• Korean Journal of Health Education and Promotion
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• v.32 no.3
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• pp.1-9
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• 2015

Objectives: The purpose of this article was to assess epidemiological characteristics and recommendations for strengthening national response and preparedness after MERS-CoV outbreak in Korea, 2015. Methods: The author reviewed epidemiological reports and policy recommendations on MERS-CoV outbreak in Korea, 2015. Results: There was no evidence that genetical difference between the MERS viruses in the Republic of Korea and recent viruses in the Middle East. From the index case to last laboratory-confirmed case, there were 186 laboratory-confirmed cases that included 36 deaths(19.4%), all of whom appear epidemiologically linked to the index cases or subsequent secondary, tertiary, and quaternary cases. This outbreak spread to hospitals through nosocomial transmission. At least, three large clusters were investigated. However, there was at least one case of community transmission of MERS-CoV. Several factors had contributed to the MERS outbreak in Korea, 2015 that including epidemiological characteristics, and infrastructure of national healthcare system for preventing and controlling emerging infectious diseases. Conclusions: It is very important that to share experiences and identify underlying causes of this outbreak for prevention and control of emerging infectious disease in the future; including epidemiology, clinical features, and public health response and preparedness.

• Korean Security Journal
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• no.52
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• pp.145-162
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• 2017

In 2005, the Republic of Korea suffered from the outbreak of MERS(Middle East respiratory syndrome), leaving 186 infectees and 38 casualties. Responding to this crisis, Korean government revealed many problems in emergency management policies and was widely criticized. A similar case in emergency management and infectious disease control is the 1999 outbreak of West Nile Virus(WNV) outbreak in the United States. During this period, the state of Oregon effectively responded to WNV through collaboration between state and local government, being considered as a model case of emergency management. This article aims to find insights in emergency management and infectious disease control by analyzing and comparing the responses of Korean MERS outbreak and Oregon's WNV outbreak focusing on interorganizational collaboration. Insights found in this study include the role of control tower, the importance of information sharing and disclosure, the role of existing systems and social networks, and sustainable intergovernmental collaboration.

• Korean Journal of Veterinary Research
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• v.37 no.4
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• pp.809-816
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• 1997

In this presented study, we established a method for diagnosis of porcine epidemic diarrhea(PED) by in situ hybridization(ISH), which made distinct progress in diagnostic pathology. We also carried out the retrospective diagnosis through ISH to assume the exact time of the first outbreak and incidence of PED in Korea. The outbreak of PED in Korea reported in 1992. However, since the end of 1980's, some researches of pig-industry have already suspected the outbreak of PED, not transmissible gastroenteritis(TGE). In this experiment, we performed the ISH using 80 formalin-fixed and paraffin-embedded tissues of porcine intestine which were requests for pathological diagnosis from 63 farms whose primary sign was diarrhea from 1984 to 1991. We prepared biotinylated cDNA probe(492base pairs) for ISH by nick translation method and carried out the ISH, using $Microprobe^{TM}$ capillary action system(Fisher $Biotech^R$). We detected PED virus in intestinal mucosa of 2 cases in 1992, 1 case in 1988, and 1 case in 1987. As a result, we assume that the outbreak of PED in Korea have already started since 1987.

• Journal of Preventive Medicine and Public Health
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• v.41 no.3
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• pp.153-158
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• 2008

Objectives : This study describes a plan that was designed to prevent a measles outbreak that showed a changed outbreak pattern. This study is based on the epidemiological investigation of a measles outbreak in a preschool in Incheon, Korea, 2006. Methods : The subjects were 152 students at a preschool where a measles outbreak occurred. A questionnaire survey was conducted and serological testing for measles-specific IgM was preformed. Results : Of the fifteen confirmed, identified cases, eleven patients had been vaccinated with one dose, one patient had received two doses and three patients were unvaccinated. The three unvaccinated cases consisted of one 5-year-old child, one 3-year-old child and one 16-month-old infant. For the cases with one dose of the vaccination, there were 11 cases, which consisted of six 5-year-old children, two 4-year-old children, two 3-year-old children and one 2-year-old child. The case with two doses of the vaccination was one 4-year-old child. The attack rate of measles was 100% in the 0-dose group, 11.2% in the 1-dose group and 2.0% in the 2-dose group. The vaccine's efficacy was 88.8% in the 1-dose group and 98.0% in the 2-dose group. The vaccine effectiveness for the 2-dose group was higher than that of the 1-dose group. Conclusions : High coverage with a 2-dose vaccination should be maintained, and the vaccination should be given at the suitable time to prevent a measles outbreak with a changed outbreak pattern.

• Journal of Food Hygiene and Safety
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• v.26 no.3
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• pp.248-253
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• 2011

KFDA compiles the statistical data of food poisoning outbreaks two or more persons since 2002 in Korea and release them to the public on the web. There is a gap of outbreak number between the real situation and the reports. To reduce the gap, addition of sporadic individual case of food poisoning may be one of the solution method. The statistical data of Japan where food consumption pattern is similar to Korea, were used in this study to compare the ratio and the pattern between the outbreak cases two or more persons and individual cases. By doing so, the data of Japan regarding to outbreak cases two or more persons will be comparable to that of Korea. The data of 2002 and 2003 in Japan showed that sporadic individual cases were 43.3% in the total food poisoning cases. The individual cases occurred highly in unknown places (90-92.3%) and home (6.2-8.5%) whileas the outbreaks two or more persons occurred mostly in the place of restaurants (46.6-50.l%) and inns (9.2-9.8%). The food-borne pathogens attributed to the individual cases were C. jejuni (51.9%), Salmonella spp. (35.3%), and V. parahaemolyticus (9.8%) while those to the outbreak cases two or more persons were norovirus (31.3%), Salmonella spp. (20.8%), C. jejuni (15.5%) in Japan. The data of 2002-2009 between Korea and Japan showed the outbreak case report rate was 1:1.5 based on the total population number.

• Korea Journal of Hospital Management
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• v.22 no.3
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• pp.144-156
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• 2017

Purpose: Crisis is inevitable to every organization and therefore, successful crisis management is critical to the organizations' survival and prosperity. With the understanding, this study aims to draw propositions for successful crisis management of hospitals when facing infectious disease outbreak. For the purpose, a case of a small and medium sized hospital's experience of crisis management during 2015 Middle East Respiratory Syndrome outbreak was analyzed. Methodology/Approach: The detailed internal circumstances and experiences of the hospital during the MERS outbreak were identified by in-depth interview as well as the extensive material review, and analyzed under the view of the theories of accident, error, and crisis in relation of organization management Findings: Overall, nine propositions are drawn by the phase of crisis. In pre-crisis phase, for example, 'the hospital preparedness has positive influence on the effective responding to the crisis'. In detection phase, 'the mindfulness of the hospital organizations' as well as the individuals' has positive influence on detecting the crisis signals'. In crisis phase, for example, 'improvising naturally occurs in crisis by the unknown disease, therefore, a component site supervisor coordinating such improvision is important'. Lastly, in post-crisis phase, 'successful crisis responding experience facilitates the positive hospital culture'. Practical implication: From the experience of a small and medium size hospital, it is suggested that proactive system approach oriented by safety is beneficial for effective crisis management.

• Journal of Preventive Medicine and Public Health
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• v.46 no.2
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• pp.62-73
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• 2013

Objectives: An outbreak of hepatitis A occurred at a residential facility for the disabled in July 10, 2011. This investigation was carried out to develop a response plan, and to find the infection source of the disease. Methods: A field epidemiologist investigated the symptoms, vaccination histories, living environments, and probable infection sources with 51 residents and 31 teachers and staff members. In July 25, 81 subjects were tested for the hepatitis A virus antibody, and specimens of the initial 3 cases and the last case were genetically tested. Results: Three cases occurred July 10 to 14, twelve cases August 3 to 9, and the last case on August 29. Among the teachers and staff, no one was IgM positive (on July 25). The base sequences of the initial 3 and of the last case were identical. The vehicle of the outbreak was believed to be a single person. The initial 3 patients were exposed at the same time and they might have disseminated the infection among the patients who developed symptoms in early August, and the last patient might have, in turn, been infected by the early August cases. Conclusions: The initial source of infection is not clear, but volunteers could freely come into contact with residents, and an infected volunteer might have been the common infection source of the initial patients. Volunteers' washing their hands only after their activity might be the cause of this outbreak. Although there may be other possible causes, it would be reasonable to ask volunteers to wash their hands both before and after their activities.

• Journal of Preventive Medicine and Public Health
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• v.42 no.6
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• pp.408-415
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• 2009

Objectives : This study was performed to investigate the mumps transmission control status and inapparent infection rate among middle and high school students in Daegu City during a mumps outbreak. Methods : Nine schools (two middle schools and seven high schools), which reported a number of mumps cases between 2007 and 2008 were selected for investigation. During March-May 2008, a standard questionnaire was distributed to gather information about case identification, instructed isolation measure, isolation status of mumps cases and related factors, and outdoor activities of nonisolated mumps case. Inapparent infection rate was estimated by serum mumps IgM and IgG antibodies status and self-reported mumps symptoms in three of the nine schools. Results : Among 2,560 respondents, more than half of students answered that they did not receive instructions in mumps transmission control measures during the outbreak. Among the 327 mumps cases identified by the questionnaire, 131 cases (40.1%) were considered as isolated and the isolation rates were significantly different among schools, grades, and gender. Of the non-isolated cases, 88.3% continued attending school. Inapparent mumps infection rates were between 56.3% and 70.2%. Conclusions : Mumps transmission control was inadequate to control the mumps outbreak. Although high inapparent infection rate would mitigate the transmission control effect of case isolation, this measure is fundamental for infection control. The reasons of this inadequate status need to be explored to develop an effective intervention strategy.

• Journal of Yeungnam Medical Science
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• v.34 no.2
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• pp.222-230
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• 2017

Background: Varicella is the most common infectious disease reported despite the high vaccination rate. Interventions that target humans are particularly effective for varicella because humans are its only natural host. On the other hand, the existing national varicella surveillance systems lack the information to identify an outbreak. Therefore, a new index to assess varicella outbreaks was developed. Methods: The residential addresses of 2,718 varicella cases reported in Daegu in 2016 were converted to geographic coordinates and the distances between new varicella case and previous cases within 21 days were calculated from the date analyzed. Two cases were considered to be adjacent if the distance between them was less than 1 km. Finally, a proximity index was introduced by dividing the number of adjacent cases by the number of new cases on the date analyzed. Results: First, time-series charts and scatter plots were used to verify that the proximity index reflected the spatial closeness of the different varicella cases. The proximity index is helpful in identifying outbreaks from a list of single varicella cases. In addition, in this study, a new epidemic characteristic of varicella based on the proximity index was shown. Conclusion: The proximity index introduced in this study can be used to determine the likelihood of an outbreak from a single case of varicella, and it can be embedded in a web-based national varicella surveillance system that is currently in operation.

• Pediatric Infection and Vaccine
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• v.22 no.3
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• pp.131-135
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• 2015

Since April 2012, more than 1,600 laboratory-confirmed human infections with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) have been reported, occurring primarily in countries in the Arabian Peninsula; the majority in Saudi Arabia. The MERS outbreak in Korea, which began in May 2015 through the importation of a single case who had recently traveled to Bahrain, the United Arab Emirates, Saudi Arabia, and Qatar. As of November 28th, 186 secondary and tertiary cases had been reported; 38 deaths, mainly associated with underlying chronic illnesses, were reported. One case was exported to China and has been recorded as the first MERS case in China. Thirty-seven confirmed cases were associated with the index case, who was hospitalized from May 15 to May 17. Emergency room at one of the nation's largest hospitals had been affected by hospital-to-hospital and intra-hospital transmissions of MERS-CoV, resulting in an outbreak of 90 infected patients. The vast majority of 186 confirmed cases are linked to a single transmission chain associated with health facilities. The median age of patients is 55 years, with a range of 16 to 87 years. The majority (61%) of patients are men. Twenty-five (14%) of the cases involve healthcare workers. The overall median incubation period was six days, but it was four days for secondary cases and six days for tertiary cases. There has been no evidence of airborne transmission and sustained human-to-human transmission in communities. Intensified public health measures, including contact tracing, quarantine and isolation of all contacts and suspected cases, and infection prevention and control have brought the MERS-CoV under control in Korea. Since 4 July no new cases have been reported.