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COVID-19: Original Article
Predictors of COVID-19 booster vaccine hesitancy among fully vaccinated adults in Korea: a nationwide cross-sectional survey
Yunha Noh, Ju Hwan Kim, Dongwon Yoon, Young June Choe, Seung-Ah Choe, Jaehun Jung, Sang-Won Lee, Ju-Young Shin
Epidemiol Health. 2022;44:e2022061.   Published online July 22, 2022
DOI: https://doi.org/10.4178/epih.e2022061
  • 2,745 View
  • 266 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study explored predictors of coronavirus disease 2019 (COVID-19) booster hesitancy among fully vaccinated young adults and parental COVID-19 vaccine hesitancy for their children.
METHODS
This cross-sectional study administered an online survey from December 2 to December 20, 2021. We enrolled participants aged 18-49 years, for whom ≥2 weeks had passed after their initial COVID-19 vaccination. We estimated odds ratios (ORs) with 95% confidence intervals (CIs) using multivariate logistic regression to evaluate factors associated with booster/vaccine hesitancy.
RESULTS
Among the 2,993 participants, 48.8% showed hesitancy (wait and see: 40.2%; definitely not: 8.7%). Booster hesitancy was more common among women (OR, 1.25; 95% CI, 1.05 to 1.50), younger people (OR, 1.44; 95% CI, 1.17 to 1.77), those with a lower education level (OR, 2.05; 95% CI, 1.10 to 3.82), those who received the mRNA-1273 vaccine type (OR, 2.01; 95% CI, 1.65 to 2.45), and those who experienced serious adverse events following previous COVID-19 vaccination (OR, 2.03; 95% CI, 1.47 to 2.80). The main reasons for booster hesitancy were concerns about safety (54.1%) and doubts about efficacy (29.8%). Among the 1,020 respondents with children aged <18 years, 65.8% were hesitant to vaccinate their children against COVID-19; hesitancy was associated with younger parental age, education level, the type of vaccine the parent received, and a history of COVID-19 infection.
CONCLUSIONS
Concerns about the efficacy and safety of COVID-19 vaccines were the major barrier to booster acceptance. The initial COVID-19 vaccine type (mRNA-1273), young age, gender (women), a low education level, and adverse events after the first COVID-19 vaccine were key predictors of booster hesitancy.
Summary
Korean summary
본 연구는 국내 19-49세 성인을 대상으로, 코로나19 3차접종 의향과 그들의 18세 미만 자녀에 대한 코로나19 기초접종 의향을 조사하고, 코로나19 백신접종 기피와 관련된 요인을 파악하고자 하였다. 2021년 12월 2일부터 20일까지 온라인 설문조사를 통하여 자료를 수집하였으며, 연구대상자는 코로나19 기초접종을 완료한 후 2주 경과한 19-49세 성인으로, 전국 대표성을 확보하기 위해 성별, 연령, 지역별로 층화하여 모집하였다. 코로나19 3차접종 기피율은 약 48.8%로 나타났으며, 접종 기피 관련 영향요인으로는 젊은 연령층, 여성, 낮은 교육수준, 기초접종 백신 종류, 기초접종 후 중증 이상반응 경험이 포함되었으며, 18세 미만 자녀에 대한 코로나19 기초접종 기피율은 65.8%로, 관련 영향요인으로는 젊은 부모 연령, 교육수준, 부모의 기초접종 백신 종류, 코로나19 감염 과거력이 포함되었다.
Key Message
Concerns about the safety and efficacy of COVID-19 vaccines were the major barrier to booster acceptance; the initial COVID-19 vaccine type (mRNA-1273), younger age, gender (women), a low education level, and adverse events after the first COVID-19 vaccine were key predictors of booster hesitancy.
Original Article
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
  • 4,714 View
  • 143 Download
  • 3 Citations
AbstractAbstract AbstractSummary PDFSupplementary 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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  • 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
    BMC Public Health.2022;[Epub]     CrossRef
  • Evaluation of Whole-Cell and Acellular Pertussis Vaccines in the Context of Long-Term Herd Immunity
    Ewa Szwejser-Zawislak, Mieszko M. Wilk, Piotr Piszczek, Justyna Krawczyk, Daria Wilczyńska, Daniela Hozbor
    Vaccines.2022; 11(1): 1.     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
  • 8,475 View
  • 219 Download
  • 7 Citations
AbstractAbstract AbstractSummary PDFSupplementary 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.
Key Message

Citations

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  • 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
  • A case-control study of acute hepatitis A in South Korea, 2019
    Jung Hee Hyun, Ju Young Yoon, Sang Hyuk Lee
    Osong Public Health and Research Perspectives.2022; 13(5): 352.     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
    Epidemiology and Health.2021; 44: e2022003.     CrossRef
  • Hepatitis A vaccination
    Li Zhang
    Human Vaccines & Immunotherapeutics.2020; 16(7): 1565.     CrossRef
  • A Study on Seroprevalence of Hepatitis A Virus among Healthcare Workers at a University-Affiliated Hospital in Deajeon, Korea
    Seul Ki Ji, So Hee Jang, Min Hee Park, Ji Eun Lee, Hye Sook Jeong, Joonhong Park, Seung Beom Han, Yunmi Yi, Sun Hee Park
    The Korean Journal of Healthcare-Associated Infection Control and Prevention.2020; 25(1): 54.     CrossRef
  • Epidemiology of viral disease outbreaks in Odisha, India (2010–2019)
    J.S. Kshatri, J. Turuk, J. Sabat, S. Subhadra, L.M. Ho, S. Rath, S.K. Palo, D. Bhattacharya, B. Dwibedi, S. Pati
    Epidemiology and Infection.2020;[Epub]     CrossRef
  • Current State and Problems of Hepatitis A and E in Japan
    Jun Inoue, Atsushi Masamune
    Nihon Naika Gakkai Zasshi.2020; 109(7): 1439.     CrossRef
Original Article
Incidence of varicella in children in Jeju-do, Korea, 2005-2016: age-period-cohort analysis
Jinhee Kim, Ji-Eun Kim, Jong-Myon Bae
Epidemiol Health. 2018;40:e2018054.   Published online November 8, 2018
DOI: https://doi.org/10.4178/epih.e2018054
  • 9,985 View
  • 198 Download
  • 3 Citations
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Although the nationwide inoculation rate of varicella vaccine was approximately 95% in Korean children recently, the number of notified varicella cases is unexpectedly continuously increasing till now. To suggest some hypotheses regarding this discrepancy, an age-period-cohort (APC) analysis as a descriptive epidemiology study was conducted for children residing in Jeju-do, Korea.
METHODS
The raw data were obtained from the nationwide database for insurance claim of healthcare fee provided by the National Health Insurance Service, Korea. The selection criteria were children aged 2-13 years who visited any healthcare center due to varicella from 2005 to 2016 while residing in Jeju-do. After calculating the birth cohort-specific crude incidence rates by age and year, the intrinsic estimator method was used to perform the APC analysis.
RESULTS
As the annual crude incidence rates decreased with increasing age between 2005 and 2016, the age and period effects also decreased. The intrinsic estimator coefficients suggesting the cohort effect shifted from positive to negative in 2011, the starting year of free varicella vaccine program in Jeju-do.
CONCLUSIONS
The results suggested that inoculated varicella vaccines have preventive effects. However, further studies to evaluate waning immunity would be needed.
Summary
Korean summary
2011년 이후 생후 12-15개월 유아에게 수두백신 무상접종을 시행해 오고 있는 제주도에 있어서, 수두발생 신고건수가 증가하는 괴리 현상에 있어, 국민건강보험공단의 수진자료를 확보하여 연령-기간-코호트 (age-period-cohort, APC) 분석을 시행하였다. 그 결과 연령이 증가하고 연도가 최근으로 올수록 수두 발생에 대한 연령과 기간효과는 점점 감소하는 반면, 수두백신 무상접종이 시작된 2011년을 전후해서 코호트 효과는 양에서 음으로 전환하였다. 따라서 현재 접종하고 있는 수두 백신은 수두발생을 예방하는 효과가 있으며, 돌발수두 발생은 이차백신 실패로 볼 수 있다.
Key Message

Citations

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  • The comparison of seroconversion rates among different varicella vaccines administered Turkish children; MAV/06 and vOka
    Zuhal Umit, Zumrut Sahbudak Bal, Aysin Zeytinoglu, Tansu Gulbahar Aydogan, Ozlem Bag, Gizem Guner Ozenen, Ferda Ozkinay, Zafer Kurugol
    Human Vaccines & Immunotherapeutics.2021; 17(11): 4190.     CrossRef
  • Recent increase in pertussis incidence in Korea: an age-period-cohort analysis
    Chanhee Kim, Seonju Yi, Sung-il Cho
    Epidemiology and Health.2021; 43: e2021053.     CrossRef
  • Incidence of Scarlet Fever in Children in Jeju Province, Korea, 2002-2016: An Age-period-cohort Analysis
    Jinhee Kim, Ji-Eun Kim, Jong-Myon Bae
    Journal of Preventive Medicine and Public Health.2019; 52(3): 188.     CrossRef
Epidemiologic Investigation
Vaccination history in elementary school children enrolled in the varicella epidemic investigations held in Jeju-si, Korea in the first half of 2017
Hyun-Suk Oh, Jong-Myon Bae
Epidemiol Health. 2017;39:e2017053.   Published online November 13, 2017
DOI: https://doi.org/10.4178/epih.e2017053
  • 8,711 View
  • 192 Download
  • 4 Citations
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The reported incidence rate of varicella infection in Jeju-do is higher compared with the national average. This study aimed to examine varicella vaccination history and evaluate clinical manifestation of varicella cases in Jeju-do.
METHODS
Based on the guideline suggested by the Korea Centers for Disease Control and Prevention (KCDC), two epidemic investigations for varicella infection were conducted in the first half of 2017. The history of varicella vaccination was confirmed using the Integrated Control System for Diseases and Health operated by the KCDC.
RESULTS
Out of a total of 60 elementary school children as the study subjects, all had been previously vaccinated against varicella. Twenty cases (33%) showed mild clinical manifestations and no complications.
CONCLUSIONS
As the government of Jeju-do has supplied a single-labeled vaccine since 2011, there is a need to evaluate the type of vaccination failure such as primary or secondary.
Summary
Korean summary
수두 발생 신고률에 있어 제주도는 전국에 비해 높은 수준을 보이고 있지만, 수둑접종률은 전국과 유사한 수준이다. 이에 2017년 상반기 수두 집단발생에 대응한 2건의 역학조사를 수행한 결과, 33%에서 돌발수두 임상 증상을 보였고 모두 백신 접종력이 있었다. 높은 발생 신고률은 지역사회 소아 개원의들의 높은 신고에 의한 것으로 유추할 수 있으며, 수두 백신 실패에 대한 추후 조사가 필요하다.
Key Message

Citations

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  • Seroprevalence and molecular characteristics of varicella-zoster virus infection in Chinese children
    Lin Luan, Xiaochen Shen, Jing Qiu, Yang Jing, Jingqi Zhang, Jie Wang, Jun Zhang, Chen Dong
    BMC Infectious Diseases.2019;[Epub]     CrossRef
  • Cost-effectiveness analysis of universal varicella vaccination in Turkey using a dynamic transmission model
    Lara J. Wolfson, Vincent J. Daniels, Matthew Pillsbury, Zafer Kurugöl, Cuneyt Yardimci, Jeffrey Kyle, Ener Cagri Dinleyici, Georges M.G.M. Verjans
    PLOS ONE.2019; 14(8): e0220921.     CrossRef
  • Incidence of varicella in children in Jeju-do, Korea, 2005-2016: age-period-cohort analysis
    Jinhee Kim, Ji-Eun Kim, Jong-Myon Bae
    Epidemiology and Health.2018; 40: e2018054.     CrossRef
  • Analysis of sero-epidemiological characteristics of varicella in healthy children in Jiangsu Province, China
    Lei Zhang, Wang Ma, Yuanbao Liu, Yong Wang, Xiang Sun, Ying Hu, Xiuying Deng, Peishan Lu, Fenyang Tang, Zhiguo Wang, Minghao Zhou
    BMC Infectious Diseases.2018;[Epub]     CrossRef
Original Articles
Hepatitis A Vaccination Rates and Related Factors in a 2005 Population-based Study in Nonsan, Korea
Eun Young Kim, Baeg Ju Na, Moo Sik Lee, Keon Yeop Kim, Moran Ki
Epidemiol Health. 2009;31:e2009003.   Published online October 12, 2009
DOI: https://doi.org/10.4178/epih/e2009003
  • 12,860 View
  • 100 Download
  • 6 Citations
AbstractAbstract PDF
Abstract
OBJECTIVES

The incidence of clinical hepatitis A has increased in young Korean adults since the mid-1990s. Although hepatitis A vaccinations have been administered in private clinics over the past 10 yr, no data exist on the vaccination rate and relating factors.

METHODS

In 2005, a population-based survey of 12-35-month-old children was carried out in Nonsan, Korea. An interview survey was completed for 71.3% of the children. All data came from a vaccination card or confirmation from a provider.

RESULTS

The hepatitis A vaccination rate was 42.3% for ≥1 dose and 24.7% for 2-dose. The results of the multivariate regression analysis for the hepatitis A vaccination showed that the second (OR=1.6) and third and successive children (OR=3.3) were less often immunized than the first child. Low economic status (OR=1.6), rural area (OR=1.5) and employed mother (OR=1.5) were also correlated with a lower vaccination rate. The hepatitis A vaccination rate was significantly lower in children who had no other vaccinations: measlesmumps-rubella (OR=2.8 for ≥1 dose and 7.3 for 2-dose), varicella (OR=20.2 and 22.0, respectively) and Haemophilus influenza type b (OR=14.3 and 13.3, respectively).

CONCLUSION

To prevent outbreaks of clinical hepatitis A by enough herd immunity, a vaccination should be included in the National Immunization Program and a vaccination policy developed and implemented that can overcome the barriers to immunization such as late birth order and a mother's employment.

Summary
Korean summary
Key Message

Citations

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  • Very low prevalence of anti-HAV in Japan: high potential for future outbreak
    Chikako Yamamoto, Ko Ko, Shintaro Nagashima, Takayuki Harakawa, Toshiko Fujii, Masayuki Ohisa, Keiko Katayama, Kazuaki Takahashi, Hiroaki Okamoto, Junko Tanaka
    Scientific Reports.2019;[Epub]     CrossRef
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    Marissa Gripenberg, Naveena Aloysia D’Cor, Maïna L’Azou, Grenville Marsh, Sophie Druelles, Joshua Nealon
    International Journal of Infectious Diseases.2018; 68: 13.     CrossRef
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    Jae Seong Baek, Mi Ah Han, Jong Park, Na-Ra Yun
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    Hee Jung Yoon, Jiseun Lim, BoYoul Choi, Jungsoo Kim, Jeonguk Kim, Changhwi Kim, Joon Soo Park, Sang-Bum Hong, Jooyoun Seo, Geun-Ryang Bae, Moran Ki
    American Journal of Infection Control.2013; 41(8): 753.     CrossRef
  • Factors Related to Completed Status and Seropositivity of Hepatitis A Immunization Among Children Aged 1–3 Years and 6–8 Years in South Korea
    Jee-Young Hong, Mo Ran Ki, Hye-Jung Hwang, Delacroix Sinny, Young-Joon Park, Geun-Ryang Bae, Moo-Sik Lee
    Osong Public Health and Research Perspectives.2013; 4(2): 93.     CrossRef
  • Evaluation on the Accuracy of Vaccination Card for National Immunization Program in a 2005 Population-Based Survey in Nonsan, Korea
    Moo-Sik Lee, Jee-Hee Kim, Kwang-Hwan Kim, Jee-Young Hong, Jin-Yong Lee, Keon-Yeop Kim
    Journal of agricultural medicine and community health.2011; 36(2): 113.     CrossRef
Measles Outbreak among Institutional Infants after Hospital Infection.
Hyung Cheol Park, Eun Young Park, Sun Hee Cho, Young Jun Choi, Hyun Kyun Ki, Young Hwa Jung, Kyung Rye Moon, So Yeon Ryu, Ki Soon Kim
Korean J Epidemiol. 2001;23(1):50-58.
  • 4,458 View
  • 16 Download
AbstractAbstract PDF
Abstract
PURPOSE
S: This study was to investigate the source of infection, mode of transmission and incidence of a measles outbreak among infants living in a Gwangju welfare institution in July 2000.
METHODS
The information about 63 children was collected through the nurses interview and blood sampling and laryngopharyngeal swab were conducted to the children. In addition, an epidemiologic survey was performed to confirm the infection dissemination route.
RESULTS
Before the outbreak, two children living at the institution were admitted to a university hospital for other health problems. These children shared a room with a 5 year old diagnosed with meningitis who was later diagnosed as having measles after rashes appeared. The two children developed measles after returning to their institution and the infection spread to other children in the institution. Among 63 children observed, 14 children(22.2%) developed measles, secondary attack rate of measles due to index cases was 19.7%. And 78.6% of the patients were between 4 and 8 months old. The room where the index case lived showed an attack rate of 81.8%, which is a much higher rate compared to other rooms. The attack rate among boys(26.0%) was higher than that of girls(12.5%), but it was not statistically significant.
CONCLUSIONS
This outbreak was considered to be a nosocomial infection, where the index cases were admitted to a hospital, infected and the infection spread to children. Further studies are necessary to find out the maternal antibody levels of infants of post-vaccinated mothers and the optimal age for measles vaccination.
Summary
Korean summary
Key Message

Epidemiol Health : Epidemiology and Health