Osong Public Health and Research Perspectives

Original Articles

mRNA vaccine effectiveness against SARS-CoV-2 B.1.617.2 (Delta) and B.1.1.529 (Omicron) variant transmission from home care cases to household contacts in South Korea: Hanul Park, Young Joon Park, Sang Eun Lee, Min Jei Lee, Hyungtae Ahn; Received September 1, 2022 Accepted November 1, 2022 Published online November 28, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0243 [Epub ahead of print]

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Abstract PDF: Objectives
Household contacts of confirmed cases of coronavirus disease 2019 (COVID-19) are exposed to a high risk of viral transmission, and secondary incidence is an important indicator of community transmission. This study analyzed the secondary attack rate and mRNA vaccine effectiveness against transmission (VET) for index cases (patients treated at home) confirmed to be infected with the Delta and Omicron variants.
Methods
The subjects of the study were 4,450 index cases and 10,382 household contacts. Logistic regression analysis was performed to compare the secondary attack rate by vaccination status, and adjusted relative risk and 95% confidence intervals were identified.
Results
The secondary attack rate of the Delta variant was 27.3%, while the secondary attack rate of the Omicron variant was 29.8%. For the Delta variant, groups with less than 90 days and more than 90 days after 2 doses of mRNA vaccination both showed a VET of 37%. For the Omicron variant, a 64% VET was found among those with less than 90 days after 2 doses of mRNA vaccination.
Conclusion
This study provides useful data on the secondary attack rate and VET of mRNA vaccines for household contacts of COVID-19 cases in South Korea.

Time-series comparison of COVID-19 case fatality rates across 21 countries with adjustment for multiple covariates: Yongmoon Kim, Bryan Inho Kim, Sangwoo Tak; Received July 25, 2022 Accepted October 18, 2022 Published online November 28, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0212 [Epub ahead of print]

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Abstract PDF: Objectives
Although it is widely used as a measure for mortality, the case fatality rate (CFR) of coronavirus disease 2019 (COVID-19) can vary over time and fluctuate for many reasons other than viral characteristics. To compare the CFRs of different countries in equal measure, we estimated comparable CFRs after adjusting for multiple covariates and examined the main factors that contributed to variability in the CFRs among 21 countries.
Methods
For statistical analysis, time-series cross-sectional data were collected from Our World in Data, CoVariants.org, and GISAID. Biweekly CFRs of COVID-19 were estimated by pooled generalized linear squares regression models for the panel data. Covariates included the predominant virus variant, reproduction rate, vaccination, national economic status, hospital beds, diabetes prevalence, and population share of individuals older than age 65. In total, 21 countries were eligible for analysis.
Results
Adjustment for covariates reduced variation in the CFRs of COVID-19 across countries and over time. Regression results showed that the dominant spread of the Omicron variant, reproduction rate, and vaccination were associated with lower country-level CFRs, whereas age, the extreme poverty rate, and diabetes prevalence were associated with higher country-level CFRs.
Conclusion
A direct comparison of crude CFRs among countries may be fallacious, especially in a cross-sectional analysis. Our study presents an adjusted comparison of CFRs over time for a more proper comparison. In addition, our findings suggest that comparing CFRs among different countries without considering their context, such as the epidemic phase, medical capacity, surveillance strategy, and socio-demographic traits, should be avoided.

Review Article

SARS-CoV-2 in brief: from virus to prevention: Hassan Karami, Zeinab Karimi, Negin Karami; Received May 21, 2022 Accepted October 11, 2022 Published online November 28, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0155 [Epub ahead of print]

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Abstract PDF: The recent outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a highly transmissible virus with a likely animal origin, has posed major and unprecedented challenges to millions of lives across the affected nations of the world. This outbreak first occurred in China, and despite massive regional and global attempts shortly thereafter, it spread to other countries and caused millions of deaths worldwide. This review presents key information about the characteristics of SARS-CoV-2 and its associated disease (namely, coronavirus disease 2019) and briefly discusses the origin of the virus. Herein, we also briefly summarize the strategies used against viral spread and transmission.

Editorial

What measures should be considered in this 2022-2023 winter season: Jong-Koo Lee; Osong Public Health Res Perspect. 2022;13(5):313-315. Published online October 28, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0286

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Original Article

Clinical outcomes of remdesivir-treated COVID-19 patients in South Korea: Mi Yu, Bryan Inho Kim, Jungyeon Kim, Jin Gwack; Osong Public Health Res Perspect. 2022;13(5):370-376. Published online October 18, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0138

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Abstract PDF: Objectives
This study analyzed the clinical outcomes of remdesivir treatment in coronavirus disease 2019 (COVID-19) patients in South Korea.
Methods
This retrospective cohort study involved the secondary analysis of epidemiological data. Among patients diagnosed with COVID-19 from July 2, 2020 to March 23, 2021 (12 AM), 4,868 who received oxygen therapy and were released from isolation after receiving remdesivir treatment were assigned to the treatment group, and 6,068 patients who received oxygen therapy but not remdesivir were assigned to the untreated group. The study subjects included children under the age of 19. The general characteristics and severity were compared between the groups. Differences in the time to death and mortality were also compared.
Results
In the untreated group, the hazard ratio [HR] for mortality was 1.59 among patients aged ≥70 years and 2.32 in patients with severe disease in comparison to the treatment group. In a comparison of survival time among patients with severe disease aged ≥70 years, the HR for mortality before 50 days was 2.09 in the untreated group compared to the treatment group.
Conclusion
Patients with remdesivir treatment showed better clinical outcomes in this study, but these results should be interpreted with caution since this study was not a fully controlled clinical trial.

Brief Reports

Adverse events of the Pfizer-BioNTech COVID-19 vaccine in Korean children and adolescents aged 5 to 17 years: Seontae Kim, Yeseul Heo, Soon-Young Seo, Do Sang Lim, Enhi Cho, Yeon-Kyeng Lee; Osong Public Health Res Perspect. 2022;13(5):382-390. Published online October 14, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0233

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Abstract PDF: Objectives
This study aimed to identify potential safety signals and adverse events following the primary Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccination series among children and adolescents aged 5 to 17 years in the Republic of Korea. Methods: Adverse events reported through the COVID-19 vaccination management system (CVMS, a web-based passive vaccine safety surveillance system) and adverse events and health conditions collected from a text message-based survey were analyzed. Results: A total of 14,786 adverse events among 5 to 17-year-old children and adolescents were reported in the CVMS; 14,334 (96.9%) were non-serious and 452 (3.1%) were serious, including 125 suspected cases of acute cardiovascular injury and 101 suspected cases of anaphylaxis. The overall reporting rate was lower in 5 to 11-year-old children (64.5 per 100,000 doses) than in 12 to 17-year-old adolescents (300.5 per 100,000 doses). The text message survey identified that local and systemic adverse events after either dose were reported less frequently in 5 to 11-year-old children than in 12 to 17-year-old adolescents (p<0.001). The most commonly reported adverse events were pain at the injection site, myalgia, headache, and fatigue/tiredness. Conclusion: The overall results are consistent with the results of controlled trials; serious adverse events were extremely rare among 5 to 17-year-old children and adolescents following Pfizer-BioNTech COVID-19 vaccination. Adverse events were less frequent in children aged 5 to 11 years than in adolescents aged 12 to 17 years.

Presumed population immunity to SARS-CoV-2 in South Korea, April 2022: Eun Jung Jang, Young June Choe, Seung Ah Choe, Yoo-Yeon Kim, Ryu Kyung Kim, Jia Kim, Do Sang Lim, Ju Hee Lee, Seonju Yi, Sangwon Lee, Young-Joon Park; Osong Public Health Res Perspect. 2022;13(5):377-381. Published online October 14, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0209

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Graphical Abstract Abstract PDF: Objectives
We estimated the overall and age-specific percentages of the Korean population with presumed immunity against severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) as of April 2022 using the national registry.
Methods
We used the national coronavirus disease 2019 (COVID-19) infection and vaccination registry from South Korea, as described to define individuals with a previous history of COVID-19 infection, vaccination, or both, as persons with presumed immunity.
Results
Of a total of 53,304,627 observed persons, 24.4% had vaccination and infection, 58.1% had vaccination and no infection, 7.6% had infection and no vaccination, and 9.9% had no immunity. The SARS-CoV-2 Omicron variant emerged at a time when the presumed population immunity ranged from 80% to 85%; however, nearly half of the children were presumed to have no immunity.
Conclusion
We report a gap in population immunity, with lower presumed protection in children than in adults. The approach presented in this work can provide valuable informed tools to assist vaccine policy-making at a national level.

Review Articles

India’s efforts to achieve 1.5 billion COVID-19 vaccinations: a narrative review: Kapil Singh, Ashwani Verma, Monisha Lakshminarayan; Osong Public Health Res Perspect. 2022;13(5):316-327. Published online October 14, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0104

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Graphical Abstract Abstract PDF: The initial case of coronavirus disease 2019 (COVID-19) in India was reported on January 30, 2020, and subsequently, the number of COVID-19-infected patients surged during the first wave of April 2020 and the second wave in the same month of 2021. The government of India imposed a strict nationwide lockdown in April 2020 and extended it until May 2020. The second wave of COVID-19 in India overwhelmed the country’s health facilities and exhausted its medical and paramedical workforce. This narrative review was conducted with the aim of summarizing the evidence drawn from policy documents of governmental and non-governmental organizations, as well as capturing India's COVID-19 vaccination efforts. The findings from this review cover the Indian government's vaccination initiatives, which ranged from steps taken to combat vaccine hesitancy to vaccination roadmaps, deployment plans, the use of digital health technology, vaccination monitoring, adverse effects, and innovative strategies such as Har Ghar Dastak and Jan Bhagidari Andolan (people’s participation). These efforts collectively culminated in the successful administration of more than 1.8 billion doses of COVID-19 vaccines in India. This review also provides insights into other countries’ responses to COVID-19 and guidance for future pandemics.

Effects of medication adherence interventions for older adults with chronic illnesses: a systematic review and meta-analysis: Hae Ok Jeon, Myung-Ock Chae, Ahrin Kim; Osong Public Health Res Perspect. 2022;13(5):328-340. Published online October 12, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0168

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Abstract PDF: This systematic review and meta-analysis aimed to understand the characteristics of medication adherence interventions for older adults with chronic illnesses, and to investigate the average effect size by combining the individual effects of these interventions. Data from studies meeting the inclusion criteria were systematically collected in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The results showed that the average effect size (Hedges’ g) of the finally selected medication adherence interventions for older adults with chronic illnesses calculated using a random-effects model was 0.500 (95% confidence interval [CI], 0.342−0.659). Of the medication adherence interventions, an implementation intention intervention (using face-to-face meetings and telephone monitoring with personalized behavioral strategies) and a health belief model–based educational program were found to be highly effective. Face-to-face counseling was a significantly effective method of implementing medication adherence interventions for older adults with chronic illnesses (Hedges’ g=0.531, 95% CI, 0.186−0.877), while medication adherence interventions through education and telehealth counseling were not effective. This study verified the effectiveness of personalized behavioral change strategies and cognitive behavioral therapy based on the health belief model, as well as face-to-face meetings, as medication adherence interventions for older adults with chronic illnesses.

Original Article

A case-control study of acute hepatitis A in South Korea, 2019: Jung Hee Hyun, Ju Young Yoon, Sang Hyuk Lee; Osong Public Health Res Perspect. 2022;13(5):352-359. Published online October 12, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0141

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Graphical Abstract Abstract PDF: Objectives
We aimed to reconfirm the source of hepatitis A virus (HAV) infection through epidemiological and genotype investigations of individual cases in a 2019 outbreak in South Korea. Methods: We investigated food intake histories, associations with hepatitis A, and genotypes of HAV in 31 patients with hepatitis aged 20 to 49 years registered in the integrated disease and health management system during December 1–7, 2019 (case group) and in 35 sex- and agematched people without a history of HAV vaccination or infection among patients’ families and colleagues (control group). Results: The consumption of salted clams was a significant factor (odds ratio, 4.33; 95% confidence interval, 1.32–14.18) in the risk factor analysis of food intake history. HAV genotypes were analyzed in 24 of 31 patients. Type IA and type IIIA were found in 23 and 1 cases, respectively. Conclusion: Salted clams are considered to have been the source of HAV infection at 49 weeks of the HAV outbreak in 2019; this result was consistent with that of a previous epidemiological investigation conducted by the Korea Disease Control and Prevention Agency in September 2019. Therefore, monitoring of the production and distribution of salted clams needs to be continued.

Review Article

Zika virus as an emerging arbovirus of international public health concern: Samira Vaziri, Siavash Hamzeh Pour, Fateme Akrami-Mohajeri; Osong Public Health Res Perspect. 2022;13(5):341-351. Published online October 12, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0101

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Abstract PDF: Zika virus (ZIKV) was identified in 1947 in a rhesus monkey during an investigation of the yellow fever virus in the Zika Forest of Uganda; it was also isolated later from humans in Nigeria. The main distribution areas of ZIKV were the African mainland and South-East Asia in the 1980s, Micronesia in 2007, and more recently the Americas in 2014. ZIKV belongs to the Flaviviridae family and Flavivirus genus. ZIKV infection, which is transmitted by Aedes mosquitoes, is an emerging arbovirus disease. The clinical symptoms of ZIKV infection are fever, headache, rashes, arthralgia, and conjunctivitis, which clinically resemble dengue fever syndrome. Sometimes, ZIKV infection has been associated with Guillain-Barré syndrome and microcephaly. At the end of 2015, following an increase in cases of ZIKV infection associated with Guillain-Barré syndrome and microcephaly in newborns in Brazil, the World Health Organization declared a global emergency. Therefore, considering the global distribution and pathogenic nature of this virus, the current study aimed at reviewing the virologic features, transmission patterns, clinical manifestations, diagnosis, treatment, and prevention of ZIKV infection.

Original Article

Investigation of SARS-CoV-2 lineages and mutations circulating in a university-affiliated hospital in South Korea analyzed using Oxford Nanopore MinION sequencing: Hyaekang Kim, Sung Hee Chung, Hyun Soo Kim, Han-Sung Kim, Wonkeun Song, Ki Ho Hong, Jae-Seok Kim; Osong Public Health Res Perspect. 2022;13(5):360-369. Published online October 11, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0183

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Abstract PDF Supplementary Material: Objectives
Despite the introduction of vaccines, treatments, and massive diagnostic testing, the evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has continued to overcome barriers that had slowed its previous spread. As the virus evolves towards increasing fitness, it is critical to continue monitoring the occurrence of new mutations that could evade human efforts to control them. Methods: We performed whole-genome sequencing using Oxford Nanopore MinION sequencing on 58 SARS-CoV-2 isolates collected during the ongoing coronavirus disease 2019 pandemic at a tertiary hospital in South Korea and tracked the emergence of mutations responsible for massive spikes in South Korea. Results: The differences among lineages were more pronounced in the spike gene, especially in the receptor-binding domain (RBD), than in other genes. Those RBD mutations could compromise neutralization by antibodies elicited by vaccination or previous infections. We also reported multiple incidences of Omicron variants carrying mutations that could impair the diagnostic sensitivity of reverse transcription-polymerase chain reaction-based testing. Conclusion: These results provide an understanding of the temporal changes of variants and mutations that have been circulating in South Korea and their potential impacts on antigenicity, therapeutics, and diagnostic escape of the virus. We also showed that the utilization of the nanopore sequencing platform and the ARTIC workf low can provide convenient and accurate SARS-CoV-2 genomic surveillance even at a single hospital.

Editorial

Preparedness for the next wave of COVID-19 in the Republic of Korea: Jong-Koo Lee; Osong Public Health Res Perspect. 2022;13(4):239-241. Published online August 31, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0240

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Brief Report

Isolation and identification of monkeypox virus MPXV-ROK-P1-2022 from the first case in the Republic of Korea: Jin-Won Kim, Minji Lee, Hwachul Shin, Chi-Hwan Choi, Myung-Min Choi, Jee Woong Kim, Hwajung Yi, Cheon-Kwon Yoo, Gi-Eun Rhie; Osong Public Health Res Perspect. 2022;13(4):308-311. Published online August 31, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0232

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Graphical Abstract Abstract PDF

Objectives
Monkeypox outbreaks in nonendemic countries have been reported since early May 2022. The first case of monkeypox in the Republic of Korea was confirmed in a patient who traveled to Europe in June 2022, and an attempt was made to isolate and identify the monkeypox virus (MPXV) from the patient’s specimens.
Methods
Clinical specimens from the patient were inoculated in Vero E6 cells. The isolated virus was identified as MPXV by the observation of cytopathic effects on Vero E6 cells, transmission electron microscopy, conventional polymerase chain reaction (PCR), and sequencing of PCR products.
Results
Cytopathic effects were observed in Vero E6 cells that were inoculated with skin lesion swab eluates. After multiple passages from the primary culture, orthopoxvirus morphology was observed using transmission electron microscopy. In addition, both MPXV-specific (F3L and ATI) and orthopoxvirus-specific genes (A39R, B2R, and HA) were confirmed by conventional PCR and Sanger sequencing.
Conclusion
These results indicate the successful isolation and identification of MPXV from the first patient in the Republic of Korea. The isolated virus was named MPXV-ROK-P1-2022.

Citations

Citations to this article as recorded by

Isolation and Characterization of Monkeypox Virus from the First Case of Monkeypox — Chongqing Municipality, China, 2022
Baoying Huang, Hua Zhao, Jingdong Song, Li Zhao, Yao Deng, Wen Wang, Roujian Lu, Wenling Wang, Jiao Ren, Fei Ye, Houwen Tian, Guizhen Wu, Hua Ling, Wenjie Tan
China CDC Weekly.2022; 4(46): 1019. CrossRef

Original Article

Insufficient weight management in pregnant women with gestational diabetes mellitus: Kyunghee Han, Dong Wook Kwak, Hyun Mee Ryu, Hyun-Young Park; Osong Public Health Res Perspect. 2022;13(4):242-251. Published online August 31, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0182

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Graphical Abstract Abstract PDF: Objectives
This study investigated whether weight was managed appropriately in pregnant women with gestational diabetes mellitus (GDM) and examined the association between insufficient gestational weight gain (GWG) and adverse pregnancy outcomes.
Methods
The study included 235 pregnant women with GDM from the Korean Pregnancy Outcome Study. GWG from the second to the third trimester (kg/wk) and total GWG (kg) were classified as insufficient, appropriate, or excessive according to the 2009 Institute of Medicine guidelines. Adverse pregnancy outcomes included maternal (hypertensive disorders of pregnancy, preterm birth, cesarean delivery, and delivery complications) and infant (low birth weight, high birth weight, neonatal intensive care unit admission, and congenital anomalies) outcomes.
Results
The proportion of pregnant women with GDM who had insufficient GWG from the second to the third trimester was 52.3%, and that of participants with total insufficient GWG was 48.1%. There were no significant associations between insufficient GWG from the second to the third trimester and adverse pregnancy outcomes. Participants with total insufficient GWG had a significantly lower risk of preterm birth (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.05–0.60) and high birth weight (OR, 0.23; 95% CI, 0.07–0.80).
Conclusion
Our findings suggest the importance of appropriate weight management and the need for GWG guidelines for pregnant women with GDM.

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