Epidemiology and Health

Original Article

Outbreak of carbapenem-resistant Enterobacterales at a long-term care facility in Seoul, Korea: surveillance and intervention mitigation strategies: Yoojin Park, Euncheol Son, Young June Choe, Cho Ryok Kang, Sangmi Roh, Young Ok Hwang, Sung-il Cho, Jihwan Bang; Epidemiol Health. 2023;45:e2023057. Published online June 9, 2023; DOI: https://doi.org/10.4178/epih.e2023057

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Abstract

OBJECTIVES
Because effective decolonization options are not available, and treatment options are limited, carbapenem-resistant Enterobacterales (CRE) constitute increasingly threatening nosocomial pathogens. To prevent CRE-associated transmission and ensure patient safety, healthcare personnel and everyone in contact with CRE-infected patients must implement stringent infection control practices. This report describes a CRE outbreak, possibly related to a caregiver at a long-term care facility (LTCF), and presents a new surveillance model to improve the infection control of CRE in Seoul, Korea.

METHODS

The Seoul Metropolitan Government surveillance system identified an outbreak of CRE in an LTCF in 2022. We obtained data on the demographic characteristics and contact histories of the inpatients, medical staff, and caregivers. To isolate the inpatients and employees exposed to CRE, we used rectal swab samples and environmental sampling during the study period (May-December 2022).

RESULTS

We identified 18 cluster cases (1 caregiver and 17 inpatients) and 12 sporadic cases with CRE, and conducted a complete 197-day follow-up of all cases in the LTCF’s isolation wards.

CONCLUSIONS

This investigation demonstrated that our surveillance model and targeted intervention, based on the cooperation of the municipal government, public health center, and infection control advisory committee, effectively contained the epidemic at the LTCF. Measures to improve the compliance of all employees in LTCFs with infection control guidelines should also be adopted.

Summary

Korean summary
서울시 CRE 감시체계를 통해 2022년 한 요양병원의 집단발생을 인지하였다. 현장역학조사를 실시하여 18명의 집단발생 사례(1명 간병인, 17명 입원환자)와 12명의 산발적인 사례를 확인하였고 감염관리 컨설팅을 통해 유행을 확산을 방지하는 중재를 시행하였다.

Key Message
The Seoul Metropolitan Government surveillance system identified an outbreak of carbapenem-resistant Enterobacterales (CRE) in a long-term care facility (LTCF) in 2022. We identified 18 cluster cases (1 caregiver and 17 inpatients) and 12 sporadic cases with CRE. In the current study, we could demonstrate that our surveillance model and targeted intervention, based on the cooperation of the municipal government, public health center, and infection control advisory committee, effectively contained the epidemic at the LTCF. Measures to improve the compliance of all employees in LTCFs with infection control guidelines should also be adopted.

Citations

Citations to this article as recorded by

Role of Probiotics in Preventing Carbapenem-Resistant Enterobacteriaceae Colonization in the Intensive Care Unit: Risk Factors and Microbiome Analysis Study
Jung-Hwan Lee, Jongbeom Shin, Soo-Hyun Park, Boram Cha, Ji-Taek Hong, Don-Haeng Lee, Kye Sook Kwon
Microorganisms.2023; 11(12): 2970. CrossRef

Epidemiologic Investigation

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.

COVID-19: Brief Communication

Clinical severity according to the primary infection variant in patients with suspected SARS-CoV-2 reinfection in Korea: Myung-Jae Hwang, Insob Hwang, Chungmin Park, Hanul Park, Taejong Son, Jong-Hun Kim; Epidemiol Health. 2023;45:e2023007. Published online December 21, 2022; DOI: https://doi.org/10.4178/epih.e2023007

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Abstract Summary PDF

Abstract

OBJECTIVES
We aimed to evaluate the severity of suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection according to variants of concern in Gyeongsangbuk-do and Daegu, Korea.

METHODS

The database of coronavirus disease 2019 (COVID-19) cases reported from epidemiological investigations through the integrated system operated by the Korea Disease Control and Prevention Agency, from January 20, 2020 to May 7, 2022 was combined with data from the Health Insurance Review and Assessment Service system. The severity odds ratio (SOR) in secondary infection episodes compared with primary infection was estimated using a generalized linear model with a binomial distribution.

RESULTS

In all patients, the SOR of SARS-CoV-2 reinfection was 0.89 (95% confidence interval [CI], 0.82 to 0.95), and the severity was lower than in the first infection. Patients who had been vaccinated within 91 days showed a more attenuated SOR (0.85; 95% CI, 0.74 to 0.98). However, despite vaccination, in patients with both primary and secondary infections caused by the Omicron variant, the severity was reduced to a lesser extent than in patients primarily infected with other variants.

CONCLUSIONS

We could make efforts to relieve the severity of COVID-19 in vulnerable populations, in which death is more likely, by recommending booster vaccinations in case of a resurgence.

Summary

Korean summary
국내 COVID-19 확진자들의 중증도 증가 위험은 재감염(2차감염) 시 감소하였지만, 1차감염과 재감염 모두 오미크론론 변이가 우세하였던 시기인 경우에는 오히려 증가하였다. 특히 마지막 예방접종일로부터 91일 이상인 확진자들과 60세이상 인구에서는 중증도 증가 위험이 더 높았다. 우리는 COVID-19가 장기화됨에 따라 취약인구집단에 대해 추가 예방접종을 권고함으로써 재감염시 중증도가 증가하는 것을 예방해야 할 필요가 있다.

Key Message
As COVID-19 prolongs, there is a need to recommend booster vaccinations for vulnerable populations to prevent the potential for increased severity in the event of reinfection.

Citations

Citations to this article as recorded by

Changes in the intrinsic severity of severe acute respiratory syndrome coronavirus 2 according to the emerging variant: a nationwide study from February 2020 to June 2022, including comparison with vaccinated populations
Boyeong Ryu, Eunjeong Shin, Dong Hwi Kim, HyunJu Lee, So Young Choi, Seong-Sun Kim, Il-Hwan Kim, Eun-Jin Kim, Sangwon Lee, Jaehyun Jeon, Donghyok Kwon, Sungil Cho
BMC Infectious Diseases.2024;[Epub] CrossRef
The effect of shortening the quarantine period and lifting the indoor mask mandate on the spread of COVID-19: a mathematical modeling approach
Jung Eun Kim, Heejin Choi, Minji Lee, Chang Hyeong Lee
Frontiers in Public Health.2023;[Epub] CrossRef
Previous infection with seasonal coronaviruses does not protect male Syrian hamsters from challenge with SARS-CoV-2
Magen E. Francis, Ethan B. Jansen, Anthony Yourkowski, Alaa Selim, Cynthia L. Swan, Brian K. MacPhee, Brittany Thivierge, Rachelle Buchanan, Kerry J. Lavender, Joseph Darbellay, Matthew B. Rogers, Jocelyne Lew, Volker Gerdts, Darryl Falzarano, Danuta M. S
Nature Communications.2023;[Epub] CrossRef

COVID-19: Original Article

The association between tobacco or nicotine product use behaviors and non-compliance with mask-wearing during the COVID-19 pandemic: a cross-sectional study in Korea: Da-eun Lee, Heewon Kang, Sung-il Cho; Epidemiol Health. 2022;44:e2022087. Published online October 7, 2022; DOI: https://doi.org/10.4178/epih.e2022087

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
It is necessary to investigate tobacco or nicotine product (TNP) use which acts as a risk factor for coronavirus disease 2019 (COVID-19) infection. Especially, wearing a mask is difficult to practice while using TNP. Therefore, this study aimed to examine the association between TNP use behaviors and non-compliance with mask-wearing during the COVID-19 pandemic.
METHODS
The samples of 208,618 Korean adults from 2020 Community Health Survey in Korea were used. As an independent variable, TNP use behaviors such as TNP use status, changes in TNP use after the COVID-19 outbreak, TNP types, and attempt to quit were analyzed. Logistic regression was performed on gender-stratified participants.
RESULTS
Among men, the odds ratio (OR) of current and former TNP users were 2.00 (95% confidence interval [CI], 1.66 to 2.40) and 1.32 (95% CI, 1.09 to 1.60), respectively, compared to never users. In women, OR was 1.50 (95% CI, 1.00 to 2.26) for former users. Cigarette use was more associated with not wearing a mask than non-cigarette tobacco or nicotine product (NCTNP) use (OR, 1.53; 95% CI, 1.12 to 2.08). Men whose TNP use decreased had lower non-compliance (OR, 0.52; 95% CI, 0.36 to 0.74); while women whose TNP use increased had lower non-compliance (OR, 0.13; 95% CI, 0.07 to 0.26).
CONCLUSIONS
Current and former users were less likely to wear masks. Cigarette use was more associated with not wearing a mask than NCTNP use. Changes in TNP use showed association for men and women; however, in the opposite direction. Therefore, more attention should be paid to TNP use prevention and cessation support during the epidemic of respiratory infectious diseases. Moreover, it is necessary to identify risk factors of cigarette users in compliance with mask-wearing.; Summary

Korean summary
담배 또는 니코틴 제품 (Tobacco or Nicotine Products, TNPs) 현재사용자와 과거사용자는 비사용자 대비 마스크 미착용 연관성이 높고, 비궐련 담배 또는 니코틴 제품 (Non-Cigarette Tobacco or Nicotine Products, NCTNPs) 사용자보다는 일반담배 사용자의 마스크 미착용 연관성이 높다. 남성에서는 코로나19 유행 이전 대비 TNPs 사용이 감소했을 때, 여성에서는 증가했을 때 마스크 미착용 연관성이 낮았다. 따라서 호흡기 감염병 유행 시기에는 더욱 TNPs 사용 예방과 금연 지원에 관심을 가질 것을 제안한다.

Key Message
During the epidemic of respiratory infectious diseases, more attention should be paid to tobacco or nicotine products (TNPs) use prevention and cessation support.

COVID-19: Perspective

Dengue and COVID-19 infections in the ASEAN region: a concurrent outbreak of viral diseases: Lowilius Wiyono, Ian Christoper N. Rocha, Trisha Denise D. Cedeño, Adriana Viola Miranda, Don Eliseo Lucero-Prisno III; Epidemiol Health. 2021;43:e2021070. Published online September 16, 2021; DOI: https://doi.org/10.4178/epih.e2021070

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Abstract Summary PDF

Abstract

Member countries of the Association of Southeast Asian Nations (ASEAN) have faced dengue outbreaks for decades, and the region has one of the highest rates of dengue globally. Outbreaks continue to occur concurrently with the coronavirus disease 2019 (COVID-19) pandemic in the 10 ASEAN countries. Both infectious diseases pose a tremendous burden in these countries related to both infection control and the economy. Increases in the number of dengue cases occurred in part due to disruptions in the pathogen-host-vector relationship caused by changes in human behaviour in response to the COVID-19 pandemic. The spread of dengue was further aggravated by the implementation of lockdowns and social distancing policies. These measures limited the coverage of dengue preventive programs and delayed the medical management of both diseases due to co-infection and misdiagnosis. It is of the utmost importance for the population to remain aware of both diseases, and dengue vector control strategies must be devised to properly address outbreaks using digitalization and remote surveillance. Similarly, critical triage algorithms and further research are also needed to combat co-infection and misdiagnosis. Controlling the spread of COVID-19 though vaccination should also be undertaken to reduce the impact of the pandemic.

Summary

Key Message
The rising dengue infection amidst the COVID-19 pandemic has indicated the need of response to mitigate the dangers of both dengue and COVID-19. Appropriate measurement from all ASEAN countries are needed to lower the number of cases and ease the burden of both dengue and COVID-19 management."

Citations

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Health System Preparedness, Response, and Incidence of Dengue in District Mianwali
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Potential inhibitors isolated from Curcuma aeruginosa against dengue virus type 2 (DENV-2) NS2B-NS3 protease activity
Siti Sarah Fazalul Rahiman, Mohammad Al-Amin, Noratiqah Mohtar, Iffah Izzati Zakaria, Ummirul Mukminin Kahar, Melati Khairuddean, Salizawati Muhamad Salhimi
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Genomic Characterization of Dengue Virus Outbreak in 2022 from Pakistan
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Vaccines.2023; 11(1): 163. CrossRef
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Sulistyawati Sulistyawati, Herman Yuliansyah, Tri Wahyuni Sukesi, Arfiani Nur Khusna, Surahma Asti Mulasari, Fatwa Tentama, Bambang Sudarsono, Fanani Arief Ghozali
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The Diagnostic Potential of RNA Aptamers against the NS1 Protein of Dengue Virus Serotype 2
Ramesh Thevendran, Sivalingam Rogini, Glenn Leighton, Atherton Mutombwera, Sarah Shigdar, Thean-Hock Tang, Marimuthu Citartan
Biology.2023; 12(5): 722. CrossRef
Incidence and mortality trends of neglected tropical diseases and malaria in China and ASEAN countries from 1990 to 2019 and its association with the socio-demographic index
Qiao Liu, Wenxin Yan, Chenyuan Qin, Min Du, Yaping Wang, Min Liu, Jue Liu
Global Health Research and Policy.2023;[Epub] CrossRef
Dengue in Pregnancy: A Southeast Asian Perspective
Vanessa Chong, Jennifer Zi Ling Tan, Valliammai Jayanthi Thirunavuk Arasoo
Tropical Medicine and Infectious Disease.2023; 8(2): 86. CrossRef
The effects of the COVID-19 pandemic on dengue cases in Malaysia
Nuur Hafizah Md Iderus, Sarbhan Singh Lakha Singh, Sumarni Mohd Ghazali, Asrul Anuar Zulkifli, Nur Ain Mohd Ghazali, Mei Cheng Lim, Lonny Chen Rong Qi Ahmad, Mohamad Nadzmi Md Nadzri, Cia Vei Tan, Ahmed Syahmi Syafiq Md Zamri, Chee Herng Lai, Nur Shuhada
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The simultaneous crises of dengue and COVID-19 in Pakistan: a double hazard for the country’s debilitated healthcare system
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Tropical Medicine and Health.2022;[Epub] CrossRef
Does COVID-19 lockdowns have impacted on global dengue burden? A special focus to India
Hemlata Sharma, Ashal Ilyas, Abhiroop Chowdhury, Nitesh Kumar Poddar, Anis Ahmad Chaudhary, Sireen Abdul Rahim Shilbayeh, Alnada Abdalla Ibrahim, Shahanavaj Khan
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Temporal Variations and Spatial Clusters of Dengue in Thailand: Longitudinal Study before and during the Coronavirus Disease (COVID-19) Pandemic
Sayambhu Saita, Sasithan Maeakhian, Tassanee Silawan
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Has COVID-19 suppressed dengue transmission in Nepal?
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COVID-19: Original Article

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

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Abstract Summary PDF Supplementary Material

Abstract

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Summary

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

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

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COVID-19: Systematic Review

Clinical outcomes of COVID-19 amongst HIV patients: a systematic literature review: Thomas Massarvva; Epidemiol Health. 2021;43:e2021036. Published online May 17, 2021; DOI: https://doi.org/10.4178/epih.e2021036

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The global pandemic coronavirus disease 2019 (COVID-19) emerged in the city of Wuhan, China around December 2019. Since then, the virus has caused severe morbidity and mortality worldwide and has put pressure on the global medical system. Still, there are limited data regarding the clinical impact of COVID-19 on people living with human immunodeficiency virus (HIV). The primary aim of this study was, therefore, to systematically review up-to-date studies reporting the clinical outcomes of COVID-19 amongst HIV patients.

METHODS

A thorough literature search was carried out using MEDLINE, Embase, Scopus, and the Cochrane Library Databases in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

A total of 22 studies were identified. Amongst 730 HIV/COVID-19-coinfected patients, 79.4% were males, the median age was 51.5 years, and the number of reported patients receiving antiretroviral drugs was 708 (97.2%). Most coinfected patients had mild to moderate symptoms, including cough (37.7%), fever (37.5%), and dyspnoea (24.7%). Among pre-existing comorbidities, hypertension (26.3%) was the most prevalent in HIV/COVID-19 coinfected patients, and 87% of coinfected patients recovered.

CONCLUSIONS

Based on the existing data in this systematic literature review, HIV patients with pre-existing comorbidities, obesity, and older age should be considered as a high-risk group for COVID-19. Furthermore, coinfected patients appear to have marginally comparable clinical outcomes with the general population. The study’s findings highlight the need for further investigation to elucidate the impact of COVID-19 infection on HIV patients.

Summary

Key Message
In this systematic literature review, various aspects of COVID-19 outcomes amongst HIV patients are identified and quantified, including the proportion of different symptoms, severity, pre-existing comorbidities, recovery, death, and the most commonly prescribed antiretroviral drugs in HIV patients with COVID-19 coinfection.

Citations

Citations to this article as recorded by

Double Trouble Co-Infections: Understanding the Correlation Between COVID-19 and HIV Viruses
Sassi Ashraf Ali Abbasi, Tarika Noor, Maneeth Mylavarapu, Monika Sahotra, Hunmble A Bashir, Rakshita Ramesh Bhat, Urmi Jindal, Uzma Amin, Anushree V, Humza F Siddiqui
Cureus.2023;[Epub] CrossRef

Original Articles

Hand-to-face contact behaviors during indoor activities in daily life among Korean adults: an observational pilot study using videotaping: Hyang Soon Oh, Mikyung Ryu, Youngran Yang; Epidemiol Health. 2021;43:e2021030. Published online April 22, 2021; DOI: https://doi.org/10.4178/epih.e2021030

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Abstract Summary PDF

Abstract

OBJECTIVES
Hand-to-face contact (HFC) is the major route for the self-inoculation of pathogens. This study aimed to describe the characteristics of HFC behaviors among Korean adults during indoor activities.

METHODS

Thirty participants were enrolled in the study, and 2 hours of videotaped data were collected from each participant. Contact data were recorded by examining the frequency and duration of HFC on the videos. Three training sessions were conducted for 2 readers to ensure the accuracy and reliability of videotape reading. Re-reading and verification of selected video data were performed to confirm intrapersonal and interpersonal validity. Contact exposure (CE) was determined by multiplying the contact frequency (CF) by the contact duration (CD) to quantify the intensity of contact during the observation time (2 hours).

RESULTS

A total of 3,007 HFCs (1,305 mucous membrane contacts and 1,702 non-mucous membrane contacts) were observed for 60 person-hours. The median CF (person/2 hr) of the mucous membranes (eye; 4.0, nose; 15.5, mouth; 16.5) was 39.5/person and the median total CD was 177.0 sec/person. The median CE (frequency-duration/sec/person) was 5,795.0 (mouth: 1,356.0, nose: 600.0, eye: 57.5).

CONCLUSIONS

This study showed that the mouth and nose were the most frequent exposure sites for HFC. Avoiding habitual HFC, awareness of self-inoculation by HFC, and vigorous hand hygiene should be strengthened to prevent the spread of infections.

Summary

Korean summary
· 얼굴의 가장 빈번한 직접 자가 손접촉 노출은 입과 코에서 발생했습니다. · 접촉 노출량 지표 (contact exposure)는 입과 코에 자가 손접촉을 보다 잘 구별할 수 있습니다. · 습관적인 손-얼굴 접촉을 피하고, 마스크 사용 및 철저한 손위생으로 감염성 질환의 전파를 예방해야 합니다.

Key Message
• Average contact frequency (no./person) and contact duration (sec/person) of hand-to-face contact to the mucous membranes were high on the mouth, nose and then nose. • Contact exposure could differentiate more distinguished the hand contacts to mouth and to nose than contact frequency. • Hand-to face contacts, especially to mouth and then to nose can be the most frequent route of self-inoculation among Korean adults. • Avoiding habitual hand-to-face contacts, mask use, and vigorous hand hygiene should be strengthened as we counter epidemics of transmitting infectious diseases.

Citations

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Impact of a Serious Game (#RedPingüiNO) to Reduce Facial Self-Touches and Prevent Exposure to Pathogens Transmitted via Hands: Quasi-Experimental Intervention
Marta Arévalo-Baeza, Alejandro Viuda-Serrano, Carmen Juan-Llamas, Pablo Sotoca-Orgaz, Iván Asín-Izquierdo
JMIR Serious Games.2023; 11: e45600. CrossRef
Hemşirelik Öğrencilerine Eğitimleri Sırasında Öğretilen Asepsi Uygulamalarının Covid -19 Pandemi Dönemindeki Bireysel Uygulamalarına Etkisi
Ayşe SERPİCİ, Neriman AKANSEL, Nursel VATANSEVER, Vahit DALKIZAN
Uludağ Üniversitesi Tıp Fakültesi Dergisi.2023; 49(2): 245. CrossRef
Hand-to-Face Contact of Preschoolers during Indoor Activities in Childcare Facilities in the Republic of Korea
Hyang Soon Oh, Mikyung Ryu
International Journal of Environmental Research and Public Health.2022; 19(20): 13282. CrossRef

Impact of early-life weight status on urinary tract infections in children: a nationwide population-based study in Korea: Hyung Eun Yim, Kyung Do Han, Bongseong Kim, Kee Hwan Yoo; Epidemiol Health. 2021;43:e2021005. Published online December 29, 2020; DOI: https://doi.org/10.4178/epih.e2021005

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Abstract Summary PDF

Abstract

OBJECTIVES
We aimed to evaluate the association between early-life weight status and urinary tract infection (UTI) risk in children.

METHODS

A nationwide study was conducted using Korean National Health Screening (NHS) data and National Health Insurance Service data. A sample cohort was selected using data from the 2014 and 2015 NHS for infants and children (4-71 months) and followed up until the end of 2017. Participants were divided into 4 groups (underweight, normal weight, overweight, and obese) based on the weight-for-age (< 2 years) or body mass index (≥ 2 years). Hazard ratios (HRs) with 95% confidence intervals (CIs) for developing UTIs, cystitis, and acute pyelonephritis (APN) were calculated using a Cox proportional hazard model.

RESULTS

Of 1,653,106 enrolled children, 120,142 (7.3%) developed UTIs, cystitis, and APN during follow-up. The underweight, overweight, and obese groups had higher risks of UTIs than the reference group after adjusting for age, sex, birth weight, and preterm birth. Between 2 years and 6 years of age, boys with underweight had a high risk of UTI and APN, while girls with overweight and obesity revealed elevated risks of UTIs, cystitis, and APN. The HRs for APN in boys with underweight and in girls with obesity were 1.46 (95% CI, 1.03 to 2.07) and 1.41 (95% CI, 1.13 to 1.75), respectively, after adjusting for age, sex, birth weight, and preterm birth. The incidence of APN did not decrease with age in underweight and obese children aged 2-6 years.

CONCLUSIONS

Children with underweight, overweight, and obesity may be at high risk for UTIs.

Summary

Korean summary
1. 영유아 및 소아에서 과소체중, 과체중 및 비만은 요로감염 발생 증가와 관련이 있다. 2. 본 전국적인 인구 기반 연구에서 2-6세 남아에서 과소체중을 보인 경우 요로감염과 신우신염 발생빈도가 증가하였으며, 2-6세 여아에서 과체중 및 비만을 보이는 경우 요로감염, 방광염, 신우신염 발생이 증가하였다. 3. 소아에서 적정체중을 유지하는 것이 요로감염, 방광염, 신우신염의 발생을 예방함에 있어서 중요하다.

Key Message
1. Being underweight, overweight, or obese can be associated with an increased risk of urinary tract infection in infants and children. 2. The underweight boys aged 2–6 years had a high risk of urinary tract infection and acute pyelonephritis, while the overweight and obese girls aged 2–6 years revealed increased risks of urinary tract infection, cystitis, and acute pyelonephritis in our nationwide population-based study on urinary tract infections. 3. Body weight control would be significant for the primary prevention of urinary tract infections, cystitis, and acute pyelonephritis in children.

Citations

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Risk factors for recurrent urinary tract infections in young infants under the age of 24 months
Min Hwa Son, Hyung Eun Yim
Childhood Kidney Diseases.2024; 28(1): 35. CrossRef
Childhood Body Mass Index (BMI) and the Risk of Infection: A Narrative Review
Houman Hashemian, Mohammad Ali Esfandiari, Setila Dalili
Journal of Comprehensive Pediatrics.2023;[Epub] CrossRef
Kidney Considerations in Pediatric Obesity
Alexandra Sawyer, Evan Zeitler, Howard Trachtman, Petter Bjornstad
Current Obesity Reports.2023; 12(3): 332. CrossRef
Association of body weight and urinary tract infections during infancy: a nationwide comparative matched cohort study
Peong Gang Park, Ji Hyun Kim, Yo Han Ahn, Hee Gyung Kang
Childhood Kidney Diseases.2023; 27(2): 111. CrossRef
Obesity and chronic kidney disease: prevalence, mechanism, and management
Hyung Eun Yim, Kee Hwan Yoo
Clinical and Experimental Pediatrics.2021; 64(10): 511. CrossRef

Estimation of the number of working population at high-risk of COVID-19 infection in Korea: Juyeon Lee, Myounghee Kim; Epidemiol Health. 2020;42:e2020051. Published online July 9, 2020; DOI: https://doi.org/10.4178/epih.e2020051

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We aimed to identify occupational groups at high-risk of coronavirus disease 2019 (COVID-19) infection in Korea, to estimate the number of such workers, and to examine the prevalence of protective resources by employment status.

METHODS

Based on the sixth Standard Occupational Classification codes, 2015 census data were linked with data from the fifth Korean Working Conditions Survey, which measured how frequently workers directly come into contact with people other than fellow employees in the workplace.

RESULTS

A total of 30 occupational groups, including 7 occupations from the healthcare and welfare sectors and 23 from other sectors, were classified as high-risk occupational groups involving frequent contact with people other than fellow employees in the workplace (more than half of the working hours). Approximately 1.4 million (women, 79.1%) and 10.7 million workers (46.3%) are employed in high-risk occupations. Occupations with a larger proportion of women are more likely to be at a high-risk of infection and are paid less. For wage-earners in high-risk occupations, protective resources to deal with COVID-19 (e.g., trade unions and health and safety committees) are less prevalent among temporary or daily workers than among those with permanent employment.

CONCLUSIONS

Given the large number of Koreans employed in high-risk occupations and inequalities within the working population, the workplace needs to be the key locus for governmental actions to control COVID-19, and special consideration for vulnerable workers is warranted.

Summary

Korean summary
코로나바이러스감염증-19 (코로나19) 유행 상황에서 감염 고위험 직업군 종사자는 보건의료복지 업종에서 총 140만 명, 그 외 업종에서 총 1,073만 명으로 추정된다. 고위험 사업장에 대해 정부가 안전보건 관리·감독·규제 및 지원 체계를 수립하고, 방역대책의 중심에 노동자의 안전과 건강 보호를 두는 관점의 전환이 필요하다. 우선 당장 역학조사 과정에서 직업관련 요소를 자세히 확인하고, 직업관련 감염에 대한 모니터링과 그에 걸맞는 대책을 마련해야 한다.

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Daniel Côté, Ellen MacEachen, Ai-Thuy Huynh, Amelia León, Marie Laberge, Samantha Meyer, Shannon Majowicz, Joyceline Amoako, Yamin Jahangir, Jessica Dubé
Frontiers in Public Health.2024;[Epub] CrossRef
Mobility and Thermal Comfort Assessment of Personal Protective Equipment for Female Healthcare Workers: Impact of Protective Levels and Body Mass Index
Do-Hee Kim, Youngmin Jun, Ho-Joon Lee, Gyeongri Kang, Cho-Eun Lee, Joo-Young Lee
Fashion & Textile Research Journal.2024; 26(1): 123. CrossRef
The Relationship between COVID-19 Exposure Risk and Burnout in Prehospital Emergency Medical Technicians
Karim Javanmardi, Neda Gilani, Mansour Ghafourifard, Abbas Dadashzadeh, Javad Dehghannejad, Hossein Feyzollahzade
Journal of Caring Sciences.2023; 12(2): 123. CrossRef
National and regional trends in the prevalence of type 2 diabetes and associated risk factors among Korean adults, 2009–2021
Jiyeon Oh, Soeun Kim, Myeongcheol Lee, Sang Youl Rhee, Min Seo Kim, Ju-Young Shin, Hyunjung Lim, Seung Won Lee, Masoud Rahmati, Sunyoung Kim, Dong Keon Yon
Scientific Reports.2023;[Epub] CrossRef
Evaluation of Vaccination and Polymerase Chain Reaction Test Positivity of Hospital Personnel During the COVID-19 Pandemic
Yasemin ASLAN, Ekrem SEVİM, Sinem GÜLER
Acibadem Universitesi Saglik Bilimleri Dergisi.2023;[Epub] CrossRef
Investigating the transmission risk of infectious disease outbreaks through the Aotearoa Co-incidence Network (ACN): a population-based study
S.M. Turnbull, M. Hobbs, L. Gray, E.P. Harvey, W.M.L. Scarrold, D.R.J. O'Neale
The Lancet Regional Health - Western Pacific.2022; 20: 100351. CrossRef
Temporal trends of sex differences for COVID-19 infection, hospitalisation, severe disease, intensive care unit (ICU) admission and death: a meta-analysis of 229 studies covering over 10M patients
Bart G. Pijls, Shahab Jolani, Anique Atherley, Janna I.R. Dijkstra, Gregor H.L. Franssen, Stevie Hendriks, Evan Yi-Wen Yu, Saurabh Zalpuri, Anke Richters, Maurice P. Zeegers
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Dmitry V. Boguslavsky, Natalia P. Sharova, Konstantin S. Sharov
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The Gendered Outbreak of COVID-19 in South Korea
Jinwoo Lee
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COVID-19 Fear, Health Behaviors, and Subjective Health Status of Call Center Workers
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Trends in Occupational Infectious Diseases in South Korea and Classification of Industries According to the Risk of Biological Hazards Using K-Means Clustering
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International Journal of Environmental Research and Public Health.2022; 19(19): 11922. CrossRef
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Wegdan A. Bani‐Issa, Hussam Al Nusair, Abdalrahman Altamimi, Sarah Hatahet, Firas Deyab, Randa Fakhry, Roba Saqan, Salwa Ahmad, Fathia Almazem
Journal of Nursing Scholarship.2021; 53(2): 171. CrossRef
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Daniel Côté, Steve Durant, Ellen MacEachen, Shannon Majowicz, Samantha Meyer, Ai‐Thuy Huynh, Marie Laberge, Jessica Dubé
American Journal of Industrial Medicine.2021; 64(7): 551. CrossRef
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Eun-Mi Baek, Woo-Yung Kim, Yoon-Jeong Kwon
International Journal of Environmental Research and Public Health.2021; 18(16): 8407. CrossRef
Infection and Risk Perception of SARS-CoV-2 among Airport Workers: A Mixed Methods Study
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International Journal of Environmental Research and Public Health.2020; 17(23): 9002. CrossRef

COVID-19: Brief Communication

Follow-up investigation of asymptomatic COVID-19 cases at diagnosis in Busan, Korea: Miyoung Lee, Youngduck Eun, Kyounghee Park, Jeonghun Heo, Hyunjin Son; Epidemiol Health. 2020;42:e2020046. Published online June 23, 2020; DOI: https://doi.org/10.4178/epih.e2020046

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The objective of the study was to conduct a follow-up investigation of 10 asymptomatic patients at diagnosis among the 98 confirmed coronavirus disease 2019 (COVID-19) cases reported in Busan between February 21, 2020 and March 13, 2020 to determine whether asymptomatic infection and transmission during asymptomatic period are possible.

METHODS

The study analyzed 10 asymptomatic, confirmed COVID-19 cases to determine whether asymptomatic infection is possible. We conducted in-depth interviews with patients and guardians; interviews with primary physicians; review of medical records and drug utilization review (DUR) reports; and base station-based location tracking.

RESULTS

Among the 98, confirmed COVID-19 cases reported in Busan, the study analyzed 10 (10.2%) asymptomatic patients at diagnosis. The results confirmed that two (2.0%) patients reported to be asymptomatic during the initial epidemiological investigation, but turned symptomatic before diagnosis as per the in-depth interview results. Four cases (4.0%) of early detection led to confirmed diagnosis during the incubation period and presentation of symptoms after diagnosis. In addition, the remaining four patients (4.0%), having no subjective symptoms nor specific findings on chest radiography and computed tomography, remained asymptomatic until the isolation order was lifted. With regard to whether transmission during the asymptomatic period is possible, it was found that one out of 23 household contacts of the confirmed patients was identified as an additional confirmed case after coming in close contact with an index patient during the presymptomatic period.

CONCLUSIONS

Among the 98 confirmed cases, asymptomatic infection was confirmed in four cases (4.0%). In addition, there was one additional confirmed case in which the patient was a family member who came in close contact with an index patient during the incubation period, thereby confirming that transmission during the asymptomatic period is possible. The possibility of transmission during the asymptomatic period has been confirmed; therefore, it is necessary to review the measures for expanding contact tracing that is currently being applied starting one day prior to the onset of symptoms.

Summary

Korean summary
본 연구는 부산광역시에서 무증상으로 COVID-19에 진단된 10명의 환자를 추적조사하여 무증상 감염이 가능한가, 무증상기에 전파가 가능한가에 대해 확인하였다. 조사결과 4명(4.0%)의 무증상 감염환자를 확인하였고, 환자의 무증상기에 밀접 접촉한 가족 중 1명의 추가 환자를 확인하여 무증상기 전파가 가능하다는 것을 확인하였다.

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Characterization of COVID-19 cases in the early phase (March to July 2020) of the pandemic in Kenya
Philip Ngere, Joyce Onsongo, Daniel Langat, Elizabeth Nzioka, Faith Mudachi, Samuel Kadivane, Bernard Chege, Elvis Kirui, Ian Were, Stephen Mutiso, Amos Kibisu, Josephine Ihahi, Gladys Mutethya, Trufosa Mochache, Peter Lokamar, Waqo Boru, Lyndah Makayotto
Journal of Global Health.2022;[Epub] CrossRef
Asymptomatic Cases, the Hidden Challenge in Predicting COVID-19 Caseload Increases
Brett Snider, Bhumi Patel, Edward McBean
Infectious Disease Reports.2021; 13(2): 340. CrossRef
Efficacy and safety of traditional Chinese medicine combined with routine western medicine for the asymptomatic novel coronavirus disease (COVID–19)
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COVID-19: Methods

Individual-based simulation model for COVID-19 transmission in Daegu, Korea: Woo-Sik Son, RISEWIDs Team; Epidemiol Health. 2020;42:e2020042. Published online June 15, 2020; DOI: https://doi.org/10.4178/epih.e2020042

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The aims of this study were to obtain insights into the current coronavirus disease 2019 (COVID-19) epidemic in the city of Daegu, which accounted for 6,482 of the 9,241 confirmed cases in Korea as of March 26, 2020, to predict the future spread, and to analyze the impact of school opening.

METHODS

Using an individual-based model, we simulated the spread of COVID-19 in Daegu. An individual can be infected through close contact with infected people in a household, at work/school, and at religious and social gatherings. We created a synthetic population from census sample data. Then, 9,000 people were randomly selected from the entire population of Daegu and set as members of the Shincheonji Church. We did not take into account population movements to and from other regions in Korea.

RESULTS

Using the individual-based model, the cumulative confirmed cases in Daegu through March 26, 2020, were reproduced, and it was confirmed that the hotspot, i.e., the Shincheonji Church had a different probability of infection than non-hotspot, i.e., the Daegu community. For 3 scenarios (I: school closing, II: school opening after April 6, III: school opening after April 6 and the mean period from symptom onset to hospitalization increasing to 4.3 days), we predicted future changes in the pattern of COVID-19 spread in Daegu.

CONCLUSIONS

Compared to scenario I, it was found that in scenario III, the cumulative number of patients would increase by 107 and the date of occurrence of the last patient would be delayed by 92 days.

Summary

Korean summary
신천지 교인 집단이 hotspot이 되어 지역사회로 전파된 대구의 COVID-19 확산을 시뮬레이션하였다. Individual based model을 이용하여 신천지 교인 집단, 즉 hotspot과 non-hotspot이 서로 다른 감염 확률을 갖고 있음을 확인하였으며, 4월 6일로 예정된 개학이 대구 지역 COVID-19 확산에 어떤 영향을 미칠지 분석하였다.

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Weiwei Zhang, Shiyong Liu, Nathaniel Osgood, Hongli Zhu, Ying Qian, Peng Jia
Systems Research and Behavioral Science.2023; 40(1): 207. CrossRef
Mathematical Modeling of COVID-19 Transmission and Intervention in South Korea: A Review of Literature
Hyojung Lee, Sol Kim, Minyoung Jeong, Eunseo Choi, Hyeonjeong Ahn, Jeehyun Lee
Yonsei Medical Journal.2023; 64(1): 1. CrossRef
Transition from growth to decay of an epidemic due to lockdown
Hamid Khataee, Jack Kibble, Istvan Scheuring, Andras Czirok, Zoltan Neufeld
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A Full-Scale Agent-Based Model to Hypothetically Explore the Impact of Lockdown, Social Distancing, and Vaccination During the COVID-19 Pandemic in Lombardy, Italy: Model Development
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Comparison of Psychosocial Distress in Areas With Different COVID-19 Prevalence in Korea
Mina Kim, In-Hoo Park, Young-Shin Kang, Honey Kim, Min Jhon, Ju-Wan Kim, Seunghyong Ryu, Ju-Yeon Lee, Jae-Min Kim, Jonghun Lee, Sung-Wan Kim
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Original Articles

Factors associated with in-hospital death in patients with nosocomial infections: a registry-based study using community data in western Iran: Salman Khazaei, Erfan Ayubi, Ensiyeh Jenabi, Saeid Bashirian, Masud Shojaeian, Leili Tapak; Epidemiol Health. 2020;42:e2020037. Published online June 1, 2020; DOI: https://doi.org/10.4178/epih.e2020037

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Abstract PDF Supplementary Material

Abstract

Objectives
Determining the predictors of in-hospital death related to nosocomial infections is an essential part of efforts made in the overall health system to improve the delivery of health care to patients. Therefore, this study investigated the predictors of in-hospital death related to nosocomial infections.

Methods

This registry-based, longitudinal study analyzed data on 8,895 hospital-acquired infections (HAIs) in Hamadan Province, Iran from March 2017 to December 2019. The medical records of all patients who had been admitted to the hospitals were extracted from the Iranian Nosocomial Infections Surveillance Software. The effects of the type and site of infection, as well as age group, on in-hospital death were estimated using univariate and multivariable Cox regression models.

Results

In total, 4,232 (47.8%) patients with HAIs were males, and their mean age was 48.25±26.22 years. In both sexes, most nosocomial infections involved Gram-negative bacteria and the most common site of infection was the urinary tract. Older patients had a higher risk of in-hospital death (adjusted hazard ratio [aHR], 2.26; 95% confidence interval [CI], 1.38 to 3.69 for males; aHR, 2.44; 95% CI, 1.29 to 4.62 for females). In both sexes, compared with urinary tract infections, an increased risk of in-hospital death was found for ventilator-associated events (VAEs) (by 95% for males and 93% for females) and bloodstream infections (BSIs) (by 67% for males and 82% for females).

Conclusion

We found that VAEs, BSIs, and fungal infections were independently and strongly associated with increased mortality.

Summary

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Fereshteh Rezaie, Farahnaz Mohammadi-Shahboulaghi, Reza Fadayevatan, Mohsen Shati, Gholamreza Ghaedamini Harouni
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Sima Rafiei, Zahra Nejatifar, Rana Soheylirad, Samira Raoofi, Fatemeh Pashazadeh Kan, Ahmad Ghashghaee
Journal of Health Reports and Technology.2022;[Epub] CrossRef
Prevalence of Nosocomial Infections During the COVID-19 Pandemic: A Systematic Review and Meta-analysis
Sima Rafiei, Zahra Nejatifar, Rana Soheylirad, Samira Raoofi, Fatemeh Pashazadeh Kan, Ahmad Ghashghaee
Journal of Health Reports and Technology.2022;[Epub] CrossRef
The Impact of COVID-19 Outbreak on Nosocomial Infection Rate: A Case of Iran
Maryam Jabarpour, Mahlagha Dehghan, Giti Afsharipour, Elham Hajipour Abaee, Parvin Mangolian Shahrbabaki, Mehdi Ahmadinejad, Mahboobeh Maazallahi, Aseer Manilal
Canadian Journal of Infectious Diseases and Medical Microbiology.2021; 2021: 1. CrossRef
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MEDSKorosh Etemad, Yousef Khani, Seyed-Saeed Hashemi-Nazari, Neda Izadi, Babak Eshrati, Yadollah Mehrabi
BMC Public Health.2021;[Epub] CrossRef

Major enteropathogens in humans, domestic animals, and environmental soil samples from the same locality: prevalence and transmission considerations in coastal Odisha, India: Arpit Kumar Shrivastava, Nirmal Kumar Mohakud, Swagatika Panda, Saumya Darshana Patra, Subrat Kumar, Priyadarshi Soumyaranjan Sahu; Epidemiol Health. 2020;42:e2020034. Published online May 26, 2020; DOI: https://doi.org/10.4178/epih.e2020034

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Abstract

Objectives
Regions with limited sanitation facilities have higher rates of infections with various enteric pathogens. It is therefore important to identify different hosts and their relative contribution to pathogen shedding into the environment, and to assess the subsequent health risks to humans.

Methods

In this study, human faecal (n=310), animal faecal (n=150), and environmental (soil) samples (n=40) were collected from the same locality and screened for selected enteric pathogens by immunochromatography and/or polymerase chain reaction.

Results

At least 1 microbial agent was detected in 49.0%, 44.7%, and 40.0% of the samples from human, animals, and soil, respectively. Among humans, rotavirus was predominantly detected (17.4%) followed by enteropathogenic Escherichia coli (EPEC) (15.4%), Shigella (13.8), and Shiga toxin-producing E. coli (STEC) (9.7%). Among animals, STEC was detected most frequently (28.0%), and EPEC was the major enteric pathogen detected in soil (30.0%). The detection rate of rotavirus was higher among younger children (≤2 years) than among older children. Single infections were more commonly detected than multiple infections in humans (p<0.01), unlike the observations in animal and soil samples. For diarrhoeagenic E. coli and Shigella, most of the human and animal isolates showed close relatedness, suggesting possible cross-infection between humans and domesticated animals in the area studied.

Conclusions

The present study provides an improved understanding of the distribution of major enteric pathogens coexisting in humans and animals in the region, thereby suggesting a high potential for possible transmission among livestock and communities residing in the studied locality.

Summary

Citations

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Habibu Tijjani, Adamu Matinja, Marwanatu Yahya, Emmanuel Aondofa, Akibu Sani
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COVID-19: Perspective

Prevention of exposure to and spread of COVID-19 using air purifiers: challenges and concerns: Seunghon Ham; Epidemiol Health. 2020;42:e2020027. Published online April 17, 2020; DOI: https://doi.org/10.4178/epih.e2020027

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1,366 Download
28 Web of Science
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Abstract PDF

Abstract

Coronavirus disease 2019 (COVID-19) is now a pandemic. The Korean government has declared a red alert, which is the highest level of the national infectious disease alert system, and the World Health Organization has similarly declared its highest-level pandemic alert (phase 6). The spread of COVID-19 is an unprecedented worldwide public health problem that governments and individuals must work to overcome. Recently, an infection cluster arose in a call center in Seoul. To support call center companies, the Korean Ministry of Employment and Labor has proposed covering the costs of installing partitions and air purifiers, providing hand sanitizers, and supplying masks to prevent droplet and aerosol infections. Air purifiers are expected to be installed on the floor with the exhaust outlets at a higher level, such as the level of the desks or breathing zones of workers. When a worker coughs or releases droplets near a colleague’s respiratory system, the droplets may spread throughout the call center via air flow from air purifier. In this fashion, a single infected person can give rise to an infection cluster. Attempts to prevent infection must not lead to new infections, and the installation of air purifiers may cause new problems. Therefore, using air purifiers to control the spread of COVID-19 should be approached with caution.

Summary

Citations

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