for certain symptoms like loss of smell and taste, indicating changing symptomatology and potentially evolving disease impact linked to different variants.

Citations

Citations to this article as recorded by

Gastrointestinal symptoms in COVID-19 and disease severity: a Japanese registry-based retrospective cohort study
Yuta Matsubara, Hiroki Kiyohara, Yohei Mikami, Kosaku Nanki, Ho Namkoong, Shotaro Chubachi, Hiromu Tanaka, Shuhei Azekawa, Shinya Sugimoto, Yusuke Yoshimatsu, Tomohisa Sujino, Kaoru Takabayashi, Naoki Hosoe, Toshiro Sato, Makoto Ishii, Naoki Hasegawa, Yuk
Journal of Gastroenterology.2024; 59(3): 195. CrossRef
Prevalence and Factors Associated with Olfactory Dysfunction in Individuals with COVID-19 in Brazil: A Study of 20,669 Cases from 2020 to 2021
Carlos Dornels Freire de Souza, Amanda Júlia de Arruda Magalhães, Yasmin Vitória Silva Nobre, Carlos Alberto Souza, André Luis Oliveira do Nascimento, Luísa Robalinho de Faria, Márcio Bezerra-Santos, Anderson da Costa Armstrong, Jandir Mendonça Nicácio, O
Medical Principles and Practice.2024; 33(2): 164. CrossRef
Risks of Adverse Outcomes for Hospitalized COVID-19 Patients during the Four Waves in Brazil According to SARS-CoV-2 Variants, Age Group, and Vaccine Status
Natália Satchiko Hojo-Souza, Waasila Jassat, Daniel Ludovico Guidoni, Fernanda Sumika Hojo de Souza
Viruses.2023; 15(10): 1997. CrossRef

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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Abstract Summary PDF Supplementary 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.

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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Abstract Summary PDF Supplementary 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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Abstract Summary PDF Supplementary 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

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Abstract Summary 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

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Abstract Summary PDF Supplementary 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

Gender differences in hepatitis A seropositivity rates according to the Republic of Korea’s vaccination policy
Hyunjin Son, Sunhyun Ahn, Wonseo Park, Gayoung Chun, Unyeong Go, Sang Gon Lee, Eun Hee Lee
Osong Public Health and Research Perspectives.2024; 15(2): 168. CrossRef
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
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

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Abstract Summary 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

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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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COVID-19: Original Article

Epidemiological characteristics of a COVID-19 outbreak caused by religious activities in Daegu, Korea: Jong-Yeon Kim, Yu-Mi Lee, Hwajin Lee, Jung-Whan Kim, Shin-Woo Kim; Epidemiol Health. 2021;43:e2021024. Published online April 14, 2021; DOI: https://doi.org/10.4178/epih.e2021024

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
A coronavirus disease 2019 (COVID-19) outbreak triggered by religious activities occurred in Daegu, Korea in February 2020. This outbreak spread rapidly to the community through high-risk groups. This study describes the characteristics of COVID-19 cases based on S religious group membership and summarizes the Daegu municipal government’s processes and responses to control the outbreak.

METHODS

The epidemiological characteristics of confirmed cases were obtained through basic and in-depth epidemiological surveys. General characteristics, the proportion of asymptomatic cases, the case-fatality rate, and the time-to-event within each group were presented after stratifying confirmed cases according to S religious group membership.

RESULTS

Overall, 7,008 COVID-19 cases were confirmed in Daegu from February 18, 2020 to June 30, 2020, and 61.5% (n= 4,309) were S religious group members. Compared with non-members, members had a higher proportion of female (p< 0.001) and younger age (p< 0.001), as well as lower disease prevalence. At the time of the investigation, 38.4% of cases in members were asymptomatic versus 23.7% of cases in non-members (p< 0.001). The case-fatality rate of non-members aged ≥ 60 years was significantly higher than that of members (p< 0.001). Compared with non-members, members had longer intervals from symptom onset to diagnosis (p< 0.001) and from diagnosis to admission (p< 0.001), and a shorter interval from admission to discharge (p< 0.001).

CONCLUSIONS

The epidemiological features of S religious group members, including the proportion of asymptomatic cases, case-fatality rate, and time-to-event, differed from non-members. The Daegu authorities prevented further COVID-19 spread through immediate isolation and active screening tests of all S religious group members.

Summary

Korean summary
2020년 2월 대구에서는 종교활동에 의한 코로나바이러스감염증-19(COVID-19) 유행이 발생하였다. 2020년 2월 18일부터 6월 30일까지 대구에서 7,008명이 확진되었으며, 이 중 약 61.5%가 S 종교집단의 신도였다. 비신도인 확진자에 비하여 S 종교집단의 신도인 확진자는 높은 여성 비율, 낮은 연령, 낮은 기저질환 유병률, 높은 무증상 감염율, 동일 연령대에 비하여 낮은 치명률을 보였다. 대구시 보건당국은 S 종교집단의 모든 회원에 대한 즉각적인 격리와 적극적인 선별검사를 통해 지역사회 내 더욱 광범위한 COVID-19 확산을 막을 수 있었다.

Key Message
A coronavirus disease 2019 (COVID-19) outbreak triggered by religious activities occurred in Daegu, Korea in February 2020. Overall, 7,008 COVID-19 cases were confirmed in Daegu from February 18, 2020 to June 30, 2020, and approximately 61.5% were S religious group members. Compared with non-members, members had a higher proportion of women, younger age, and lower disease prevalence, higher proportion of asymptomatic cases and lower case-fatality rate within the same age group. The Daegu authorities prevented further COVID-19 spread through immediate isolation and active screening tests of all S religious group members.

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COVID-19: Brief Communication

Analyzing the effects of social distancing on the COVID-19 pandemic in Korea using mathematical modeling: Sunhwa Choi, Moran Ki; Epidemiol Health. 2020;42:e2020064. Published online September 7, 2020; DOI: https://doi.org/10.4178/epih.e2020064

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
During the 6 months since the first coronavirus disease 2019 (COVID-19) patient was diagnosed in Korea on January 20, 2020, various prevention and control measures have been implemented according to the COVID-19 epidemic pattern. Therefore, this study aimed to estimate the reproductive numbers (R) for each epidemic stage to analyze the effects of the preventive measures and to predict the COVID-19 transmission trends.

METHODS

We estimated the transmission rates for each epidemic stage by fitting a COVID-19 transmission model, based on a deterministic mathematical model, to the data on confirmed cases. The effects of preventive measures such as social distancing by time period were analyzed, and the size and trends of future COVID-19 outbreaks were estimated.

RESULTS

The value of R was 3.53 from February18, 2020 to February 28, 2020, and the mean R reduced to 0.45 from March 14, 2020 to April 29, 2020, but it significantly increased to 2.69 from April 30, 2020 to May13, 2020 and it was maintained at 1.03 from May 14, 2020 to July 23, 2020.

CONCLUSIONS

According to the estimated R, it had fallen to below 1 and was maintained at that level owing to the isolation of infected persons by the public health authorities and social distancing measures followed by the general public. Then, the estimated R increased rapidly as the contact among individuals increased during the long holiday period from April 30, 2020 to May 5, 2020. Thereafter, the value of R dropped, with the continued use of preventive measures but remained higher than 1.00, indicating that the COVID-19 outbreak can be prolonged and develop into a severe outbreak at any time.

Summary

Korean summary
수학적 모델링을 통하여 코로나-19 유행양상에 따른 시기별 감염재생산수(reproductive number)를 추정하고, 시기별 방역정책의 효과를 분석하여 향후 유행의 규모와 유행 종료 시점 등을 예측하였다. 그 결과, 4월30일부터 5월5일까지의 긴 연휴 기간을 통해 사람들 간의 접촉이 증가하면서 감염재생산수가 급격히 증가하였고(4월 30일 - 5월 13일까지 평균 R=2.69), 그 후, 지속적인 방역조치로 인해 5월 14일-7월 23일까지 평균 R=1.03로 감소하였으나, 여전히 1보다 큰 값으로 나타나, 코로나-19유행이 지속되고 있으며 언제라도 다시 큰 유행으로 커질 수 있다고 예측되었다.

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COVID-19: Original Article

Outbreak investigation: transmission of COVID-19 started from a spa facility in a local community in Korea: Taewon Han; Epidemiol Health. 2020;42:e2020056. Published online July 29, 2020; DOI: https://doi.org/10.4178/epih.e2020056

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
In Korea, there have been 10,480 confirmed cases of coronavirus disease 2019 (COVID-19) as of April 11, 2020. We investigated the transmission of COVID-19 in a cluster of cases.

METHODS

We analyzed the epidemiological characteristics of 10 confirmed COVID-19 patients in an outbreak that started at Spa facility A in a local community in Korea on March 28, 2020 and traced them through April 8, 2020. Epidemiological surveys and diagnostic tests were conducted for each contact, and the secondary attack rate was estimated.

RESULTS

There were 3 male confirmed patients (30.0%) and 7 female confirmed patients (70.0%), and their mean age was 53.5 years (range, 2.0 to 73.0). Two patients (20.0%) were asymptomatic. The incubation period was between 3 days and 12 days. Three confirmed patients were infected at female’s Spa facility A and 7 confirmed patients were second, third, and fourth generations of transmission. Seven confirmed patients contracted COVID-19 through presymptomatic contact. In total, 192 contacts were identified, with a secondary attack rate of 3.6%. Eighty-three contacts (43.2%) were aged 40-59 years, and the secondary attack rate was the highest (12.1%) in those aged ≥60 years. Most exposures (n=156, 81.3%) involved casual contact. The number of visitors using the female’s spa facility was 58, including 3 confirmed patients, resulting in a secondary outbreak rate of 5.9%.

CONCLUSIONS

This study presents a cluster of cases occurring in a setting with high temperature and humidity. The second, third, and fourth generations were transmitted through presymptomatic contact.

Summary

Korean summary
본 연구는 목욕탕에서 시작된 지역사회로 전파된 코로나19의 유행조사를 통해 전증상전파와 그 영향에 대해서 알아보고자 하였다. 유행조절과 감염원파악을 위해 목욕탕 방문자와 각 확진자들의 접촉자에 대해서 역학조사 및 검사를 진행하였으며 이에 기반하여 이차감염률을 추정하였고, 이를 통해 전증상 전파 역시도 코로나19 유행에 큰 영향을 미친다는 것을 알 수 있었다. 이러한 전증상전파가 특징인 코로나19 유행을 조절하기 위해선 보건당국의 빠른 접촉자 파악과 격리, 검사 뿐만 아니라 국민들의 개인위생 및 사회적 거리두기가 필수적이다.

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COVID-19: Original Article

Estimating the reproductive number and the outbreak size of COVID-19 in Korea: Sunhwa Choi, Moran Ki; Epidemiol Health. 2020;42:e2020011. Published online March 12, 2020; DOI: https://doi.org/10.4178/epih.e2020011

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3,289 Download
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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Since the first novel coronavirus disease 2019 (COVID-19) patient in Korea was diagnosed on January 20, 2020, 30 patients were diagnosed until February 17, 2020. However, 5,298 additional patients were confirmed until March 4, 2020. Therefore, our objective was to estimate the reproduction number (R) and evaluate the effectiveness of preventive measures.

METHODS

A COVID-19 transmission model (SEIHR) was established to suit the Korean outbreak. The number of daily confirmed cases in Daegu and North Gyeongsang Province (NGP), the main area of outbreak, was used. The first patient’ symptom onset date in the Daegu/NGP outbreak was assumed as January 22, 2020. The R according to the start date of the effect of preventive measures was estimated.

RESULTS

The estimated R in Hubei Province, China, was 4.0281, whereas the estimated initial R in Korea was 0.555, but later in Daegu/NGP, the value was between 3.472 and 3.543. When the transmission period decreases from 4-day to 2-day, the outbreak ends early, but the peak of the epidemic increases, and the total number of patients does not change greatly. It was found that, if transmission rate decreases, the outbreak ends early, and the size of the peak and the total number of patients also decreases.

CONCLUSIONS

To end the COVID-19 epidemic, efforts to reduce the spread of the virus, such as social distancing and wearing masks, are absolutely crucial with the participation of the public, along with the policy of reducing the transmission period by finding and isolating patients as quickly as possible through the efforts of the quarantine authorities.

Summary

Korean summary
수학적 모델링을 통하여 코로나-19 감염재생산수( R )와 대구, 경북의 유행 규모와 유행 종료 시점 등을 예측해보았다. 그 결과 중국 후베이성의 R=4, 한국 초기 30일간의 유행은 R=0.5, 대구/경북의 3월 4일까지의 유행은 R=3.5 수준으로 나타났다. 하지만 방역당국의 적극적인 코로나-19검사로 환자들의 감염전파기간이 짧아지고, 국민들의 마스크 쓰기, 사회적 거리두기 등의 감염 예방조치 적극 참여로 전파율이 낮아져 5월 1일경에 하루 환자 1명 수준으로 예측되었다.

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COVID-19: Special Article

Epidemiologic characteristics of early cases with 2019 novel coronavirus (2019-nCoV) disease in Korea: Moran Ki, Task Force for 2019-nCoV; Epidemiol Health. 2020;42:e2020007. Published online February 9, 2020; DOI: https://doi.org/10.4178/epih.e2020007

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Abstract Summary PDF Supplementary Material

Abstract

In about 20 days since the diagnosis of the first case of the 2019 novel coronavirus (2019-nCoV) in Korea on January 20, 2020, 28 cases have been confirmed. Fifteen patients (53.6%) of them were male and median age of was 42 years (range, 20-73). Of the confirmed cases, 16, 9, and 3 were index (57.2%), first-generation (32.1%), and second-generation (10.7%) cases, respectively. All first-generation and second-generation patients were family members or intimate acquaintances of the index cases with close contacts. Fifteen among 16 index patients had entered Korea from January 19 to 24, 2020 while 1 patient had entered Korea on January 31, 2020. The average incubation period was 3.9 days (median, 3.0), and the reproduction number was estimated as 0.48. Three of the confirmed patients were asymptomatic when they were diagnosed. Epidemiological indicators will be revised with the availability of additional data in the future. Sharing epidemiological information among researchers worldwide is essential for efficient preparation and response in tackling this new infectious disease.

Summary

Korean summary
2020년 1월 20일 한국의 신종코로나바이러스 감염자가 확진된 이후 약 20일만에 28명이 확진되었다. 확진자중 지표환자가 16명(57.2%), 1세대환자 9명(32.1%), 2세대환자가 3명(10.7%)이다. 지표환자 16명중 15명은 1월 19일-24일에, 1명은 1월 31일에 국내에 입국하였다. 환자들의 잠복기는 평균 3.9일 (중위값 3일), 감염재생산수(R)는 0.48로 추정되었다. 확진자 중 3명은 증상이 없는 상태에서 확진이 되었다. 향후 새로운 정보가 나오면 역학 지표들이 수정될 것이다.

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Original Article

Ebola virus disease outbreak in Korea: use of a mathematical model and stochastic simulation to estimate risk: Youngsuk Ko, Seok-Min Lee, Soyoung Kim, Moran Ki, Eunok Jung; Epidemiol Health. 2019;41:e2019048. Published online November 24, 2019; DOI: https://doi.org/10.4178/epih.e2019048

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
According to the World Health Organization, there have been frequent reports of Ebola virus disease (EVD) since the 2014 EVD pandemic in West Africa. We aim to estimate the outbreak scale when an EVD infected person arrives in Korea.

METHODS

Western Africa EVD epidemic mathematical model SEIJR or SEIJQR was modified to create a Korean EVD outbreak model. The expected number of EVD patients and outbreak duration were calculated by stochastic simulation under the scenarios of Best case, Diagnosis delay, and Case missing.

RESULTS

The 2,000 trials of stochastic simulation for each scenario demonstrated the following results: The possible median number of patients is 2 and the estimated maximum number is 11 when the government intervention is proceeded immediately right after the first EVD case is confirmed. With a 6-day delay in diagnosis of the first case, the median number of patients becomes 7, and the maximum, 20. If the first case is missed and the government intervention is not activated until 2 cases of secondary infection occur, the median number of patients is estimated at 15, and the maximum, at 35.

CONCLUSIONS

Timely and rigorous diagnosis is important to reduce the spreading scale of infection when a new communicable disease is inflowed into Korea. Moreover, it is imperative to strengthen the local surveillance system and diagnostic protocols to avoid missing cases of secondary infection.

Summary

Korean summary
본 연구는 수학적 모델과 확률 시뮬레이션 기법을 이용하여 국내에 유입되지 않았던 에볼라바이러스병(EVD)의 확산 위험도를 정량적으로 예측하는 첫 번째 연구이다. 또한 이 연구를 통해 에볼라바이러스병 환자의 유입 시 발생 가능한 진단 지연 혹은 유입 미인지 상황을 가정하여 발생할 수 있는 2차 감염자 수 및 감염 종식까지의 기간을 계산했고 에볼라바이러스 유입 대비 실시간모니터링의 중요성과 확산 시 상황에 따른 최대 일일 환자수를 합리적으로 제시할 수 있다.

Citations

Citations to this article as recorded by

Estimating the Transmission Risk of COVID-19 in Nigeria: A Mathematical Modelling Approach
Irany FA, Akwafuo SE, Abah T, Mikler AR
Journal of Health Care and Research.2020; 1(3): 135. CrossRef

Special Article

Causes and countermeasures for repeated outbreaks of hepatitis A among adults in Korea: Moran Ki, Hyunjin Son, Bo Youl Choi; Epidemiol Health. 2019;41:e2019038. Published online September 22, 2019; DOI: https://doi.org/10.4178/epih.e2019038

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Abstract Summary PDF Supplementary Material

Abstract

The 2019 hepatitis A outbreak has become increasingly prevalent among adults in Korea and is the largest outbreak since that in 2009-2010. The incidence in the current outbreak is highest among adults aged 35-44 years, corresponding to the peak incidence among those aged 25-34 years 10 years ago. This may indicate a cohort effect in the corresponding age group. Causes of these repeated outbreaks of hepatitis A in Korea are low level of immunity among adults, Korean food culture that consumes raw seafood such as salted clam and inadequate public health system. Among countermeasures, along with general infectious disease control measures including control of the infectious agent, infection spread, and host, urgent actions are needed to review the vaccination policy and establish an adequate public health system.

Summary

Korean summary
2019년 한국 성인의 A형 간염 유행은 10년전 대규모 유행 이후 가장 큰 규모로발생하고 있다. 주 발생 연령이 10년전 유행보다 10세가 증가한 35-44세로 나타나 연령 코호트 효과라 볼 수 있다. 우리나라의 A형 간염 반복 유행의 원인은 성인의 낮은 집단면역수준, 어패류 생식문화, 공중보건의료체계 미비 등으로 보인다. 이에 대한 대책은 일반적인 감염관리대책인 감염원관리, 전파관리, 숙주관리와 함께 효율적인 백신접종정책, 공고한 공중보건관리체계 마련 등의 근본적 대책이 시급하다.

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