Outbreaks of Middle East Respiratory Syndrome in Two Hospitals Initiated by a Single Patient in Daejeon, South Korea / 감염과화학요법

BACKGROUND: A Middle East Respiratory Syndrome coronavirus (MERS-CoV) outbreak in South Korea in 2015 started by a single imported case and was amplified by intra- and inter-hospital transmission. We describe two hospital outbreaks of MERS-CoV infection in Daejeon caused by a single patient who was infected by the first Korean case of MERS. MATERIALS AND METHODS: Demographic and clinical information involving MERS cases in the Daejeon cluster were retrospectively collected and potential contacts and exposures were assessed. The incubation periods and serial intervals were estimated. Viral RNAs were extracted from respiratory tract samples obtained from the index case, four secondary cases and one tertiary case from each hospital. The partial S2 domain of the MERS-CoV spike was sequenced. RESULTS: In Daejeon, a MERS patient (the index case) was hospitalized at Hospital A in the first week of illness and was transferred to Hospital B because of pneumonia progression in the second week of illness, where he received a bronchoscopic examination and nebulizer therapy. A total of 23 secondary cases (10 in Hospital A and 13 in Hospital B) were detected among patients and caregivers who stayed on the same ward with the index case. There were no secondary cases among healthcare workers. Among close hospital contacts, the secondary attack rate was 15.8% (12/76) in Hospital A and 14.3% (10/70) in Hospital B. However, considering the exposure duration, the incidence rate was higher in Hospital B (7.7/100 exposure-days) than Hospital A (3.4/100 exposure-days). In Hospital B, the median incubation period was shorter (4.6 days vs. 10.8 days), the median time to pneumonia development was faster (3 days vs. 6 days) and mortality was higher (70% vs. 30.8%) than in Hospital A. MERS-CoV isolates from 11 cases formed a single monophyletic clade, with the closest similarity to strains from Riyadh. CONCLUSION: Exposure to the MERS case in the late stage (2nd week) of diseases appeared to increase the risk of transmission and was associated with shorter incubation periods and rapid disease progression among those infected. Early detection and isolation of cases is critical in preventing the spread of MERS in the hospital and decreasing the disease severity among those infected.

Comparison of Nutritional Status of the Daejeon Metropolitan Citizens by Frequency of Eating Out

This study aims at investigating the health and nutritional status of the adults according to frequency of eating out. One day food intake data were collected by 24 hr recall dietary survey and body size, blood pressure and some blood lipids and other constituents were measured on 137 Daejeon metropolitan citizens 20 yrs old and above who visited Chungnam National University Hospital for physical examination during the period of December 6, to December 15, 2008. The frequency of eating out were categorized into four levels: less than once a week, once a week, 2-3 times a week, 4 times a week and above. Body mass Index, waist circumference, blood pressure, blood lipid, blood glucose, GPT and GOT did not showed any significant difference according to the frequency of eating out of the subjects. Though, systolic blood pressures and serum levels of total cholesterol and LDL-cholesterol showed a little tendency to be high in the subjects eating out 2-3 times a week. In the contrary, serum triglyceride level tended to be low in the same group. The subjects eating out 4 times a week and over took more total protein, animal protein, animal fat, phosphorus and vitamin B2 than any other group. Also protein energy ratio was the highest in the group eating out 4 times a week and above and they took more animal food group, other food group, beverages . teas and alcohols than other groups eating out. These results showed that higher frequency of eating out leads to higher intake of protein, fat, phosphorus, animal food groups and other food groups (oils, beverages, seasonings) and to lower intake of vitamin C and plant food groups. It, thus, suggested that the strategy for restaurant business is required to provide the menu substituted animal food by more plant food.

Seroprevalence of Toxoplasma gondii Infection and Characteristics of Seropositive Patients in General Hospitals in Daejeon, Korea

To figure out the epidemiological status and relevance with other diseases in toxoplasmosis, we checked serum IgG antibody titers of 1,265 patients and medical records of seropositive patients. Seropositive rates were 6.6% by latex agglutination test (LAT) and 6.7% by ELISA. No significant differences were detected between sexes and age groups. The peak seroprevalence was detected in the 40-49-year-old age group. According to clinical department, Toxoplasma-positive rates were high in patients in psychiatry, ophthalmology, health management, emergency medicine, and thoracic surgery. Major coincidental diseases in seropositive cases were malignant neoplasms, diabetes mellitus, arthritis, chronic hepatitis B, chronic renal diseases, schizophrenia, and acute lymphadenitis, in the order of frequency. In particular, some patients with chronic hepatitis B and malignant neoplasms had high antibody titers. These results revealed that the seroprevalence of toxoplasmosis in a general hospital-based study was similar to that in a community-based study, and T. gondii seropositivity may be associated with neoplasms, diabetes, and other chronic infections.

Public Recognition and Acceptance of Yookmee ('6 dishes') Designated by Daejeon Metropolitan City as the Foods Representative of the Daejeon Area / 대한지역사회영양학회지

This study was conducted to devise a scheme for the development of foods designated as Yookmee ("6 dishes), which are representative food of Daejeon area. The Yookmee consist of Seolleongtang (ox bone soup and boiled rice), Samgyetang (chicken stew stuffed with glutinous rice and ginseng), Dolsotbap (boiled rice mixed with vegetables), Goojeukmook (acorn jelly), Sootgol-naengmyeon (cold buckwheat noodles with broth) and Daecheongho minmulgogimaeuntang (spicy hot freshwater fish soup). A questionnaire was developed and administered by means of an interview regarding the subjects' recognition of and preference for the six dishes, their usual eating places and eating frequencies, the need for some standardization of recipes and for nutrition labeling including serving sizes and nutrient content. The total number of subjects who participated in this study were 328 (male 112, female 216) living in Daejeon. The subjects who were aware of the presence of Yookmee were more in their thirties or older (15%) compared to those in their twenties (9.6%). The percentages of the subjects who recognized the Yookmee as the representative foods were twice among those in their thirties (over 60%), as compared to 31.5% in their twenties (p < 0.001). Samgyetang was one of the favorite foods of all the Yookmee among those in their twenties and Goojeukmook was the favorite for all the other age groups. The incidence of those eating one of Yookmee more than once a month was 51.5% in all the age groups, but the intake frequency was lower among those in their twenties (43.8%). The percentage of those who recommended Yookmee as a food for guests was the highest among those in their fifties (54.7%). The first reason why the subjects do not recommend these foods was because they were unfamiliar with Yookmee; among those in their thirties and forties the 2nd reason was because it is not much enough in quality or quantity to be served as a food for guests. Over 60% of the subjects felt the need for standardization of Yookmee, recipes for especially those in their fifties did feel the needs (92.5%). Furthemore, regarding labeling of serving sizes and nutrients contents, over 80% of the subjects wanted these, and this desire tended to increase with age. From these results, it seems reasonable to accept Yookmee as the representative foods of Daejeon, despite the fact that many people do not yet currently do so. Since most of the subjects (85.4%) partake Yookmee outside of their homes, it is recommended that efforts need to be expanded on enhancing the nutritional quality, the taste and the quality control of Yookmee by standardizing the recipes, labeling the serving sizes and nutrient contents, and providing educational and publicity programs.

Tyrophagus putrescentiae: An imporiant allergen in Daejeon / 천식및알레르기

BACKGROUND: Tyrophagus putrescentiae is one of the storage mites found not only within storehouses but also in the house dust, and is known as the third most common mite following Dermatophagoides pteronyssinus and Dermatophagoides farinae in houses in Korea. There has been few reports on its sensitization rate in this country. OBJECT: The aim of this study was to evaluate its sensitization rate and clinical features of T. putrescentiae sensitized patients with allergic diseases in Daejeon area. METHODS: Skin prick tests with 33 common inhalant allergens including Tetranychus urticae and T. putrescentiae were done in 308 allergy patients who had visited Allergy Clinic of Eulji University Hospital from June, 2001 to April, 2002, and their clinical characteristics of these patients were analyzed. RESULTS: A total of 193(62.7%) out of 308 patients showed positive responses to more than one allergen. The prevalence of sensitization was highest for mites(51.9%) followed by cockroach (25.0%), weeds pollens(17.5%), animal epithelium(16.9%), fungi(16.2%), grasses pollens(15.6%) and tree pollens(14.6%). Among mites, sensitization rate to T. urticae was highest as 128 (41.6%), followed by D. farinae, 96(31.2%), T. putrescentiae, 95(30.8%), and D. pteronyssinus, 92(29.9%). Among positive responders to mites, eight patients with perennial asthma were sensitized to T. putrescentiae only. Sensitization to D. farinae and animal epithelium were more prevalent in Deajeon city compared to surrounding rural areas (for D. farinae, 72/203(35.5%) vs. 24/105(22.9%) respectively. P=.024, and for animal epithelium, 42/203(20.7%) vs. 10/105 (9.5%) respectively. P=.013). CONCLUSION: Tyrophagus putrescentiae was one of the most common inhalant allergens as well as house dust mite and two spotted spider mite in patients visiting an Allergy Clinic in Daejeon area. Further study will be needed to elucidate the clinical significance of T. putres-centiae -sensitized patients.