Journal of Preventive Medicine and Public Health

Original Article

Associations Between Indoor Air Pollutants and Risk Factors for Acute Respiratory Infection Symptoms in Children Under 5: An Analysis of Data From the Indonesia Demographic Health Survey: Ichtiarini Nurullita Santri, Yuniar Wardani, Yohane Vincent Abero Phiri, Gunchmaa Nyam, Tyas Aisyah Putri, Khoiriyah Isni, Dyah Suryani, Grace Sambo; J Prev Med Public Health. 2023;56(3):255-263. Published online April 18, 2023; DOI: https://doi.org/10.3961/jpmph.22.470

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Abstract PDF: Objectives
The study investigated the association between indoor air pollution (IAP) and risk factors for acute respiratory infection (ARI) symptoms in children under 5 years of age.
Methods
A cross-sectional study was conducted using data derived from Indonesia Demographic and Health Survey in 2017. Binary logistic regression modeling was employed to examine each predictor variable associated with ARI among children under 5 years of age in Indonesia.
Results
The study included a total of 4936 households with children. Among children under 5 years old, 7.2% reported ARI symptoms. The presence of ARI symptoms was significantly associated with the type of residence, wealth index, and father’s smoking frequency, which were considered the sample’s socio-demographic characteristics. In the final model, living in rural areas, having a high wealth index, the father’s smoking frequency, and a low education level were all linked to ARI symptoms.
Conclusions
The results revealed that households in rural areas had a substantially higher level of reported ARI symptoms among children under 5 years old. Furthermore, the father’s smoking frequency and low education level were associated with ARI symptoms.; Summary

COVID-19: Perspective

Characteristics of the COVID-19 Outbreak in Korea From the Mass Infection Perspective: Yun Jung Kang; J Prev Med Public Health. 2020;53(3):168-170. Published online March 19, 2020; DOI: https://doi.org/10.3961/jpmph.20.072

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On December 31, 2019, the Chinese government officially announced that the country had some cases of pneumonia with an unknown cause. By February 8, 2020, there were 24 confirmed cases in Korea, and the number of cases has steadily increased since then. On March 9, 2020, the cumulative number of confirmed cases in Korea was 7382, with 51 deaths. This study examines the characteristics of the coronavirus disease 2019 (COVID-19) outbreak from the perspective of the large-scale number of confirmed COVID-19 cases and deaths. This study is significant in that it emphasizes the precautionary principle in preventing and managing infectious diseases, and makes suggestions for urgently needed public health policies.

Summary

Citations

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Outbreaks of COVID-19 in indoor places of worship: a systematic review
F Bert, G Lo Moro, A Peano, C Previti, R Siliquini
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Super-spreaders of novel coronaviruses that cause SARS, MERS and COVID-19: a systematic review
Julii Brainard, Natalia R. Jones, Florence C.D. Harrison, Charlotte C. Hammer, Iain R. Lake
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Cho Ryok Kang, Sae Kyung Joo, Ho Jun Kim, Yoojin Park, In Sil Huh, Young Sin Moon, Kwang Hwan Oh, Hyon Jeen Ham, Jin Kyeong Han, Jung Il Kim, Jin Yong Lee, Baeg Ju Na
Public Health Affairs.2020; 4(1): e6. CrossRef

Original Articles

Development of a Social Contact Survey Instrument Relevant to the Spread of Infectious Disease and Its Application in a Pilot Study Among Korean Adults: Hyang Soon Oh, Youngran Yang, Mikyung Ryu; J Prev Med Public Health. 2020;53(2):106-116. Published online February 9, 2020; DOI: https://doi.org/10.3961/jpmph.19.251

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Abstract Summary PDF Supplementary Material

Objectives
This study aimed to develop a valid social contact survey instrument and to verify its feasibility for use among Korean adults.
Methods
The Delphi technique was used to develop an instrument to assess social contacts, which was then applied in a cross-sectional pilot study. A panel of 15 medical professionals reviewed the feasibility and validity of each item. The minimum content validity ratio was 0.49. Thirty participants used the developed measure to record contacts during a 24-hour period.
Results
After a systematic review, the survey instrument (parts I and II) was developed. Part I assessed social contact patterns over a 24-hour period, and part II assessed perceptions of contacts in daily life and preventive behaviors (hand hygiene and coughing etiquette). High validity and feasibility were found. In the pilot study, the 30 participants had a combined total of 198 contacts (mean, 6.6 daily contacts per person). The participants’ age (p=0.012), occupation (p<0.001), household size (p<0.001), education (p<0.001), personal income (p=0.003), and household income (p<0.001) were significantly associated with the number of contacts. Contacts at home, of long duration, and of daily frequency were relatively likely to be physical. Assortative mixing was observed between individuals in their 20s and 50s. Contact type differed by location, duration, and frequency (p<0.001).
Conclusions
The developed social contact survey instrument demonstrated high validity and feasibility, suggesting that it is viable for implementation.

Summary

Korean summary
본 연구에서는 감염접촉전파에 대한 인식과 사회적접촉을 측정 도구를 델파이 방법으로 개발하여 국내최초로 한국 성인의 사회적접촉을 측정하였다. 참여자 30명은 24시간 동안 총 198명을 접촉하였으며(6.6명/일/인), 접촉자수는 연령 (p=0.012), 직업(p<0.001), 가구수 (p<0.001), 교육수준 (p<0.001), 개인소득 (p=0.003), 가구소득 (p<0.001)에 따라 차이가 있었다. 동질성 혼합(assortative mixing)은 20대와 50대에서 보였으며, 접촉유형은 접촉장소, 접촉기간, 접촉빈도에 따라 유의하였다(p<0.001). 향후 국내 사회적 접촉 양상과 특성에 관한 전국적인 후속연구를 제언한다.

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A pilot study investigating the social contact patterns of Korean elderly
Hyang Soon Oh, Sun Young Jeong, Youngran Yang
Public Health Nursing.2021; 38(5): 926. CrossRef
Prospective Diary Survey of Preschool Children's Social Contact Patterns: A Pilot Study
Hyang Soon Oh, Mikyung Ryu
Child Health Nursing Research.2020; 26(4): 393. CrossRef

Prescription of Systemic Steroids for Acute Respiratory Infections in Korean Outpatient Settings: Overall Patterns and Effects of the Prescription Appropriateness Evaluation Policy: Taejae Kim, Young Kyung Do; J Prev Med Public Health. 2020;53(2):82-88. Published online November 18, 2019; DOI: https://doi.org/10.3961/jpmph.19.090

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Abstract Summary PDF

Objectives
The objective of this study was to identify individual and institutional factors associated with the prescription of systemic steroids in patients with acute respiratory infections and to investigate the role of a policy measure aimed to reduce inappropriate prescriptions. Methods: We used data from the National Health Insurance Service-National Sample Cohort from 2006 to 2015 and focused on episodes of acute respiratory infection. Descriptive analysis and multiple logistic regression analysis were performed to identify individual-level and institution-level factors associated with the prescription of systemic steroids. In addition, steroid prescription rates were compared with antibiotic prescription rates to assess their serial trends in relation to Health Insurance Review and Assessment Service (HIRA) Prescription Appropriateness Evaluation policy. Results: Among a total of 9 460 552 episodes of respiratory infection, the steroid prescription rate was 6.8%. Defined daily doses/1000 persons/d of steroid increased gradually until 2009, but rose sharply since 2010. The steroid prescription rate was higher among ear, nose and throat specialties (13.0%) than other specialties, and in hospitals (8.0%) than in tertiary hospitals (3.0%) and other types of institutions. Following a prolonged reduction in the steroid prescription rate, this rate increased since the HIRA Prescription Appropriateness Evaluation dropped steroids from its list of evaluation items in 2009. Such a trend reversal was not observed for the prescription rate of antibiotics, which continue to be on the HIRA Prescription Appropriateness Evaluation list. Conclusions: Specialty and type of institution are important correlates of steroid prescriptions in cases of acute respiratory infection. Steroid prescriptions can also be influenced by policy measures, such as the HIRA Prescription Appropriateness Evaluation policy.

Summary

Korean summary
이 연구에서는 요양급여 청구자료를 기준으로 급성 상기도 감염에서 스테로이드를 처방하는 경우와 관련하여 다음과 같은 특징을 확인하였다. 첫째, 환자 특성과 기관 특성을 모두 고려하였을 때 진료과목과 기관의 종별 구분에서 감기 스테로이드 처방률은 상당한 변이를 보였다. 둘째, 약제급여적정성평가 항목에서 스테로이드가 제외된 직후 처방률이 시계열적으로 상승하였으며, 이는 처방 행태에 정책 요인이 중요한 영향을 미칠 수 있음을 뜻한다.

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Effects of monthly evaluations on the rates of irrational antimicrobial prescription in the outpatient and emergency departments at Ningbo No. 6 Hospital, Ningbo, China
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Systemic glucocorticoid prescriptions pattern and factors of inappropriate use in primary care institutions of Southwest China
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Brief Report

Epidemiological and Clinical Characteristics of Confirmed Cases of Severe Fever With Thrombocytopenia Syndrome in Jeju Province, Korea, 2014-2018: Jinhee Kim, Jong-Myon Bae; J Prev Med Public Health. 2019;52(3):195-199. Published online April 3, 2019; DOI: https://doi.org/10.3961/jpmph.18.289

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Abstract Summary PDF Supplementary Material

Objectives
Jeju Province is well known as the region showing the highest incidence of severe fever with thrombocytopenia syndrome (SFTS) in South Korea. The aim of this study was to evaluate the epidemiological and clinical characteristics of SFTS patients in Jeju Province.
Methods
The primary data for this study were obtained from the Integrated Diseases and Health Control System of the Korea Centers for Disease Control and Prevention (KCDCIS). The selection criteria were confirmed cases of SFTS with a residence listed in Jeju Province at the time of diagnosis, reported to the KCDCIS between July 16, 2014 and November 30, 2018.
Results
Of 55 confirmed cases of SFTS, the case fatality rate was 10.9% (95% confidence interval [CI], 4.1 to 22.2). The most common presenting symptoms at diagnosis of severe fever, myalgia, and diarrhea had incidences of 83.6% (95% Cl, 71.2 to 92.2), 45.5% (95% Cl, 32.0 to 59.5), and 40.0% (95% CI, 27.0 to 54.1), respectively.
Conclusions
Compared to SFTS patients nationwide in 2013-2015, the subjects of this study exhibited a lower case fatality rate and had a lower incidence of severe fever, myalgia, and confusion.

Summary

Korean summary
2014-2018년 제주도 SFTS 환자의 치명률은 10.9% (95%CI: 4.1-22.2)로, 2014-2017년 전국 SFTS 환자의 치명률 19.3% (95%CI: 16.1-22.8)와 유사한 수준이다. 중국환자에 비하여 제주도 환자는 고열, 근육통, 혼수 발현률이 상대적으로 낮으며, 설사는 유사한 수준이었다

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Seroprevalence of severe fever with thrombocytopenia syndrome using specimens from the Korea National Health & Nutrition Examination Survey
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Clinical symptoms associated with fatality of severe fever with thrombocytopenia syndrome: A systematic review and meta-analysis
Yao Wang, Zexuan Song, Xiaoying Xu, Xuemin Wei, Haowen Yuan, Hao Liang, Hongling Wen
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Journal of Medical Virology.2021; 93(6): 3960. CrossRef
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X. Y. Huang, Z. Q. He, B. H. Wang, K. Hu, Y. Li, W. S. Guo
Epidemiology and Infection.2020;[Epub] CrossRef
Four Year Surveillance of the Vector Hard Ticks for SFTS, Ganghwa-do, Republic of Korea
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The Korean Journal of Parasitology.2019; 57(6): 691. CrossRef

Special Article

Researches of Epigenetic Epidemiology for Infections and Radiation as Carcinogen: Jong-Myon Bae; J Prev Med Public Health. 2018;51(4):169-172. Published online July 2, 2018; DOI: https://doi.org/10.3961/jpmph.18.070

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Abstract PDF Supplementary Material

In recent years, a number of studies have been reported on the various types of cancer arising from epigenetic alterations, including reports that these epigenetic alterations occur as a result of radiation exposure or infection. Thyroid cancer and breast cancer, in particular, have high cancer burden, and it has been confirmed that radiation exposure or onco-viral infection are linked to increased risk of development of these two types of cancer, respectively. Thus, the environment-epigenetic alteration-cancer occurrence (EEC) hypothesis has been suggested. This paper reviews the trends in research supporting this hypothesis for radiation exposure and onco-viral infection. If more evidences accumulate for the EEC hypothesis from future research, those findings may greatly aid in the prevention, early diagnosis, treatment, and prognosis of the thyroid cancer and breast cancer.

Summary

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Original Article

Knowledge, Perceptions, and Self-reported Performance of Hand Hygiene Among Registered Nurses at Community-based Hospitals in the Republic of Korea: A Cross-sectional Multi-center Study: Hyang Soon Oh; J Prev Med Public Health. 2018;51(3):121-129. Published online May 14, 2018; DOI: https://doi.org/10.3961/jpmph.17.188

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Abstract PDF Supplementary Material

Objectives
To assess the nurses’ hand hygiene (HH) knowledge, perception, attitude, and self-reported performance in small- and medium-sized hospitals after Middle East Respiratory Syndrome outbreak.
Methods
The structured questionnaire was adapted from the World Health Organization’s survey. Data were collected between June 26 and July 14, 2017.
Results
Nurses showed scores on knowledge (17.6±2.5), perception (69.3±0.8), self-reported HH performance of non-self (86.0±11.0), self-reported performance of self (88.2±11.0), and attitude (50.5±5.5). HH performance rate of non-self was Y₁=36.678+ 0.555X₁ (HH performance rate of self) (adjusted R²=0.280, p<0.001). The regression model for performance was Y₄=18.302+0.247X₄₁ (peception)+0.232X₄₂ (attitude)+0.875X₄₂ (role model); coefficients were significant statistically except attitude, and this model significant statistically (adjusted R²=0.191, p<0.001).
Conclusions
Advanced HH education program would be developed and operated continuously. Perception, attitude, role model was found to be a significant predictors of HH performance of self. So these findings could be used in future HH promotion strategies for nurses.

Summary

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Brief Report

Community-acquired Legionnaires’ Disease in a Newly Constructed Apartment Building: Sukhyun Ryu, Kyungho Yang, Byung Chul Chun; J Prev Med Public Health. 2017;50(4):274-277. Published online June 28, 2017; DOI: https://doi.org/10.3961/jpmph.17.066

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Abstract PDF

Objectives
Legionnaires’ disease (LD) is a severe type of pneumonia caused by inhalation of aerosols contaminated with Legionella. On September 22, 2016, a single case of LD was reported from a newly built apartment building in Gyeonggi province. This article describes an epidemiologic investigation of LD and identification of the possible source of infection. Methods: To identify the source of LD, we interviewed the patient’s husband using a questionnaire based on the Legionella management guidelines from the Korea Centers for Disease Control and Prevention. Water samples from the site were collected and analyzed. An epidemiological investigation of the residents and visitors in the apartment building was conducted for 14 days before the index patient’s symptoms first appeared to 14 days after the implementation of environmental control measures. Results: Legionella pneumophila serogroup 1 was isolated from the heated-water samples from the patient’s residence and the basement of the apartment complex. Thirty-two suspected cases were reported from the apartment building during the surveillance period, yet all were confirmed negative based on urinary antigen tests. Conclusions: The likely source of infection was the building’s potable water, particularly heated water. Further study of effective monitoring systems in heated potable water should be considered.

Summary

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Original Articles

Bacterial Contamination and Disinfection Status of Laryngoscopes Stored in Emergency Crash Carts: Jae Hyung Choi, Young Soon Cho, Jung Won Lee, Hee Bong Shin, In Kyung Lee; J Prev Med Public Health. 2017;50(3):158-164. Published online April 4, 2017; DOI: https://doi.org/10.3961/jpmph.17.013

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Abstract PDF

Objectives
To identify bacterial contamination rates of laryngoscope blades and handles stored in emergency crash carts by hospital and area according to the frequency of intubation attempts.
Methods
One hundred forty-eight handles and 71 blades deemed ready for patient use from two tertiary hospitals were sampled with sterile swabs using a standardized rolling technique. Samples were considered negative (not contaminated) if no colonies were present on the blood agar plate after an 18-hour incubation period. Samples were stratified by hospital and according to the frequency of intubation attempts (10 attempts per year) using the χ²-test and Fisher exact test.
Results
One or more species of bacteria were isolated from 4 (5.6%) handle tops, 20 (28.2%) handles with knurled surfaces, and 27 (18.2%) blades. No significant differences were found in microbial contamination levels on the handle tops and blades between the two hospitals and two areas according to the frequency of intubation attempts. However, significant differences were found between the two hospitals and two areas in the level of microbial contamination on the handles with knurled surfaces (p<0.05).
Conclusions
Protocols and policies must be reviewed to standardize procedures to clean and disinfect laryngoscope blades and handles; handles should be re-designed to eliminate points of contact with the blade; and single-use, one-piece laryngoscopes should be introduced.

Summary

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Current Status of Infection Prevention and Control Programs for Emergency Medical Personnel in the Republic of Korea: Hyang Soon Oh, Dong Choon Uhm; J Prev Med Public Health. 2015;48(6):330-341. Published online November 25, 2015; DOI: https://doi.org/10.3961/jpmph.15.058

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Abstract PDF Supplementary Material

Objectives
Emergency medical personnel (EMPs) are pre-hospital emergency responders who are at risk of exposure to infections and may also serve as a source for the transmission of infections. However, few studies of infection control have specifically addressed EMPs in the Republic of Korea (hereafter Korea). The goal of this study was to assess the current status of infection prevention and control programs (IPCPs) for EMPs in Korea.
Methods
A cross-sectional survey was conducted to quantitatively assess the resources and activities of IPCPs. A total of 907 EMPs in five metropolitan cities completed a structured questionnaire from September 2014 to January 2015. The data were analyzed using descriptive statistics, multi-response analysis, and the chi-square test.
Results
The mean age of the participants was 34.8±15.1 years. IPCPs were found to have weaknesses with regard to the following resources: the assignment of infection control personnel (ICP) (79.5%), hand hygiene resources such as waterless antiseptics (79.3%), the use of paper towels (38.9%), personal protective equipment such as face shields (46.9%), and safety containers for sharps and a separated space for the disposal of infectious waste (10.1%). Likewise, the following activities were found to be inadequately incorporated into the workflow of EMPs: education about infection control (77.5%), post-exposure management (35.9%), and the decontamination of items and spaces after use (88.4%). ICP were found to have a significant effect on the resources and activities of IPCPs (p<0.001). The resources and activities of IPCPs were found to be significantly different among the five cities (p<0.001).
Conclusions
IPCPs for EMPs showed some limitations in their resources and activities. IPCPs should be actively supported, and specific IPCP activities for EMPs should be developed.

Summary

Citations

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Evaluation of the characteristics of infection prevention and control programs and infection control committees in Brazilian hospitals: A countrywide cross-sectional study
Beatriz Arns, Crepin Aziz Jose Oluwafoumi Agani, Guilhermo Prates Sesin, Jaqueline Driemeyer C. Horvath, Débora Vacaro Fogazzi, Fernanda Kelly Romeiro Silva, Lauren Sezera Costa, Adriano Jose Pereira, Antônio Paulo Nassar Junior, Bruno Tomazini, Camila Di
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“Hand hygiene perception and self-reported hand hygiene compliance among emergency medical service providers: a Danish survey”
Heidi Storm Vikke, Svend Vittinghus, Martin Betzer, Matthias Giebner, Hans Jørn Kolmos, Karen Smith, Maaret Castrén, Veronica Lindström, Marja Mäkinen, Heini Harve, Christian Backer Mogensen
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2019;[Epub] CrossRef

Respiratory Syncytial Virus Outbreak in the Basic Military Training Camp of the Republic of Korea Air Force: Won-Ju Park, Seok-Ju Yoo, Suk-Ho Lee, Jae-Woo Chung, Keun-Ho Jang, Jai-Dong Moon; J Prev Med Public Health. 2015;48(1):10-17. Published online January 14, 2015; DOI: https://doi.org/10.3961/jpmph.14.037

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98 Download
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Abstract PDF

Objectives
An outbreak of acute febrile illness occurred in the Republic of Korea Air Force boot camp from May to July 2011. An epidemiological investigation of the causative agent, which was of a highly infective nature, was conducted.
Methods
Throat swabs were carried out and a multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) assay was performed to identify possible causative factors.
Results
The mean age of patients who had febrile illness during the study period was 20.24 years. The multiplex RT-PCR assay identified respiratory syncytial virus (RSV) as the causative agent. The main symptoms were sore throat (76.0%), sputum (72.8%), cough (72.1%), tonsillar hypertrophy (67.9%), and rhinorrhea (55.9%). The mean temperature was 38.75°C and the attack rate among the recruits was 15.7% (588 out of 3750 recruits), while the mean duration of fever was 2.3 days. The prognosis was generally favorable with supportive care but recurrent fever occurred in 10.1% of the patients within a month.
Conclusions
This is the first epidemiological study of an RSV outbreak that developed in a healthy young adult group. In the event of an outbreak of an acute febrile illness of a highly infective nature in facilities used by a young adult group, RSV should be considered among the possible causative agents.

Summary

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Hye Young Kim, Ki Wook Yun, Hee Jin Cheong, Eun Hwa Choi, Hoan Jong Lee
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COVID-19 outbreak in a military unit in Korea
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Nurse-perceived Patient Adverse Events and Nursing Practice Environment: Jeong-Hee Kang, Chul-Woung Kim, Sang-Yi Lee; J Prev Med Public Health. 2014;47(5):273-280. Published online September 12, 2014; DOI: https://doi.org/10.3961/jpmph.14.019

11,700 View
145 Download
17 Crossref

Abstract PDF

Objectives
To evaluate the occurrence of patient adverse events in Korean hospitals as perceived by nurses and examine the correlation between patient adverse events with the nurse practice environment at nurse and hospital level. Methods: In total, 3096 nurses working in 60 general inpatient hospital units were included. A two-level logistic regression analysis was performed. Results: At the hospital level, patient adverse events included patient falls (60.5%), nosocomial infections (51.7%), pressure sores (42.6%) and medication errors (33.3%). Among the hospital-level explanatory variables associated with the nursing practice environment, ‘physician- nurse relationship’ correlated with medication errors while ‘education for improving quality of care’ affected patient falls. Conclusions: The doctor-nurse relationship and access to education that can improve the quality of care at the hospital level may help decrease the occurrence of patient adverse events.

Summary

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Brief Report

Epidemiological Investigation of an Outbreak of Salmonellosis in Gyeongju, Korea: Seok-Ju Yoo, Hyun-Sul Lim, Kwan Lee; J Prev Med Public Health. 2014;47(3):177-181. Published online May 30, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.3.177

9,568 View
104 Download
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Abstract PDF

Objectives

A salmonellosis outbreak occurred within a community of Gyeongju residents who ingested catered food from a wedding in June 2009. We aimed to epidemiologically investigate the probable vehicle of the infection.

Methods

We conducted a retrospective cohort study on 34 local residents who ingested the wedding food.

Results

Among the 34 residents, 31 (91.2%) reported symptoms of infection after eating the food. Among all of the wedding foods, pan-fried foods were highly associated with the diarrheal attack rate. On bacteriological examination, Salmonella species were detected in the pan-fried foods among the leftover foods and in 17 of the 31 stool specimens from the cases. There were five different types of pan-fried foods, but the onset of symptoms was independent of the ingredients used. We found that the pan-fried food was prepared at a food store in Seoul and that eggs were a common ingredient.

Conclusions

The major cause of the salmonellosis in this population was presumed to be the pan-fried food prepared with contaminated eggs. These food items might have been partially undercooked because of their irregular shape, which allowed the Salmonella species to survive and multiply before ingestion.

Summary

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Original Articles

Epidemiological Investigation of an Outbreak of Hepatitis A at a Residential Facility for the Disabled, 2011: Hyun-Sul Lim, Kumbal Choi, Saerom Lee; J Prev Med Public Health. 2013;46(2):62-73. Published online March 28, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.2.62

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Abstract PDF

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.

Summary

Citations

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Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020
Noele P. Nelson, Mark K. Weng, Megan G. Hofmeister, Kelly L. Moore, Mona Doshani, Saleem Kamili, Alaya Koneru, Penina Haber, Liesl Hagan, José R. Romero, Sarah Schillie, Aaron M. Harris
MMWR. Recommendations and Reports.2020; 69(5): 1. CrossRef
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Curtis Croker, Susan Hathaway, Amy Marutani, Margilane Hernandez, Crystal Cadavid, Shobita Rajagopalan, Bessie Hwang, Moon Kim
Infection Control & Hospital Epidemiology.2018; 39(07): 881. CrossRef
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Xu-Sheng Zhang, Giovanni Lo Iacono, Eric HY Lau
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Epidemiology and Infection.2014; 142(7): 1450. CrossRef

Prevalence of Positive Carriage of Tuberculosis, Methicillin-resistant Staphylococcus aureus, and Vancomycin-resistant Enterococci in Patients Transported by Ambulance: A Single Center Observational Study: Young Sun Ro, Sang Do Shin, Hyun Noh, Sung-Il Cho; J Prev Med Public Health. 2012;45(3):174-180. Published online May 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.3.174

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Abstract PDF

Objectives

An ambulance can be a potential source of contagious or droplet infection of a community. We estimated the prevalence of positive carriage of tuberculosis (TB), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococci (VRE) in patients transported by ambulance.

Methods

This was a retrospective observational study. We enrolled all patients who visited a tertiary teaching hospital emergency department (ED). Blood, sputum, urine, body fluid, and rectal swab samples were taken from patients when they were suspected of TB, MRSA, or VRE in the ED. The patients were categorized into three groups: pre-hospital ambulance (PA) group; inter-facility ambulance (IA) group; and non-ambulance (NA) group. Adjusted odds ratio (OR) and 95% confidence intervals (CI) were calculated using a multivariable logistic regression model for the prevalence of each infection.

Results

The total number of patients was 89206. Of these, 9378 (10.5%) and 4799 (5.4%) were in the PA and IA group, respectively. The prevalence of TB, MRSA, and VRE infection were 0.3%, 1.1%, and 0.3%, respectively. In the PA group, the prevalence of TB, MRSA, and VRE were 0.3%, 1.8%, and 0.4%. In the IA group, the prevalence of TB, MRSA, and VRE were 0.7%, 4.6%, and 1.5%, respectively. The adjusted ORs (95% CI) of the PA and IA compared to the NA group were 1.02 (0.69 to 1.53) and 1.83 (1.24 to 2.71) for TB, 2.24 (1.87 to 2.69) and 5.47 (4.63 to 6.46) for MRSA, 2.59 (1.78 to 3.77) and 8.90 (6.52 to 12.14) for VRE, respectively.

Conclusions

A high prevalence of positive carriage of TB, MRSA, and VRE in patients transported by metropolitan ambulances was found.

Summary

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高橋治郎, 世良紳語, 井上貴博, 宮本聡美, 上野太輔, 稲吉祐樹, 椎野泰和
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Diego Schaps, Anjni Patel Joiner, Deverick J. Anderson
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