Publications by authors named "Eun Hwa Choi"

167 Publications

Surveillance of COVID-19-Associated Multisystem Inflammatory Syndrome in Children, South Korea.

Emerg Infect Dis 2021 Feb 4;27(4). Epub 2021 Feb 4.

A concerning development during the coronavirus disease pandemic has been multisystem inflammatory syndrome in children. Reports of this condition in East Asia have been limited. In South Korea, 3 cases were reported to the national surveillance system for multisystem inflammatory syndrome in children. All case-patients were hospitalized and survived with no major disease sequelae.
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http://dx.doi.org/10.3201/eid2704.210026DOI Listing
February 2021

Complete mitochondrial genome of a hen harrier (Accipitriformes: Accipitridae) from South Korea.

Mitochondrial DNA B Resour 2021 Jan 19;6(1):185-186. Epub 2021 Jan 19.

Department of Biology, Teachers College & Institute for Phylogenomics and Evolution, Kyungpook National University, Daegu, South Korea.

A hen harrier (Accipitriformes: Accipitridae), a migrant raptor having a wide breeding range from Europe to Northeast Asia, migrates to more southerly areas (Southern Europe, China, Korea and Japan) in winter. In this study, the complete mitochondrial genome of was completely sequenced and characterized. It was 20,173 bp in length being composed of 13 protein-coding genes, 22 transfer RNA genes, two ribosomal RNA genes and two control regions. It has a base composition of A (32.2%), G (12.6%), C (30.5%) and T (24.7%). The phylogenetic tree reconstructed based on the maximum likelihood (ML) method confirms that places within the clade of the family Accipitridae in the monophyletic avian order Accipitriformes.
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http://dx.doi.org/10.1080/23802359.2020.1860700DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832496PMC
January 2021

Limited Benefit of Facility Isolation and the Rationale for Home Care in Children with Mild COVID-19.

J Korean Med Sci 2021 Feb 1;36(5):e45. Epub 2021 Feb 1.

Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

Considering the mild degree of coronavirus disease 2019 (COVID-19) in children and the enormous stress caused by isolation in unfamiliar places, policies requiring mandatory isolation at medical facilities should be reevaluated especially given the impact of the pandemic on the availability of hospital beds. In this study, we assessed the usefulness of facility isolation and the transmissibility of severe acute respiratory syndrome coronavirus 2 by infected children to uninfected caregivers in isolation units at a hospital and a residential treatment center in Seoul during August-November 2020. Fifty-three children were included and median age was 4 years (range, 0-18). All were mildly ill or asymptomatic and isolated for a median duration of 12 days. Thirty percent stayed home longer than 2 days before entering isolation units from symptom onset. Among 15 uninfected caregivers, none became infected when they used facemasks and practiced hand hygiene. The results suggest children with mild COVID-19 may be cared safely at home by a caregiver in conditions with adherence to the preventive measures of wearing facemasks and practicing hand hygiene.
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http://dx.doi.org/10.3346/jkms.2021.36.e45DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850862PMC
February 2021

Draft Genome of the Edible Oriental Insect .

Front Genet 2020 13;11:593994. Epub 2021 Jan 13.

Department of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju, South Korea.

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http://dx.doi.org/10.3389/fgene.2020.593994DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838600PMC
January 2021

Antimicrobial Resistance and Molecular Analysis of in Staphylococcal Scalded Skin Syndrome among Children in Korea.

J Korean Med Sci 2021 Jan 18;36(3):e22. Epub 2021 Jan 18.

Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

Background: Staphylococcal scalded skin syndrome (SSSS) is a skin disease characterized by blistering and desquamation caused by exfoliative toxins (ETs) of (). Although many countries show predominance of methicillin-susceptible (MSSA), cases of methicillin-resistant (MRSA) have been reported.

Methods: Twenty-six children aged <15 years diagnosed with SSSS from January 2010 to December 2017 from three hospitals were included. isolates from cases were analyzed for multilocus sequence types and ETs. Medical records were reviewed for clinical characteristics, treatment, and antimicrobial susceptibility patterns of .

Results: Among the 26 cases, mean age was 2.3 years. According to skin manifestations patients were classified as generalized (n = 10, 38.5%), intermediate (n = 11, 42.3%), and abortive (n = 5, 19.2%). Among all cases, 96.2% (25/26) were due to MRSA and the macrolide-resistance rate was 92.3% (24/26). ST89 (n = 21, 80.8%) was the most prevalent clone, followed by single clones of ST1, ST5, ST72, ST121, and ST1507. The eta gene was detected in one (3.8%) isolate which was MSSA. The gene was detected in 14 (53.8%) isolates, all of which were ST89. Nafcillin or first-generation cephalosporin was most commonly prescribed (n=20, 76.9%). Vancomycin was administered in four patients (15.4%) and clindamycin in nine patients (34.6%). Among MRSA cases, there was no difference in duration of treatment when comparing the use of antimicrobials to which the causative bacteria were susceptible or non-susceptible (9.75 vs. 8.07 days, > 0.05).

Conclusion: isolated from children with SSSS in Korea demonstrated a high prevalence of methicillin-resistant ST89 clones that harbored the gene. The predominance of MRSA suggests that antibiotics to which MRSA are susceptible may be considered for empirical antibiotic treatment in children with SSSS in Korea. Further studies on the role and effectiveness of systemic antibiotics in SSSS are warranted.
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http://dx.doi.org/10.3346/jkms.2021.36.e22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813586PMC
January 2021

Clinical aspects for differential diagnosis of Kawasaki disease shock syndrome: a case control study.

BMC Pediatr 2021 Jan 8;21(1):25. Epub 2021 Jan 8.

Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.

Background: Because of the absence of a specific diagnostic test and pathognomonic clinical features, physicians must rely on the presence of specific clinical criteria and laboratory data that support the diagnosis of KD. To help clinicians distinguish KD, KDSS, septic shock, and TSS earlier, we suggest differential diagnosis and treatment guideline.

Methods: Medical records of immunocompetent patients who were admitted to the pediatric department with a diagnosis of KDSS, septic shock or TSS (SS group) were retrospectively reviewed. In addition, KD patients were selected by seasonal matching to each case of KDSS patient by date of admission (± 2 weeks).

Results: There were 13 patients with KDSS, 35 patients with SS group, and 91 patients with KD. In comparison between KDSS and septic shock group, KDSS group had significantly higher rate of coronary aneurysm incidence, and higher left ventricle dysfunction rate. In comparison between KDSS and TSS, patients with KDSS had a significantly higher erythrocyte sedimentation rate (ESR) and significantly lower creatinine. Receiver operation characteristic curve revealed that the optimal ESR cut off value for determining the KDSS was 56.0 (sensitivity 75.0%, specificity of 100.0%) and the optimal creatinine cut off value for determining the TSS was 0.695 (sensitivity 76.9%, specificity 84.6%).

Conclusions: Clinical symptoms, laboratory finding, echocardiography, and culture studies can be used to differentiate KD, KDSS, septic shock and TSS.
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http://dx.doi.org/10.1186/s12887-020-02488-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790725PMC
January 2021

Sustained Vaccination Coverage during the Coronavirus Disease 2019 Epidemic in the Republic of Korea.

Vaccines (Basel) 2020 Dec 22;9(1). Epub 2020 Dec 22.

Division of National Immunization Program and Vaccine-Preventable Disease Control, Korea Disease Control and Prevention Agency, Cheongju 28159, Korea.

Amid the COVID-19 pandemic, vaccination coverage may decline due to limited accessibility to healthcare. We assessed the impact of the COVID-19 pandemic on vaccination coverage and the incidence of vaccine-preventable diseases (VPDs) in the Republic of Korea. National vaccination coverage of 10 essential vaccines administered to children between January-June 2019 and January-June 2020 was analyzed. The national incidence of selected VPDs was compared for the corresponding periods. During the COVID-19 outbreak, the vaccination rate in children aged 0-35 months in Korea did not decrease significantly, whereas the vaccination rate for children aged 4-6 years decreased by 1.4-1.9%. The overall incidence of VPDs decreased by 10-50% between 2019 and 2020, especially with varicella. Thus, the COVID-19 pandemic did not result in a decrease in vaccination coverage among Korean children, which prevented a surge in VPD incidence. Maintaining essential vaccination coverage without interruption is important during the response to the COVID-19 pandemic.
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http://dx.doi.org/10.3390/vaccines9010002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822189PMC
December 2020

The complete mitochondrial genome of a whiter-spotted flower chafer, (Coleoptera: Scarabaeidae).

Mitochondrial DNA B Resour 2020 Oct 21;5(3):3602-3604. Epub 2020 Oct 21.

Department of Biology Education, Teachers College & Institute for Phylogenomics and Evolution, Kyungpook National University, Daegu, Republic of Korea.

The complete mitochondrial genome of an important Scarabaeidae insect that is distributed across most Asian countries, was characterized using long template PCR methods. It was 17,783 bp in length being composed of 13 protein coding genes (PCGs), 22 transfer RNA genes (tRNAs), two ribosomal RNA genes (rRNAs) and a non-coding region. The phylogenetic tree reconstructed based on the maximum likelihood (ML) method confirmed that was placed within the clade of Scarabaeidae and Polyphaga species forming a complete monophyly.
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http://dx.doi.org/10.1080/23802359.2020.1824592DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594739PMC
October 2020

The complete mitochondrial genome of (Octocorallia: Calcaxonia: Primnoidae) from South Korea.

Mitochondrial DNA B Resour 2020 Jan 20;5(1):725-726. Epub 2020 Jan 20.

Department of Biology Education, Teachers College & Institute for Phylogenomics and Evolution, Kyungpook National University, Daegu, Republic of Korea.

(Anthozoa: Octocorallia: Primnoidae) is an endangered marine soft coral species discovered on a 50-100 m deep reefs in South Korea. We analyzed the mitochondrial genome sequence of this species. The genome size was 19,037 bp in length consisting of 14 protein coding genes (PCGs), two rRNA genes and a tRNA gene. Our phylogenetic analysis for this species with 33 Octocorallia species reconstructed based on the nucleotide sequences of 14 PCGs showed that was placed as a sister to and Primnoidae formed a monophyletic group.
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http://dx.doi.org/10.1080/23802359.2020.1715275DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7748699PMC
January 2020

COVID-19 in children across three Asian cosmopolitan regions.

Emerg Microbes Infect 2020 Dec;9(1):2588-2596

Department of Respiratory Medicine, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.

As another wave of COVID-19 outbreak has approached in July 2020, a larger scale COVID-19 pediatric Asian cohort summarizing the clinical observations is warranted. Children confirmed with COVID-19 infection from the Republic of Korea, the Hong Kong Special Administrative Region (HKSAR) and Wuhan, China, during their first waves of local outbreaks were included. Their clinical characteristics and the temporal sequences of the first waves of local paediatric outbreaks were compared. Four hundred and twenty three children with COVID-19 were analyzed. Wuhan had the earliest peak, followed by Korea and HKSAR. Compared with Korea and Wuhan, patients in HKSAR were significantly older (mean age: 12.9 vs. 10.8 vs. 6.6 years,  < 0.001, respectively) and had more imported cases (87.5% vs. 16.5% vs. 0%,  < 0.001, respectively). The imported cases were also older (13.4 vs. 7.6 years,  < 0.001). More cases in HKSAR were asymptomatic compared to Korea and Wuhan (45.5% vs. 22.0% vs. 20.9%,  < 0.001, respectively), and significantly more patients from Wuhan developed fever (40.6% vs. 29.7% vs. 21.6%, =0.003, respectively). There were significantly less imported cases than domestic cases developing fever after adjusting for age and region of origin ( = 0.046). 5.4% to 10.8% of patients reported anosmia and ageusia. None developed pediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PMIS-TS). In general, adolescents were more likely to be asymptomatic and less likely to develop fever, but required longer hospital stays. In conclusion, majority patients in this pediatric Asian cohort had a mild disease. None developed PIMS-TS. Their clinical characteristics were influenced by travel history and age.
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http://dx.doi.org/10.1080/22221751.2020.1846462DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7723019PMC
December 2020

Effective and Rapid Microbial Identification in Pediatric Osteoarticular Infections Using Blood Culture Bottles.

J Bone Joint Surg Am 2020 Oct;102(20):1792-1798

Divisions of Pediatric Orthopaedics (C.H.S., T.-J.C., I.H.C., and W.J.Y.), and Pediatrics (E.H.C.), Seoul National University Children's Hospital, Seoul, Republic of Korea.

Background: The detection and identification of pathogenic microorganisms are essential for the treatment of osteoarticular infection. However, obtaining a sufficient amount of specimen from pediatric patients is often difficult. Herein, we aimed to demonstrate the effectiveness of the blood culture bottle (BCB) system in pediatric osteoarticular infections. We hypothesized that our BCB culture method is superior to the conventional swab and tissue culture methods in terms of required specimen size, incubation time, and microbial identification rate.

Methods: We analyzed the prospectively collected data of pediatric patients who underwent surgical treatment for osteoarticular infections between August 2016 and October 2019. Four needles were dipped in the infected fluid or tissue during the surgical procedure as soon as the infected area was exposed and were used to inoculate 2 aerobic pediatric BCBs and 2 anaerobic general BCBs. We also collected 2 conventional swab samples and 2 tissue samples from the identical area. The microbial identification rate and the time required for identification were compared between BCB, swab, and tissue cultures.

Results: Forty patients constituted the study group; 13 patients had osteomyelitis, 17 patients had septic arthritis, and 10 patients had both. Of these 40 patients, the microbial identification rate was higher with BCB cultures (27 [68%]) than with swab cultures (18 [45%]; p = 0.004) or tissue cultures (15 [38%]; p < 0.001). Nine samples (9 patients [23%]) were only positive in the BCB culture. Positive microbial growth was not detected with conventional culture methods when microorganisms did not grow on the BCB culture. Compared with swab culture (4.3 ± 1.1 days; p < 0.001) or tissue culture (4.4 ± 1.1 days; p < 0.001), the BCB culture reduced the time required for microbial identification (3.5 ± 0.9 days).

Conclusions: In pediatric osteoarticular infections, the BCB culture system improved the microbial identification rate, reduced the time to identification, and permitted a smaller-volume specimen, compared with traditional culture systems.

Level Of Evidence: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.2106/JBJS.20.00219DOI Listing
October 2020

Molecular phylogenetic, population genetic and demographic studies of Nodularia douglasiae and Nodularia breviconcha based on CO1 and 16S rRNA.

Sci Rep 2020 10 6;10(1):16572. Epub 2020 Oct 6.

Department of Biology Education, Teachers College and Institute for Phylogenomics and Evolution, Kyungpook National University, Daegu, 41566, Republic of Korea.

Freshwater mussels belonging to the genus Nodularia (Family Unionidae) are known to be widely distributed in East Asia. Although phylogenetic and population genetic studies have been performed for these species, there still remain unresolved questions in their taxonomic status and biogeographic distribution pathways. Here, the nucleotide sequences of CO1 and 16S rRNA were newly determined from 86 N. douglasiae and 83 N. breviconcha individuals collected on the Korean Peninsula. Based on these data, we revealed the following results: (1) N. douglasiae can be divided into the three genetic clades of A (only found in Korean Peninsula), B (widely distributed in East Asia), and C (only found in the west of China and Russia), (2) the clade A is not an independent species but a concrete member of N. douglasiae given the lack of genetic differences between the clades A and B, and (3) N. breviconcha is not a subspecies of N. douglasiae but an independent species apart from N. douglasiae. In addition, we suggested the plausible scenarios of biogeographic distribution events and demographic history of Nodularia species.
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http://dx.doi.org/10.1038/s41598-020-72015-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538972PMC
October 2020

Changes in the Etiology and Clinical Characteristics of Pediatric Infective Endocarditis in South Korea.

Pediatr Infect Dis J 2021 Feb;40(2):123-127

From the Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.

Objective: Changes in the epidemiology, clinical manifestations, and outcomes of infective endocarditis (IE) have been reported in recent years. This study was performed to analyze changing trends in the etiology of IE in children in South Korea.

Study Design: A retrospective study of children with IE was conducted from 2 hospitals in Korea from 2004 to 2019. IE was defined according to the Modified Duke criteria. We analyzed the etiology and clinical outcome of 96 cases and compared the etiology with that during 1987-1997, as described in a previous study.

Results: A total of 96 cases in 89 children satisfied the modified Duke criteria. The median age was 9.5 years. Preexisting structural heart diseases were identified in 81 cases (84.4%). Ten of the 15 cases with normal heart anatomy had a history of indwelling central venous catheters and underlying noncardiac conditions. Of the 72 identified organisms, common pathogens included Staphylococcus aureus, 24 (32.9%); viridans streptococci, 22 (30.2%); coagulase-negative staphylococci, 14 (19.2%); and Candida species, 7 (9.6). Sixty-three cases (66.7%) required surgical intervention, and the overall fatality rate was 7.9%. Compared with the period of 1987-1997, an increasing trend in the proportion of staphylococci as the etiology of IE in 2004-2019 was observed (26.7% vs. 51.8%, P = 0.029). In addition, S. aureus was associated with the high rate of developing complications (P < 0.05).

Conclusion: In South Korea, Gram-positive cocci represent 85% of all etiologic agents of IE in children with an increasing trend in the proportion of staphylococci.
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http://dx.doi.org/10.1097/INF.0000000000002917DOI Listing
February 2021

Clinical Characteristics and Viral RNA Detection in Children With Coronavirus Disease 2019 in the Republic of Korea.

JAMA Pediatr 2021 01;175(1):73-80

Department of Pediatrics, St Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.

Importance: There is limited information describing the full spectrum of coronavirus disease 2019 (COVID-19) and the duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detection in children.

Objective: To analyze the full clinical course and the duration of SARS-CoV-2 RNA detectability in children confirmed with COVID-19 in the Republic of Korea, where rigorous public health interventions have been implemented.

Design, Setting, And Participants: This case series of children with COVID-19 was conducted in 20 hospitals and 2 nonhospital isolation facilities across the country from February 18, 2020, to March 31, 2020. Children younger than 19 years who had COVID-19 were included.

Exposures: Confirmed COVID-19, detected via SARS-CoV-2 RNA in a combined nasopharyngeal and oropharyngeal swab or sputum by real-time reverse transcription-polymerase chain reaction.

Main Outcomes And Measures: Clinical manifestations during the observation period, including the time and duration of symptom occurrence. The duration of SARS-CoV-2 RNA detection was also analyzed.

Results: A total of 91 children with COVID-19 were included (median [range] age, 11 [0-18] years; 53 boys [58%]). Twenty children (22%) were asymptomatic during the entire observation period. Among 71 symptomatic cases, 47 children (66%) had unrecognized symptoms before diagnosis, 18 (25%) developed symptoms after diagnosis, and only 6 (9%) were diagnosed at the time of symptom onset. Twenty-two children (24%) had lower respiratory tract infections. The mean (SD) duration of the presence of SARS-CoV-2 RNA in upper respiratory samples was 17.6 (6.7) days. Virus RNA was detected for a mean (SD) of 14.1 (7.7) days in asymptomatic individuals. There was no difference in the duration of virus RNA detection between children with upper respiratory tract infections and lower respiratory tract infections (mean [SD], 18.7 [5.8] days vs 19.9 [5.6] days; P = .54). Fourteen children (15%) were treated with lopinavir-ritonavir and/or hydroxychloroquine. All recovered, without any fatal cases.

Conclusions And Relevance: In this case series study, inapparent infections in children may have been associated with silent COVID-19 transmission in the community. Heightened surveillance using laboratory screening will allow detection in children with unrecognized SARS-CoV-2 infection.
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http://dx.doi.org/10.1001/jamapediatrics.2020.3988DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455883PMC
January 2021

Role of children in household transmission of COVID-19.

Arch Dis Child 2020 Aug 7. Epub 2020 Aug 7.

Department of Paediatrics, Seoul National University College of Medicine, Seoul, The Republic of Korea

Objective: Transmissibility of COVID-19 by children in the household is not clear. Herein, we describe children's role in household transmission of COVID-19.

Design And Setting: All paediatric COVID-19 index cases and their household members reported from 20 January to 6 April 2020 in South Korea were reviewed. The secondary attack rate (SAR) from child index case to household secondary case was calculated. Epidemiological and clinical findings of child index case-household secondary case pair was assessed.

Results: A total of 107 paediatric COVID-19 index cases and 248 of their household members were identified. One pair of paediatric index-secondary household case was identified, giving a household SAR of 0.5% (95% CI 0.0% to 2.6%). The index case was self-quarantined at home after international travel, stayed in her room, but shared a meal table with the secondary case.

Conclusion: The SAR from children to household members was low in the setting of social distancing, underscoring the importance of rigorous contact tracing and early isolation in limiting transmission within households.
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http://dx.doi.org/10.1136/archdischild-2020-319910DOI Listing
August 2020

Effectiveness of trivalent inactivated influenza vaccines in children during 2017-2018 season in Korea: Comparison of test-negative analysis by rapid and RT-PCR influenza tests.

Int J Infect Dis 2020 Oct 25;99:199-203. Epub 2020 Jul 25.

Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea; Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address:

Objectives: In Korea, the National Immunization Program provided trivalent inactivated influenza vaccines (IIV3) to all children aged 6-59 months during the 2017-2018 season. In this study, we aimed to evaluate the vaccine effectiveness (VE) of IIV3 in children during the 2017-2018 season.

Methods: Children aged 6-59 months who were tested for influenza for their acute respiratory illness in four hospitals during the 2017-2018 influenza season were included. We estimated the VE of IIV3 by test-negative case-control design based on the rapid influenza diagnostic test (RIDT) or reverse transcription polymerase chain reaction (RT-PCR) test results.

Results: A total of 4738 children were included in this study. The number of laboratory-confirmed influenza cases was 845 (17.8%), and there were 478 cases of influenza A and 362 cases of influenza B. The adjusted VE based on RT-PCR was 53.4% (95% CI, 25.3-70.5) against any influenza, 68.8% (95% CI, 38.7-84.1) against influenza A, and 29.7% (95% CI, -35.1 to 61.8) for influenza B. The adjusted VE based on RIDT was 14.8% (95% CI, -4.4 to 30.0) against any influenza, 24.2% (95% CI, 3.1-40.2) against influenza A, and -5.1% (95% CI, -42.6 to 21.4) against influenza B. Age-specific VE based on RT-PCR against any influenza was 44.1% (95% CI, -0.2 to 67.8) in children aged 6 months to 2 years and 59.3% (95% CI, 8.8-81.9) in children aged 3-<5 years.

Conclusion: Our results suggest moderate protection (53.4%) of IIV3 against RT-PCR laboratory-confirmed influenza in children in the 2017-2018 influenza season. However, the RIDT hampered the validity to assess VE during influenza season. Caution is needed when interpreting an RIDT-based test negative design influenza VE study.
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http://dx.doi.org/10.1016/j.ijid.2020.07.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7381399PMC
October 2020

Financial Burden of Hospitalization of Children with Coronavirus Disease 2019 under the National Health Insurance Service in Korea.

J Korean Med Sci 2020 Jun 22;35(24):e224. Epub 2020 Jun 22.

Department of Pediatrics, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.

Coronavirus disease 2019 (COVID-19) has resulted in an ongoing pandemic; however, the socioeconomic burden of COVID-19 treatment in the pediatric population remains unclear. Thus, the aim of this study was to determine the hospitalization periods and medical costs among children with COVID-19. In total, 145 billing statements for pediatric patients receiving healthcare services because of COVID-19 from February 1, 2020 to March 31, 2020 were used. The study showed that individual treatment costs for children with COVID-19 are approximately USD 2,192 under the Korean National Health Insurance Service System. This study revealed the differences in cost among age groups, determined by the type of hospital wherein admission occurred, as a trend of increasing age, increasing hospitalization time, and increasing cost was observed. Tailored COVID-19 treatment strategies by age group may lower costs and increase the effectiveness of resource allocation.
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http://dx.doi.org/10.3346/jkms.2020.35.e224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308138PMC
June 2020

Defining Association between COVID-19 and the Multisystem Inflammatory Syndrome in Children through the Pandemic.

J Korean Med Sci 2020 06 8;35(22):e204. Epub 2020 Jun 8.

Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.

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http://dx.doi.org/10.3346/jkms.2020.35.e204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279946PMC
June 2020

Viral RNA Load in Mildly Symptomatic and Asymptomatic Children with COVID-19, Seoul, South Korea.

Emerg Infect Dis 2020 Oct 4;26(10):2497-2499. Epub 2020 Jun 4.

Along with positive SARS-CoV-2 RNA in nasopharyngeal swabs, viral RNA was detectable at high concentration for >3 weeks in fecal samples from 12 mildly symptomatic and asymptomatic children with COVID-19 in Seoul, South Korea. Saliva also tested positive during the early phase of infection. If proven infectious, feces and saliva could serve as transmission sources.
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http://dx.doi.org/10.3201/eid2610.202449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510743PMC
October 2020

Abiotrophia defectiva as a cause of infective endocarditis with embolic complications in children.

Infection 2020 Oct 30;48(5):783-790. Epub 2020 May 30.

Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.

Abiotrophia defectiva is a rare pathogen of infective endocarditis (IE) but is frequently involved in embolic complication and valvular dysfunction. IE caused by A. defectiva in children is poorly studied. This study reports four cases of A. defectiva IE in children and reviews previously reported five pediatric cases of A. defectiva IE. Most of the patients presented with a subacute course, with prolonged fever or atypical symptoms. Eight patients had embolic complications at presentation. All nine children were treated with combination antimicrobial therapy and six of them received surgical intervention. All patients recovered well without relapse. A. defectiva should be considered in children with infective endocarditis, especially in those with atypical presentations. As complications are frequent and more than half of the patients need surgical treatment, prompt diagnosis along with appropriate treatment is necessary.
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http://dx.doi.org/10.1007/s15010-020-01454-zDOI Listing
October 2020

Selecting coronavirus disease 2019 patients with negligible risk of progression: early experience from non-hospital isolation facility in Korea.

Korean J Intern Med 2020 07 29;35(4):765-770. Epub 2020 May 29.

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

Background/aims: As the novel coronavirus (coronavirus disease 2019 [COVID-19]) outbreak progresses rapidly, staying home is recommended for suspected patients; however, the safety of this recommendation is uncertain. In Korea, non-hospital facilities called "living and treatment centers (LTCs)" have been established since 5 March 2020. The LTCs provided a unique opportunity to evaluate the safety of selection criteria for low-risk groups.

Methods: Between 5 March and 9 April 2020, patients with COVID-19 who met the following criteria were admitted to the LTC; alert, age below 65 years old, no underlying disease or well-controlled underlying disease, body temperature below 38.0°C, whether taking antipyretics or not, and no dyspnea. Patients were closely observed by doctors or nurses' interviews twice a day and transferred to hospitals when symptoms worsened.

Results: A total of 113 patients were admitted to the LTC; 52.2% were female, with a median age of 25 years (interquartile range, 21.5 to 39.5). Of 113 patients, 54 (47.8%) were asymptomatic at diagnosis, and 15 (13.3%) had no symptoms until they were released from isolation. During the follow-up period, two (1.8%) patients were transferred to a hospital but did not progress to severe status during hospitalization.

Conclusion: The risk of progression was negligible in COVID-19 patients who met the admission criteria for LTC at the time of diagnosis. LTCs could be a safe alternative considering shortage of hospital beds.
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http://dx.doi.org/10.3904/kjim.2020.159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373958PMC
July 2020

Outbreak investigation of Serratia marcescens neurosurgical site infections associated with a contaminated shaving razors.

Antimicrob Resist Infect Control 2020 05 12;9(1):64. Epub 2020 May 12.

Center for Infection Control and Prevention, Seoul National University Hospital, Seoul, South Korea.

Background: Surgical site infection (SSI) is the most common healthcare-associated infection. We report an outbreak of neurosurgical site infections caused by Serratia marcescens after craniotomy in a tertiary care hospital.

Methods: Between August 6 and 21, 2018, five cases of early-onset SSI caused by S. marcescens after craniotomy were recorded in a 1786-bed tertiary care hospital. Cultures were collected from potential environmental sources and healthcare workers. Whole-genome sequencing (WGS) was used to investigate the genetic relationships among S. marcescens isolates.

Results: The outbreak involved five patients; S. marcescens was isolated from the cerebrospinal fluid, pus, tissue, and blood samples from these patients. S. marcescens was also isolated from shaving razors and brushes. All S. marcescens isolates from the infected patients and razors showed the same resistance patterns on antibiotic-susceptibility tests. WGS revealed close clustering among four of five isolates from the patients and among three of four isolates from the razors. No additional patient developed S. marcescens infection after we stopped using the razors for scalp shaving.

Conclusions: We report an outbreak of neurosurgical site infections after craniotomy, which was associated with shaving razors contaminated by S. marcescens. Shaving scalps with razors should be avoided to prevent SSI.
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http://dx.doi.org/10.1186/s13756-020-00725-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216399PMC
May 2020

Sequential Analysis of Viral Load in a Neonate and Her Mother Infected With Severe Acute Respiratory Syndrome Coronavirus 2.

Clin Infect Dis 2020 11;71(16):2236-2239

Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.

We report changes in viral load over time in a 27-day-old neonate with coronavirus disease 2019 who presented with fever, cough, and vomiting. Severe acute respiratory syndrome coronavirus 2 RNA was detected in the nasopharynx, oropharynx, stool, saliva, plasma, and urine. The highest viral RNA copies in nasopharynx decreased over time while viral load in stool remained high.
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http://dx.doi.org/10.1093/cid/ciaa447DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184375PMC
November 2020

Are We Ready for Coronavirus Disease 2019 Arriving at Schools?

J Korean Med Sci 2020 Mar 23;35(11):e127. Epub 2020 Mar 23.

Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

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http://dx.doi.org/10.3346/jkms.2020.35.e127DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7086087PMC
March 2020

First Pediatric Case of Coronavirus Disease 2019 in Korea.

J Korean Med Sci 2020 Mar 23;35(11):e124. Epub 2020 Mar 23.

Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.

The large outbreak of coronavirus disease 2019 (COVID-19) that started in Wuhan, China has now spread to many countries worldwide. Current epidemiologic knowledge suggests that relatively few cases are seen among children, which limits opportunities to address pediatric specific issues on infection control and the children's contribution to viral spread in the community. Here, we report the first pediatric case of COVID-19 in Korea. The 10-year-old girl was a close contact of her uncle and her mother who were confirmed to have COVID-19. In this report, we present mild clinical course of her pneumonia that did not require antiviral treatment and serial viral test results from multiple specimens. Lastly, we raise concerns on the optimal strategy of self-quarantine and patient care in a negative isolation room for children.
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http://dx.doi.org/10.3346/jkms.2020.35.e124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7086086PMC
March 2020

Associations between geographic region and immune response variations to pneumococcal conjugate vaccines in clinical trials: A systematic review and meta-analysis.

Int J Infect Dis 2020 Mar;92:261-268

Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address:

Objective: Geographic region can be an important source of variation in the immune response to pneumococcal conjugate vaccines (PCV). The aim of this study was to collate data from available PCV clinical trials in order to characterize the differences in antibody responses in different countries.

Methods: A systematic review and meta-analysis was conducted to examine the difference in antibody responses after primary series of PCVs in infants, associated with geographic regions, compared with each other and with the different PCVs using random-effects models.

Results: A total of 69 trials were included. Studies conducted in the Western Pacific Region (WPR) showed higher geometric mean concentrations (GMC) compared to studies conducted in Europe. The pooled GMC for serotype 4 after three doses of PCV7 in the WPR was 5.19 μg/ml (95% confidence interval 4.85-5.53 μg/ml), while for studies conducted in Europe this was 2.01 μg/ml (95% confidence interval 1.88-2.14 μg/ml). The IgG GMC ratios among the WPR versus European regions ranged from 1.51 to 2.87 for PCV7, 1.69 to 3.22 for PCV10, and 1.49 to 3.08 for PCV13.

Conclusions: Studies conducted in the WPR generally showed greater antibody responses than the studies conducted in Europe. Indications of differences among geographic regions highlight the fact that further research is needed to compare the biological factors contributing to immune responses, which may affect vaccination schedules.
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http://dx.doi.org/10.1016/j.ijid.2019.12.021DOI Listing
March 2020

Molecular epidemiology of respiratory syncytial virus for 28 consecutive seasons (1990-2018) and genetic variability of the duplication region in the G gene of genotypes ON1 and BA in South Korea.

Arch Virol 2020 May 6;165(5):1069-1077. Epub 2020 Mar 6.

Department of Pediatrics, Seoul National University College of Medicine, Seoul, 03080, South Korea.

We investigated the molecular epidemiology of respiratory syncytial virus (RSV) isolated from children during 28 consecutive seasons (1990-2018) and the genetic variability of the duplication region of RSV genotypes ON1 and BA in South Korea. RSV was identified using culture-based methods in Hep-2 cells and was grouped as RSV-A or RSV-B by an immunofluorescence assay. The second hypervariable region of the G gene was sequenced for genotyping. The nucleotide and deduced amino acid sequences of the duplication region of RSV ON1 and BA were analyzed. A total of 670 RSV-A and 233 RSV-B isolates were obtained. For RSV-A, the NA1 genotype predominated during the 2004/2005-2011/2012 seasons. The ON1 genotype was first detected in 2011 and has since replaced all other genotypes. For RSV-B, the GB3 genotype predominated during the 1999/2000-2005/2006 seasons, but the BA genotype also replaced all other genotypes of RSV-B after the first season in which it was isolated (2005/2006). In ON1 and BA genotype RSV strains, novel sequence types of the duplication region of the G gene were identified in 50-95% and 33-80% of the isolates, respectively, in each season. The ON1 and BA9 genotypes are responsible for the current epidemics of RSV infection in South Korea. The sequences in the duplication region of the G gene have evolved continuously and might be sufficient for the identification of specific strains of the RSV-A ON1 and RSV-B BA genotypes.
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http://dx.doi.org/10.1007/s00705-020-04580-zDOI Listing
May 2020

Cytomegalovirus disease in a retinoblastoma cohort: The role of preemptive screening.

Pediatr Blood Cancer 2020 03 2;67(3):e28101. Epub 2019 Dec 2.

Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

Background: Cytomegalovirus (CMV) disease is underrecognized in children with retinoblastoma. This study investigated rates of CMV infection and disease in this specific population receiving chemotherapy.

Methods: From a cohort of 164 patients with retinoblastoma diagnosed from 2011 to 2018, 107 patients were evaluated for CMV infection determined by antigenemia assay or real-time PCR. Preemptive CMV screening was implemented in 2013. CMV disease was diagnosed by tissue biopsy, culture, or ophthalmic examination.

Results: Thirty-seven and 70 patients before and after the screening strategy, respectively, were included. Before screening, 10/37 (27%) were diagnosed with CMV infection during chemotherapy. Among them, 5 (50%) developed CMV disease (hepatitis, pneumonia, and retinitis) and one patient died of CMV pneumonia. During screening, 18/70 (26%) were documented with 36 episodes of CMV infection and 9 patients received 25 preemptive antiviral therapies. Age at chemotherapy tended to be younger in patients with CMV infection, and fewer were seronegative prior to chemotherapy. Patients who started chemotherapy at <12 months of age received preemptive therapies significantly more often than those started at ≥12 months. Two (11%) out of 18 patients with CMV infection developed CMV retinitis and colitis, and there were no fatal cases. Preemptive therapy along with active CMV screening significantly reduced the risk of developing CMV disease, from 14% to 2.9% (P = 0.047).

Conclusions: Children with retinoblastoma can experience significant morbidity and even mortality from CMV infection during chemotherapy in Korea. Preemptive screening and appropriate antiviral therapy can reduce the development of CMV disease and subsequent mortality.
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http://dx.doi.org/10.1002/pbc.28101DOI Listing
March 2020