Regional Distribution of Hepatitis C Virus Infection in the Republic of Korea, 2007-2011

( Geun Yong Kwon ),( Hyung Min Lee ),( Jin Gwack ),( Sang Won Lee ),( Moran Ki ),( Seung Ki Youn ) 대한소화기학회 2014 Gut and Liver Vol.8 No.4

Background/Aims: In Korea, hepatitis C is included as an infectious disease in a sentinel surveillance system. Recently, a large variation in hepatitis C incidence between different regions in Korea has been noticed. The current study verified the nationwide distribution of hepatitis C infection for effective prevention and management. Methods: We counted the number of hepatitis C patients who visited a hospital per county using the National Health Insurance database from 2007 to 2011. The age-adjusted prevalence ratio was used, and the age adjustment method was used as an indirect standardization method. Disease mapping and spatial analysis were conducted using a geographic information system. Results: The annual prevalence of diagnosed hepatitis C was approximately 0.12% to 0.13% in Korea. The age-adjusted prevalence ratios in Busan, Jeonnam, and Gyeongnam were high (1.75, 1.4, and 1.3, respectively). The three regions in the southern coastal area of the Korean Peninsula were identified as a high-prevalence cluster (Moran`s index, 0.3636). Conclusions: The present study showed that hepatitis C infection has very large regional variation, and there are several high-risk areas. Preventive measures focusing on these areas should be applied to block the transmission of hepatitis C and reduce the disease burden. (Gut Liver 2014;8:428-432)

The economic burden of human papillomavirus infection-associated diseases in the Republic of Korea, 2002–2015

Ki, Moran,Choi, Hwa Young,Han, Minji,Oh, Jin-Kyoung Elsevier 2018 Vaccine Vol.36 No.31

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>This prevalence-based, cost-of-illness study estimated the health care costs of human papillomavirus (HPV) infection-associated diseases in the era before the introduction of organized HPV vaccination for 12-year-old girls in 2016, South Korea.</P> <P><B>Methods</B></P> <P>The claims data provided by the National Health Insurance Service was used to estimate the prevalence of HPV-associated diseases and their direct medical costs, including costs related to hospitalizations, outpatient visits, and medications.</P> <P><B>Results</B></P> <P>A total of 1.3 million men and women used medical services for HPV-attributed diseases between 2002 and 2015. Among women, the most common diseases attributable to HPV were cervical dysplasia (64.4%), anogenital warts (12.9%), cervical carcinoma in situ (10.7%) and cervical cancer (2.6%), whereas anogenital warts (80.6%), benign neoplasms of larynx (14.3%), and anal cancers (8.9%) were most common among men. In 2015, the healthcare cost attributable to HPV was 124.9 million US dollars (USD) representing 69.0% of the annual cost of all HPV-associated diseases. At a cost of 75.1 million USD, cervical cancer contributed the largest economic burden in 2015 followed by cervical dysplasia (19.4 million USD) and cervical carcinoma in situ (10.7 million USD). These three conditions represented 58.2% of the total annual cost of all HPV-associated diseases, while 84.2% of the total annual cost was attributable to HPV. Annual health care costs increased from 42.6 million USD in 2002 to 180.9 million USD in 2015.</P> <P><B>Conclusion</B></P> <P>The healthcare costs associated with HPV-related diseases in Korea are substantial and increased between 2002 and 2015 mainly caused by increased number of patients. Expanding the target age for HPV vaccination of girls and introducing HPV vaccination for boys are possible ways of reducing the economic burden of HPV-associated disease and should be considered.</P>

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

Moran Ki 한국역학회 2020 Epidemiology and Health Vol.42 No.-

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.

Healthcare Costs for Chronic Hepatitis C in South Korea from 2009 to 2013: An Analysis of the National Health Insurance Claims’ Data

( Moran Ki ),( Hwa Young Choi ),( Kyung-ah Kim ),( Eun Sun Jang ),( Sook-hyang Jeong ) 대한간학회 2017 Gut and Liver Vol.11 No.6

Background/Aims: The introduction of direct-acting antivirals (DAA) in 2013 revolutionized hepatitis C virus (HCV) treatment, offering a cure rate >90%. However, this therapy is expensive, and estimations of the number of chronic HCV-infected (CHC) patients and their treatment costs pre-2013 are therefore essential for creating policies and expanding drug access. Herein, we aimed to investigate the number of HCV-related liver disease patients, their healthcare utilization, their annual direct medical costs, and the interferon-based antiviral treatment rates and costs from 2009 to 2013 in South Korea. Methods: The National Health Insurance database was reviewed, and patients diagnosed with CHC from 2009 to 2013 were extracted. Data regarding detailed healthcare utilization, prescribed drugs, and direct medical costs were obtained. For annual direct healthcare cost calculations, a prevalence-based approach was used. Results: Overall, 181,768 CHC patients were identified. In 2013, the annual per-patient costs for chronic hepatitis, liver cirrhosis, hepatocellular carcinoma, and the first year post-liver transplant were 895, 1,873, 6,945, and 67,359 United States dollars, respectively. Interferon-based antiviral therapeutics were prescribed to 25,223 patients (13.9%). Conclusions: Healthcare costs have increased remarkably with increasing liver disease severity. Thus, efforts to stop disease progression are needed. Moreover, the low rate of interferon-based therapy indicates an unmet need for DAA. (Gut Liver 2017;11:835-842)

2015 MERS outbreak in Korea: hospital-to-hospital transmission

Moran Ki 한국역학회 2015 Epidemiology and Health Vol.37 No.-

The distinct characteristic of the Middle East Respiratory Syndrome (MERS) outbreak in South Korea is that it not only involves intra-hospital transmission, but it also involves hospital-to-hospital transmission. It has been the largest MERS outbreak outside the Middle East, with 186 confirmed cases and, among them, 36 fatal cases as of July 26, 2015. All confirmed cases are suspected to be hospital-acquired infections except one case of household transmission and two cases still undergoing examination. The Korean health care system has been the major factor shaping the unique characteristics of the outbreak. Taking this as an opportunity, the Korean government should carefully assess the fundamental problems of the vulnerability to hospital infection and make short- as well as long-term plans for countermeasures. In addition, it is hoped that this journal, Epidemiology and Health, becomes a place where various topics regarding MERS can be discussed and shared.

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

Moran Ki,Hyunjin Son,Bo Youl Choi 한국역학회 2019 Epidemiology and Health Vol.41 No.-

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.

Risk of Hepatocellular Carcinoma in Korean Patients with Metabolic Syndrome: A Big Data Analysis

( Moran Ki ),( Hwa Young Choi ),( Bo Hyun Kim ),( Joong-won Park ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: The Metabolic syndrome (MetS) and/or its individual componentshave been linked to the development of various cancers. Recentstudies have suggested MetS as a risk factor of hepatocellular carcinoma(HCC). However, the association between MetS and HCC is incontroversial especially in an HBV- and HCV-endemic area. We evaluatedthe association between the MetS and HCC in Korea.Methods: The HCC incidences according to the MetS were analyzedin general population by using the Health Examination Cohort dataof National Health Insurance. We followed all 112,794 people whowere 40-79 years old and had health examination in 2002 or 2003.According to limited source justification, the criteria for MetS areas follows: BMI 25+, hypertension SBP 130+ or DBP 85+, fastingblood glucose (FBG) 100mg/dL+ and total cholesterol (TC) 240mg/dL+. Cox proportional hazard regression models were used.Results: Out of 112,794 people, 40,443(35.9%) had one,26,410(23.4%) had two, 19,874(17.6%) had three, and 1,604(1.4%)had four components of MetS. HCC incidence rates for 10 yearswere 1.27% for one, 1.38% for two, 0.59% for three, and 1.12%for four components groups of MetS. Univariate analysis on risk ofHCC showed significant results with hypertension (HR: 1.184), FBG(HR: 1.256) and TC (HR: 0.676). However, after adjusting for age,sex, alcohol drinking, and viral hepatitis (B and/or C), only TC (HR:0.717) showed a significant result. After excluding TC which showedprotective effect, adjusted HRs of BMI, FBG, and hypertension werenot significant (1.016, 1.046 and 1.038, respectively).Conclusions: MetS may not be a significant risk for HCC developmentin a Korean population-based study. A subsequent analysis of theHCC risk and MetS is currently under way in the second set includingdata of triglyceride and HDL-cholesterol.

Health Indicators Related to Disease, Death, and Reproduction

Choi, Jeoungbin,Ki, Moran,Kwon, Ho Jang,Park, Boyoung,Bae, Sanghyuk,Oh, Chang-Mo,Chun, Byung Chul,Oh, Gyung-Jae,Lee, Young Hoon,Lee, Tae-Yong,Cheong, Hae Kwan,Choi, Bo Youl,Park, Jung Han,Park, Sue K. The Korean Society for Preventive Medicine 2019 Journal of Preventive Medicine and Public Health Vol.52 No.1

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.

Strengthening epidemiologic investigation of infectious diseases in Korea: lessons from the Middle East Respiratory Syndrome outbreak

Changhwan Lee,Moran Ki 한국역학회 2015 Epidemiology and Health Vol.37 No.-

The recent outbreak of Middle East Respiratory Syndrome (MERS) coronavirus infection in Korea resulted in large socioeconomic losses. This provoked the Korean government and the general public to recognize the importance of having a well-established system against infectious diseases. Although epidemiologic investigation is one of the most important aspects of prevention, it has been pointed out that much needs to be improved in Korea. We review here the current status of the Korean epidemiologic service and suggest possible supplementation measures. We examine the current national preventive infrastructure, including human resources such as Epidemic Intelligence Service officers, its governmental management, and related policies. In addition, we describe the practical application of these resources to the recent MERS outbreak and the progress in preventive measures. The spread of MERS demonstrated that the general readiness for emerging infectious diseases in Korea is considerably low. We believe that it is essential to increase society’s investment in disease prevention. Fostering public health personnel, legislating management policies, and establishing research centers for emerging infectious diseases are potential solutions. Evaluating international preventive systems, developing cooperative measures, and initiating improvements are necessary. We evaluated the Korean epidemiologic investigation system and the public preventive measures against infectious diseases in light of the recent MERS outbreak. We suggest that governmental authorities in Korea enforce preventive policies, foster the development of highly qualified personnel, and increase investment in the public health domain of infectious disease prevention.

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

Sunhwa Choi,Moran Ki 한국역학회 2020 Epidemiology and Health Vol.42 No.-

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.