Osong Public Health and Research Perspectives

Original Articles

Risk factors for transmission in a COVID-19 cluster infection in a high school in the Republic of Korea: Jin-Hwan Jeon, Su Jin Kang, Se-Jin Jeong, Hyeon-Cheol Jang, Young-Joon Park, Sang-Eun Lee; Osong Public Health Res Perspect. 2023;14(4):252-262. Published online July 27, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0125

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Abstract PDF: Objectives
This study aimed to examine the scale, characteristics, risk factors, and modes of transmission in a coronavirus disease 2019 (COVID-19) outbreak at a high school in Seoul, Republic of Korea.
Methods
An epidemiological survey was conducted of 1,118 confirmed cases and close contacts from a COVID-19 outbreak at an educational facility starting on May 31, 2021. In-depth interviews, online questionnaires, flow evaluations, and CCTV analyses were used to devise infection prevention measures. Behavioral and spatial risk factors were identified, and statistical significance was tested.
Results
Among 3rd-year students, there were 33 confirmed COVID-19 cases (9.6%). Students who used a study room in the annex building showed a statistically significant 4.3-fold elevation in their relative risk for infection compared to those who did not use the study room. Moreover, CCTV facial recognition analysis confirmed that 17.8% of 3rd-year students did not wear masks and had the lowest percentage of mask-wearers by grade. The air epidemiological survey conducted in the study room in the annex, which met the 3 criteria for a closed space, confirmed that there was only 10% natural ventilation due to the poor ventilation system.
Conclusion
To prevent and manage the spread of COVID-19 in educational facilities, advance measures that consider the size, operation, and resources of each school are crucial. In addition, various survey methodologies should be used in future studies to quickly analyze a wider range of data that can inform an evidence-based quarantine response.

Results of contact tracing for SARS-CoV-2 Omicron sub-lineages (BA.4, BA.5, BA.2.75) and the household secondary attack risk: Mi Yu, Sang-Eun Lee, Hye Young Lee, Hye-jin Kim, Yeong-Jun Song, Jian Jeong, Ae Kyung Park, Il-Hwan Kim, Eun-jin Kim, Young-Joon Park; Osong Public Health Res Perspect. 2023;14(3):173-179. Published online June 22, 2023; DOI: https://doi.org/10.24171/j.phrp.2022.0285

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Graphical Abstract Abstract PDF: Objectives
This study aimed to assess the contact tracing outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron sub-lineages BA.4, BA.5, and BA.2.75 within Republic of Korea, and to generate foundational data for responding to future novel variants.
Methods
We conducted investigations and contact tracing for 79 confirmed BA.4 cases, 396 confirmed BA.5 cases, and 152 confirmed BA.2.75 cases. These cases were identified through random sampling of both domestically confirmed and imported cases, with the goal of evaluating the pattern of occurrence and transmissibility.
Results
We detected 79 instances of Omicron sub-lineage BA.4 across a span of 46 days, 396 instances of Omicron sub-lineage BA.5 in 46 days, and 152 instances of Omicron sub-lineage BA.2.75 over 62 days. One patient with severe illness was confirmed among the BA.5 cases; however, there were no reports of severe illness in the confirmed BA.4 and BA.2.75 cases. The secondary attack risk among household contacts were 19.6% for BA.4, 27.8% for BA.5, and 24.3% for BA.2.75. No statistically significant difference was found between the Omicron sub-lineages.
Conclusion
BA.2.75 did not demonstrate a higher tendency for transmissibility, disease severity, or secondary attack risk within households when compared to BA.4 and BA.5. We will continue to monitor major SARS-CoV-2 variants, and we plan to enhance the disease control and response systems.

Clinical epidemiological applicability of real-time polymerase chain reaction for COVID-19: Geehyuk Kim, Jun-Kyu Kang, Jungho Kim, Jiyoung Lee, Jin Gwack; Osong Public Health Res Perspect. 2022;13(4):252-262. Published online July 27, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0135

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Graphical Abstract Abstract PDF: Objectives
Real-time polymerase chain reaction is currently used as a confirmatory test for coronavirus disease 2019 (COVID-19). The test results are interpreted as positive, negative, or inconclusive, and are used only for a qualitative classification of patients. However, the test results can be quantitated using threshold count (Ct) values to determine the amount of virus present in the sample. Therefore, this study investigated the diagnostic usefulness of Ct results through various quantitative analyzes, along with an analysis of clinical and epidemiological characteristics.
Methods
Clinical and epidemiological data from 4,642 COVID-19 patients in April 2021 were analyzed, including the Ct values of the RNA-dependent RNA polymerase (RdRp), envelope (E), and nucleocapsid (N) genes. Clinical and epidemiological data (sex, age, underlying diseases, and early symptoms) were collected through a structured questionnaire. A correlation analysis was used to examine the relationships between variables.
Results
All 3 genes showed statistically significant relationships with symptoms and severity levels. The Ct values of the RdRp gene decreased as the severity of the patients increased. Moreover, statistical significance was observed for the presence of underlying diseases and dyspnea.
Conclusion
Ct values were found to be related to patients’ clinical and epidemiological characteristics. In particular, since these factors are closely related to symptoms and severity, Ct values can be used as primary data for predicting patients’ disease prognosis despite the limitations of this method. Conducting follow-up studies to validate this approach might enable using the data from this study to establish policies for preventing COVID-19 infection and spread.

Review Article

Review of the early reports of the epidemiological characteristics of the B.1.1.7 variant of SARS-CoV-2 and its spread worldwide: Yeonju Kim, Eun-Jin Kim, Sang-Won Lee, Donghyok Kwon; Osong Public Health Res Perspect. 2021;12(3):139-148. Published online June 24, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0037

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9 Citations

Abstract PDF

The variant B.1.1.7 of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the RNA virus causing the pandemic more than a year worldwide, was reported from United Kingdom (UK) in late December 2020. It was reported that mortality increases by 65% and transmissibility increases by 70%, which may result in an increase of reproduction number to 1.13−1.55 from 0.75−0.85. To analyze the global increasing trend of the variant B.1.1.7, we extracted results of B.1.1.7 from GISAID on May 11 and May 12, 2021, and conducted a doseresponse regression. It took 47 days to reach 20% and 121 days to reach 50% among the sequence submitted from UK. In Korea, cases of B.1.1.7 have increased since the first report of three cases on December 28, 2020. Positive rate of B.1.1.7 in Korea was 21.6% in the week from May 9 to May 15, 2021. Detection rate of the variants is expected to increase further and new variants of SARS-CoV-2 are emerging, so a close monitoring and control would be maintained for months.

Citations

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Original Articles

Epidemiological, imaging, laboratory, and clinical characteristics and factors related to mortality in patients with COVID-19: a single-center study: Zohreh Azarkar, Hamid Salehiniya, Toba Kazemi, Hamid Abbaszadeh; Osong Public Health Res Perspect. 2021;12(3):169-176. Published online May 26, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0012

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Abstract PDF

Objectives
Coronavirus disease 2019 (COVID-19) is a novel pandemic. Considerable differences in disease severity and the mortality rate have been observed in different parts of the world. The present study investigated the characteristics and outcomes of patients hospitalized with COVID-19 in Iran.
Methods
We established a retrospective cohort to study hospitalized COVID-19 patients in Iran. Epidemiological, imaging, laboratory, and clinical characteristics and outcomes were recorded from medical documents. The chi-square test, t-test, and logistic regression models were used to analyze the data. A p<0.05 was considered to indicate statistical significance.
Results
In total, 364 cases (207 males and 157 females) were analyzed. The most common symptoms were cough, fever, and dyspnea. Multifocal bilateral ground-glass opacities with peripheral distribution were the predominant imaging finding. The mean age of patients was 54.28±18.81 years. The mean age of patients who died was 71.50±14.60 years. The mortality rate was 17.6%. The total proportion of patients with a comorbidity was 47.5%, and 84.4% of patients who died had a comorbidity. Sex, history of diabetes mellitus, and dyslipidemia were not significantly associated with mortality (p>0.05). However, mortality showed significant relationships with body mass index; age; history of hypertension, chronic kidney disease (CKD), ischemic heart disease, cerebrovascular accident (CVA), pulmonary disease, and cancer; and abnormal high-resolution computed tomography (HRCT) findings (p<0.05 for all). Cancer had the highest odds ratio.
Conclusion
Comorbidities (especially cancer, CKD, and CVA), severe obesity, old age, and abnormal HRCT findings affected the health outcomes of patients hospitalized with COVID-19.

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Effects of SARS-CoV-2 infections in patients with cancer on mortality, ICU admission and incidence: a systematic review with meta-analysis involving 709,908 participants and 31,732 cancer patients
Mehmet Emin Arayici, Nazlican Kipcak, Ufuktan Kayacik, Cansu Kelbat, Deniz Keskin, Muhammed Emin Kilicarslan, Ahmet Veli Kilinc, Sumeyye Kirgoz, Anil Kirilmaz, Melih Alihan Kizilkaya, Irem Gaye Kizmaz, Enes Berkin Kocak, Enver Kochan, Begum Kocpinar, Fatm
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Risk Factors Associated with Severity and Death from COVID-19 in Iran: A Systematic Review and Meta-Analysis Study
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A Healthcare-Associated Outbreak of HCV Genotype 2a at a Clinic in Seoul: Siwon Choi, Hyerim Lee, Hyungmin Lee, Yoon-Seok Chung; Osong Public Health Res Perspect. 2021;12(1):3-12. Published online February 23, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.12.1.02

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Abstract PDF: Objectives
An epidemiological investigation was conducted into a hepatitis C virus (HCV) outbreak at an outpatients clinic in Seoul (2011–2012). The aim of the study was to analyze the scale of infection, identify the source of infection, and route of transmission to prevent hepatitis C transmission in the future.
Methods
A retrospective study of the outpatients and health care workers (n = 7,285) in the target outpatient clinic during 2011–2012 was conducted. The history of the study population infection with hepatitis C, electronic medical records, field visits, and health care worker interviews were examined for the period between March 1^st, 2006 and March 25^th, 2016. The blood samples were collected and tested for anti-HCV antibodies, HCV RNA and HCV gene in 2016.
Results
The rate of anti-HCV positive results was 4.4% in the study population. The risk factors associated with an anti-HCV positive result were ≥ 10 clinic visits, and receiving an invasive procedure including a nerve block and a block of the peripheral branch of the spinal nerve (p < 0.05). There were 112 HCV RNA positive cases out of 320 anti-HCV positive test result cases, amongst which 100 cases had the dominant HCV genotype 2a which formed either 1 cluster (n = 56) or 2 clusters (n = 25). This result indicated exposure to a high-association infection source.
Conclusion
Anti-HCV antibodies and genotypic analysis showed an epidemiological association between the outbreak of HCV and invasive procedures performed (2011–2012) at an outpatients clinic in Seoul.

Short Communications

Coronavirus Disease-19: The First 7,755 Cases in the Republic of Korea: Osong Public Health Res Perspect. 2020;11(2):85-90. Published online April 30, 2020; DOI: https://doi.org/10.24171/j.phrp.2020.11.2.05; Correction in: Osong Public Health Res Perspect 2020;11(3):146

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Abstract PDF

We report the first 7,755 patients with confirmed COVID-19 in Korea as of March 12^th, 2020. A total of 66 deaths have been recorded, giving a case fatality proportion of 0.9%. Older people, and those with comorbidities were at a higher risk of a fatal outcome. The highest number of cases of COVID-19 were in Daegu, followed by Gyeongbuk. This summary may help to understand the disease dynamics in the early phase of the COVID-19 outbreaks, and may therefore, guide future public health measures.

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Coronavirus Disease-19: Summary of 2,370 Contact Investigations of the First 30 Cases in the Republic of Korea: Osong Public Health Res Perspect. 2020;11(2):81-84. Published online April 30, 2020; DOI: https://doi.org/10.24171/j.phrp.2020.11.2.04

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Abstract PDF

Between January 24^th and March 10^th, a total of 2,370 individuals had contact with the first 30 cases of COVID-19. There were 13 individuals who contracted COVID-19 resulting in a secondary attack rate of 0.55% (95% CI 0.31–0.96). There were 119 household contacts, of which 9 individuals developed COVID-19 resulting in a secondary attack rate of 7.56% (95% CI 3.7–14.26).

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Original Articles

Epidemiological Characterization of Imported Systemic Mycoses Occurred in Korea: Seung-Hak Cho, Young-Bin Yu, Je-Seop Park, Keun-Dol Yook, Young-Kwon Kim; Osong Public Health Res Perspect. 2018;9(5):255-260. Published online October 31, 2018; DOI: https://doi.org/10.24171/j.phrp.2018.9.5.07

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Abstract PDF

Objectives

Imported systemic mycoses is a severe fungal infection that can cause diseases in healthy people. However, there is a serious lack of epidemiological data about imported systemic mycoses. Therefore, an epidemiological characterization of imported systemic mycoses in Korea was performed.

Methods

We collected health insurance data between 2008 and 2012 from the Health Insurance Corporation and analyzed the data to determine the prevalence and treatment management of imported systemic mycoses.

Results

The prevalence of imported systemic mycoses between 2008 and 2012 increased slowly by 0.49/100,000 to 0.53/100,000 persons. The prevalence of coccidioidomycosis increased from 0.28/100,000 in 2008 to 0.36/100,000 persons in 2012. A mean of 229.6 cases occurred each year. Children and the elderly showed higher prevalence than adults in the 20- to 59-year-old age group. The rate of infection according to region ranged from 0.18/100,000 persons in Ulsan, to 0.59/100,000 persons in Gyeonggi. The prevalence in females was higher than that in males. Inpatient treatment was 3.3% (38 cases), with 96.7% treated as outpatients. Hospitalizations cost 272.7 million won and outpatient treatments cost 111.7 million won. The treatment cost for coccidioidomycosis from 2008 to 2012 was 330.9 million won, with personal charges of 79.2 million won and insurance charges of 251.7 million won. Most of the expenses for the coccidioidomycosis treatment were for inpatient treatment.

Conclusion

The results in this study may be a useful resource for determining the changes in the trend of imported systemic mycoses.

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The clinical laboratory evolution in coccidioidomycosis detection: Future perspectives
José María Gastélum-Cano, Mitzuko Dautt-Castro, Alfonso García-Galaz, Katya Felix-Murray, Antonio Rascón-Careaga, Manuel A. Cano-Rangel, María A. Islas-Osuna
Journal of Medical Mycology.2021; 31(3): 101159. CrossRef
Emerging Invasive Fungal Infections: Clinical Features and Controversies in Diagnosis and Treatment Processes

Hongliang Zhang, Aiqun Zhu
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Epidemiological Aspects of Visceral Leishmaniasis in Larestan and Ghiro-Karzin Counties, Southwest of Iran: Nasiri Zahra, Keshavarzi Davood, Akbari Morteza, Soltani Zahra; Osong Public Health Res Perspect. 2018;9(2):81-85. Published online April 30, 2018; DOI: https://doi.org/10.24171/j.phrp.2018.9.2.07

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Abstract PDF

Objectives

Leishmania parasites are the causative agents of leishmaniasis. The Visceral leishmaniasis (VL) form of the disease is fatal if not treated in most cases. This study examined the epidemiological aspects of VL in two southwest counties of Iran.

Methods

This was a retrospective study of hospitalized patients with a laboratory confirmation of VL from Larestan and Ghiro-Karzin Counties.

Results

For Larestan county, a decline in the incidence of VL has been observed from 2004 to 2015. Significantly more males (n = 14) than females (n = 6) were infected with VL in this county (p < 0.05), >95% of cases in children under 5 years of age. In Ghiro-Karzin county, the results were similar to a decline in VL infection from 2004 to 2015, and slightly more males (n = 14) than females (n = 11). Similarly, the majority of the patients infected with VL were children under 5 years old (88%).

Conclusion

The results from this study indicate that although the incidence of VL infection has reduced over time, VL was more prevalent in boys under 5 years old, suggesting that more attention to controlling the parasite and its vector are required.

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Efficacy and safety of single-dose liposomal amphotericin B in patients with visceral leishmaniasis in Bangladesh: a real-life experience
Md. Rezaul Ekram, Mohammad Robed Amin, Mohammad Jahid Hasan, Md. Abdullah Saeed Khan, Rajib Nath, Pranab Kumar Mallik, Alex Lister, Monjur Rahman
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Surveillance of Bacillus cereus Isolates in Korea from 2012 to 2014: Su-Mi Jung, Nan-Ok Kim, Injun Cha, Hae-young Na, Gyung Tae Chung, Hyo Sun Kawk, Sahyun Hong; Osong Public Health Res Perspect. 2017;8(1):71-77. Published online February 28, 2017; DOI: https://doi.org/10.24171/j.phrp.2017.8.1.10

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Abstract PDF

Objectives

To investigate the prevalence and toxin production characteristics of non-emetic and emetic Bacillus cereus strains isolated via the laboratory surveillance system in Korea.

Methods

A total of 667 B. cereus strains were collected by the Korea National Research Institute of Health laboratory surveillance system from 2012 to 2014. The collected strains were analyzed by geographical region, season, patient age, and patient sex. Additionally, the prevalence rates of enterotoxin and emetic toxin genes were evaluated.

Results

The isolation rate of B. cereus strains increased during the summer, but the isolation rate was evenly distributed among patient age groups. Emetic toxin was produced by 20.2% of the isolated strains. The prevalence rates of five enterotoxin genes (entFM, nheA, cytK2, hblC, and bceT) were 85.0, 78.6, 44.5, 36.6, and 29.7%, respectively, among non-emetic strains and 77.8, 59.3, 17.8, 11.9 and 12.6%, respectively, among emetic strains. Thus, the prevalence rates of all five enterotoxin genes were lower in emetic B. cereus.

Conclusion

The prevalence of enterotoxin genes differed between non-emetic and emetic B. cereus strains. Among emetic B. cereus strains, the prevalence rates of two enterotoxin genes (cytK2 and hblC) were lower than those among the non-emetic strains. In both the emetic and non-emetic strains isolated in Korea, nheA and entFM were the most prevalent enterotoxin genes.

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Epidemiology and Inequality in the Incidence and Mortality of Nasopharynx Cancer in Asia: Neda Mahdavifar, Mahshid Ghoncheh, Abdollah Mohammadian-Hafshejani, Bahman Khosravi, Hamid Salehiniya; Osong Public Health Res Perspect. 2016;7(6):360-372. Published online December 31, 2016; DOI: https://doi.org/10.1016/j.phrp.2016.11.002

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Abstract PDF

Objectives
One of the most common head and neck cancers is nasopharynx cancer. Knowledge about the incidence and mortality of this disease and its distribution in terms of geographical areas is necessary for further study and better planning. Therefore, this study was conducted with the aim of determining the incidence and mortality rates of nasopharynx cancer and its relationship with the Human Development Index (HDI) in Asia in 2012.
Methods
The aim of this ecologic study was to assess the correlation between age-specific incidence rate (ASIR) and age-specific mortality rate (ASMR) with HDI and its components, which include the following: life expectancy at birth, mean years of schooling, and gross national income per capita. Data about SIR and SMR for every Asian country for 2012 were obtained from the global cancer project. We used the correlation bivariate method for the assessment. Statistical significance was assumed if p < 0.05. All reported p values are two-sided. Statistical analyses were performed using SPSS (Version 15.0, SPSS Inc.).
Results
A total of 68,272 cases (males, 71.02%; females, 28.97%; sex ratio, 2.45) and 40,530 mortalities (males, 71.63%; females, 28.36%; sex ratio, 2.52) were recorded in Asian countries in 2012. The five countries with the highest ASIR of nasopharynx cancer were Malaysia, Singapore, Indonesia, Vietnam, and Brunei, and the five countries with the highest ASMR were Indonesia, Vietnam, Singapore, Malaysia, and Brunei. The correlation between HDI and ASIR was 0.097 (p = 0.520) [0.105 in men (p = 0.488) and 0.119 in women (p = 0.901)]. The correlation between HDI and ASMR was –0.102 (p = 0.502) [–0.072 in men (p = 0.633) and –0.224 in women (p = 0.134)].
Conclusion
Nasopharynx cancer is native to Southeast Asia. The highest incidence and mortality rates are found in Malaysia, Singapore, Indonesia, Vietnam, and Brunei. No significant relation was found between the standardized incidence and mortality rates of nasopharynx cancer and the HDI components. Further studies are recommended in Southeast Asian countries in order to find the etiology of cancer, as well as its diagnosis and treatment.

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Epidemiological and Clinical Features of People with Malta Fever in Iran: A Systematic Review and Meta-Analysis: Mahmood Moosazadeh, Roja Nikaeen, Ghasem Abedi, Motahareh Kheradmand, Saeid Safiri; Osong Public Health Res Perspect. 2016;7(3):157-167. Published online June 30, 2016; DOI: https://doi.org/10.1016/j.phrp.2016.04.009

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Abstract PDF

Objectives
Numerous studies have reported the epidemiological and clinical features of Malta fever incidence in Iran. Review and synthesis of the related literature through meta-analysis can provide an appropriate measurement for aforementioned indices. Therefore, the present study aimed to determine the epidemiological and clinical features of people with Malta fever in Iran.
Methods
The required documents were obtained through searching national and international databases. In each study, standard deviation of the indices was calculated using binomial distribution formulas. Finally, the heterogeneity index was determined between studies using Cochran (Q) and I² tests.
Results
Combining the results of 47 articles in the meta-analysis indicated that 57.6% (55.02–60.1%) and 42.3% (49.8–44.9%) of the patients were male and female, respectively. Most of the patients lived in rural areas; 68.4% (63.6–73.2%) compared to 31.4% (26.7–36.3%). In addition, 20.8% (17.4–24.2%) of the patients were ranchers and farmers, 16.9% (14.5–19.4%) were students, and 31.6% (27–36.2%) were housewives. Of the patients studies, 50.5% (35.6–65.2%) experienced contact with animals and 57.1% (46.4–67.9%) used unpasteurized dairy products. Fever, joint pain, and sweating were detected among 65.7% (53.7–77.8%) and 55.3% (44.4–66.2%), respectively.
Conclusion
The present study revealed that the frequency of male patients with brucellosis was considerably more than that of female patients. The number of patients with Malta fever in rural areas was significantly more than in urban areas. High-risk behavior, unprotected contact with animals, and using unpasteurized dairy products were among the most significant factors affecting Malta fever incidence in Iran. Fever, joint pain, and sweating were detected among most of the patients with Malta fever.

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Brief Report

Comparison of the Epidemiological Aspects of Imported Dengue Cases between Korea and Japan, 2006–2010: Young Eui Jeong, Won-Chang Lee, Jung Eun Cho, Myung-Guk Han, Won-Ja Lee; Osong Public Health Res Perspect. 2016;7(1):71-74. Published online February 28, 2016; DOI: https://doi.org/10.1016/j.phrp.2015.12.001

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Abstract PDF

To compare the epidemiological characteristics of dengue cases imported by travelers or immigration in both Korea and Japan, we determined dengue incidence and related risk factors. During 2006–2010, 367 and 589 imported dengue cases were reported in Korea and Japan, respectively. In Korea, the presumptive origins for the dengue infections were Southeast Asia (82.6%), Southern Asia (13.9%), Eastern Asia (1.1%), South America (0.3%), Central America (0.3%), Africa (0.3%), and other countries (1.6%). In Japan, the origins of the infections were Southeast Asia (69.8%), Southern Asia (20.0%), Eastern Asia (1.7%), South America (2.5%), Central America (1.2%), Africa (1.2%), Oceania (2.4%), and other countries (1.2%). In both countries, more dengue cases were reported for men than for women (p < 0.01), and those aged 20–30 years accounted for > 60% of the total cases. The frequency of imported cases in summer and autumn (∼70% of total cases) was similar in both countries. This study demonstrates that there is a similar pattern of imported dengue cases in Korea and Japan. Therefore, there is a risk of an autochthonous dengue outbreak in Korea, as indicated by the recent outbreak in Japan in 2014.

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Original Article

Middle East Respiratory Syndrome Coronavirus Outbreak in the Republic of Korea, 2015: Osong Public Health Res Perspect. 2015;6(4):269-278. Published online August 31, 2015; DOI: https://doi.org/10.1016/j.phrp.2015.08.006; Correction in: Osong Public Health Res Perspect 2016;7(2):138

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Abstract PDF

Objectives
The outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the Republic of Korea started from the index case who developed fever after returning from the Middle East. He infected 26 cases in Hospital C, and consecutive nosocomial transmission proceeded throughout the nation. We provide an epidemiologic description of the outbreak, as of July 2015.
Methods
Epidemiological research was performed by direct interview of the confirmed patients and reviewing medical records. We also analyzed the incubation period, serial interval, the characteristics of superspreaders, and factors associated with mortality. Full genome sequence was obtained from sputum specimens of the index patient.
Results
A total of 186 confirmed patients with MERS-CoV infection across 16 hospitals were identified in the Republic of Korea. Some 44.1% of the cases were patients exposed in hospitals, 32.8% were caregivers, and 13.4% were healthcare personnel. The most common presenting symptom was fever and chills. The estimated incubation period was 6.83 days and the serial interval was 12.5 days. A total of 83.2% of the transmission events were epidemiologically linked to five superspreaders, all of whom had pneumonia at presentation and contacted hundreds of people. Older age [odds ratio (OR) = 4.86, 95% confidence interval (CI) 1.90–12.45] and underlying respiratory disease (OR = 4.90, 95% CI 1.64–14.65) were significantly associated with mortality. Phylogenetic analysis showed that the MERS-CoV of the index case clustered closest with a recent virus from Riyadh, Saudi Arabia.
Conclusion
A single imported MERS-CoV infection case imposed a huge threat to public health and safety. This highlights the importance of robust preparedness and optimal infection prevention control. The lessons learned from the current outbreak will contribute to more up-to-date guidelines and global health security.

Citations

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