How lessons learned from the 2015 Middle East respiratory syndrome outbreak affected the response to coronavirus disease 2019 in the Republic of Korea

The Republic of Korea (ROK) experienced a public health crisis due to Middle East respiratory syndrome (MERS) in 2015 and is currently going through the coronavirus disease 2019 (COVID-19) pandemic. Lessons learned from the disastrous MERS outbreak were ref lected in the preparedness system, and the readiness capabilities that were subsequently developed enabled the country to successfully flatten the epidemic curve of COVID-19 in late February and March 2020. In this review, we summarize and compare the epidemiology and response of the ROK to the 2015 MERS outbreak and the COVID-19 epidemic in early 2020. We emphasize that, because further COVID-19 waves seem inevitable, it is urgent to develop comprehensive preparedness and response plans for the worst-case scenarios of the COVID-19 pandemic. Simultaneously strengthening healthcare capacity to endure the peak demand and implementing smart strategies to sustain social distancing and public hygiene are necessary until safe and effective therapeutics and vaccines against COVID-19 are available.

Psychogenic illness following vaccination: exploratory study of mass vaccination against pandemic influenza A (H1N1) in 2009 in South Korea

PURPOSE: Adverse events during mass vaccination campaigns have had a profoundly negative impact on vaccine coverage rates. The objective of the study was to identify the characteristics of reported psychogenic illness cases following mass vaccination that needed further interventions of the national immunization program. MATERIALS AND METHODS: We collected documents that were submitted to the Korea Centers for Disease Control and Prevention for vaccine injury compensation, and analyzed cases of psychogenic illness following pandemic influenza A (H1N1) vaccination in 2009 which were confirmed by the Korean Advisory Committee on Vaccine Injury Compensation. RESULTS: During the 2009-2010 influenza season, 13 million Koreans were vaccinated against pandemic influenza. Of 28 reported psychogenic illness cases following immunization, 25 were vaccinated through school-located mass immunization. Significant numbers of them were female adolescents (68%) or had underlying vulnerable conditions or emotional life stressors (36%). They required lengthy hospitalization (median, 7 days) and high medical costs (median, US $1,582 per case). CONCLUSION: Health authorities and organizers of future mass vaccinations should be well aware of the possible occurrence of psychogenic illness, acknowledge their detailed characteristics, and take its economic burden into account to mitigate the risk of transmission of infectious diseases efficiently.

Acute Myopericarditis caused by Human Metapneumovirus

Human metapneumovirus is known to be similar to respiratory syncytial virus. Because of an incomplete protective immune response to new genotypes, re-infection occurs frequently, especially in the elderly. However, the clinical manifestations of human metapneumovirus need to be further characterized in adults. A 73-year-old woman presented to the emergency room with acute dyspnea, chest discomfort and influenza-like illness. The patient was diagnosed with human metapneumovirus infection, complicated by pneumonia and myopericarditis. With supportive care including oxygen supplementation, the patient recovered completely without any serious sequelae. Human metapneumovirus infection may contribute to the development of cardiovascular manifestations, particularly in the elderly population.

Influenza and Pneumococcal Vaccine Coverage Rates among Patients Admitted to a Teaching Hospital in South Korea

BACKGROUND: Influenza and pneumococcal vaccinations can reduce morbidity and mortality especially in the elderly and patients with chronic medical disease. The purpose of this study was to estimate vaccination coverage of these populations in a hospital setting. MATERIALS AND METHODS: We conducted a cross-sectional, descriptive study involving adult patients admitted to a 1,000-bed teaching hospital on April 15, 2013. We ascertained the information on whether the patient had received influenza vaccination within a year prior to admission or pneumococcal vaccination by interviewing each patient. RESULTS: A total of 491 eligible patients aged > or =50 years or with chronic medical illnesses were analyzed. The overall vaccination rate for influenza was 57.2%, and that of pneumococcus was 17.6% among the vaccine-eligible subjects. Influenza/pneumococcal vaccination rates of patients by disease were 62.8%/17.2% for diabetes, 53.3%/15.6% for malignancy, 67.6%/23.5% for chronic pulmonary disease, 66.7%/15.3% for chronic cardiovascular disease, 68.7%/26.9% for chronic renal disease, and 51.2%/18.6% for chronic hepatic disease. Young adult patients with chronic medical conditions were consistently less likely to receive influenza and pneumococcal vaccines irrespective of the underlying disease. CONCLUSION: The influenza and pneumococcal vaccine coverage rates among hospitalized patients were low in South Korea. This was especially the case for young adult patients with chronic medical illnesses.

Physician Attitudes toward the Herpes Zoster Vaccination in South Korea

This survey investigated Korean physician attitudes toward the herpes zoster (HZ) vaccine. A total of 400 physicians answered a self-reported questionnaire. Most physicians knew that HZ poses a significant socioeconomic burden and had good knowledge about HZ and its vaccine. Physicians who did not recommend HZ vaccine were concerned about costs (90.7%, 78/86) and doubted the effectiveness of the vaccine (58.1%, 50/86). Patient demand had a profound effect on physicians decisions; 84.9% (73/86) of them who said not recommending HZ vaccine reported that they would provide the vaccine upon patient request. In conclusion, educational initiatives should be targeted toward both physicians and patients.

Pulmonary Toxocariasis Mimicking Invasive Aspergillosis in a Patient with Ulcerative Colitis

A 45-year-old-male who had underlying ulcerative colitis and presented with fever and dry cough. Initially, the patient was considered to have invasive aspergillosis due to a positive galactomannan assay. He was treated with amphotericin B followed by voriconazole. Nevertheless, the patient deteriorated clinically and radiographically. The lung biopsy revealed eosinophilic pneumonia, and ELISA for Toxocara antigen was positive, leading to a diagnosis of pulmonary toxocariasis. After a 10-day treatment course with albendazole and adjunctive steroids, the patient recovered completely without any sequelae. Pulmonary toxocariasis may be considered in patients with subacute or chronic pneumonia unresponsive to antibiotic agents, particularly in cases with eosinophilia.

Long-term immunogenicity of the influenza vaccine at reduced intradermal and full intramuscular doses among healthy young adults

PURPOSE: To prepare for vaccine shortages under an influenza pandemic, several antigen-sparing strategies have been investigated. This study was aimed to evaluate the immunogenicity of influenza vaccine at reduced intradermal and full intramuscular dose. MATERIALS AND METHODS: We compared the effect of one-fifth and one-half intradermal doses to the full intramuscular dose on immunogenicity in healthy young adults, using a commercial influenza vaccine. A hemagglutination inhibition assay was used to compare the immunogenicity of the vaccination methods. RESULTS: The one-fifth intradermal dose (3 microg hemagglutinin antigen, HA) was given to 30 participants, the one-half intradermal dose (7.5 microg HA) was given to 30, and the full intramuscular dose (15 microg HA) was given to 32. No significant differences among injection routes and dosages were seen for seroprotection rate, seroconversion rate, or geometric mean titer (GMT) fold-increase for A/H1N1, A/H3N2, and B at around 4 weeks from vaccination. Although GMT for influenza B was significantly lower at six months for the one-fifth intradermal vaccination compared to the full-dose intramuscular vaccination (32.8 vs. 63.2, p=0.048), all three groups met the Evaluation of Medicinal Products (EMA) immunogenicity criteria through 1 to 6 months. CONCLUSION: Intradermal administration of a one-fifth dose of influenza vaccine elicited antibody responses comparable to the intradermal one-half dose and a conventional intramuscular vaccination at 1 month post-vaccination. The immunogenicity of the one-fifth intradermal dose was sufficient to meet the requirement for the EMA criteria at six months after influenza vaccination.

Two Cases of Cecal Schwannoma Which Were Removed by Endoscopic Mucosal Resection

Schwannoma in colorectum is a rare subepithelial polyp of mesenchymal origin, which is derived from the neural sheath, and most of reported cases were removed surgically. We, herein, describe two cases of schwannoma of the cecum, which were removed by endoscopic mucosal resection. A 34-year-old man and a 62-year-old man presented with abdominal discomfort and bowel habit change. The patients were diagnosed with a subepithelial tumor in the cecum on colonoscopy and underwent endoscopic mucosal resection under a tentative impression as neuroendocrine tumor, such as carcinoid tumor. Histopathology and immunohistochemistry confirmed the colonic lesion to be a benign schwannoma.

A Case of Multiple Osteoporotic Compression Fractures in Young Man with Budd-Chiari Syndrome

Osteoporosis in young men is extremely rare. In this report, we demonstrate a rare case of multiple vertebral fractures discovered in a young man with Budd-Chiari syndrome without prior history of trauma. A 29-year-old man was diagnosed as Budd-Chiari syndrome 12 years ago and underwent a mesocaval shunt to relieve the hepatic vein obstruction and was on warfarin therapy. He suffered from low back pain and it was not relieved by analgesics. A T-L spine X-ray revealed multiple compression fractures and the z-score at lumbar spine was -3.7 which is below the expected range for that age. The patient was treated with calcium, vitamin D and bisphosphonate, and showed clinical improvement. This case highlights the importance of the investigation for secondary osteoporosis in young adults with an underlying disease that alters bone metabolism.

Hepatic and Small Bowel Mucormycosis after Chemotherapy in a Patient with Acute Myeloid Leukemia: A Case Report and Literature Review

We present a case of a 64-year-old woman with acute myeloid leukemia who developed a hepatic abscess during the neutropenic period after induction chemotherapy. To treat the abscess, meropenem and ciprofloxacin were administered to target Klebsiella pneumoniae and percutaneous drainage performed. As a result, the patient's fever and c-reactive protein (CRP) subsequently improved. After six weeks of antibiotic therapy, an abdominal computed tomography scan revealed remains of the liver abscess as well as an ileus in the small bowel. Molds from the Mucor genus were cultured from repeated liver abscess drainage and an abscess wall biopsy confirmed hepatic mucormycosis. Along with administration of amphotericin-B deoxycholate for four weeks, we performed lobectomy for hepatic mucormycosis and small bowel resection for a suspected small bowel mucormycosis. After these operations, the patient received liposomal amphotericin B for three weeks and was then maintained with oral posaconazole for more than four weeks. Our case report suggests that hepatic mucormycosis should be considered when a hepatic abscess exhibits a retarded response to antibacterial agents, especially for patients with risk factors. In addition, because an isolated hepatic mucormycosis is infrequent, a thorough search for the extent of the disease is necessary before surgical resection.