Publications by authors named "Moran Ki"

113 Publications

A cost-effectiveness study of universal screening for hepatitis C virus infection in South Korea: A societal perspective.

Clin Mol Hepatol 2021 Nov 5. Epub 2021 Nov 5.

Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

Background/aims: This study aimed to evaluate the cost-effectiveness of hepatitis C virus (HCV) screening compared with no screening in the Korean population from societal and healthcare system perspectives.

Methods: A published decision-tree plus Markov model was used to compare the expected costs and quality-adjusted life years (QALY) between one-time universal HCV screening and no screening in the population aged 40-65 years using the National Health Examination program (NHE). Input parameters were obtained from analyses of the National Health Insurance claims data, Korean HCV cohort data, or from the literature review. The population aged 40-65 years was simulated in a model spanning a lifetime from both the healthcare system and societal perspectives, which included productivity loss cost owing to HCV-related deaths. The incremental cost-effectiveness ratio (ICER) between universal screening and no screening was estimated.

Results: The HCV screening strategy had an ICER of $2,666QALY and $431/QALY from the healthcare system and societal perspectives, respectively. Both ICERs were far less than the willingness-to-pay (WTP) threshold of $25,000/QALY, showing that universal screening was highly cost-effective compared with no screening. In the various sensitivity analyses, the most influential parameters on cost-effectiveness were the antibodies to HCV (anti-HCV) prevalence, screening costs, and treatment acceptance; however, all ICERs were consistently less than the threshold. If the anti-HCV prevalence was over 0.18%, screening could be cost-effective.

Conclusions: One-time universal HCV screening in the Korean population aged 40-65 years using NHE would be highly cost-effective from both healthcare system and societal perspectives.
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http://dx.doi.org/10.3350/cmh.2021.0236DOI Listing
November 2021

Epidemiology and treatment status of hepatitis C virus infection among people who have ever injected drugs in South Korea: a prospective multicenter cohort study from 2007 to 2019 in comparison with non-PWID.

Epidemiol Health 2021 Oct 6:e2021077. Epub 2021 Oct 6.

Seoul National University Bundang Hospital , Seongnam, Korea.

Objectives: Injection drug use is a major risk factor for hepatitis C virus (HCV) infection; however, limited data are available in South Korea. Thus, this study aimed to investigate the epidemiological and clinical characteristics, treatment uptake, and outcomes of HCV infection among people who inject drugs (PWID).

Methods: We used the data from the Korea HCV cohort, which prospectively enrolled patients with HCV infection between 2007 and 2019. Clinical data and results of the questionnaire survey focused on the lifetime risk factors for HCV infection were analyzed based on the self-reported history of injection drug use.

Results: Among the 2,468 patients, 166 (6.7%) had a history of injection drug use (PWID group). In the PWID group, the patients were younger (50.68.2 vs. 58.213.1 years) and the proportion of males was higher (81.9% vs. 48.8%) than in the non-PWID group. The distribution of PWID showed significant regional variations. Exposure to other risk factors for HCV infection was different between the groups. The proportion of patients with genotype non-2 infection was higher in the PWID group. Treatment uptake was higher in the PWID group in the interferon era; however, it was comparable between the groups in the direct-acting antiviral era. The rate of sustained virological response did not differ between the groups.

Conclusion: By 2019, PWID were a minority among the HCV-infected people in Korea. The epidemiological characteristics were different between the groups, but not the treatment uptake and outcomes. Therefore, active screening and treatment should be offered to PWID in Korea.
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http://dx.doi.org/10.4178/epih.e2021077DOI Listing
October 2021

Precautionary Behavior Practices and Psychological Characteristics of COVID-19 Patients and Quarantined Persons.

Int J Environ Res Public Health 2021 Jun 4;18(11). Epub 2021 Jun 4.

Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea.

Background: since the coronavirus disease (COVID-19) was first reported in 2019, South Korea has enforced isolation of patients with confirmed cases of COVID-19, as well as quarantine for close contacts of individuals diagnosed with COVID-19 and persons traveling from abroad, in order to contain its spread. Precautionary behavior practices and psychological characteristics of confirmed and quarantined persons were investigated for planning pandemic recovery and preparedness.

Methods: this study was conducted with 1716 confirmed patients and quarantined persons in Daegu and Busan, regions where a high number of cases were confirmed during the early stage of the COVID-19 outbreak in South Korea. We collected online survey data from 23 April to 20 May 2020, in Daegu, and 28 April to 27 May 2020, in Busan, in cooperation with Daegu and Busan Infectious Disease Control Centers and public health centers in the regions. COVID-19 symptoms, pre-cautionary behavior practices, psychological states, and the need for improvement in isolation/quarantine environments were examined using an online survey.

Results: compared to patients infected with coronavirus, quarantined persons engaged in more hygiene-related behaviors (e.g., hand washing, cough etiquette, and proper mask-wearing) and social distancing. COVID-19 patients had a strong fear of stigma, while quarantined persons had a strong fear of contracting COVID-19. Study participants responded that it was necessary to provide financial support and adequate information during isolation/quarantine.

Conclusions: the study highlights the importance of precautionary behavior to prevent COVID-19 infection and the need to provide support (both psychological and financial) to patients and quarantined persons, to reinforce effective communication, social solidarity, and public health emergency preparedness (PHEP) in a pandemic situation.
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http://dx.doi.org/10.3390/ijerph18116070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200059PMC
June 2021

Estimated incidence of juvenile-onset recurrent respiratory papillomatosis in Korea.

Epidemiol Health 2021 10;43:e2021019. Epub 2021 Mar 10.

Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea.

Objectives: Recurrent respiratory papillomatosis (RRP) is caused by human papillomavirus (HPV) types 6 and 11 and is potentially preventable through vaccination. This study estimated the incidence of juvenile-onset RRP before the implementation of the national HPV vaccination program in Korea.

Methods: We conducted a cohort study using claims data provided by a mandatory insurance program to estimate the incidence of RRP and associated healthcare use. Patients with juvenile RRP were defined as those aged ≤12 years with ≥2 admissions or ≥2 outpatient visits during which they received the International Classification of Diseases, 10th revision code for benign neoplasms of the larynx (D14.1).

Results: During 2002-2014, 123 children (74 boys and 49 girls) were diagnosed with RRP. The patients had a mean of 6.5 person-years of follow-up. The incidence was estimated at 0.30/100,000 person-years. The median age at diagnosis was 4.0 years (mean, 4.3). Thirty-six (29.3%) patients underwent surgery, including 23 patients (18.7%) who underwent 2 or more surgical procedures. Severe disease, measured by more frequent surgical procedures and shorter time intervals between consecutive operations, was associated with a younger age at diagnosis.

Conclusions: The estimated incidence of juvenile-onset RRP in Korea was similar to that reported in other countries. The RRP burden should continue to be monitored using National Health Insurance Service claims data.
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http://dx.doi.org/10.4178/epih.e2021019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189843PMC
May 2021

Fluoroquinolone Can Be an Effective Treatment Option for Acute Pyelonephritis When the Minimum Inhibitory Concentration of Levofloxacin for the Causative Is ≤16 mg/L.

Antibiotics (Basel) 2021 Jan 2;10(1). Epub 2021 Jan 2.

Department of Internal Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea.

The purpose of this study was to determine whether the fluoroquinolone (FQ) minimum inhibitory concentration (MIC) for the causative agent influences the clinical response of FQ treatment at 72 h in patients with community-acquired acute pyelonephritis (CA-APN). We prospectively collected the clinical data of women with CA-APN from 11 university hospitals from March 2010 to February 2012 as well as isolates from the urine or blood. In total, 78 patients included in this study received FQ during the initial 72 h, and the causative was detected. The clinical response at 72 h was significantly higher in patients with a levofloxacin MIC ≤ 16 mg/L than in those with an MIC > 16 mg/L (70.4% vs. 28.6%, = 0.038). No difference was observed in clinical response at 72 h based on ciprofloxacin MIC. To summarize, FQ can be an effective treatment option for CA-APN when levofloxacin MIC against is ≤16 mg/L.
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http://dx.doi.org/10.3390/antibiotics10010037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823373PMC
January 2021

Understanding South Korea's Response to the COVID-19 Outbreak: A Real-Time Analysis.

Int J Environ Res Public Health 2020 12 21;17(24). Epub 2020 Dec 21.

Institute of Global Health, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland.

This case study focuses on the epidemiological situation of the COVID-19 outbreak, its impacts and the measures South Korea undertook during the first wave of the COVID-19 pandemic. Since the first case was confirmed on 20 January 2020, South Korea has been actively experiencing the COVID-19 outbreak. In the early stage of the pandemic, South Korea was one of the most-affected countries because of a large outbreak related to meetings of a religious movement, namely the Shincheonji Church of Jesus, in a city called Daegu and North Gyeongsang province. However, South Korea was held as a model for many other countries as it appeared to slow the spread of the outbreak with distinctive approaches and interventions. First of all, with drastic and early intervention strategies it conducted massive tracing and testing in a combination of case isolation. These measures were underpinned by transparent risk communication, civil society mobilization, improvement of accessibility and affordability of the treatment and test, the consistent public message on the potential benefit of wearing a mask, and innovation. Innovative measures include the mobile case-tracing application, mobile self-quarantine safety protection application, mobile self-diagnosis application, and drive-thru screening centres. Meanwhile, the epidemic has brought enormous impacts on society economically and socially. Given its relationship with China, where the outbreak originated, the economic impact in South Korea was predicted to be intense and it was already observed since February due to a decline in exports. The pandemic and measures undertaken by the government also have resulted in social conflicts and debates, human-right concerns, and political tension. Moreover, it was believed that the outbreak of COVID-19 and the governmental responses towards it has brought a huge impact on the general election in April. Despite of the large outbreak in late February, the Korean government has flattened the COVID-19 curve successfully and the downward trend in the number of new cases remained continuously as of 30 April. The most distinctive feature of South Korea's responses is that South Korea conducted proactive case finding, contacts tracing, and isolations of cases instead of taking traditional measures of the containment of the epidemic such as boarder closures and lockdowns.
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http://dx.doi.org/10.3390/ijerph17249571DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766828PMC
December 2020

Incidence and mortality of cervical cancer in Vietnam and Korea (1999-2017).

Epidemiol Health 2020 16;42:e2020075. Epub 2020 Dec 16.

Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.

Objectives: Cervical cancer is a major disease burden in Vietnam. This study aimed to estimate the incidence and mortality rates of cervical cancer in Vietnam (1999-2017) in comparison to those in Korea, where a population-based cancer registry and national cervical cancer screening program have been implemented.

Methods: The estimated incidence and mortality of cervical cancer in Vietnam and Korea (1999-2017) were collected from Global Burden of Disease 2017 study. Estimated age-standardized rates (ASRs) in both countries were calculated utilizing the 1999-2017 population of each country and the World Health Organization standard population. The reported ASRs in Korea were also computed using data on incidence and mortality (1999-2017) and the Korean population from the Korea Statistical Information Service.

Results: In Vietnam, the estimated incidence and mortality of cervical cancer decreased annually by 0.84% and 1.01%. In Korea, the trend of reported incidence showed a dramatic drop (1999-2007 annual percent change [APC], -4.53%) before stably declining (2007-2017 APC, -2.71%). Reported mortality also significantly decreased (2003-2008 APC, -6.63%), and then maintained a stable decline (2008-2017 APC, -3.78%). The incidence and mortality rates were higher in Vietnam than in Korea. The declining trend of incidence and mortality in Vietnam was slower than the corresponding trends in Korea.

Conclusions: A national screening program should be implemented for Vietnamese women aged over 30 to maintain, or even hasten, the decline in cervical cancer incidence and mortality. A population-based cancer registry may help monitor the effectiveness of a cervical cancer screening program.
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http://dx.doi.org/10.4178/epih.e2020075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137369PMC
February 2021

Population Attributable Fraction of Helicobacter pylori Infection-Related Gastric Cancer in Korea: A Meta-Analysis.

Authors:
Yoon Park Moran Ki

Cancer Res Treat 2021 Jul 15;53(3):744-753. Epub 2020 Dec 15.

Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.

Purpose: This study aimed to determine the proportion of gastric cancer attributable to Helicobactor pylori in the Korean population. Infection with H. pylori has been recognized as the most significant risk factor for gastric cancer. In Korea, gastric cancer is the most common cancer that accounted for 13.3% of all cancers in 2016. In particular, men are most commonly diagnosed with gastric cancer; the age-standardized incidence rate in men is 49.6 per 100,000, which is more than twice the incidence in women.

Materials And Methods: The population attributable fraction (PAF) was calculated as a function of the relative risk (RR) of gastric cancer associated with H. pylori infections. To estimate PAF of gastric cancer due to H. pylori, the prevalence of H. pylori infections was extrapolated for the year of 1990 and a pooled RR was obtained by conducting a meta-analysis of studies recently published in Korea.

Results: The estimated prevalence of H. pylori was 76.4% in men and 71.9% in women. The RRs (95% confidence interval) pooled from case-control studies using a random effects model was 1.69 (1.29-2.22) for overall gastric cancer and 2.17 (1.04-4.55) for non-cardia gastric cancer. Using the RR for overall gastric cancer, the estimated PAFs due to H. pylori were 34.5% in men and 33.2% in women.

Conclusion: The occurrence of gastric cancer in Koreans may be affected by other risk factors in addition to H. pylori infection, which may contribute to increasing baseline risk for gastric cancer.
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http://dx.doi.org/10.4143/crt.2020.610DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8291171PMC
July 2021

The Economic Burden of Cancers Attributable to Infection in the Republic of Korea: A Prevalence-Based Study.

Int J Environ Res Public Health 2020 10 19;17(20). Epub 2020 Oct 19.

Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, 323 Ilsan-ro, Ilsandong-gu, Goyang-si 410-769, Korea.

Infection is a major cause of cancers. We estimated the economic burden of cancers attributable to infection in 2014 in Korea, where cancer causing infection is prevalent, but the economic burden of it has never been examined. Cancer patients were defined as those having made medical claims as recorded by the National Health Insurance Service, which is a mandatory insurance for all citizen. We multiplied the costs by the population-attributable fraction for each type of cancer. The study included direct and indirect costs, where direct costs comprised direct medical and non-medical costs of inpatients and outpatients, while indirect costs were estimated by identifying future income loss due to premature death, productivity loss during hospitalization/outpatient visits, and job loss. In 2014, there were 100,054 infection-related cancer patients, accounting for 10.7% of all Korean cancer cases for that year. Direct costs of cancers associated with infection stood at nearly USD 676.9 million, while indirect costs were much higher at USD 2.57 billion. The average expenditure of a typical patient was USD 32,435. Economic burden of cancers attributable to infection is substantial in Korea, accounting for 0.23% of the national gross domestic product and 1.36% of national healthcare expenditure in 2014.
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http://dx.doi.org/10.3390/ijerph17207592DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7593934PMC
October 2020

Analyzing the effects of social distancing on the COVID-19 pandemic in Korea using mathematical modeling.

Epidemiol Health 2020 7;42:e2020064. Epub 2020 Sep 7.

Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.

Objectives: During the 6 months since the first coronavirus disease 2019 (COVID-19) patient was diagnosed in Korea on January 20, 2020, various prevention and control measures have been implemented according to the COVID-19 epidemic pattern. Therefore, this study aimed to estimate the reproductive numbers (R) for each epidemic stage to analyze the effects of the preventive measures and to predict the COVID-19 transmission trends.

Methods: We estimated the transmission rates for each epidemic stage by fitting a COVID-19 transmission model, based on a deterministic mathematical model, to the data on confirmed cases. The effects of preventive measures such as social distancing by time period were analyzed, and the size and trends of future COVID-19 outbreaks were estimated.

Results: The value of R was 3.53 from February18, 2020 to February 28, 2020, and the mean R reduced to 0.45 from March 14, 2020 to April 29, 2020, but it significantly increased to 2.69 from April 30, 2020 to May13, 2020 and it was maintained at 1.03 from May 14, 2020 to July 23, 2020.

Conclusions: According to the estimated R, it had fallen to below 1 and was maintained at that level owing to the isolation of infected persons by the public health authorities and social distancing measures followed by the general public. Then, the estimated R increased rapidly as the contact among individuals increased during the long holiday period from April 30, 2020 to May 5, 2020. Thereafter, the value of R dropped, with the continued use of preventive measures but remained higher than 1.00, indicating that the COVID-19 outbreak can be prolonged and develop into a severe outbreak at any time.
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http://dx.doi.org/10.4178/epih.e2020064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871167PMC
October 2020

Comorbidities and Prescribed Medications in Korean Patients with Chronic Hepatitis C: A Nationwide, Population-Based Study.

Gut Liver 2021 Mar;15(2):295-306

Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

Background/aims: Extrahepatic comorbidities and comedication are important to consider in the treatment of chronic hepatitis C (CHC) patients with direct-acting antivirals (DAAs) due to the risk of drug-drug interaction (DDI) and the effect of comorbidities on clinical outcomes. This study aimed to investigate the detailed profiles of comorbidities and comedication among Korean CHC patients.

Methods: All adult patients (≥18 years old) with a primary diagnostic code of CHC in 2013 were selected from the National Health Insurance claims database. For each patient, all ICD-10 codes listed as primary or secondary diagnoses and all prescribed medications were collected.

Results: Among 47,104 CHC patients (median age, 57 years; male, 49.3%), 84.8% had at least one comorbidity for a mean number of 2.4, which increased with age. The most prevalent comorbidities were hypertension, esophagitis, dyslipidemia, diabetes mellitus, and peptic ulcer. Overall, 96.8% of the patients took at least one prescribed medication, with a mean of 8.1 medications/ year, and the three most common drug types were analgesics, gastrointestinal agents, and antibacterials. Use of at least one drug with a DDI risk category of "contraindicated medication" or "required dose-reduction/additional monitoring" was observed in 97% of the overall patients. The proportion of prescribed medications that were contraindicated with DAAs varied from 2.0% to 38.9% depending on the hepatitis C virus regimen.

Conclusions: The majority of CHC patients had comorbidities; almost all patients took multiple prescribed medications, the number of which increased with age, and significant DDI risk was present in 97% of this Korean patient cohort. Comorbidities and comedication profiles should be considered during DAA therapy.
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http://dx.doi.org/10.5009/gnl19387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7960981PMC
March 2021

Association between viral hepatitis infection and Parkinson's disease: A population-based prospective study.

J Viral Hepat 2020 11 10;27(11):1171-1178. Epub 2020 Jul 10.

Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.

The association between hepatitis virus infection and Parkinson's disease remains controversial. To determine whether hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are associated with an increased risk of Parkinson's disease in Korean aged ≥40 years, we completed a population-based prospective study including patients without infections and those with HBV, HCV and HBV/HCV infections from 2005 to 2015. We used the International Classification of Diseases 10th Revision to identify Parkinson's disease (G20) and chronic hepatitis C virus (B18.2) and chronic hepatitis B virus infections (B18.0 or B18.1). To identify Parkinson's disease risk, competing risk analysis adjusted for age, sex, comorbidities and death was performed. Overall, 1 010 317 patients (358 052, noninfection; 488 990, hepatitis B; 144 459 hepatitis C; and 18 680 hepatitis B/C) were included. The incidence density of Parkinson's disease per 10 000 person-years was highest in the hepatitis C group (8.0), followed by the hepatitis B/C (6.8) and hepatitis B (5.0) groups. Hypertension, ischaemic heart disease, epilepsy, stroke and depressive disorder increased the hazard of Parkinson's disease in all groups. The adjusted hazard ratios were 1.25 (95% confidence interval: 1.17-1.35), 1.39 (95% confidence interval: 1.27-1.52) and 1.46 (95% confidence interval: 1.14-1.85) in the HBV, HCV, and HBV/HCV groups, respectively. Our findings suggest that adult patient of 40 years and older with HBV and HCV infections should be monitored for signs of Parkinson's disease so that early intervention and accurate treatment can be provided for minimizing the development and consequences of Parkinson's disease.
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http://dx.doi.org/10.1111/jvh.13346DOI Listing
November 2020

Risk estimation of the SARS-CoV-2 acute respiratory disease outbreak outside China.

Theor Biol Med Model 2020 06 5;17(1). Epub 2020 Jun 5.

Department of Mathematics, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul, 05029, South Korea.

Background: On December 31, 2019, the World Health Organization was alerted to the occurrence of cases of pneumonia in Wuhan, Hubei Province, China, that were caused by an unknown virus, which was later identified as a coronavirus and named the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to estimate the reproductive number of SARS-CoV-2 in the Hubei Province and evaluate the risk of an acute respiratory coronavirus disease (COVID-19) outbreak outside China by using a mathematical model and stochastic simulations.

Results: We constructed a mathematical model of SARS-CoV-2 transmission dynamics, estimated the rate of transmission, and calculated the reproductive number in Hubei Province by using case-report data from January 11 to February 6, 2020. The possible number of secondary cases outside China was estimated by stochastic simulations in various scenarios of reductions in the duration to quarantine and rate of transmission. The rate of transmission was estimated as 0.8238 (95% confidence interval [CI] 0.8095-0.8382), and the basic reproductive number as 4.1192 (95% CI 4.0473-4.1912). Assuming the same rate of transmission as in Hubei Province, the possibility of no local transmission is 54.9% with a 24-h quarantine strategy, and the possibility of more than 20 local transmission cases is 7% outside of China.

Conclusion: The reproductive number for SARS-CoV-2 transmission dynamics is significantly higher compared to that of the previous SARS epidemic in China. This implies that human-to-human transmission is a significant factor for contagion in Hubei Province. Results of the stochastic simulation emphasize the role of quarantine implementation, which is critical to prevent and control the SARS-CoV-2 outbreak outside China.
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http://dx.doi.org/10.1186/s12976-020-00127-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272210PMC
June 2020

Molecular Epidemiology of Ciprofloxacin-Resistant Isolated from Community-Acquired Urinary Tract Infections in Korea.

Infect Chemother 2020 Jun 13;52(2):194-203. Epub 2020 May 13.

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

Background: is the predominant causative pathogen for community-acquired urinary tract infections (UTIs), and the increase in fluoroquinolone-resistant is of great concern in Korea. The objectives of this study were to investigate the genotypic characteristics and molecular epidemiology of ciprofloxacin-resistant (CIP-R) isolated from community-acquired UTIs in Korea.

Materials And Methods: samples isolated from the blood or urine were collected from patients with community-acquired acute pyelonephritis aged 15 years and more who were admitted to 12 Korean hospitals from 1st April 2010 to 29th February 2012. Phylogenetic typing, multilocus sequence typing, and molecular characterization of β-lactamase and plasmid-mediated quinolone resistance determinants were performed for CIP-R isolates.

Results: A total of 569 isolates were collected, and 122 (21.4%) isolates were CIP-R isolates. The most prevalent sequence type (ST) was ST131 (28.7%, 35/122), followed by ST393 (14.7%, 18/122), ST1193 (13.1%, 16/122), ST38 (9.0%, 11/122), and ST405 (8.2%, 10/122). The antimicrobial resistance rates of ST131 to cefepime (22.9%, 8/35), ST38 to gentamicin (100%, 11/11), and ST405 to cefotaxime (66.7%, 6/9) were significantly higher than the resistance rates of all other STs combined. Notably, 40% (4/10) of ST405 clones produced extended-spectrum β-lactamases and were co-resistant to trimethoprim/sulfamethoxazole. (20%, 7/35) and CTX-M-14 (40%, 4/10) were more frequently observed in ST131 and ST405 compared with other clones, respectively.

Conclusions: Among the CIP-R uropathogenic isolates in this study, ST131, ST38, and ST405 were specifically associated with antimicrobial resistance.
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http://dx.doi.org/10.3947/ic.2020.52.2.194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335657PMC
June 2020

Estimating the reproductive number and the outbreak size of COVID-19 in Korea.

Epidemiol Health 2020 12;42:e2020011. Epub 2020 Mar 12.

Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.

Objectives: Since the first novel coronavirus disease 2019 (COVID-19) patient in Korea was diagnosed on January 20, 2020, 30 patients were diagnosed until February 17, 2020. However, 5,298 additional patients were confirmed until March 4, 2020. Therefore, our objective was to estimate the reproduction number (R) and evaluate the effectiveness of preventive measures.

Methods: A COVID-19 transmission model (SEIHR) was established to suit the Korean outbreak. The number of daily confirmed cases in Daegu and North Gyeongsang Province (NGP), the main area of outbreak, was used. The first patient' symptom onset date in the Daegu/NGP outbreak was assumed as January 22, 2020. The R according to the start date of the effect of preventive measures was estimated.

Results: The estimated R in Hubei Province, China, was 4.0281, whereas the estimated initial R in Korea was 0.555, but later in Daegu/NGP, the value was between 3.472 and 3.543. When the transmission period decreases from 4-day to 2-day, the outbreak ends early, but the peak of the epidemic increases, and the total number of patients does not change greatly. It was found that, if transmission rate decreases, the outbreak ends early, and the size of the peak and the total number of patients also decreases.

Conclusions: To end the COVID-19 epidemic, efforts to reduce the spread of the virus, such as social distancing and wearing masks, are absolutely crucial with the participation of the public, along with the policy of reducing the transmission period by finding and isolating patients as quickly as possible through the efforts of the quarantine authorities.
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http://dx.doi.org/10.4178/epih.e2020011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7285447PMC
April 2020

Epidemiologic characteristics of early cases with 2019 novel coronavirus (2019-nCoV) disease in Korea.

Authors:
Moran Ki

Epidemiol Health 2020 9;42:e2020007. Epub 2020 Feb 9.

Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.

In about 20 days since the diagnosis of the first case of the 2019 novel coronavirus (2019-nCoV) in Korea on January 20, 2020, 28 cases have been confirmed. Fifteen patients (53.6%) of them were male and median age of was 42 years (range, 20-73). Of the confirmed cases, 16, 9, and 3 were index (57.2%), first-generation (32.1%), and second-generation (10.7%) cases, respectively. All first-generation and second-generation patients were family members or intimate acquaintances of the index cases with close contacts. Fifteen among 16 index patients had entered Korea from January 19 to 24, 2020 while 1 patient had entered Korea on January 31, 2020. The average incubation period was 3.9 days (median, 3.0), and the reproduction number was estimated as 0.48. Three of the confirmed patients were asymptomatic when they were diagnosed. Epidemiological indicators will be revised with the availability of additional data in the future. Sharing epidemiological information among researchers worldwide is essential for efficient preparation and response in tackling this new infectious disease.
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http://dx.doi.org/10.4178/epih.e2020007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7285424PMC
March 2020

Ebola virus disease outbreak in Korea: use of a mathematical model and stochastic simulation to estimate risk.

Epidemiol Health 2019 24;41:e2019048. Epub 2019 Nov 24.

Department of Mathematics, Konkuk University, Seoul, Korea.

Objectives: According to the World Health Organization, there have been frequent reports of Ebola virus disease (EVD) since the 2014 EVD pandemic in West Africa. We aim to estimate the outbreak scale when an EVD infected person arrives in Korea.

Methods: Western Africa EVD epidemic mathematical model SEIJR or SEIJQR was modified to create a Korean EVD outbreak model. The expected number of EVD patients and outbreak duration were calculated by stochastic simulation under the scenarios of Best case, Diagnosis delay, and Case missing.

Results: The 2,000 trials of stochastic simulation for each scenario demonstrated the following results: The possible median number of patients is 2 and the estimated maximum number is 11 when the government intervention is proceeded immediately right after the first EVD case is confirmed. With a 6-day delay in diagnosis of the first case, the median number of patients becomes 7, and the maximum, 20. If the first case is missed and the government intervention is not activated until 2 cases of secondary infection occur, the median number of patients is estimated at 15, and the maximum, at 35.

Conclusions: Timely and rigorous diagnosis is important to reduce the spreading scale of infection when a new communicable disease is inflowed into Korea. Moreover, it is imperative to strengthen the local surveillance system and diagnostic protocols to avoid missing cases of secondary infection.
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http://dx.doi.org/10.4178/epih.e2019048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7005456PMC
February 2020

Causes and countermeasures for repeated outbreaks of hepatitis A among adults in Korea.

Epidemiol Health 2019 22;41:e2019038. Epub 2019 Sep 22.

Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea.

The 2019 hepatitis A outbreak has become increasingly prevalent among adults in Korea and is the largest outbreak since that in 2009-2010. The incidence in the current outbreak is highest among adults aged 35-44 years, corresponding to the peak incidence among those aged 25-34 years 10 years ago. This may indicate a cohort effect in the corresponding age group. Causes of these repeated outbreaks of hepatitis A in Korea are low level of immunity among adults, Korean food culture that consumes raw seafood such as salted clam and inadequate public health system. Among countermeasures, along with general infectious disease control measures including control of the infectious agent, infection spread, and host, urgent actions are needed to review the vaccination policy and establish an adequate public health system.
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http://dx.doi.org/10.4178/epih.e2019038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883026PMC
November 2019

Costs of viral hepatitis B in the Republic of Korea, 2002-2015.

J Viral Hepat 2020 02 14;27(2):156-167. Epub 2019 Nov 14.

Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.

The Republic of Korea has a high prevalence of hepatitis B virus (HBV) infection, and the policies concerning costly antiviral medication have been revised recently. However, in the past 10 years, no related research on costs has been conducted. The objective of this study was to estimate the economic burden of viral hepatitis B and determine the trend of changes in its costs between 2002 and 2015. Claims data from the National Health Insurance Service were used. To identify viral hepatitis B cases, the ICD-10th code B16, B17.0, B18.0 and B18.1 were used based on a primary diagnosis. This study was conducted from a societal perspective regarding both direct and indirect costs. Annual costs were adjusted for inflation by calculations based on the 2015 costs. The number of patients with viral hepatitis B increased from 213 758 in 2002 to 342 672 in 2015. The total socio-economic costs increased from 127.1 million USD in 2002 to 459.1 million USD in 2015, mainly due to the increase in pharmaceutical costs, which accounted for the largest proportion of total costs since 2009-220.5 million USD in 2015, which was ~15 times higher than that in 2002. The healthcare costs for viral hepatitis B accounted for 0.13% of the national health expenditure in 2002, increasing to 0.31% in 2015. The economic burden of viral hepatitis B has increased in the Republic of Korea. It is therefore essential to reduce the healthcare costs of HBV infection by establishing an effective management policy.
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http://dx.doi.org/10.1111/jvh.13219DOI Listing
February 2020

The change in the nationwide seroprevalence of hepatitis C virus and the status of linkage to care in South Korea from 2009 to 2015.

Hepatol Int 2019 Sep 20;13(5):599-608. Epub 2019 Aug 20.

Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea.

Background: Hepatitis C virus (HCV) requires epidemiological monitoring to estimate its disease burden and to develop countermeasures. This study aimed to investigate the difference between the 2015 and 2009 nationwide anti-HCV seroprevalence and to determine linkage to care estimates in South Korea.

Methods: A total 268,422 examinees ≥ 20 years old were included in 2015 from 33 medical institutions nationwide. Electronically extracted data were retrospectively analyzed to calculate the age-, sex-, and area-adjusted anti-HCV prevalence. Seroprevalence in 2015 was measured using the same method as that in 2009. For anti-HCV-positive subjects, medical records were reviewed to see whether HCV RNA testing or antiviral treatment was performed.

Results: Adjusted anti-HCV prevalence was 0.60% (95% confidence interval, 0.57-0.63) based on general Korean population in 2015. It showed an increasing trend according to age; 0.23% in thirties, 0.38% in forties, 0.63% in fifties, 1.08% in sixties, and 1.65% in those aged ≥ 70 years. From 2009 to 2015, the adjusted anti-HCV prevalence decreased by 30%, with odds ratio of 0.70 (95% CI 0.70-0.71). There was significant intranational regional variation and changing pattern of seroprevalence. Among 1359 anti-HCV-positive subjects, HCV RNA test was performed in 60% and 25.4% had positivity. Treatment-initiated and cured rates in 2015 were 18.5% and 10.9%, respectively.

Conclusions: Anti-HCV prevalence in South Korea was 0.6% in 2015, showing a 30% decrease from that in 2009. Although the HCV RNA testing rate was increased since 2009, this remains suboptimal. Moreover, the treatment uptake rate should be improved in South Korea.
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http://dx.doi.org/10.1007/s12072-019-09975-yDOI Listing
September 2019

Epidemiological and Clinical Characteristics of Hepatitis C Virus Infection in South Korea from 2007 to 2017: A Prospective Multicenter Cohort Study.

Gut Liver 2020 03;14(2):207-217

Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

Background/aims: This study aimed to elucidate the epidemiological and clinical characteristics of chronic hepatitis C (CHC) patients in South Korea from 2007 to 2017 and to compare the treatment patterns between two periods before and after the first approval of direct-acting antivirals (DAA) in South Korea in 2015.

Methods: This prospective, multicenter cohort enrolled 2,758 patients with hepatitis C virus (HCV) viremia at seven tertiary centers, and clinical data were prospectively collected with questionnaire surveys focused on lifetime risk factors related to HCV infection.

Results: The HCV patients had a mean age of 57.3 years (50.8% male). Among them, 14.3% showed a positive history of transfusion before HCV screening and 5.6% reported intravenous drug use (IVDU), with significant differences in these risk factors between men and women. The proportions of patients with chronic hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC) were 69.5%, 18.9%, and 11.5%, respectively. The mean alanine aminotransaminase level was within the upper normal limit at 49.9%, and the major genotypes were 1b (48.2%) and 2 (46.4%). The overall treatment rate was 53.8%, showing a rapid transition from interferon-based therapy to DAA therapy. In the post-DAA-approval era, the untreated group was older, had a higher prevalence of HCC, and had less education than the treated group.

Conclusions: More than 90% of CHC patients were over 40 years old, the major genotypes were 1b and 2, and IVDU was observed in less than 6% of CHC patients. Approximately half of the patients underwent antiviral therapy even in the DAA era, showing an unmet need with regard to HCV elimination.
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http://dx.doi.org/10.5009/gnl19005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7096238PMC
March 2020

Comparative Analysis of Eleven Healthcare-Associated Outbreaks of Middle East Respiratory Syndrome Coronavirus (Mers-Cov) from 2015 to 2017.

Sci Rep 2019 05 14;9(1):7385. Epub 2019 May 14.

Formerly Outbreak Investigation Task Force, Centre for Global Health, Institut Pasteur, 75015, Paris, France.

Since its emergence in 2012, 2,260 cases and 803 deaths due to Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported to the World Health Organization. Most cases were due to transmission in healthcare settings, sometimes causing large outbreaks. We analyzed epidemiologic and clinical data of laboratory-confirmed MERS-CoV cases from eleven healthcare-associated outbreaks in the Kingdom of Saudi Arabia and the Republic of Korea between 2015-2017. We quantified key epidemiological differences between outbreaks. Twenty-five percent (n = 105/422) of MERS cases who acquired infection in a hospital setting were healthcare personnel. In multivariate analyses, age ≥65 (OR 4.8, 95%CI: 2.6-8.7) and the presence of underlying comorbidities (OR: 2.7, 95% CI: 1.3-5.7) were associated with increased mortality whereas working as healthcare personnel was protective (OR 0.07, 95% CI: 0.01-0.34). At the start of these outbreaks, the reproduction number ranged from 1.0 to 5.7; it dropped below 1 within 2 to 6 weeks. This study provides a comprehensive characterization of MERS HCA-outbreaks. Our results highlight heterogeneities in the epidemiological profile of healthcare-associated outbreaks. The limitations of our study stress the urgent need for standardized data collection for high-threat respiratory pathogens, such as MERS-CoV.
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http://dx.doi.org/10.1038/s41598-019-43586-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517387PMC
May 2019

Airflow analysis of Pyeongtaek St Mary's Hospital during hospitalization of the first Middle East respiratory syndrome patient in Korea.

R Soc Open Sci 2019 Mar 13;6(3):181164. Epub 2019 Mar 13.

Department of Architectural Engineering, Sejong University, Seoul, South Korea.

Middle East respiratory syndrome (MERS) is known to be transmitted through close contact. However, epidemiological surveys of MERS in Korea indicated that some secondary patients were infected without close contact. Therefore, the possibility of other transmission routes must be identified. In this study, the possibility of MERS spreading through airflow was investigated on the eighth floor of Pyeongtaek St Mary's Hospital. Computational fluid dynamics was used to analyse the indoor airflow and passive tracer diffusion during the index patient's stay. Six cases were simulated for different outdoor wind directions and indoor mechanical ventilation operations. When a passive tracer was released in ward 8104, where the index patient was hospitalized, the passive tracer spread through the indoor airflow, which was created by the outdoor airflow. Ward 8109, which had the largest number of infected cases and was far distant from ward 8104, showed passive tracer concentration in all cases. This result indicates that MERS may have spread through airflow. The study results do not imply that the infection pathway of MERS is airborne. However, the results show the possibility of MERS spreading through airflow in specific environments such as poor ventilation environments.
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http://dx.doi.org/10.1098/rsos.181164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6458380PMC
March 2019

Risk of cervical dysplasia among human papillomavirus-infected women in Korea: a multicenter prospective study.

J Gynecol Oncol 2019 May;30(3):e50

Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.

Objective: Human papillomavirus (HPV) infection is the most important risk factor for cervical cancer, which progresses from precursor lesions with no symptom if left untreated. We compared the risk of cervical dysplasia among HPV-positive Korean women based on HPV types and infection patterns.

Methods: We observed participants of a 5-year multicenter prospective cohort study, comprising HPV-positive women with either atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion of the cervix at their enrollment. Follow-ups, comprising cytology and HPV DNA testing results, were included in the final analysis. Incidence was calculated for each infection pattern (persistent infection, incidental infection, and clearance). To investigate cervical dysplasia risk, we used Cox proportional hazard models adjusted for variables that were significantly different among infection patterns. From April 2010 to September 2017, 71 of 1,027 subjects developed cervical dysplasia more severe than high-grade squamous intraepithelial lesion of the cervix.

Results: Of these 71 subjects, persistent infection, incidental infection, and clearance were noted in 30, 39, and 2 individuals, respectively. Based on changes in DNA results during follow-up, cumulative incidence was 27.2%, 10.4%, and 0.5% for persistent infection, incidental infection, and clearance, respectively. Compared to clearance, the adjusted hazard ratios for cervical dysplasia were 51.6 and 24.1 for persistent and incidental infections, respectively (p<0.001).

Conclusion: Individuals persistently infected with the same HPV types during the follow-up period had the highest risk of severe cervical dysplasia. Hence, it is necessary to monitor HPV types and infection patterns to prevent severe cervical precancerous lesions.
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http://dx.doi.org/10.3802/jgo.2019.30.e50DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6424843PMC
May 2019

Health Indicators Related to Disease, Death, and Reproduction.

J Prev Med Public Health 2019 Jan 23;52(1):14-20. Epub 2019 Jan 23.

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

One of the primary goals of epidemiology is to quantify various aspects of a population's health, illness, and death status and the determinants (or risk factors) thereof by calculating health indicators that measure the magnitudes of various conditions. There has been some confusion regarding health indicators, with discrepancies in usage among organizations such as the World Health Organization the, Centers for Disease Control and Prevention (CDC), and the CDC of other countries, and the usage of the relevant terminology may vary across papers. Therefore, in this review, we would like to propose appropriate terminological definitions for health indicators based on the most commonly used meanings and/or the terms used by official agencies, in order to bring clarity to this area of confusion. We have used appropriate examples to make each health indicator easy for the reader to understand. We have included practical exercises for some health indicators to help readers understand the underlying concepts.
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http://dx.doi.org/10.3961/jpmph.18.250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378386PMC
January 2019

Prevalence of human papillomavirus-related diseases in the Republic of Korea: a cross-sectional study.

Sex Transm Infect 2019 06 24;95(4):292-299. Epub 2019 Jan 24.

Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea

Objective: We aimed to evaluate trends in the prevalence of human papillomavirus (HPV)-related diseases in the era before the introduction of organised HPV vaccination programmes in the Republic of Korea.

Methods: This cross-sectional study used National Health Insurance Service data from 2002 to 2015 and included participants who were diagnosed with the following HPV-related diseases (codes from the International Classification of Diseases, 10th Revision): genital warts (A63.0); cancer in the head and neck (C00-C10), anus (C21), vulva (C51), vagina (C52), cervix uteri (C53) and penis (C60); carcinoma in situ (CIS) of the lip/oral cavity/pharynx (D00.0), anus (D01.3), cervix (D06), vulva (D07.1), vagina (D07.2) and penis (D07.4); benign neoplasms of the larynx (D14.1); and dysplasia of the cervix (N87), vagina (N89) and vulva (N90). For each diagnosis, the fraction of cases attributable to HPV in Korea was assessed based on the percentages of diseases attributable to HPV reported in some international studies. The age-standardised prevalence was estimated using the direct population-based method.

Results: The overall age-standardised prevalence of HPV-related diseases increased from 2002 to 2015, mainly due to increased prevalence of genital warts in men and cervical dysplasia and CIS in women. In women, genital wart prevalence increased from 2002 (24.4 per 100 000) to 2011 (57.1) and then decreased until 2015 (53.5); in men, the prevalence increased steadily from 2002 (22.9) to 2015 (109.4). The prevalence of cervical dysplasia and CIS increased (from 86.5 in 2002 to 484.5 in 2015, and from 60.3 in 2002 to 114.9 in 2015, respectively), but that of cervical cancer decreased (from 120.0 in 2002 to 106.9 in 2015).

Conclusions: Non-organised HPV vaccination and organised cervical cancer screening may have contributed to the downward trend in genital wart prevalence and the upward trend in cervical abnormalities among women.
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http://dx.doi.org/10.1136/sextrans-2018-053742DOI Listing
June 2019

Airflow as a Possible Transmission Route of Middle East Respiratory Syndrome at an Initial Outbreak Hospital in Korea.

Int J Environ Res Public Health 2018 12 6;15(12). Epub 2018 Dec 6.

Department of HVAC & Firefighting Engineering, Gachon University, Seongnam 13120, Korea.

In this study, the results of an airflow investigation conducted on 7 June 2015 as part of a series of epidemiologic investigations at Pyeongtaek St. Mary's Hospital, South Korea, were investigated. The study involved 38 individuals who were infected directly and indirectly with Middle East Respiratory Syndrome (MERS), by a super-spreader patient. Tracer gas experiments conducted on the eighth floor, where the initial patient was hospitalized, confirmed that the tracer gas spread to adjacent patient rooms and rooms across corridors. In particular, the experiment with an external wind direction and speed similar to those during the hospitalization of the initial patient revealed that the air change rate was 17⁻20 air changes per hour (ACH), with air introduced through the window in the room of the infected patient (room 8104). The tracer gas concentration of room 8110, which was the farthest room, was 7.56% of room 8104, indicating that a high concentration of gas has spread from room 8104 to rooms across the corridor. In contrast, the tracer gas was barely detected in a maternity ward to the south of room 8104, where there was no secondary infected patient. Moreover, MERS is known to spread mainly by droplets through close contact, but long-distance dispersion is probable in certain environments, such as that of a super-spreader patient hospitalized in a room without ventilation, hospitals with a central corridor type, and indoor airflow dispersion due to external wind.
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http://dx.doi.org/10.3390/ijerph15122757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313554PMC
December 2018

Risk factors for cytological progression in HPV 16 infected women with ASC-US or LSIL: The Korean HPV cohort.

Obstet Gynecol Sci 2018 Nov 15;61(6):662-668. Epub 2018 Oct 15.

Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, College of Medicine, Dankook University, Seoul, Korea.

Objective: This study was to identify the risk factors for cytological progression in women with atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL).

Methods: We analyzed data from women infected with the human papillomavirus (HPV) who participated in the Korean HPV cohort study. The cohort recruited women aged 20-60 years with abnormal cervical cytology (ASC-US or LSIL) from April 2010. All women were followed-up at every 6-month intervals with cervical cytology and HPV DNA testing.

Results: Of the 1,158 women included, 654 (56.5%) and 504 (43.5%) women showed ASC-US and LSIL, respectively. At the time of enrollment, 143 women tested positive for HPV 16 (85 single and 58 multiple infections). Cervical cytology performed in the HPV 16-positive women showed progression in 27%, no change in 23%, and regression in 50% of the women at the six-month follow-up. The progression rate associated with HPV 16 infection was higher than that with infection caused by other HPV types (relative risk [RR], 1.75; 95% confidence interval [CI], 1.08-2.84; =0.028). The cytological progression rate in women with persistent HPV 16 infection was higher than that in women with incidental or cleared infections (<0.001). Logistic regression analysis showed a significant relationship between cigarette smoking and cytological progression (RR, 4.15; 95% CI, 1.01-17.00).

Conclusion: The cytological progression rate in HPV 16-positive women with ASC-US or LSIL is higher than that in women infected with other HPV types. Additionally, cigarette smoking may play a role in cytological progression.
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http://dx.doi.org/10.5468/ogs.2018.61.6.662DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236089PMC
November 2018

Cost-effectiveness of sofosbuvir plus ribavirin therapy for hepatitis C virus genotype 2 infection in South Korea.

J Gastroenterol Hepatol 2019 Apr 25;34(4):776-783. Epub 2018 Dec 25.

Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea.

Background And Aim: For genotype 2 chronic hepatitis C (CHC), the efficacy and safety of sofosbuvir plus ribavirin therapy (SOF + RBV) was better than pegylated interferon plus ribavirin therapy (PR) at a greater drug cost. This study investigated the cost-effectiveness of SOF + RBV compared with PR for treatment-naïve genotype 2 CHC in South Korea.

Methods: Using a decision analytic Markov model, a cost-effectiveness analysis comparing SOF + RBV with PR or no treatment for treatment-naïve genotype 2 CHC was performed with probabilistic and deterministic sensitivity analyses from the payer's perspective in 2017. Three cohorts of patients aged 40-49, 50-59, and 60-69 years were simulated to progress through the fibrosis stages F0-F4 to end-stage liver disease, hepatocellular carcinoma, or death. Published and calculated data on the clinical efficacy of the regimen, health-related quality of life, costs, and transition probabilities were used.

Results: While the incremental cost-effectiveness ratio for PR was dominant over no treatment, the incremental cost-effectiveness ratios for SOF + RBV were $20 058 for the patients in their 40s, $19 662 for those in their 50s, and $22 278 for those in their 60s compared with PR. Probabilistic sensitivity analysis indicated an 89.0% probability for the SOF + RBV to be cost-effective at a willingness to pay of $29 754.4 (per-capita gross domestic product in 2017) for the patients in their 40s and 94.1% and 89.1% for the patients in their 50s and 60s, respectively.

Conclusions: The SOF + RBV is a cost-effective option for genotype 2 treatment-naïve CHC patients, especially for the patients with liver cirrhosis in Korea.
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http://dx.doi.org/10.1111/jgh.14554DOI Listing
April 2019

Socioeconomic Inequalities in Colorectal Cancer Screening in Korea, 2005-2015: After the Introduction of the National Cancer Screening Program.

Yonsei Med J 2018 Nov;59(9):1034-1040

Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.

Purpose: This study aimed to investigate inequalities in colorectal cancer (CRC) screening rates in Korea and trends therein using the slope index of inequality (SII) and relative index of inequality (RII) across income and education groups.

Materials And Methods: Data from the Korean National Cancer Screening Survey, an annually conducted, nationwide cross-sectional survey, were utilized. A total of 17174 men and women aged 50 to 74 years were included for analysis. Prior experience with CRC screening was defined as having either a fecal occult blood test within the past year or a lifetime colonoscopy. CRC screening rates and annual percentage changes (APCs) were evaluated. Then, SII and RII were calculated to assess inequality in CRC screening for each survey year.

Results: CRC screening rates increased from 23.4% in 2005 to 50.9% in 2015 (APC, 7.8%; 95% CI, 6.0 to 9.6). Upward trends in CRC screening rates were observed for all age, education, and household income groups. Education inequalities were noted in 2009, 2014, and overall pooled estimates in both indices. Income inequalities were inconsistent among survey years, and overall estimates did not reach statistical significance.

Conclusion: Education inequalities in CRC screening among men and women aged 50 to 74 years were observed in Korea. No apparent pattern, however, was found for income inequalities. Further studies are needed to thoroughly outline socio-economic inequalities in CRC screening.
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http://dx.doi.org/10.3349/ymj.2018.59.9.1034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6192887PMC
November 2018
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