Epidemiology and Health

Original Articles

Increasing trends in mortality and costs of infectious diseases in Korea: trends in mortality and costs of infectious diseases: Dahye Baik, Byung-Woo Kim, Moran Ki; Epidemiol Health. 2022;44:e2022010. Published online January 3, 2022; DOI: https://doi.org/10.4178/epih.e2022010

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Abstract

OBJECTIVES
In an era when the average life expectancy and overall mortality rate have improved, Korea remains at risk for infectious disease outbreaks that place substantial burdens on the healthcare system. This study investigated trends in mortality and the economic burden of infectious diseases.

METHODS

Healthcare data from the Health Insurance Review and Assessment Service (2009-2019) and the Korean Statistics Information Service (1997-2019) were used. We selected 10 infectious disease groups (intestinal infections, tuberculosis, vaccine- preventable diseases, sepsis, viral hepatitis, HIV-related diseases, central nervous system infections, rheumatic heart diseases, respiratory tract infections, and arthropod-borne viral diseases).

RESULTS

The age-standardized mortality rate for infectious diseases increased from 27.2 per 100,000 population in 1997 to 37.1 per 100,000 population in 2019 and has had an upward trend since 2004. During this same period, significant increases were seen in respiratory tract infections and among elderly persons, especially those aged ≥85 years. The costs for infectious diseases increased from 4.126 billion US dollar (USD) in 2009 to 6.612 billion USD in 2019, with respiratory tract infections accounting for 3.699 billion USD (69%). The annual cost per patient for visits for medical care due to infectious diseases increased from 131 USD in 2009 to 204 USD in 2019.

CONCLUSIONS

Mortality among elderly persons and those with respiratory tract infections increased during the study period. The economic burden of infectious diseases has consistently increased, especially for respiratory tract infections. It is therefore essential to establish effective management policies that considers specific infectious diseases and patient groups.

Summary

Korean summary
우리나라의 감염병으로 인한 사망률과 의료비용은 증가하고 있다. 특히 고령층에서의 높은 사망률과 과다한 의료비용 지출을 고려하면, 호흡기 감염 관리에 집중하는 것이 중요하며 각 감염병 그룹별로 효과적인 정책과 효율적인 관리가 필요하다. 본 연구는 COVID-19 발생 이전의 우리나라 감염병의 사망률과 발생, 의료비 부담의 장기적인 추세를 분석한 중요한 레퍼런스가 될 것이다.

Key Message
In Republic of Korea, the mortality trends (1997-2019) and costs (2009-2019) of infectious disease have increased and this study is particularly important reference for identifying the long-term trends including mortality, outbreak, financial burden of infectious disease in Korea before COVID-19 outbreak.

Citations

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Validation of operational definitions of mortality in a nationwide hemodialysis population using the Health Insurance Review and Assessment Service databases of Korea
Dong Hee Lee, Ye-Jee Kim, Hyangkyoung Kim, Hyung Seok Lee
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Mortality Burden Due to Short-term Exposure to Fine Particulate Matter in Korea
Jongmin Oh, Youn-Hee Lim, Changwoo Han, Dong-Wook Lee, Jisun Myung, Yun-Chul Hong, Soontae Kim, Hyun-Joo Bae
Journal of Preventive Medicine and Public Health.2024; 57(2): 185. CrossRef
Glycaemic status, insulin resistance, and risk of infection-related mortality: a cohort study
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Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1. CrossRef

Experience of 16 years and its associated challenges in the Field Epidemiology Training Program in Korea: Moo-Sik Lee, Eun-Young Kim, Sang-Won Lee; Epidemiol Health. 2017;39:e2017058. Published online December 25, 2017; DOI: https://doi.org/10.4178/epih.e2017058

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Abstract

OBJECTIVES
The field epidemiologist system of South Korea, which employs public health doctors who are relatively more readily available, was created in 1999 to ensure a ready supply of experts for epidemiological investigations and enable an effective response for new and reemerging infectious diseases. However, the 2015 outbreak of Middle East Respiratory Syndrome revealed limitations in the existing systems of management of field epidemiologists and communicable diseases.

METHODS

The present study aims to evaluate data on current states, administrative reports, and other literature on the field epidemiologist system that has been in place in South Korea for 16 years since 1999 and to suggest appropriate future improvements in this system.

RESULTS

By suggesting methods to evaluate the field epidemiologist system and training programs and by suggesting ways for the Korea Centers for Disease Control and Prevention to conduct evaluations on its own, the present study provides supporting evidence for improvement of systems for training of experts in epidemiological investigations. Moreover, based on the findings, this study also suggests methods to systematically train experts in communicable diseases management and a sustainable system to establish the basis of and develop strategies for a systematic and phased management of field epidemiologist training programs.

CONCLUSIONS

The present study suggests the possibility of establishing dedicated training facilities, revising the guidelines on training and improvement of the competency of public health experts, while not limiting the scope of application to communicable diseases.

Summary

Korean summary
목적 : 이 연구는 한국의 역학조사관제도의 바람직한 개선방향을 제시하고자 하였다. 방법 : 1999년 이후 16년간 한국에서 진행되어왔던 역학조사관 제도의 운영 현황자료, 각종 문헌, 행정보고서 등을 리뷰하고, 분석 및 평가하였다. 결과 : 연구 분석결과를 활용하여 보다 체계적인 감염병 관리 전문가 양성을 위한 방안과 역학조사관 교육 프로그램의 체계적인, 단계적인 운영 기반을 구축하고 전략 개발을 위한 지속가능한 수행체계를 제안하였으며, 역학조사관 제도 및 교육프로그램의 평가 방법을 제시하고, 향후 질병관리본부에서 자체적인 평가방향을 제안하였다. 또한 감염병에만 국한되지 않는 공중보건 전문인력 양성 및 역량 강화의 가이드라인 개정 및 전문 교육기관 설립에 대한 가능성을 제안함으로써 한국의 역학조사 전문인력 양성을 위한 제도개선을 위한 근거 자료를 마련하였다. 결론 : 이 연구에서 제안된 안을 바탕으로 향후 한국의 역학조사관제도의 적극적인 개선이 요구된다.

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Evaluation of Ethiopia’s field epidemiology training program – frontline: perspectives of implementing partners
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Yemen Advanced Field Epidemiology Training Program: An Impact Evaluation, 2021
Maeen Abduljalil, Abdulhakeem Al Kohlani, Aisha Jumaan, Abdulwahed Al Serouri
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감염병 위기상황 대비 방역인력 양성 방향
무식 이
Public Health Weekly Report.2022; 15(46): 2811. CrossRef
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Haeng-Mi Son, Won-Hee Choi, Hye-Ryun Yang, Young-Hui Hwang
The Journal of Korean Academic Society of Nursing Education.2022; 28(4): 433. CrossRef
Evaluation of a New Field Epidemiology Training Program Intermediate Course to Strengthen Public Health Workforce Capacity in Tanzania
Kate Wilson, Amir Juya, Ahmed Abade, Senga Sembuche, Devotha Leonard, Julie Harris, Samantha Perkins, Stella Chale, Muhammad Bakari, Janneth Mghamba, Pamela Kohler
Public Health Reports.2021; 136(5): 575. CrossRef
Turnover Intention among Field Epidemiologists in South Korea
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International Journal of Environmental Research and Public Health.2020; 17(3): 949. CrossRef
The United Kingdom Field Epidemiology Training Programme: meeting programme objectives
Paola Dey, Jeremy Brown, John Sandars, Yvonne Young, Ruth Ruggles, Samantha Bracebridge
Eurosurveillance.2019;[Epub] CrossRef

MERS-Perspective

Strengthening epidemiologic investigation of infectious diseases in Korea: lessons from the Middle East Respiratory Syndrome outbreak: Changhwan Lee, Moran Ki; Epidemiol Health. 2015;37:e2015040. Published online September 16, 2015; DOI: https://doi.org/10.4178/epih/e2015040

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Abstract

The recent outbreak of Middle East Respiratory Syndrome (MERS) coronavirus infection in Korea resulted in large socioeconomic losses. This provoked the Korean government and the general public to recognize the importance of having a well-established system against infectious diseases. Although epidemiologic investigation is one of the most important aspects of prevention, it has been pointed out that much needs to be improved in Korea. We review here the current status of the Korean epidemiologic service and suggest possible supplementation measures. We examine the current national preventive infrastructure, including human resources such as Epidemic Intelligence Service officers, its governmental management, and related policies. In addition, we describe the practical application of these resources to the recent MERS outbreak and the progress in preventive measures. The spread of MERS demonstrated that the general readiness for emerging infectious diseases in Korea is considerably low. We believe that it is essential to increase society’s investment in disease prevention. Fostering public health personnel, legislating management policies, and establishing research centers for emerging infectious diseases are potential solutions. Evaluating international preventive systems, developing cooperative measures, and initiating improvements are necessary. We evaluated the Korean epidemiologic investigation system and the public preventive measures against infectious diseases in light of the recent MERS outbreak. We suggest that governmental authorities in Korea enforce preventive policies, foster the development of highly qualified personnel, and increase investment in the public health domain of infectious disease prevention.

Summary

Korean summary
2015년 한국의 메르스 유행시 실제 시행되었던 역학조사 내용을 기술하고, 단계별로 문제점을 검토하였다. 또한 향후 역학조사 강화방안으로 1)관련 법령 수정, 2)역학조사 전문인력 강화, 3) 신종 감염병 연구센터 필요성 등을 제시하였다. 이번 메르스 위기를 기회로 삼아 한국 감염병 대비대응체계를 굳건히 하여야 할 것이다.

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Ely Zarina Samsudin, Siti Munira Yasin, Nur-Hasanah Ruslan, Nik Nairan Abdullah, Ahmad Faiz Azhari Noor, Ahmad Fitri Abdullah Hair
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Epidemiology and Characteristics of Pediatric Respiratory Virus Infection From 2017 to 2019 Focusing on Human Coronavirus: A Retrospective Study of a Single Center in Northwestern Gyeonggi-do
Hyoungsuk Park, Kyoung Won Cho, Lindsey Yoojin Chung, Jong Min Kim, Jun Hyuk Song, Kwang Nam Kim
Pediatric Infection & Vaccine.2023; 30(2): 62. CrossRef
How has Guinea learnt from the response to outbreaks? A learning health system analysis
Tamba Mina Millimouno, Bruno Meessen, Willem Van De Put, Marlon Garcia, Bienvenu Salim Camara, Aliki Christou, Therese Delvaux, Sidikiba Sidibé, Abdoul Habib Beavogui, Alexandre Delamou
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Uncertain future of privacy protection under the Korean public health emergency preparedness governance amid the COVID-19 pandemic
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The impact of the Middle East Respiratory Syndrome coronavirus on inbound tourism in South Korea toward sustainable tourism
Yunseon Choe, Junhui Wang, HakJun Song
Journal of Sustainable Tourism.2021; 29(7): 1117. CrossRef
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Katelyn J. Yoo, Soonman Kwon, Yoonjung Choi, David M. Bishai
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Asian Social Work and Policy Review.2021; 15(3): 267. CrossRef
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Kristine M. Smith, Catherine C. Machalaba, Richard Seifman, Yasha Feferholtz, William B. Karesh
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Hee Sun Kang, Ye Dong Son, Sun‐Mi Chae, Colleen Corte
International Journal of Nursing Practice.2018;[Epub] CrossRef
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Yeong-jun Song, Jeong-Sun Yang, Hee Jung Yoon, Hae-Sung Nam, Soon Young Lee, Hae-Kwan Cheong, Woo-Jung Park, Sung Han Park, Bo Youl Choi, Sung Soon Kim, Moran Ki
Epidemiology and Health.2018; 40: e2018014. CrossRef
Airflow as a Possible Transmission Route of Middle East Respiratory Syndrome at an Initial Outbreak Hospital in Korea
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Identifying determinants of heterogeneous transmission dynamics of the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea, 2015: a retrospective epidemiological analysis
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MERS-Letter to the Editor

A lesson learned from the MERS epidemic in Korea: an essay on MERS: Kwang-Ho Meng; Epidemiol Health. 2015;37:e2015034. Published online July 30, 2015; DOI: https://doi.org/10.4178/epih/e2015034

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Abstract

이번 메르스 사태에서 보듯이 감염병의 유행방지는 무엇보다 환자로 확진 받았거나 의심되는 사람들 스스로 다른 사람에게 병을 옮기지 않도록 하는 것이 중요하다. 자신은 다소 불편하더라도 남을 ‘배려하는’ 성숙된 시민의식이 중요하다는 말이다. 남을 배려하는 이런 인문학적 성찰이야말로 메르스와 같은 감염병 예방을 위한 ‘가장 효과적인 백신’이라 할 수 있다.

Summary

Korean summary
이번 메르스 사태에서 보듯이 감염병의 유행방지는 무엇보다 환자로 확진 받았거나 의심되는 사람들 스스로 다른 사람에게 병을 옮기지 않도록 하는 것이 중요하다. 자신은 다소 불편하더라도 남을 ‘배려하는’ 성숙된 시민의식이 중요하다는 말이다. 남을 배려하는 이런 인문학적 성찰이야말로 메르스와 같은 감염병 예방을 위한 ‘가장 효과적인 백신’이라 할 수 있다.

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COVID-19 Pandemi Korkusu ile Hemşirelerin Bakım Verici Rolüne İlişkin Tutumları Arasındaki İlişki
Ebubekir KAPLAN, Mehmet Cihad AKTAŞ, Hatice KAYA
Sağlık Bilimleri Üniversitesi Hemşirelik Dergisi.2021; 3(3): 135. CrossRef
Beyond the fear: Nurses’ experiences caring for patients with Middle East respiratory syndrome: A phenomenological study
Jin Young Lee, Jeong Hee Hong, Eun Young Park
Journal of Clinical Nursing.2020; 29(17-18): 3349. CrossRef
Complementing conventional infectious disease surveillance with national health insurance claims data in the Republic of Korea
Jaehun Jung, Jae Hyoung Im, Young-Jin Ko, Kyungmin Huh, Chang-gyo Yoon, Chulwoo Rhee, Young-Eun Kim, Dun-Sol Go, Arim Kim, Yunsun Jung, Munkhzul Radnaabaatar, Seok-Jun Yoon
Scientific Reports.2019;[Epub] CrossRef

Brief Communication

A community-level Communicable Disease Surveillance System in a Metropolitan city.: Sun Seog Kweon, Hyung Cheol Park, Hyun Nam, Jin Su Choi; Korean J Epidemiol. 2008;30(2):294-300. Published online December 31, 2008; DOI: https://doi.org/10.4178/kje.2008.30.2.294

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Abstract PDF: Abstract
OBJECTIVES
The surveillance of infectious diseases, which is crucial in public health, may also suffer from poor community support. In South Korea, the government operates several national surveillance system for the National notifiable infectious diseases(NNID). Some programs work satisfactorily but other programs may not be fully accepted at the community level which result in low participation and delayed report.
METHODS
May 2003, to improve the blind side of the National Surveillance System, a district health agency initiated a community based surveillance system for infectious diseases called as Communicable Disease Information Sharing System (CDISS) to complement the national program. As the name suggests, it underscores the mutual benefit of surveillance for public and private health sectors through partnership. With collaboration of participating private clinics and hospitals around the district, the health agency collects data and provides the health practitioners more up-to-dated information on the trend of infectious diseases than National level information. Total population of study area, Dong-gu which locate in the center of Gwangju-metropolitan city, is about 120,000 in 2005. Reporting facilities consist of 6 daycare clinics, 3 hospitals, and 1 university hospital, 2 local public health organizations.
RESULTS
CDISS was introduced in May 2003, and full system has been successfully operated since March 2004 with 10 participating facilities. Each reporting facility regularly sends the weekly reporting form, filled with the number of patients in last week, to Dong-gu District Health Center in every Wednesday. All data were organized in tables and graphs by weekly summarizing the reporting data and interpreted information. Feedback is done to reporting facilities until Friday through faxes, email, website (http://kjdisweb.richis.org) ?at least a week earlier than National Surveillance System.If reported data exceeded epidemic alert level, the community warnings are issued through mass-media and other means of public communication.During the period of CDISS operation, some epidemic events and sporadic outbreak occurred in Dong-gu were detected well-earlier than the notification at national level, such as chickenpox, viral enteritis, and epidemic keratoconjunctivitis(EKC).
CONCLUSIONS
The program has been functioning successfully with active community participation and revealed to be economic and effective way of disease surveillance in the community. Several episodes of disease epidemic were reported by the program well before the recognition of the epidemic at the national level. We suggest that the community surveillance program may well complement national surveillance system.; Summary

Review

Overview of Emerging Infectious Diseases in Korea.: Bo Youl Choi; Korean J Epidemiol. 2008;30(2):147-155. Published online December 31, 2008; DOI: https://doi.org/10.4178/kje.2008.30.2.147

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Abstract

The term and concept of emerging infectious diseases (EID) has been burgeoned out in the early 1990s and EID were expected as the most important public health problems of all of countries and global community as a whole. EID have been confirmed as the most important health and security problems when the global community has been experienced a lot of outbreaks of EID including avian influenza in Hong Kong (1997), Nipah encephalitis in Malaysia and Singapore (1999), and anthrax bioterrorism in U.S.A. (2001), and SARS outbreaks in global community (2003). Pandemic influenza could be a big disaster in global community in the near future in the situation of the occurrence of H5N1 avian influenza and it's human cases in southeastern Asian countries. This paper described the EIDs in terms of two epidemiologic transition theories, and described the important EID in global community since 1970s and reviewed the remarkable emerging and re-emerging infectious diseases in Korea since 1990. Seven factors contributing to EID and the convergence model for EID were introduced. In conclusion, the preparedness and response plan of public health authority the role of epidemiologist was suggested. Especially the cooperative activities between epidemiologists and other field or sector's professionals were emphasized to find out the etiology or risk factors of EID and preparedness and response plan.

Summary

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Infectious disease-related laws: prevention and control measures
Mijeong Park
Epidemiology and Health.2017; 39: e2017033. CrossRef

Original Articles

Reporting of National Notifiable Infectious Diseases (NNIDs) and Related Characteristics.: Ye soon Kim, Kee ho Park, Hyo soon Yoo, Jun wook Kwon, Euichul Shin; Korean J Epidemiol. 2007;29(2):200-210.

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communicable diseases. The purposes of the study is to estimate reporting proportion of National Notifiable Infectious Diseases(NNIDs) and investigate characteristics related to reporting using KAP(knowledge, attitude, practice) model.
METHOD
We surveyed randomly selected 2,185 physicians (speciality: internal medicine, family medicine, pediatrics, dermatology, general physicians) of their knowledge, attitude, and practice of NNIDs reporting through self-administered mail questionnaires. Of them, 231 physicians responded (response proportion: 10.6%).
RESULT
The reporting proportion was estimated to 27.0%. Recognition level (knowledge) of NNIDs was relatively high with proportion of 69.4%, and attitude (public health importance) of reporting was 65.8%. Multiple logistic regression analysis showed that knowledge, attitude significantly affected physicians' reporting in a positive direction (O.R. 6.2, 6.2 respectively). Whereas, senior age group, specialty (family medicine, pediatrics, dermatology) showed significantly lower reporting. General (tertiary care) hospital level of care showed significantly higher reporting practice (alpha=0.05).
CONCLUSION
The NNIDs reporting proportion, 27.0% is similar with those studied recently. Continuous efforts to increase the performance level of communicable diseases surveillance system. Of those, restructuring surveillance systems considering characteristics of notifiable diseases classes must be stressed. Educational approach of physicians needs to be tailored specially to newly-designated diseases such as Group II, Designated Group NNIDs.; Summary

Epidemic modeling and Table-top Exercise for Emerging Infectious Diseases in Korea.: Byung Chul Chun; Korean J Epidemiol. 2006;28(1):47-63.

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Understanding the spread of infections is of vital importance in the control of epidemics and the development of proper policies toprevent infectious diseases. Theory and techniques have been developed for the study of both the evolution of diseases with individual people and the transmission of infections through populations. From broad theoretical issues to specific practical problems, the mathematical modeling studies of infectious diseases have provided great insight to solve the mechanisms of disease spread and to predict the course of epidemics. Emerging and reemerging infectious diseases have attracted widespread concern in Korea. While preparing the influenza pandemic plan in 2004, we developed a model of the new influenza pandemic to estimate the number of cases and deaths, the shortage of medical resources, and the effect of interventions such as isolation and vaccination. Based on this model, we constructed a possible pandemic scenario of the emerging virus, and designed a table-top exercise for public health officials and related administration staff. On March 30th, 2005, the exercise was performed and the results were evaluated as successful. In the case of bioterrorism, a model of small pox epidemic was developed in 2005 to examine the speed of the disease spread in the population and to evaluate the intervention effects in a Korean city. The simulation results were also helpful to form a guideline to prepare for a small pox epidemic. These two experiments confirmed the usefulness of epidemic modeling in Korea.; Summary

Reviews

Epidemiology and Prevention Strategies of Avian Influenza.: Byung chul Chun, Jae hong Kim, Yoon jung Lee, Kang Chun, Hyun mee Kim, Young kuk Kwon, Jun gu Choi, Eun kyoung Lee, Choi kyu Park, Sung hwan Wee, Soon ja Choi; Korean J Epidemiol. 2005;27(1):90-107.

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Natural infections with influenza A viruses have been reported in a variety of animal species including humans, pigs, horses, sea mammals, and birds. Although viruses of relatively few haemagglutinin(HA) and neuraminidase(NA) subtype combinations have been isolated from mammalian species, all subtypes, in most combinations, have been isolated from birds. During the past few years, several subtypes of avian influenza A have been shown to cross the species barrier and infect humans. During an outbreak of a highly pathogenic influenza A(H5N1) virus among poultry in Hong Kong in 1997, 6 of 18 people with confirmed infection died. And a total of 89 human infections with influenza A(H7N7), including 1 resulting in the death of a Dutch veterinarian, occurred during the extensive outbreak in 2003. During late 2003 and early 2004, there were reports of large outbreaks of H5N1 among poultry throughout Asia (including Korea, Japan, Indonesia, Vietnam, Thailand, Laos, Cambodia, and China). In Korea, we had also highly pathogenic avian influenza(HPAI) outbreak in 2003~2004 with a first suspected case reported on 10 December 2003. The case was reported at a parent stock farm for broilers, which was located in Chungbuk province, and the farm was immediately placed under movement restrictions. Laboratory tests confirmed the outbreak of HPAI on 12 December 2003. Up to 20 March 2004, a total of 19 farms were confirmed as having been infected with HPAI virus. No further outbreaks occurred after that date. Fortunately there were no human cases founded in this epidemic in Korea. In January 2004, there was confirmation that influenza A(H5N1) virus had been isolated from patients who had died of a respiratory illness in Vietnam. Total 107 human confirmed cases were reported until June 2005 to WHO, threatening new pandemic outbreak. We reviewed our prevention and control strategies of avian influenza and preparedness to the pandemic outbreak.; Summary

Introduction of zoonses in Korea.: Seung churl Park, Byung Chul Chun, Ki Dong Park; Korean J Epidemiol. 2005;27(1):1-11.

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Many new human pathogens that have emerged or reemerged worldwide originated from animals or from products of animal origin. Many animal species as well as categories of agents have been involved in the emergence of diseases. Nearly all of these emergent disease episodes have involved zoonotic infectious agents; that is, they have involved the transmission of the etiologic agent to humans from an ongoing reservoir life cycle in animals or arthropods. Control of zooneses depends on attempts to reduce vector populations of limit contact with reservior species. But in most instances, the control efforts require environmental or human behavioral modification in addition to direct efforts at vector population reduction. We described the general ecological characteristics of zoonses and epidemiologic features of 7 important zoonoses in Korea-anthrax, brucellosis, rabies, E. coli O157 infection, japanese B encephalitis, bovine spongiform encephalitis and variant Creutzfelt-Jacob diseases, and high pathogenic avian influenza. We have made some suggestions in this article. First the network of medical field and veterinary field(including experts and governmental organization) should be systematically organized in zoonosis surveillance, epidemic investigation, outbreak control and so forth. Second, we should practically prepare the new emerging epidemics-including pandemic and bioterrorism in connection with zoonoses control. Third, we need ecological and epidemiological basic studies on zoonoses in Korea, and finally, the zoonoses control policy should be connected food safety.; Summary

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