Transmission Dynamics of the Delta Variant of SARS-CoV-2 Infections in South Korea.

BACKGROUND: The Delta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was the predominant variant worldwide at the time of this study. However, its transmission dynamics were unclear. METHODS: We analyzed 405 local cases infected with the Delta variant of SARS-CoV-2 and temporal patterns of viral shedding identified between 22 June and 31 July 2021 in Daejeon, South Korea. RESULTS: Overall, 20% were presymptomatic at the time of epidemiological investigation. We identified 6 clustered outbreaks, and all were associated with indoor facilities. In 23 household contacts, the secondary attack rate was 63%. We estimated the mean serial interval as 3.26 days (95% credible interval, 2.92-3.60), and 15% (95% confidence interval, 13%-18%) of cases seeded 80% of all local transmission. Analysis of the nasopharyngeal swab samples identified virus shedding from the presymptomatic cases and the highest viral load was observed 2 days after symptom onset. CONCLUSIONS: Our findings suggest that the Delta variant is highly transmissible in indoor settings and households. Rapid contact tracing, isolation of the asymptomatic contacts, strict adherence to public health measures, and increased uptake of coronavirus disease 2019 (COVID-19) vaccination, including booster doses, are needed to reduce community transmission of the Delta variant.

Paradoxical health care utilization patterns among children in Korea who did not receive mandatory pneumococcal vaccination.

BACKGROUND: Unvaccinated children in the National Immunization Program (NIP) are a public health concern. We used Korean national population data to analyze health care utilization patterns of NIP-eligible children and identify the unvaccinated group. METHODS: Pneumococcal vaccination (PCV) records were reviewed to determine the vaccination status of children born between 2013 and 2015. Children who received three doses or more from a 3 + 1 schedule were defined as vaccinated, while those who had not received any pneumococcal vaccinations were defined as unvaccinated. Corresponding health care utilization records were retrieved from the National Health Insurance Review and Assessment Service. The incidence of combined pneumococcal infections and health care utilization rates were estimated and the proportion of complementary and alternative medicine (CAM) utilization among the total health care utilization records was measured. RESULTS: In total, 26,893 (2.1%) of 1,272,685 children remained unvaccinated. The incidence of pneumococcal infection was lower in unvaccinated children, at 10.1 cases (9.8-10.3) per 1000 person-months. However, their health care utilization was significantly lower than that noted for vaccinated children (hospital visit rate: 26.6 (95% confidence interval [CI] 26.5-26.7) vs. 3.2 (3.2-3.3) visits annually), indicating underdetection. CAM treatment was sought at least three times often more in unvaccinated children than in vaccinated children (3.5% vs. 1.1%). CONCLUSION: Unvaccinated children showed significantly lower utilization of overall health care than the vaccinated children; however, a higher preference for CAM was noted among unvaccinated children than among vaccinated children. These differences in care-seeking patterns should be considered when identifying unvaccinated children and providing protection through vaccination programs.

Perspectives on antenatal education associated with pregnancy outcomes: Systematic review and meta-analysis.

BACKGROUND: Many studies on the relation between maternal health and infant health, including the effect of structured antenatal education, have been published and expanded over the years. AIM: Investigate the impact of various antenatal education programmes on pregnancy outcomes to aid the development of future guidelines related to maternal and foetal health. METHODS: Bibliographic databases (Cochrane, PubMed, EMBASE, CINAHL, Korean Studies Information Service System) were searched up to November 2018, following the PICO criteria: population (pregnant women), intervention (antenatal education), comparison (not specified), and outcome (maternal and foetal outcome including physical or mental health components). FINDINGS: We included 23 eligible studies consisting of 14 controlled trials and 9 observational studies. The maternal physical outcomes depending on participation in antenatal education were not significantly different; however, the caesarean birth rate was lower in the antenatal education group (relative risk, RR, 0.90; 95% confidence interval, CI, 0.82-0.99), as was the use of epidural anaesthesia (RR, 0.84; 95% CI, 0.74-0.96). The maternal mental health outcomes of stress and self-efficacy significantly improved in the antenatal education group, although there was no difference in anxiety and depression. The foetal outcomes of birth weight or gestational age at birth were also not different between the groups. CONCLUSION: Antenatal education can reduce maternal stress, improve self-efficacy, lower the caesarean birth rate, and decrease the use of epidural anaesthesia; however, there is limited evidence of its effects on maternal or foetal physical outcomes. Therefore, antenatal education should be standardised to elucidate its actual mental and physical health effects.

Perspective of the comparative effectiveness of non-pharmacologic managements on postpartum hemorrhage using a network meta-analysis.

OBJECTIVE: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and is both unpredictable and inevitable. While uterotonic drugs are routinely recommended, there is ongoing debate on the ideal intervention to control uterine bleeding. This review aims to compare the use of non-pharmacologic treatments with peripartum hysterectomy in cases of life-threatening uncontrolled obstetric hemorrhage. The review's objective is to use a network meta-analysis to help prevent maternal deaths and rank the treatments according to success rates. METHODS: We searched MEDLINE (PubMed), Embase, and the Cochrane Library, from January 2014 until December 2018. A second search was carried out in April 2019 before the final data analysis. Network meta-analysis allows for the calculation of the effect size between treatment groups through indirect treatment comparison. RESULTS: We confirmed that balloon-assisted management is the best intervention for uncontrolled postpartum bleeding with pharmacologic treatment. This is followed by uterine artery embolization and surgical procedures, which can help avoid the need for a hysterectomy. The balloon tamponade demonstrated lower failure rate than the surgical procedure with odds ratio (OR) of 0.44 and 95% confidence intervals (CIs) 0.50-30.54. Uterine artery embolization had a lower risk for hysterectomy than the surgical procedure group (OR, 0.74; 95% CI, 0.22-2.50). CONCLUSION: For the quick treatment of postpartum bleeding, balloon tamponade is the best method for uncontrolled postpartum bleeding with pharmacologic treatment, followed by uterine artery embolization and surgical procedures.