<b>Objectives</b><br/>This study presents the standardized protocols developed by the Clinical-Based Human Microbiome Research and Development Project (cHMP) in the Republic of Korea. <br/><b>Methods</b><br/>It addresses clinical metadata collection, specimen handling, DNA extraction, sequencing methods, and quality control measures for microbiome research. <br/><b>Results</b><br/>The cHMP involves collecting samples from healthy individuals and patients across various body sites, including the gastrointestinal tract, oral cavity, respiratory system, urogenital tract, and skin. These standardized procedures ensure consistent data quality through controlled specimen collection, storage, transportation, DNA extraction, and sequencing. Sequencing encompasses both amplicon and whole metagenome methods, followed by stringent quality checks. The protocols conform to international guidelines, ensuring that the data generated are both reliable and comparable across microbiome studies. <br/><b>Conclusion</b><br/>The cHMP underscores the importance of methodological standardization in enhancing data integrity, reproducibility, and advancing microbiome-based research with potential applications for improving human health outcomes.

<b>Objectives</b><br/>In the Republic of Korea, the previous surveillance system for zoonotic tuberculosis (TB) involved the X-ray testing of humans in contact with Mycobacterium bovis-infected livestock. In contrast, the updated surveillance system incorporates the genotyping of cultured Mycobacterium isolates for high-risk occupational groups. This study aimed to systematically document the detection, diagnosis, assessment, and response in the epidemic investigation of zoonotic TB in a laboratory worker in the Republic of Korea. <br/><b>Methods</b><br/>M. bovis was confirmed using spoligotyping and whole genome sequencing. Clinical characteristics were reviewed through epidemiological investigation and interviews with the affected individual. Transmission routes and secondary spread were assessed via field epidemiological investigations and contact evaluations using chest X-ray and interferon gamma release assay for latent TB infection. <br/><b>Results</b><br/>A 56-year-old laboratory worker presented with chest X-ray findings compatible with TB and subsequently tested positive for M. bovis. She had no clinical or family history of TB and remained asymptomatic. She completed a 6 month treatment regimen of isoniazid, rifampin, ethambutol, and pyrazinamide without hospitalization. Although no direct transmission pathways for zoonotic TB were identified, her work in a laboratory, processing specimens for zoonotic TB, indicated potential laboratory related exposure. <br/><b>Conclusion</b><br/>This case underscores the importance of stringent use of personal protective equipment among high-risk occupational groups and the implementation of an enhanced surveillance system to report zoonotic TB. These findings highlight the need for a One Health approach and proactive surveillance, emphasizing the necessity of refining and strengthening surveillance systems for precise monitoring and an effective response.

<b>Objectives</b><br/>Subacute sclerosing panencephalitis (SSPE) is a rare but fatal neurodegenerative disease caused by persistent measles virus infection. After a significant measles outbreak in 2000–2001, the Republic of Korea implemented a nationwide measles elimination program, which led to a dramatic reduction in measles incidence. This study aimed to evaluate the impact of these measles elimination efforts on the incidence of SSPE in the Republic of Korea. <br/><b>Methods</b><br/>This nationwide, population-based retrospective cohort study identified patients newly diagnosed with measles and SSPE between 2007 and 2022, registered in the Health Insurance Review and Assessment Service (HIRA) and Korea Disease Control and Prevention Agency (KDCA) databases. Population-based incidence rates of measles and SSPE were calculated and compared annually. <br/><b>Results</b><br/>A total of 236 measles cases (HIRA data) and 1,168 measles cases (KDCA data), along with 2,736 SSPE cases, were diagnosed during the study period. Measles incidence significantly declined, reaching zero cases in 2021, while SSPE incidence displayed an upward trend, peaking in 2014. The mean age at SSPE onset was 21.2 years, with a marked male-to-female ratio of 13.0:1. <br/><b>Conclusion</b><br/>SSPE incidence was remarkably low in the post-outbreak period, likely attributable to successful measles control. This study underscores the critical importance of maintaining low measles incidence through sustained vaccination efforts, preventing SSPE and other measles-related complications.

<b>Objectives</b><br/>To develop and evaluate forecasting models using the Holt-Winters statistical approach and the long short-term memory (LSTM) deep learning method for weekly seasonal influenza-like illness (ILI) incidences in Saudi Arabia. The study compares model performance and assesses the predictive value added by incorporating region-specific exogenous variables within Middle Eastern epidemiological modeling. <br/><b>Methods</b><br/>This study compared the performance of Holt-Winters and LSTM models in forecasting weekly ILI cases in Saudi Arabia, using data collected from 2017 to 2022. Time series analysis integrated exogenous variables including climatic conditions and population mobility trends. The Holt-Winters model employed both additive and multiplicative seasonal components. Model performance was evaluated using root mean squared error (RMSE), mean absolute percentage error, and R2. <br/><b>Results</b><br/>The best-performing model, LSTM with exogenous variables, achieved an RMSE of 28.55, mean absolute error (MAE) of 0.14, R2 of 0.96, and percent bias (PBIAS) of +2.1%, indicating negligible systematic error. The LSTM model without exogenous variables demonstrated slightly lower accuracy (RMSE of 34.07, MAE of 0.18, R2 of 0.93, PBIAS of +5.8%), indicating strong predictive capability but less precision in determining peak ILI cases. The Holt-Winters model effectively captured seasonal and long-term trends, but showed a moderate performance with an RMSE of 82.57, MAE of 0.38, R2 of 0.58, and a high PBIAS of +14.2%, revealing significant unexplained variability during periods of high incidence fluctuation. <br/><b>Conclusion</b><br/>This study highlights the respective strengths and limitations of statistical and machine learning approaches for ILI forecasting.

<b>Objectives</b><br/>This study investigated the correlation between food insecurity and infectious diseases among toddlers in Indonesia. <br/><b>Methods</b><br/>This research employed a cross-sectional study design using data from the 2021 Indonesian Nutrition Status Survey, which included a sample of 84,115 toddlers. Food insecurity levels were assessed using the food insecurity experience scale, developed by the Food and Agriculture Organization. The dependent variable, infectious disease, was defined as a toddler experiencing 1 or more of the following conditions: acute respiratory infections, diarrhea, pneumonia, measles, or worms. Multivariate analysis was conducted using multiple logistic regression to determine adjusted odds ratios (ORs). <br/><b>Results</b><br/>The findings indicate that 23.78% of toddlers experienced at least 1 infectious disease. While more than half of the respondents were food secure, 26.5% faced mild food insecurity, 13.6% moderate food insecurity, and 6.5% severe food insecurity. Toddlers from households experiencing mild, moderate, and severe food insecurity had higher risks of infectious diseases compared to those from food-secure households, with adjusted ORs of 1.367 (95% confidence interval [CI], 1.308–1.428), 1.490 (95% CI, 1.399–1.588), and 1.500 (95% CI, 1.374–1.638), respectively. <br/><b>Conclusion</b><br/>In conclusion, more severe food insecurity is correlated with an increased risk of toddlers suffering infectious diseases.

<b>Objectives</b><br/>This study investigated the relationship between metabolic factors (blood lipids and glucose) and inflammatory indicators (tumor necrosis factor-alpha [TNF-α] and high-sensitivity C-reactive protein [hs-CRP]), disease activity, and the rheumatoid arthritis (RA) risk. <br/><b>Methods</b><br/>Serum fasting blood glucose (FBG) and lipid profiles—including total cholesterol (Chol), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein—were measured in 100 RA patients and 100 healthy individuals. Disease severity was assessed using the disease activity score 28. Inflammatory indicators (TNF-α and hs-CRP) were measured using the enzyme-linked immunosorbent assay method. <br/><b>Results</b><br/>In RA patients, serum FBG, TG, Chol/HDL, and TG/HDL were significantly elevated, whereas HDL levels reduced compared to healthy individuals. Multivariate analysis indicated that each unit increase in serum FBG, HDL, Chol/HDL, and TG/HDL was associated with a 64% increase (p<0.001), a 7% reduction (p=0.001), a 52% increase (p=0.007), and a 54% increase (p=0.001) in the odds of RA, respectively. Disease activity showed no correlation with metabolic factors (p>0.05). Among all metabolic factors studied, FBG had the largest area under the curve (0.981) (p<0.0001) for predicting RA. Across the total participant group, FBG, TG, and TG/HDL were positively associated with hs-CRP and TNF-α (p<0.05). HDL showed an inverse association with hs-CRP (p=0.008). Among RA patients specifically, TNF-α positively correlated with TG and TG/HDL, while hs-CRP correlated only with TG/HDL. <br/><b>Conclusion</b><br/>These findings indicate that increased FBG and Chol/HDL and decreased HDL may elevate RA risk by promoting systemic inflammation. Among these, elevated FBG may serve as the strongest predictor of RA risk.

<b>Objectives</b><br/>This study aimed to identify safe, conserved, and highly immunogenic epitopes from all proteins of human-infecting norovirus (NoV) and to design a multi-epitope subunit vaccine construct from these epitopes using an immunoinformatics approach. Additionally, the vaccine construct was evaluated using both sequence- and structure-based assessments. <br/><b>Methods</b><br/>Conserved fragments were identified from all proteins of human-infecting NoV, and B and T lymphocyte epitopes were subsequently predicted using multiple epitope prediction tools. The selected epitopes were linked to form a multi-epitope construct, incorporating various adjuvants in the design. Vaccine constructs with different adjuvants were analyzed for their physicochemical properties and immune simulation profiles, and the optimal combination was selected as the final vaccine candidate for further study. Finally, molecular docking and dynamics simulations were performed to visualize the interaction between the construct and a host immune receptor. <br/><b>Results</b><br/>Twenty-two safe, conserved, and highly immunogenic epitopes were identified from all human-infecting NoV proteins. The construct adjuvanted with 50S ribosomal protein L7/L12 (50SrpL7/L12) was chosen as the final vaccine candidate due to its optimal physicochemical properties and favorable immune simulation profile. Furthermore, the construct exhibited high binding affinity and a stable interaction with toll-like receptor 4). <br/><b>Conclusion</b><br/>The multi-epitope subunit vaccine designed in this study shows promise as a potential NoV vaccine candidate for human immunization. Further in vitro and in vivo experiments are warranted to validate these findings.

<b>Objectives</b><br/>The objectives of this review and meta-analysis were twofold: first, to critically evaluate the effectiveness of cognitive behavioral therapy (CBT)-based interventions relative to standard care or control conditions in promoting smoking abstinence at the end of treatment, and second, to determine abstinence rates at 3 and 6 months of follow-up. <br/><b>Methods</b><br/>A comprehensive search of electronic databases, including PubMed, Cochrane Library, PsycINFO, Embase, and ClinicalTrials.gov, was conducted for randomized controlled trials published from 2001 to September 2024. Studies evaluating the effect of CBT on abstinence rates among healthy smokers (aged ≥12 years) were included and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. <br/><b>Results</b><br/>Out of 1,514 study records screened, 7 studies (comprising 17 arms and 1,438 participants) met eligibility criteria for inclusion in the final analysis. The pooled analysis revealed that CBT significantly improved smoking abstinence rates, demonstrating a fourfold increase in effectiveness compared to controls (odds ratio [OR], 4.04; 95% confidence interval [CI], 2.73–5.99; I2=19%; p<0.00001). Additionally, CBT significantly impacted smoking cessation at 3-month follow-up (OR, 1.62; 95% CI, 1.11–2.38; I2=0%; p=0.01) and 6-month follow-up (OR, 2.19; 95% CI, 1.59–3.00; I2=0%; p<0.00001). <br/><b>Conclusion</b><br/>CBT has demonstrated efficacy in facilitating smoking abstinence, particularly immediately after treatment, with sustained but diminished effects over time. However, robust conclusions on the efficacy of CBT require further studies involving larger sample sizes, diverse geographical regions, and longer follow-up periods.

<b>Objectives</b><br/>Vitamin D regulates immune function, cell proliferation, and differentiation. Its deficiency is linked to sepsis, although the causal relationship remains unclear. Studies suggest a strong correlation between FokI polymorphism and sepsis in the context of vitamin D deficiency. This study examined the association between vitamin D levels, the VDR FokI polymorphism, and sepsis risk through a systematic review and meta-analysis. <br/><b>Methods</b><br/>Relevant articles from 2014–2024 were identified from various databases, including PubMed, Scopus, and Cochrane. A meta-analysis was conducted to assess the difference in vitamin D levels between the sepsis and control groups, as well as the relationship between VDR FokI genotypes (TT, CT, CC) and sepsis risk. <br/><b>Results</b><br/>Vitamin D levels in sepsis patients were consistently lower than in the control group, with a mean difference of –4.17 ng/mL (95% confidence interval, –7.87 to –0.47; p=0.03). However, the relationship between VDR FokI genotype and sepsis risk was not statistically significant (p>0.05), although several individual studies showed a positive correlation. High heterogeneity was found in the analysis of vitamin D levels (I2=100%) and FokI genotypes (I2=91%), which affected the interpretation of the results. <br/><b>Conclusion</b><br/>Vitamin D deficiency is a potential risk factor for sepsis, while the relationship between the VDR FokI polymorphism and sepsis risk requires further investigation. These findings highlight the importance of early detection of vitamin D deficiency as a preventive strategy in at-risk populations, although additional studies with more standardized designs are needed to definitively confirm this relationship.

<b>Objectives</b><br/>This review and meta-analysis examined the effectiveness of non-pharmacological therapies delivered through school-based interventions for smoking cessation among adolescents in South and Southeast Asian countries. <br/><b>Methods</b><br/>A systematic search was conducted across PubMed, Scopus, Science Direct, BioMed Central, the Cochrane Library, and ProQuest Dissertations & Theses Global from inception to October 2024. Eligible studies comprised randomized controlled trials and quasi-experimental studies that compared non-pharmacological smoking cessation interventions delivered in schools or other educational institutions. Data on smoking abstinence outcomes were extracted from published studies, and odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model via the Mantel-Haenszel estimator. <br/><b>Results</b><br/>Seven studies involving 1,260 participants were included. The meta-analysis demonstrated that non-pharmacological school-based therapies significantly increased smoking abstinence compared to controls (OR, 2.83; 95% CI, 1.83–4.40; p<0.001. Subgroup analyzes revealed benefits across both randomized controlled trials and quasi-experimental studies with varying abstinence rates. Studies utilizing biochemical verification showed significant positive effects despite substantial heterogeneity, and short-term (<3 months) abstinence was significantly higher in intervention groups compared to controls. Overall, no differences were found between subgroups regarding intervention effectiveness. <br/><b>Conclusion</b><br/>This meta-analysis indicates that non-pharmacological school-based interventions positively impact smoking abstinence rates, although effectiveness may vary based on study design, follow-up duration, and use of biochemical verification. The findings underscore the need for further research with larger sample sizes, extended follow-up periods, and improved methodological rigor in these regions.

<b>Objectives</b><br/>This study aimed to explore factors influencing satisfaction with medical services among medically underserved populations at the free medical clinic, providing data to improve free medical services for these populations. Methods: We employed a descriptive correlational study design involving 112 individuals (aged 19 years and older) from medically underserved populations who visited the clinic. Data were collected through face-to-face surveys from September to October 2023, and statistical analyses (t-tests, analysis of variance, Pearson correlation, and hierarchical multiple regression) were used to identify key predictors of satisfaction. Results: Perceived support from healthcare providers emerged as the strongest predictor of satisfaction with medical services, demonstrating a significant positive association. While social support was positively correlated with perceived support from healthcare providers, it did not independently predict satisfaction. Conclusion: These findings underscore the importance of healthcare provider and social support in increasing satisfaction with medical services among medically underserved populations. Developing tailored healthcare programs and specialized healthcare provider training are essential strategies to improve healthcare access and outcomes for these vulnerable groups.

<b>Objectives</b><br/>This study aimed to investigate the combined effects of individual, household, and community-level factors on coronavirus disease 2019 (COVID-19) vaccination intention using a multilevel analysis. Methods: This cross-sectional study analyzed raw data from the 2021 Korea Community Health Survey and regional statistics from 255 health centers, with a final sample of 229,216 individuals. Multilevel analysis was conducted, focusing on individual, household, and community-level factors. Individual-level factors included demographics, health status, and COVID-19 concerns; household-level factors included income and marital status; and community-level factors included city type and vaccination rates. Results: At the individual level, significant differences were observed across all variables. At the household level, higher vaccination intention was associated with households of 4 or more members and a monthly income of 4 million Korean won or more. At the community level, higher flu vaccination rates, greater concern about COVID-19 infection, and higher COVID-19 vaccination rates were linked to increased vaccination intention. Conclusion: This study highlights that COVID-19 vaccination intention is influenced by factors at the individual, household, and community levels. Vaccination strategies that integrate household and community-level approaches may be more effective. Policymakers should consider both individual and social health factors when designing vaccination policies.

<b>Objectives</b><br/>Klebsiella pneumoniae is known as one of the most common causes of hospitalacquired infections. Its prevalence poses substantial challenges to both hospital and public health systems, particularly due to the rise of multidrug‐resistant strains. Understanding the epidemiology and resistance properties of K. pneumoniae can inform antimicrobial stewardship and infection control programs. A cross-sectional study was employed from November 2021 to November 2023. Methods: A total of 24 isolates underwent antimicrobial susceptibility testing using the disk diffusion method, an extended-spectrum beta-lactamase (ESBL) production test, and molecular gene detection. Results: The study found that 95.8% of clinical isolates were classified as multidrug-resistant. All isolates were resistant to ampicillin (100%). A high percentage of isolates were resistant to cefazolin (91.7%), ceftriaxone (87.5%), cefotaxime (87.5%), cefepime (87.5%), ciprofloxacin (83.3%), and sulfamethoxazole-trimethoprim (83.3%). Of the 24 isolates, 87.5% harbored ESBL genes, while the frequencies for GES, NDM, SIM, and OXA-48 were 16.7%, 20.8%, 8.3%, and 41.7%, respectively. Notably, the OXA-23 and OXA-51 genes, which are typically associated with Acinetobacter baumannii, were detected in 16.7% and 20.8% of isolates, respectively. Moreover, the prevalence of virulence genes rmpA, acrAB, and tolC was 0%, 95.8%, and 87.5%, respectively. Conclusion: This study demonstrated a high level of antibiotic resistance and a significant presence of virulence genes among K. pneumoniae isolates. Consequently, these findings represent a critical public health issue that requires heightened awareness among all stakeholders, including health workers.

<b>Objectives</b><br/>The study aimed to analyze the core capacities to implement World Health Organization International Health Regulations (IHR) in 6 countries: Indonesia, Cambodia, Vietnam, the Dominican Republic, Ghana, and the Republic of Korea. Methods: Secondary data from relevant databases and reports, including the electronic State Party Self-Assessment Annual Reporting mechanism and global health security index, were used to assess health security in these countries. Descriptive statistics summarized the basic features of the scores, and a strengths, weaknesses, opportunities, and threats (SWOT) analysis was subsequently performed to identify factors affecting health security scores while highlighting key similarities and differences between countries. Results: Early warning and event management emerged as the primary strength in most countries. Common opportunities included international commitments and immunization programs. In contrast, many countries shared weaknesses related to the policy, legal, and normative frameworks for IHR implementation, as well as challenges in human resources, chemical event management, and radiation emergency preparedness. Recurring threats involved issues such as biosafety, biosecurity, dual-use research and the culture of responsible science, infection control practices, coordination between public health and security authorities, laboratory supply chain vulnerabilities, and communication with healthcare workers during public health emergencies. Conclusion: In order to counter future global health threats, countries should prioritize enhancing surveillance capacity (early warning and event management) as well as the immunization indicator (vaccination rates for human and animal diseases, including the national vaccine delivery system).