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COVID-19: Perspective
COVID-19 outbreak, herd immunity formation, and future public health strategies
Youngtaek Kim, Yoon Hyung Park
Epidemiol Health. 2021;43:e2021071.   Published online September 16, 2021
DOI: https://doi.org/10.4178/epih.e2021071
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  • 202 Download
  • 1 Web of Science
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
In Korea, where the successful control of the coronavirus disease 2019 (COVID-19) epidemic have been implemented by the follow-up survey management (containment) of COVID-19-infected persons, the number of infected persons has increased rapidly, and a re-epidemic trend is emerging. The Korean government is strengthening epidemic prevention activities, such as increasing the social distance in the metropolitan area to four levels and increasing the vaccination rate. The public has been complaining of dissatisfaction with the atrophy of socioeconomic activities and of distrust of epidemic prevention policies. Australia started with an incidence similar to that of Korea, but its social activities are more flexible than those of Korea, where the incidence is maintained at approximately 0.1 per 100,000 people. In comparing the differences between both countries in terms of the Oxford COVID-19 Government Response Tracker Stringency Index, it was found that Australia effectively regulates the number of infected cases by high-intensity intermittent mitigation and the subsequent allowance of social activities. Korea has also recommended a high-intensity intermittent mitigation policy as in Australia until community herd immunity via vaccination is formed.
Summary
Korean summary
COVID-19 효과적으로 관리하는 방안으로 4-7일 정도의 강력한 통제(mitigation, Lock down)를 하여 감염량을 대폭 감소 시킨 후 2-3개월간 대폭 완화된 사회적 거리 두기를 시행하는 방안을 제안한다 완화된 사회적 거리 두기에는 마스크만 착용하고, 학생들의 등교, 음식점 등 모임, 예식 모임 등에 제한을 두지 않는 방안이다. 호주의 사례를 밴치마킹한 모형이다. 이와 함께 단기간에 많은 사람을 예방 접종하여 지역사회 면역력을 올려야 한다. 이를 위해 접종 시기를 늦추더라도 백신을 충분히 확보한 후 접종일 시작할 것을 권고한다.
Key Message
The public has been complaining of dissatisfaction with the atrophy of socio-economic activities and of distrust of epidemic prevention policies. South Korea would change the COVID-19 prevention and control policies from November, 2021. Authors recommended a high-intensity intermittent mitigation and the subsequent allowance of social activities policy as in Australia until community herd immunity via vaccination is formed.
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
  • 8,865 View
  • 243 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary 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.

Citations

Citations to this article as recorded by  
  • 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
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COVID-19: Perspective
COVID-19 herd immunity in the absence of a vaccine: an irresponsible approach
Jade Khalife, Derrick VanGennep
Epidemiol Health. 2021;43:e2021012.   Published online February 3, 2021
DOI: https://doi.org/10.4178/epih.e2021012
  • 10,980 View
  • 371 Download
  • 7 Web of Science
  • 7 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread rapidly throughout the human population, the concept of “herd immunity” has attracted the attention of both decision-makers and the general public. In the absence of a vaccine, this entails that a large proportion of the population will be infected to develop immunity that would limit the severity and/or extent of subsequent outbreaks. We argue that adopting such an approach should be avoided for several reasons. There are significant uncertainties about whether achieving herd immunity is possible. If possible, achieving herd immunity would impose a large burden on society. There are gaps in protection, making it difficult to shield the vulnerable. It would defeat the purpose of avoiding harm caused by the virus. Lastly, dozens of countries are showing that containment is possible.
Summary
Key Message
Pursuing herd immunity without a vaccine involves numerous uncertainties, is costly in terms of lives and disease, is ineffective, and - being unethical and uncompassionate - is not compatible with human dignity and development.

Citations

Citations to this article as recorded by  
  • Analyzing natural herd immunity media discourse in the United Kingdom and the United States
    Marco Zenone, Jeremy Snyder, Alessandro Marcon, Timothy Caulfield, Veena Sriram
    PLOS Global Public Health.2022; 2(1): e0000078.     CrossRef
  • Evaluation of science advice during the COVID-19 pandemic in Sweden
    Nele Brusselaers, David Steadson, Kelly Bjorklund, Sofia Breland, Jens Stilhoff Sörensen, Andrew Ewing, Sigurd Bergmann, Gunnar Steineck
    Humanities and Social Sciences Communications.2022;[Epub]     CrossRef
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    Yuval Arbel, Yifat Arbel, Amichai Kerner, Miryam Kerner
    Sustainability.2022; 14(16): 10286.     CrossRef
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    Jade Khalife
    Global Health Research and Policy.2022;[Epub]     CrossRef
  • Herd immunity: challenges and the way forward in Korea
    Jiyoung Oh, Sohyun Kim, Boyeong Ryu, Minjoung Shin, Bryan Inho Kim
    Epidemiology and Health.2021; 43: e2021054.     CrossRef
  • COVID-19 vaccine uptake and vaccine hesitancy in Indian patients with cancer: A questionnaire-based survey
    Vanita Noronha, George Abraham, SureshKumar Bondili, Annu Rajpurohit, RakeshP Menon, Shreya Gattani, Mehak Trikha, Rajanigandha Tudu, KishoreKumar Kota, AjayKumar Singh, Prahalad Elamarthi, GoutamSantosh Panda, RahulKumar Rai, MadalaRavi Krishna, SravanKu
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Review
Zika: what we do and do not know based on the experiences of Brazil
Cristina Possas
Epidemiol Health. 2016;38:e2016023.   Published online May 31, 2016
DOI: https://doi.org/10.4178/epih.e2016023
  • 18,279 View
  • 380 Download
  • 17 Web of Science
  • 21 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Zika virus, which was first discovered in 1947, has become a global threat to human health as it is rapidly spreading through Latin America, the Caribbean, the US and Asia, after causing a large outbreak in the Northeast region of Brazil in 2015. There is ample evidence to support that Zika virus is associated with neurological complications such as microcephaly. The review aims to provide an overview on the complex issues involved in the emergence of Zika virus’s neurological disorders and to discuss possible explanations of Zika virus introduction and dissemination in Brazil. We also suggest national and global strategies to adequately respond to the Zika virus emergence.
METHODS
We provide an analytical evaluation of the main issues related to the Zika outbreak in Brazil, based on available scientific literature, including government documents, and on epidemiological information from national surveillance databases.
RESULTS
The studies on the clinical manifestations of the Zika virus infection coupled with the epidemiological surveillance information in Brazil have provided significant evidence that the Zika virus is associated with neurological disorders such as microcephaly and Guillain-Barré syndrome. Based on phylogenetic and molecular analysis, the hypothesis regarding the introduction of Zika virus in the country is that it took place following international events in 2013 and 2014, when many foreign visitors could have brought Zika virus into Brazil. The immunologically naïve status of populations in the Americas, previous infection with dengue virus, and the increased activity of Aedes aegypti might be the contributing factors for such an outbreak in Brazil. The Zika virus emergence emphasized the importance of cross-disciplinary perspective. Besides the scientific-based vector control strategies, it is important to understand the nature of the evolutionary processes involved in the viral evolution in complex ecosystems and to have social and anthropological knowledge on the conditions related to the spread of the disease in order to properly respond to the spread of the Zika virus.
CONCLUSIONS
The experiences of Brazil have demonstrated the significance of multi-disciplinary approach in response to new and resurgent arboviral diseases and provided important lessons that could be applied to other developing countries.
Summary

Citations

Citations to this article as recorded by  
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Original Articles
Seroprevalence of measles and mumps antibody among preschool children in Korea, according to their vaccination history.
Jung Hwa Lee, Geun Ryang Bae, Chang Sik Park, Yoon Seok Chung, Young A Kang, Hyun Woo Han, Chun Kang
Korean J Epidemiol. 2008;30(1):34-40.   Published online June 30, 2008
DOI: https://doi.org/10.4178/kje.2008.30.1.34
  • 65,535 View
  • 44 Download
  • 2 Crossref
AbstractAbstract PDF
Abstract
PURPOSE
To maintain measles elimination status, we evaluated the seropositivity of measles and mumps according to time interval since the first or second dose of MMR in children aged 4 to 6 years, who are starting communal life. MATERIALS AND METHOD: 2,447 children aged 4 to 6 years were enrolled at 251 public health centers over the period of March to May 2007. Subjects were verified their date of MMR vaccination and then their blood was sampled for serologic test. Measles and mumps IgG antibody was tested by ELISA at Korea CDC.
RESULTS
Vaccination coverage was 99.9% in the first dose, 64.9% in the second dose regardless of gender. Seropositivity of measles and mumps was 95.7%, 85.5% in the first dose and 98.7%, 98.1% in the second dose, respectively. The seropositivity of measles was 88.1% in 6-year-olds who did not receive the second dose of MMR. As time since receipt, seropositivity of measles tended to decrease over time and was 93.3% in vaccinees over 48 months after the first dose.
CONCLUSION
A first dose MMR at 12-15 months cannot lead to herd immunity. More public information is needed to encourage second dose vaccination before admission to day-care center or kindergarten.
Summary

Citations

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The Cross-sectional Study on the Relationship of Health Behavior and Immune Function.
Soon Young Lee, Yeon Sook Yun, Ki Whan Kim, Seon Woo Kim, Ju Won Park
Korean J Epidemiol. 1998;20(2):212-218.
  • 5,499 View
  • 10 Download
AbstractAbstract PDF
Abstract
To investigate the association of individual health behaviors with imune response against tumor or viral infection, peripheral blood lymphocytes of 185 healthy males in aged from 35 to 44 years for natural killer(NK) cell activity, frequencies of lymphocytes subsets and proliferation response of T and B cell. NK cell activity was determined by Cr release activity assay and lymphocytes subsets were counted using surface antigens(CD4, CD8, CD56) by flow cytometry. The responsiveness of T and B were measured as proliferation stimulated by mitogens. Subjects were classified into four distinct lifestyle patterns, health promotive lifestyle, passive lifestyle, fitness lifestyle and hedonic lifestyle from information on their health behaviors(cigarette smoking, alcohol consumption, and physical activity). Health promotive lifestyle had the highest NK cell activity(Lu30/10(6)CD56) which was significantly higher than hedonic lifestyle)p<0.05). The responsiveness of T cell was significantly lower in passive lifestyle and hedonic lifestyles compared to health promotive lifestyle and fitness lifestyles(p<0.05). However, there was no significant difference in the responsiveness of B cell, CD4, and CD8 among four lifestyles. This cross-sectional study showed the NK cell activity in individuals with desirable health behaviors was lower. The variation of immunity among individuals was not considered in this study, hence the intervention study reflection individual variations is recommended.
Summary

Epidemiol Health : Epidemiology and Health