• Asian Pacific Journal of Cancer Prevention
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• v.14 no.11
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• pp.6955-6959
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• 2013

The incidence of hepatocellular carcinoma (HCC) is relatively high in Southeast Asia. Globally, HCC has a high fatality rate and short survival. The objectives of this retrospective cohort study were to review the epidemiology and survival of HCC patients at a tertiary centre in north-east of Peninsular Malaysia. Subjects were adult HCC patients diagnosed by histopathology or radio-imaging. Secondary liver carcinoma was excluded. Kaplan Meier and multiple Cox proportional hazard survival analyses were used. Only 210 HCC cases from years 1987-2008, were included in the final analysis. The number of cases was increasing annually. The mean age was 55.0 (SD 13.9) years with male:female ratio of 3.7:1. Approximately 57.6% had positive hepatitis B virus, 2.4% hepatitis C virus, 20% liver cirrhosis and 8.1% chronic liver disease. Only 2.9% had family history and 9.0% had frequently consumed alcohol. Most patients presented with abdominal pain or discomfort and had hepatomegaly, 47.9% had an elevated ${\alpha}$-fetoprotein level of 800 IU/ml or more, 51.9% had multiple tumors and 44.8% involved multiple liver lobes. Approximately 63.3% were in stage 3 and 23.4% in stage 4, and 82.9% did not receive any treatment. The overall median survival time was 1.9 months (95% confidence interval (CI): 1.5, 2.3). The 1-month, 6-month, 1-year and 2-year survival rates were 71.8%, 23.3%, 13.0% and 7.3% respectively. Significant prognostic factors were Malay ethnicity [Adjusted hazard ratio (AHR) 1.6; 95%CI: 1.0, 2.5; p=0.030], no chemotherapy [AHR 1.7; 95%CI: 1.1, 2.5; p=0.017] and Child-Pugh class C [AHR 2.6; 95%CI: 1.4, 4.9; p=0.002]. HCC in our study affected a wide age range, mostly male, in advanced stage of disease, with no treatment and very low survival rates. Primary prevention should be advocated in view of late presentation and difficulty of treatment. Vaccination of hepatitis virus and avoidance of liver toxins are to be encouraged.

• Pediatric Infection and Vaccine
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• v.15 no.1
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• pp.5-11
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• 2008

Primary rotavirus gastroenteritis infection usually occurs in infants under 2 years of age worldwide regardless of level of hygiene, quality of water, food or sanitation or type of behavior. In Korea, the disease mostly occurred in infants under 2 year old, and usually in late fall to early winter with the highest incidence shown in November until early 1990s. However, since then, relatively the age incidence of this infection has increased in children over 2 years old, and it has mainly occurred in late winter to early spring with the highest incidence shown between February and March. And rotavirus gastroenteritis serotypes varied year to year as well as varied by year within the same region in our country. The comparison of severity scores between age groups in Korea showed that severity score was lowest in infants less than 3 months and highest in infants more than 6 months and less than 12 months, and hospitalization period between age groups was longest in infants older than 3 months and less than 3 months and highest in infants more than 6 months and less than 12 months and less than 6 months. In this aspect, rotavirus vaccines should be given to infants less than 2 years of age in whom the incidence of rotavirus gastroenteritis is the highest, and vaccination should be ideally started before 3 months considering hospitalization period and severity of rotavirus gastroenteritis. However, It should be careful for the introduction of new rotavirus vaccine, and the effectiveness of rotavirus vaccines should be assessed by long-term post marketing surveillance. And we guess an multivalent vaccine may be an ideal rotavirus vaccine to prevent primary infection caused by variable rotavirus strains in Korea. In addition, clinical epidemiology studies on rotavirus gastroenteritis which evaluate the age and serotypes related severity should be continuously conducted in various regions.

• Proceedings of the Microbiological Society of Korea Conference
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• 2000.10a
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• pp.78-82
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• 2000

The AIDS epidemic continues unabated in many part of the world. After near two decades, no vaccine is available to combat the spread of this deadly disease. Much of the HIV -1 vaccine effort during the past decade has focused on the viral envelope glycoprotein, largely because it is the only protein that can elicit neutralizing antibodies (Nabs). Eliciting broadly cross-reactive Nabs has been a primary goal. The intrinsic genetic diversity of the viral envelope, however, has been one of the major impediments in vaccine development. We have recently completed a comprehensive study examining whether it is possible to elicit broadly acting Nabs by immunizing monkeys with mixtures of envelope proteins from multiple HIV -1 isolates. We compared the humoral immune responses elicited by vaccination with either single or multiple envelope proteins and evaluated the importance of humoral and non-humoral immune response in protection against a challenge virus with a homologous or heterologous envelope protein. Our results show that (1) Nab is the correlate of sterilizing immunity, (2) Nabs against primary HIV -1 isolates can be elicited by the live vector-prime/protein boost approach, and (3) polyvalent envelope vaccines elicit broader Nab response than monovalent vaccines. Nonetheless, our findings clearly indicate that the increased breadth of Nab response is by and large limited to strains included in the vaccine mixture and does not extend to heterologous non-vaccine strains. Our study strongly demonstrates how difficult it may be to elicit broadly reactive Nabs using envelope proteins and sadly predicts a similar fate for many of the vaccine candidates currently being evaluated in clinical trials. We have started to evaluate other vaccine candidates (e.g. genetically modified envelope proteins) that might elicit broadly reactive Nabs. We are also exploring other vaccine strategies to elicit potent cytotoxic T lymphocyte responses. Preliminary results from some of these experiments will be discussed.

• Journal of the Korean Arthroscopy Society
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• v.12 no.2
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• pp.129-133
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• 2008

Although the incidence of tuberculosis has been decreased due to new anti-tuberculous agents, improved socioeconomic status and development of multimodal preventive methods, in recent that is increased due to low vaccination rate and appearance of multidrug resistence organism. And the incidence of pyogenic shoulder joint arthritis is increasing due to frequent injection therapy as primary treatment. We have managed the mixed shoulder joint arthritis-pyogenic and tuberculous-with arthroscopic debridement and antituberculous medication successfully and then we report this case with relevant literatures.

• Pediatric Infection and Vaccine
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• v.15 no.2
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• pp.108-114
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• 2008

Japanese encephalitis is the leading cause of viral encephalitis in Asia, where it accounts for up to 50,000 cases. Approximately 20% of affected patients die, and 30-50% of survivors have significant neurological sequelae. Inactivated mouse-brain derived Japanese encephalitis vaccines has been effectively implemented to control the disease effectively in Korea and several other Asian countries. However, the vaccine is expensive and difficult to produce, requires multiple doses, and has been associated with hypersensitivity reactions and rare adverse neurologicale events. The live-attenuated SA14-14-2 vaccine derived from primary hamster kidney (PHK) cells was developed in China and has been used there since 1988. Outside China, it has been licensed and used in Korea and several other Asian countries. This vaccine is effective and inexpensive. However, the lack of precedence for using a PHK cell substrate in a live-attenuated vaccine is a special issue of concern. The WHO working group has recommended additional safety studies in selected high-risk groups, as well as ongoing post-marketing studies to ensure long-term safety. Recently, a new inactivated vaccine and live-attenuated chimeric vaccine have been developed from vero cells. With this background, this article summarized the current status of Japanese encephalitis vaccination worldwide and in Korea.

• Proceedings of the Korea Society of Poultry Science Conference
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• 2000.11a
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• pp.66-69
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• 2000

To investigate the influence of feeding Enviro on noxious gas of environmental controlled poultry house and performance of broiler chicks. Diets contained 21.5, 19.00 CP and 3,100, 3,200 kcal/kg ME, respectively for starting and finishing period. Enviro were supplemented with 0, 0.2, 0.4, 0.6 and 0, 0.1, 0.2, 0.3% in Expt 1and 2, respectively. CO$_2$and ammonia gas were periodically detected for finishing period in Expt 1. Weight gain, feed intake and feed conversion(FC) were measured for five weeks in Expt. 2. ND antibody titer were also measured after primary and booster vaccination at two and four weeks old. In Expt 1, chicks fed 0.2% Enviro showed 32.8ppm and 1719 ppm of ammonia gas, CO$_2$in poultry house and significantly decrease compared to that of control(P<0.05). Weight gain of chicks fed 0.1 and 0.2% Enviro was significantly increased for starting period(P<0.05) but was not statistically different for finishing period. Feed intake was no significantly different of all treatments. Chicks showed lower FC in 0.3% Enviro treatment for starting period(P<0.05) than others, but was not for finishing period. ND AB titet of chicks fed Enviro was prone to be higher than control, but was not significantly different. The results of these experiments indicated that 0.1% Enviro supplement would be maximize the performance of broiler chicks.

• Health Policy and Management
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• v.9 no.4
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• pp.87-119
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• 1999

The main purpose of this research is to measure and analyze how productive the health centers are and how much inputs(or outputs) in the inefficient health centers should be decreased(or increased) for efficiency. The evaluation of the performance of health centers gives a strong incentive to improve resource allocation in regional health planning. It has been, however, implemented very rarely until now. In this regard, this paper measures the performance of the health centers with a single indicator for multiple-outputs in terms of productivity(technical efficiency), based on Data Envelopment method. The 20 Kyungnam health centers which provide clinic services and specific primary health care services were analyzed. The results show that 50.0% of 20 health centers were productive with respective to overall technical efficiency, 65.0% were productive for pure technical efficiency, and 50.0% for scale efficiency. The inefficient group includes Geoje, Mahsan, Miryang, Sahchun, Tongyoung, Gosung, Nahmhae, Euryang, Hahmahn, Hahbchun health centers. The worst case was identified as Tongyoung health center which represented a 47.5% efficiency, compared with productive health centers. The empirical results for input-output analysis indicates that the low-productive health centers have excessive manpower in administration department, producing low outputs in clinical services and vaccination program. These findings imply that a systemic evaluation of the performance of the Korean health centers and the subsequent structural reform are strongly required.

• Clinical and Experimental Pediatrics
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• v.49 no.8
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• pp.864-869
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• 2006

Purpose : We evaluated the immunogenicity and safety of eIPV(Imovax $Polio^{(R)}$) in a group of healthy Korean infants on a three-dose primary vaccination. Methods : Eighty one healthy infants aged 8-10 weeks were enrolled, and 79(male 42, female 37) completed the study. Three doses of eIPV were injected intramuscularly at 2, 4 and 6 months of age as of primary vaccination. Most subjects received concomitant vaccines such as DTaP and/or Hib at 2, 4, and 6 months of age. Immediate reactions were monitored for 30 minutes after each injection. Local and systemic events were recorded for 72 hours following each immunization by parents/guardians. Poliovirus specific neutralizing antibodies were measured using enzyme immuno-assay (EIA) at prior to and 1 month after the third dose. An antibody titer of 1:8 or higher was considered seroprotective. Geometric mean titers(GMTs) to each poliovirus type antigen were also measured. Results : One month after the third dose of eIPV, all infants(100 percent) were seroprotective. The geometric mean titers(GMTs) were 1,532(95 percent CI : 1,312-1,788) in type 1 and 835(95 percent CI : 684-1,018) in type 2 and 846(95 percent CI : 692-1,035) in type 3. Overall, local reactions were observed in 10 percent of infants and systemic reactions in 26.2 percent of infants. All reactions were observed within 3 days after vaccination and resolved without treatment. Conclusion : eIPV(Imovax $Polio^{(R)}$) is a well-tolerated and highly immunogenic vaccine. It can be administered either alone or simultaneously with other routine vaccines to Korean infants.

• Journal of agricultural medicine and community health
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• v.37 no.4
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• pp.233-245
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• 2012

Objectives: Understanding the predictor of immunization status in childhood is critical issue to improve National Immunization Program (NIP). The aims of this study were to verify the status of up-to-date or complete immunization coverage and to investigate its related factors. Methods: As of 2005, according to local residence registry data, there were 2,188 children who aged 12 to 35 months in Nonsan city, Korea. We conducted household survey for aged 12 to 35 months children, using questionnaires to obtain data on the status of immunization such as BCG, DTaP (diphtheria, tetanus, and pertussis), Polio, and MMR (mump, measles, rubella). Finally 1,472 participated in the survey. The operating definitions used in this study were following; "Complete immunization rate" refers to the rate of children who received all immunization within recommended age intervals fully "on-time"; "The 4:3:1 series" means status of receiving the fourth diphtheria-tetanus-pertussis (4 DTP), the third Polio (3 Polio), and the first measles-mumps-rubella (1 MMR) doses. Multivariate logistic regression analyses were used to determine factors affecting complete vaccination coverage of children. Results: Immunization rates of vaccine based on the vaccination card were from 92.7% to 96.4% except 4th DTaP (79.3%). Complete immunization rate of Korea NIP was 74.0% and that of the 4:3:1 series was 77.1%. A parent as primary caregiver (OR 0.59, 95% CI 0.39-0.87 at 19-35 months of children's age) and first-born children (OR 1.79, 95% CI 1.05-3.03 at 24-35 months of children's age) were significantly related to complete immunization coverage of Korea NIP. And a parent as primary care giver (OR 0.58, 95% CI 0.38-0.88 at 19-35 months of children's age) and first-born children (OR 1.94, 95% CI 1.21-3.14 at 19-35 months, OR 2.23, 95% CI 1.27-3.91 at 24-35 months of children's age) were significantly related to complete immunization rate of 4:3:1 series. Conclusions: Government should take actions to increase complete immunization rate. In particular, intervention on the secondary caregiver and non-first-born children should be needed.

• Clinical and Experimental Pediatrics
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• v.45 no.8
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• pp.980-986
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• 2002

Purpose : Although the number of patients with measles have dramatically decreased since the introduction of measles vaccines in 1965, measles outbreaks have occurred periodically every 4-6 years during the 1990s(1989-1990 and 1993-1994). During 2000-2001, measles prevailed all over the country again. A characteristic of current epidemics is that the majority of affected population was infants and school-aged children. This study was designed to analyze the epidemic and clinical features of measles prevalence during 2000-2001 and to find ways to overcome vaccination failure. Methods : We reviewed the records of 59 patients with mealses admitted in the Pediatric Department of Pusan National University Hospital from January 2000 to October 2001 for patient's age, month of admission, history of vaccination, clinical features and complications. Antibody titers of measles-specific IgM and IgG were measured by enzyme immunoassay. Results : The epidemic show two peaks in the age distribution. Forty three patients(72.9%) were under 2-years of age and 14 patients(23.7%) were over 5-years of age. Outbreaks had high incidence in July to August, 2000 and March to April, 2001, then faded away after July, 2001. Vaccinated group comprised 30.5% and unvaccinated group comprised 69.5% and their mean age was $9.25{\pm}4.27$ years old and $0.95{\pm}0.30$ years old respectively. Positive rate of IgM was 86.7% in vaccinated group and 90.3% in unvaccinated group. This means there was primary vaccine failure; 13 cases of 15 vaccinated patients were positive in IgM antibody. During the prevalence, two patients died with mealses complication. One of them was immunocompromised. Conclusion : To prevent another prevalence of measles in the future, we must enhance revaccination at ages 4-6 and check vaccination status when children enter elementary school. These will produce over 95% of herd immunity, with catch-up MMR vaccination which has been completed already.