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Six year national trend of childhood aseptic meningitis incidence in Korea, 1996-2001

Authors:
Hae-Kwan Cheong at Sungkyunkwan University
Hae-Kwan Cheong
Sue Kyung Park
Sue Kyung Park
Sue Kyung Park
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Moran Ki at National Cancer Center Korea
Moran Ki
Kwan Lee at Dongguk University
Kwan Lee
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Abstract

BACKGROUND AND OBJECTIVES: Aseptic meningitis is a disease of children with seasonal outbreak in summer. In spite of high morbidity, it is not notifiable without reported nationwide morbidity. The authors estimated incidence of aseptic meningitis and its descriptive characteristics and time- and space-clustering pattern. SUBJECTS AND METHODs: Cases of aseptic meningitis were extracted from National Health Insurance payment request data of National Health Insurance Corporation from January 1996 to December 2001. Cases were classified by region, institution, and hospitalization. Standardized incidence was calculated and compared by the region, month of the year whether there is any clustering. RESULTS: Nationwide incidence of aseptic meningitis among children under 15 years old over the six year period was 3.48 per 1,000 per year. Incidence was higher in female (2.80/1,000) compared to male (4.02/1,000). Age-specific incidence was highest in 5 years old. Annual incidence was highest in 1997 (8.44/1,000) and lowest in 2000 (0.79 /1,000) with outbreak every 3 or 4 years. Outbreak was mostly confined in summer months, between May and Septe- mber. However, seasonal pattern was variable by year. Southern provinces and metropolitan areas had higher incidences and pattern was more prominent in the years with higher outbreak. Time-dependent pattern of the disease from south to north was not prominent. DISCUSSIONS AND CONCLUSIONS: We have calculated the nationwide incidence of the aseptic meningitis over six year period. In terms of aseptic meningitis, using National Health Insurance data for the estimation of the incidence is a plausible method for the surveillance of the disease.
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252
서 론
[1-4].
.
enterovirus,
adenovirus, arbovirus, mumps, herpes virus
[5-6]. (enterovirus)
80%
[7-9].
68
, , ,
, (herpangina),
[10-11].
, 15
, 1991
B5[12] , 1993 B3 7 [13] ,
1994 B3 3 [14], 1995 B3
7 [13,15], 1996 B1[13], A24
9[16], 1997 B5 Echo 30[17,18], 1998
6[19]
.
.
-
[10].
3-4
. 1990
1990 , 1993 1997 ,
[17,20]. 3
5-7 8
.
[17],
1997 ,
4
6
[21].
.
, ,
.
국내 소아 무균성 뇌막염의 전국적 발생 양상
정해관 박수경 기모란 이관
성균관대학교 의과대학 사회의학교실 서울대학교 의과대학 예방의학교실
을지대학교 의과대학 예방의학교실 동국대학교 의과대학 예방의학교실
원 저
253
.
.
,
.
[22].
6
, ,
, .
연구 대상 및 방법
1996 2001
.
,
15
(ICD-10) A87 (Viral men-
ingitis), A87.8 (Other specified viral meningitis)
A87.9 (Viral meningitis NOS)
, , ,
, , .
1998
15 20,707
. 3
5,037 (30.0%)
86.3%, 77.7%
,
[22].
1 . 1
.
. , ,
, , ,
, , .
, , ,
,
.
,
.
.
10
.
1996 2001
, ,
2000
.
결 과
1.
발생 환자
1996 6 15
209,063 .
65,512 31.3% .
6 1997
86,368 2000 7,826
.
13,426 - 38,962
(Table 1).
45.1% .
254
(Table 2).
60.4%, 42.4%, 2.4%
86.9% , 96.4%
.
2.
전국 발생률
6 1,000
3.48 4.02 . 2.80
Year Admission Outpatient Total
1996 6,723 6,703 13,426
1997 27,259 59,109 86,368
1998 15,651 23,117 38,768
1999 5,937 17,776 23,713
2000 1,486 6,340 7,826
2001 8,456 30,506 38,962
Total 65,512
(31.3%)
143,551
(68.7%)
209,063
(100.0%)
Table
Table Table
Table
1.
1. 1.
1.
Number
of
admitted
and
out
patient
aseptic
meningitis
cases
by
year
General hospital Hospital Clinic Total
1996 8,289 844 4,293 13,426
1997 39,361 7,169 39,838 86,368
1998 24,377 3,758 10,633 38,768
1999 8,443 939 14,331 23,713
2000 2,178 189 5,459 7,826
2001 11,548 1,727 25,687 38,962
Total 94,196
(45.1%)
14,626
(7.0%)
100,241
(47.9%)
209,063
(100.0%)
Table
Table Table
Table
2.
2. 2.
2.
Number
of
pediatric
aseptic
meningitis
cases
by
year
and
type
of
institution
Male Female Total
No. Incidence* No. Incidence* No. Incidence*Adjusted
incidence
1996 8,558 1.56 4,868 0.99 13,426 1.29 1.30
1997 53,284 9.86 33,084 6.85 86,368 8.44 8.61
1998 24,363 4.57 14,405 3.03 38,768 3.84 3.89
1999 14,404 2.73 9,309 1.98 23,713 2.38 2.37
2000 4,584 0.87 3,242 0.69 7,826 0.79 0.79
2001 23,733 4.55 15,229 3.28 38,962 3.95 3.94
Total 128,926 4.02 80,137 2.80 209,063 3.45 3.48
(61.7%) (38.3%) (100.0%)
*/1,000/yr.
Adjusted for the population in the year 2000.
Table
Table Table
Table
3.
3. 3.
3.
Incidence
of
pediatric
aseptic
meningitis
by
gender
and
year,
1996-2001
255
1.43 .
1997 1,000 8.61
2000 0.79 (Table 3).
5 .
3-7
(Fig. 1).
1996 3
7
7 .
, 2001
.
.
6
1997
2000
(Fig. 2). 2000
2 1
. 1993 2002
3-4 .
Incidence
(/1,000)
16
14
12
10
8
6
4
2
0
Age
0246810 12 14
Year
1996
1997
1998
1999
2000
2001
Fig.
Fig.Fig.
Fig. 1.
1.1.
1. Incidence of pediatric aseptic meningitis by age and year, 1996-2001. Incidence is highest between
age
three to seven, peaks at five. However, yearly pattern shows slight difference by year to year.
7
Incidence (/1
'
000)
1996
6
5
4
3
2
1
0
1 3 5 7 9 1 1 3 5 7 9 1 1 3 5 7 9 1 1 3 5 7 9 1 1 3 5 7 9 1 1 3 5 7 9 1
1997 1998 1999 2000 2001
Fig.
Fig.Fig.
Fig. 2.
2.2.
2. National incidence of pediatric aseptic meningitis by year and month, 1996-2001.
256
5
6 -7 9
. 1996
. 1997
. 1997 6 1,000
6.4
1,000 1.44 ~ 3.10 .
11 ~ 3 0.3/1,000
(Fig. 3).
1996
Incidence (/1'000)
7
6
5
4
3
2
1
0
1 2 3 4 5 6 7 8 9 10 11 12
1996
1997
1998
1999
2000
2001
Month
Fig.
Fig.Fig.
Fig. 3.
3.3.
3. National incidence of pediatric aseptic meningitis by year and month, 1996-2001.
Region 1996 1997 1998 1999 2000 2001 Total
Seoul 1.22 7.32 4.21 1.60 0.71 3.60 3.28
Busan 1.53 9.72 4.41 1.65 0.36 3.12 3.76
Daegu 1.98 3.22 2.75 6.03 2.42 4.15 3.48
Incheon 0.93 6.58 2.43 1.41 0.42 1.81 2.29
Gwangju 0.77 11.89 3.44 1.73 0.67 5.32 3.96
Daejeon 0.76 8.81 2.33 1.50 0.45 4.61 3.10
Ulsan 4.13 6.70 2.78 2.95 1.43 3.76 3.70
Gyeonggi 1.19 7.51 3.57 2.32 0.63 3.76 3.09
Gangwon 1.07 7.89 4.83 2.79 0.54 5.24 3.80
Chungbuk 0.82 9.79 3.93 2.38 0.34 2.64 3.35
Chungnam 0.29 8.06 1.51 0.63 0.30 4.90 2.62
Jeonbuk 1.98 19.33 4.21 4.96 1.54 9.27 7.05
Jeonnam 1.28 11.32 3.21 1.49 0.27 4.17 3.79
Gyeongbuk 1.47 5.10 3.03 0.99 0.25 1.79 2.17
Gyeongnam 2.24 16.16 3.25 4.27 2.61 9.37 6.40
Jeju 0.27 9.64 1.38 6.30 0.39 2.09 3.35
Table
Table Table
Table
4.
4. 4.
4.
Incidence
of
pediatric
aseptic
meningitis
by
region
and
year,
1996-2001
(/1,000)
257
, 1997 , 1998 , 1999 ,
2000 2001
(Table 4). 6
6 , 5 , , , ,
3 .
.
.
,
10-90
10
(Fig. 6).
.
1997
.
고 찰
6 34,800 1,000
3.48
1997 86,368 , 1,000
8,61 .
4-6
.
-
[23].
1.44
.
2
1996 1997 1998
1999 2000 2001 Incidence (/1,000)
0 -0.09
0.1-0.19
0.2-0.29
0.3-0.29
0.4-0.49
0.5-0.74
0.75-0.99
1.0-1.9
2.0-
Fig.
Fig.Fig.
Fig. 4.
4.4.
4. Geographic distribution of pediatric aseptic meningitis by year, 1996-2001.
258
[24].
,
,
[10].
,
[10]. 5-8
.
350
Incidence (/1'000'000)
300
250
200
150
100
50
0
1996
제주
전남
광주
부산
울산
경남
전북
대구
경북
충남
대전
충북
경기
인천
서울
강원
123456789101112
Month
350
Incidence (/1'000'000)
300
250
200
150
100
50
0
1997 제주
전남
광주
부산
울산
경남
전북
대구
경북
충남
대전
충북
경기
인천
서울
강원
123456789101112
Month
350
Incidence (/1'000'000)
300
250
200
150
100
50
0
1998
제주
전남
광주
부산
울산
경남
전북
대구
경북
충남
대전
충북
경기
인천
서울
강원
123456789101112
Month
350
Incidence (/1'000'000)
300
250
200
150
100
50
0
1999
제주
전남
광주
부산
울산
경남
전북
대구
경북
충남
대전
충북
경기
인천
서울
강원
123456789101112
Month
350
Incidence (/1'000'000)
300
250
200
150
100
50
0
2000
제주
전남
광주
부산
울산
경남
전북
대구
경북
충남
대전
충북
경기
인천
서울
강원
123456789101112
Month
350
Incidence (/1'000'000)
300
250
200
150
100
50
0
2001
제주
전남
광주
부산
울산
경남
전북
대구
경북
충남
대전
충북
경기
인천
서울
강원
12345678910 1112
Month
Fig.
Fig.Fig.
Fig. 5.
5.5.
5. Geographic distribution of incidence of pediatric aseptic meningitis by week of the year, 1996-2001.
This
graphs show that from south to north pattern of the progression of the outbreak of the disease is
not
evident. Disease clustering is more evident in localized area in each region.
259
.
5
.
.
.
-
(1-3 ) ,
.
.
.
.
.
50
Week
45
40
35
30
25
20
15
10
5
0제
주광
주경
남전
북경
북대
전경
기서
울
지역
10
50
90
Percentile
1996
45-50
40-45
35-40
30-35
25-30
20-25
15-20
5-10
0-5
50
Week
45
40
35
30
25
20
15
10
5
0제
주광
주경
남전
북경
북대
전경
기서
울
지역
10
60
Percentile
1997
50
Week
45
40
35
30
25
20
15
10
5
0제
주광
주경
남전
북경
북대
전경
기서
울
지역
10
60
1998
45-50
40-45
35-40
30-35
25-30
20-25
15-20
5-10
0-5
50
Week
45
40
35
30
25
20
15
10
5
0제
주광
주경
남전
북경
북대
전경
기서
울
지역
10
50
90
Percentile
1999
50
Week
45
40
35
30
25
20
15
10
5
0제
주광
주경
남전
북경
북대
전경
기서
울
지역
10
50
90
Percentile
2000
50
Week
45
40
35
30
25
20
15
10
5
0제
주광
주경
남전
북경
북대
전경
기서
울
지역
10
50
90
2001
Fig.
Fig.Fig.
Fig. 6.
6.6.
6. Distribution of onset of pediatric aseptic meningitis cases in a year by region, 1996-2001. Each grid
in
Y-axis means percentile of the whole patients in each year. Color stripes in each graph denotes
the
week of the year. Regions are placed by the level of latitude increasing from left to right. These
graphs
show that progression of pediatric aseptic meningitis is not dependent on the latitude, without
any
evidence of from south to north progression of the disease. It suggests that transmission of the
disease
is dependent on the factors other than temperature.
260
.
.
,
.
, 500 1
[6].
,
[6].
.
[25].
, 1999 6
8 9
, 10
43.5-126.4 [6].
10 275
.
,
.
,
1000/mcL , 40-80%,
, 100 mg/dL ,
40%
,
[].
,
(RT-PCR)
.
3873 47.6%(1845 ) ,
40.5%(1,568 )
.
,
.
, ,
, ,
, , ,
, , ±5%
, [22].
, ,
.
,
,
.
, ,
.
.
.
261
.
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clinical relevance of 'CSF viral culture'. A two-year
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iruses and other enteroviruses. In: Belshe RB,
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11. Morens DM, Pallansch MA. Epidemiology. In:
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1st ed. Washington, D.C.: ASM Press; 1995. p.3-23.
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1991 . 1993;36:
506-11.
13. , , , , , .
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1994;5:89-90.
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103-4.
18. , , , , , .
. 1999;31:402-5.
19. , , , , , .
: 1993-1998. 1999;31:382-9.
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22. , , , , .
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262
Background and objectives: Aseptic meningitis is a disease of children with seasonal outbreak in summer. In spite
of high morbidity, it is not notifiable without reported nationwide morbidity. The authors estimated incidence of aseptic
meningitis and its descriptive characteristics and time- and space-clustering pattern.
Subjects and methods: Cases of aseptic meningitis were extracted from National Health Insurance payment request
data of National Health Insurance Corporation from January 1996 to December 2001. Cases were classified by region,
institution, and hospitalization. Standardized incidence was calculated and compared by the region, month of the year
whether there is any clustering.
Results: Nationwide incidence of aseptic meningitis among children under 15 years old over the six year period was
3.48 per 1,000 per year. Incidence was higher in female (2.80/1,000) compared to male (4.02/1,000). Age-specific
incidence was highest in 5 years old. Annual incidence was highest in 1997 (8.44/1,000) and lowest in 2000 (0.79
/1,000) with outbreak every 3 or 4 years. Outbreak was mostly confined in summer months, between May and Septe-
mber. However, seasonal pattern was variable by year. Southern provinces and metropolitan areas had higher incidences
and pattern was more prominent in the years with higher outbreak. Time-dependent pattern of the disease from south
to north was not prominent.
Discussions and conclusions: We have calculated the nationwide incidence of the aseptic meningitis over six year
period. In terms of aseptic meningitis, using National Health Insurance data for the estimation of the incidence is a
plausible method for the surveillance of the disease.
: Aseptic meningitis, Enterovirus, Descriptive epidemiology, Clustering
Six year national trend of childhood aseptic meningitis
incidence in Korea, 1996-2001
Hae-Kwan Cheong
1)
, Sue Kyung Park
2)
, Moran Ki
3)
, Kwan Lee
4)
... The numbered enteroviruses (68 to 71) bring HFMD, bronchiolitis, conjunctivitis, meningitis and paralysis resembling poliomyelitis [1,2]. In East Asian countries including Korea, Japan, and Taiwan, HFMD, AM, and AHC are predominantly found during summer and early fall [4][5][6][7][8]. The seasonality of these enteroviral diseases suggests that meteorological variables and water quality parameters might influence the spread and distribution of enteroviruses [9,10]. ...
... In a sentinel surveillance the Korea Centers for Disease Control and Prevention (KCDC) held from 2010 to 2013, 214,642 (0.53%) patients among 40,461,309 outpatient visits were clinically diagnosed with HFMD [8]. The outbreaks of AM in Korea occurred approximately every three years since 1990 [6,12]. Average annual incidence of AM among children under 15 was 3.5 per 1000 in 1996-2001 [6]. ...
... The outbreaks of AM in Korea occurred approximately every three years since 1990 [6,12]. Average annual incidence of AM among children under 15 was 3.5 per 1000 in 1996-2001 [6]. During an outbreak in 2008, 67.7% of the samples from 758 enterovirus-positive patients were positive for AM, and of those, 98% were from children younger than 15 years [12]. ...
Impact of Drinking Water Quality on the Development of Enteroviral Diseases in Korea
Article
Full-text available
Enterovirus diseases are fecal-orally transmitted, and its transmission may be closely related with the drinking water quality and other environmental factors. This study aimed to assess the association between environmental factors including drinking water quality and the incidence of enteroviral diseases in metropolitan provinces of Korea. Using monthly number of hand-foot-mouth disease (HFMD), aseptic meningitis (AM) and acute hemorrhage conjunctivitis (AHC) cases, generalized linear Poisson model was applied to estimate the effects of environmental factors on the monthly cases. An increase of mean temperature was associated with an increase of enteroviral diseases at 0–2 months lag, while an increase of turbidity was associated with increase in HFMD at 1 month lag and a decrease in AHC. An increase of residual chlorine in municipal drinking water was associated with a decrease in HFMD and AHC 2 and 3 months later. An increase of pH was associated with a maximum increase in AM 3 months later. The meta-analysis revealed the effects of the provincial and pooled variation in percent change of risks of environmental factors on HFMD, AM, and AHC cases at specific selected lags. This study suggests that the drinking water quality is one of the major determinants on enteroviral diseases.
View
... In Korea, enteroviral AM has become a serious public health problem among children [24,25]. Outbreaks of AM occurred approximately every three years since 1990 [5,24,26]. ...
... Outbreaks of AM occurred approximately every three years since 1990 [5,24,26]. In 1996-2001, the average annual incidence of AM among children under 15 was 3.5 per 1000 [25]. isolates of echovirus (13) and CAV (serotypes 24 and 9) were identified in 2939 patients with AM and other enteroviral diseases [7]. ...
... For example, echovirus (9) in 1993, echovirus (serotypes 30 and 6) in 1998, echovirus (13) and CAV (24) in 2002, echovirus (18) and CBV (5) in 2005, and echovirus (serotypes 6 and 30) in 2008 [5,7,26,27]. Previous Korean studies have mostly focused on the descriptive, seroepidemiology, and molecular biology of EVs [25][26][27]. However, there is a need for in-depth statistical analysis of the relationship between meteorological variables and AM cases in Korea. ...
Associations between Meteorological Factors and Aseptic Meningitis in Six Metropolitan Provinces of the Republic of Korea
Article
Full-text available
We assessed the association between climate factors and a number of aseptic meningitis cases in six metropolitan provinces of the Republic of Korea using a weekly number of cases from January 2002 to December 2012. Generalized linear quasi-Poisson models were applied to estimate the effects of climate factors on the weekly number of aseptic meningitis cases. We used generalized additive and generalized additive mixed models to assess dose–response relationships. A 1 °C increase in mean temperature was associated with an 11.4% (95% confidence interval (CI): 9.6%–13.3%) increase in aseptic meningitis with a 0-week lag; a 10 mm rise in rainfall was associated with an 8.0% (95% CI: 7.2%–8.8%) increase in aseptic meningitis with a 7-week lag; and a 1 mJ/m² increase of solar radiation was associated with a 5.8% (95% CI: 3.0%–8.7%) increase in aseptic meningitis with a 10-week lag. Nino3 showed positive effects in all lags, and its one unit increase was associated with an 18.9% (95% CI: 15.3%–22.6%) increase of aseptic meningitis at lag 9. The variability in the relationship between climate factors and aseptic meningitis could be used to initiate preventive measures for climate determinants of aseptic meningitis.
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... limitations of the NHI database on the accuracy of diagnosis by using the KCCR database to assess the number of patients with thyroid cancer. Diagnostic accuracy is a common limitation in using health administrative data, although the reliability of the information in the NHI database has been previously validated in several studies [25][26][27][28][29]. ...
Changes in the Diagnostic Efficiency of Thyroid Fine-Needle Aspiration Biopsy during the Era of Increased Thyroid Cancer Screening in Korea
Article
Full-text available
  • Feb 2019
Purpose: The volume of thyroid cancer screening and subsequent thyroid fine-needle aspiration (FNA) have rapidly increased in South Korea. We analyzed the thyroid cancer diagnoses/thyroid FNA ratio according to the annual number of FNA to evaluate changes in the diagnostic efficiency of FNA. Materials and methods: This was a nationwide population-based retrospective cohort study. The overall thyroid cancer diagnoses/thyroid FNA ratio and annual incremental thyroid cancer diagnoses/incremental thyroid FNA ratio were indirectly calculated using data obtained from the Korea Central Cancer Registry database and the Korean National Health Insurance Service claims database from 2004 to 2012. Pearson correlation analyses were performed to evaluate the strength of linear associations between variables. Results: The number of thyroid FNA increased from 28,596 to 177,805 (6.2-fold increase) from 2004 to 2012. The overall thyroid cancer diagnoses/thyroid FNA ratio decreased from 36.5% in 2004 to 25.1% in 2012 and was negatively correlated to the number of FNA (R=‒0.977, p<0.001). The annual incremental thyroid cancer diagnoses/incremental thyroid FNA ratios (range, 15.3% to 30.7%) were always lower than the overall thyroid cancer diagnoses/thyroid FNA ratio in each year and also worsened according to the increase in the number of FNA (R=‒0.853, p=0.007). Conclusion: The diagnostic performance of both overall and annual incremental thyroid FNA worsened, whereas the number of thyroid FNA procedures increased. More sophisticated indications for FNA are required to improve its diagnostic efficiency, considering the increased burden of screening-detected thyroid nodules.
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... 23 In addition to acute gastroenteritis, some studies have suggested that contaminated water is a potential risk associated with the spread of aseptic meningitis and hand, foot, and mouth disease. [24][25][26] In 2006, the frequency of handwashing with soap after using a public restroom was approximately 17% in the handwashing observational survey conducted in Korea. 16 In the survey conducted in 2013, it was 23.5%, which is still low compared with the North American The risk of diarrheal and intestinal infectious disease due to inadequate drinking water provided by the WHO and IHME is mainly calculated from data for low-or middle-income countries. ...
Burden of Disease Attributable to Inadequate Drinking Water, Sanitation, and Hygiene in Korea
Article
Full-text available
  • Oct 2018
Background Diarrheal and intestinal infectious disease caused by inadequate drinking water, sanitation, and hygiene (WASH) is not only a great concern in developing countries but also a problem in low-income populations and rural areas in developed countries. In this study, we assessed the exposure to inadequate WASH in Korea and estimated the burden of disease attributable to inadequate WASH. Methods We used observational data on water supply, drinking water, sewage treatment rate, and hand washing to assess inadequate WASH conditions in Korea, and estimated the level of exposure in the entire population. The disease burden was estimated by applying the cause of death data from death registry and the morbidity data from the national health insurance to the population attributable fraction (PAF) for the disease caused by inappropriate WASH. Results In 2013, 1.4% of the population were exposed to inadequate drinking water, and 1.0% were living in areas where sewerage was not connected. The frequency of handwashing with soap after contact with excreta was 23.5%. The PAF due to inadequate WASH as a cluster of risk factors was 0.353 (95% confidence interval [CI], 0.275–0.417), among which over 90% were attributable to hand hygiene factors that were significantly worse than those in American and European high-income countries. Conclusion The level of hand hygiene in Korea has yet to be improved to the extent that it shows a significant difference compared to other high-income countries. Therefore, improving the current situation in Korea requires a continuous hand washing campaign and a program aimed at all people. In addition, continuous policy intervention for improvement of sewage treatment facilities in rural areas is required, and water quality control monitoring should be continuously carried out.
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The Prevalence and Features of Korean Gout Patients Using the National Health Insurance Corporation Database
Article
Full-text available
  • Jan 2011
Objective. We wanted to evaluate the prevalence of gout and its features in Korean people using the National Health Insurance Corporation (NHIC) database. Methods. Using the NHIC database from 2001 to 2008, we selected the gout patients who were coded as having gout as a main diagnosis. From the total number of gout pa-tients, we evaluated the prevalence of gout and its features. Results. The prevalence of gout prevalence was 0.171% in 2001 and 0.397% in 2008, and there was a 2.317 fold in-creased during over the 7 years. In 2008, the percentage of fifth and sixth decade patients was 48.5% and that of the male patients were 89.8% of the total gout patients. The increasing rate of the prevalence of gout during the same period was also higher in males (the male vs. female ratio was 5.3:1 in 2001 and 8.8:1 in 2008). The gout preva-lence increased year by year to the eighth decade, and the peak prevalence age group was the ninth decade in 2001, the eighth decade in 2002-2005 and the seventh decade in 2006-2008. The prevalence ratio of 2008 to 2001 was high-er for the males and the younger age group; that of third decade for males was 9.87 , which was over the 10 times higher compared to that of the ninth decade (9.87 vs. 0.89, respectively). Conclusion. The prevalence of gout in 2008 using the NHIC database was 0.397%, so the prevalence of gout in-creased 2.317 fold over the 7 years, and nearly 90% of the gout patients were male. The increasing rate of gout prev-alence was higher in the males and the younger age group.
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Factors associated with gout in South Koreans: Analysis using the National Health Insurance Corporation and the National Health Screening Exam databases
Article
  • Feb 2013
  • CLIN RHEUMATOL
The aim of this study was to identify the factors associated with gout among South Koreans. A case control study of gout patients newly diagnosed between January 1, 2007, and December 31, 2008, and matching controls was conducted using the nationwide database (National Health Insurance Corporation and National Health Screening Exam (NHSE) database), which included the health-care records of 48.1 million individuals. Of 495,998 newly diagnosed patients, we included 18,123 who were ≥40 years old and had an NHSE before diagnosis of gout. To elucidate the factors associated with gout, multivariate conditional logistic analyses were performed. Gout was associated with drinking ≥1/week (p < 0.001), drinking ≥1 bottle of soju/session (p < 0.001), high body mass index (BMI) (p < 0.001), high blood pressure (p < 0.001), high total cholesterol (p < 0.001), proteinuria (multivariate odds ratio (OR) = 1.75; 95 % confidence interval (CI) = 1.53-2.00), and an elevated uric acid (multivariate OR = 1.54; 95 % CI = 1.22-1.94). Exercise frequency was not significantly associated with gout. Prediabetic blood sugar level (100-125 mg/dL) was associated with gout in the univariate analysis, but not in the multivariate analysis. Diabetic blood sugar level (≥126 mg/dL) was associated with a decreased odds of gout (multivariate OR = 0.79; 95 % CI = 0.73-0.86). Our nationwide South Korean study showed that frequent and excessive alcohol consumption, high BMI, high blood pressure, high total cholesterol, proteinuria, and high uric acid are associated with gout.
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Transmission of Seasonal Outbreak of Childhood Enteroviral Aseptic Meningitis and Hand-foot-mouth Disease
Article
Full-text available
  • May 2010
  • J KOREAN MED SCI
This study was conducted to evaluate the modes of transmission of aseptic meningitis (AM) and hand-foot-mouth disease (HFMD) using a case-control and a case-crossover design. We recruited 205 childhood AM and 116 HFMD cases and 170 non-enteroviral disease controls from three general hospitals in Gyeongju, Pohang, and Seoul between May and August in both 2002 and 2003. For the case-crossover design, we established the hazard and non-hazard periods as week one and week four before admission, respectively. In the case-control design, drinking water that had not been boiled, not using a water purifier, changes in water quality, and contact with AM patients were significantly associated with the risk of AM (odds ratio [OR]=2.8, 2.9, 4.6, and 10.9, respectively), while drinking water that had not been boiled, having a non-water closet toilet, changes in water quality, and contact with HFMD patients were associated with risk of HFMD (OR=3.3, 2.8, 6.9, and 5.0, respectively). In the case-crossover design, many life-style variables such as contact with AM or HFMD patients, visiting a hospital, changes in water quality, presence of a skin wound, eating out, and going shopping were significantly associated with the risk of AM (OR=18.0, 7.0, 8.0, 2.2, 22.3, and 3.0, respectively) and HFMD (OR=9.0, 37.0, 11.0, 12.0, 37.0, and 5.0, respectively). Our findings suggest that person-to-person contact and contaminated water could be the principal modes of transmission of AM and HFMD.
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The Male Predominance in the Incidence of Infectious Diseases in Children: A Postulated Explanation for Disparities in the Literature
Article
  • May 1992
In children, a male predominance in the incidence of symptomatic disease has been reported for some infectious agents and not for others. Not only are the factors underlying these sex differences poorly understood, but it is also not clear why the differences are described only for selected infectious diseases. In this study of sex-and age-specific incidence of infectious diseases in children, a possible explanation for the inconsistencies in the literature was explored. The sex ratio in reported disease incidence in Israel during a period of about 20 years was examined for various viral and bacterial infections. In addition, an hypothetical mathematical model was developed which assumes increased susceptibility to infectious disease (such as in relative immune deficiency) in a proportion of males. In children aged under 4 years, a higher incidence among males was consistently observed for all diseases, and the sex ratio varied between 1.16(95% confidence interval (CI): 1.13–1.18) for shigellosis to 1.98(95% CI: 1.79–2.17) for viral meningitis. The highest ratios were associated with the diseases which tend to present asymptomatically most often, which is consistent with the predictions of the model. The male excess in symptomatic disease appears to be present for most infectious diseases and this should be taken into account in studies comparing observed disease incidence between groups with different sex ratios. The incon sistencies in reports on the excess male morbidity for infectious diseases may be due to variations in symptomatic to asymptomatic infection ratios.
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The Acute Aseptic Meningitis Syndrome
Article
  • Jan 1991
  • INFECT DIS CLIN N AM
The acute aseptic meningitis syndrome is an entity that presents a diagnostic challenge to the clinician. Although many infectious and noninfectious etiologies exist for this syndrome, viruses, especially nonpolio enteroviruses, are the classic and most important agents encountered. The incidence of polio and mumps meningitis has declined dramatically in the vaccine era, but recently described pathogens, such as human immunodeficiency virus and Borrelia burgdorferi (Lyme disease agent) are now important considerations in the differential diagnosis. Specifically treatable entities (eg, mycobacterial or fungal meningitis, herpes simplex encephalitis, parameningeal infection) that may mimic aseptic meningitis in their initial presentations must not be overlooked. A careful approach to the patient and a rational use of laboratory studies are the basis for establishing a specific diagnosis and assuring a favorable outcome.
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Temporal and Geographic Patterns of Isolates of Nonpolio Enterovirus in the United States, 1970-1983
Article
  • Mar 1986
Surveillance data on nonpolio enterovirus (NPEV) from the Centers for Disease Control (Atlanta, Georgia) for the United States from 1970 to 1983 were analyzed for the temporal and geographic patterns of the most common types of NPEV isolated. The number of isolates varied from year to year, partly because of variation in the number of reporting laboratories and partly because of true variation in the rate of isolation. The most common types isolated also varied from year to year, yet the 15 most common types over the entire 14-year period accounted for 65%–89% of isolates for a given year. The 15 most common types of NPEV had two basic patterns of isolation, one in which a type had periodic epidemic years and the other in which it did not. In 11 of the 14 years there was one or more epidemic types, each accounting for ⩾ 20% of all isolates of NPEV that year. The six most common isolates in March, April, and May predicted an average of 59% of the total isolates detected in July-December of that year.
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Viral Meningitis
Article
  • Apr 1985
  • MED CLIN N AM
Viral meningitis is part of the aseptic meningitis syndrome but must be distinguished from bacterial meningitis on the basis of a careful examination of the CSF and sound clinical judgment. Enteroviruses probably account for the bulk of cases of aseptic meningitis that occur in the United States and which are reported to the Centers for Disease Control each year. The seasonal pattern in the incidence of aseptic meningitis is largely due to the seasonal variation of enteroviral infections. Early on, the CSF in patients with viral meningitis frequently contains a predominance of polymorphonuclear leukocytes and may even have a low glucose level. The presence of neutrophils in the initial CSF sample is especially common in patients with enteroviral infections. A CSF glucose level lower than 50 per cent of a simultaneously drawn blood glucose determination is not uncommon in patients with viral meningitis due to mumps, LCM, and herpes simplex. In a patient with a predominance of polymorphonuclear leukocytes in the initial CSF specimen and in whom a viral infection is suspected, antibiotics may be withheld if a spinal tap is repeated within 12 hours. A shift from polymorphonuclear leukocytes to mononuclear cells makes viral meningitis the likely diagnosis. Both herpes simplex and varicella-zoster may infect the meninges by means of spread from cervical and dorsal root ganglia in a retrograde fashion much the way they spread in an antegrade fashion to the skin. HSV-2 is more likely to cause the clinical syndrome of viral meningitis, while HSV-1 is more likely to cause a meningoencephalitis with serious brain dysfunction. The identification of a specific viral agent in body fluids, especially the CSF, in a patient with aseptic meningitis is of more than academic interest, since it can shorten duration of hospital stay and eliminate unnecessary antimicrobial therapy. The diagnosis of enteroviral infections depends upon the isolation of a virus from CSF, stool, or throat plus a fourfold antibody response in the serum to the viral isolate. The 60-odd serotypes of enterovirus, each with different antigenic determinants, preclude serologic testing alone as a useful diagnostic test to identify the patient infected with coxsackievirus or echovirus. For infections, due to herpes simplex, varicella-zoster, LCM, and arboviruses, a serologic test alone can be useful.(ABSTRACT TRUNCATED AT 400 WORDS)
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The clinical relevance of 'CSF viral culture'. A two-year experience with aseptic meningitis in Rochester, NY
Article
  • May 1982
The clinical relevance of CSF viral cultures was evaluated by reviewing the records of 390 patients whose CSF was cultured for virus during a two-year period. The diagnoses at hospital discharge were aseptic meningitis, meningoencephalitis, or both in 111 patients, and enterovirus was isolated from the CSF or other test specimens in 46 patients (41%). The diagnosis or management of nearly one half of the patients from whom enterovirus was isolated was directly influenced by this information. Hospitalization and the unnecessary use of antibiotics were shortened by at least 70 days. Enterovirus was the only virus isolated from the CSF during the study period. The CSF was more likely positive for an enterovirus if it was drawn from a young patient with aseptic meningitis during the summer of fall months. The clinical data obtained from this study are discussed and compared with national statistics.
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Sensitive populations: Who is at the greatest risk?
Article
  • Jul 1996
  • INT J FOOD MICROBIOL
The purpose of this article was to review the existing literature to define those groups of individuals who would be at the greatest risk of serious illness and mortality from water and foodborne enteric microorganisms. This group was found to include the very young, the elderly, pregnant women, and the immunocompromised. This segment of the population currently represents almost 20% of the population in the United States and is expected to increase significantly by the beginning of the next century, because of increases in life-span and the number of immunocompromised individuals. More than half of documented deaths from gastroenteritis and hepatitis A illness occur in the elderly in developed countries. The overall case fatality ratio for foodborne bacterial gastroenteritis outbreaks in nursing homes is 10 times greater than the general population. Pregnant mothers suffer from a case fatality ratio from hepatitis E infections ten times greater than the general population during waterborne disease outbreaks. Enteric diseases are most common and devastating among the immunocompromised. Cryptosporidium is a serious problem among patients with acquired immuno-deficiency syndrome (AIDS). Cancer patients undergoing chemotherapy and transplant patients, are also at significantly greater risk of dying from enteric viral infections than the general population. This review indicates the need for consideration of enhanced protection for certain segments of the population who will suffer the most from food and waterborne pathogens.
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A season of aseptic meningitis in Germany: Epidemiologic, clinical and diagnostic aspects
Article
  • Jan 2003
We assessed epidemiologic, clinical and laboratory features of aseptic meningitis during one season of multiserotype enteroviral meningitis in East Germany in 70 consecutive patients with aseptic meningitis admitted to the Children's University Hospital Leipzig. Patients, age 1 to 16 years, typically presented with headache, emesis and fever, whereas signs of meningeal irritation were only moderately expressed in one-half of the patients. The median number of leukocytes in the CSF was 151 cells/mm(3) (range, 2 to 1,820) with a high percentage of polymorphonuclear cells (PMNs). Initial blood counts showed mild leukocytosis and pronounced PMN predominance (78.9 +/- 1.3%). The percentage of PMNs in the peripheral blood decreased in favor of mononuclear cells after 3 days to a pattern more compatible with viral infection as opposed to that suggestive for bacteria in the beginning. Mean cerebrospinal fluid values of protein, glucose and lactate and the C-reactive protein were mildly elevated or normal. Nonpolio enteroviruses were detected in 30 of 70 patients. Subsequent serotyping revealed echovirus type 13 (13 patients), type 6 (2), type 30 (1) and coxsackie B virus type 5 (2). There were no differences in demographic or clinical data between enterovirus positive and negative patients. Even though individual laboratory values do not solely allow discrimination between viral and bacterial meningitis, the combined epidemiologic, clinical and laboratory data facilitate the diagnosis of aseptic meningitis in most cases. Viral diagnostics, identifying echovirus type 13 that thus far has not been associated with epidemics of meningitis, adds important epidemiologic information.
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Temporal and geographic patterns of isolates of nonpolio enterovirus in the United States, 1973-1983
  • Jan 1986
  • 346-351
  • R A Strikas
  • L J Anderson
  • R A Parker
Strikas RA, Anderson LJ, Parker RA. Temporal and geographic patterns of isolates of nonpolio enterovirus in the United States, 1973-1983. J Infet Dis 1986;153:346-51.
Centers for Disease Prevention and Control. Summary of notifiable disease
  • Jan 1994
  • 1-8
Centers for Disease Prevention and Control. Summary of notifiable disease, United States, 1994. MMWR 1995;43(53):1-8.
Centers for Disease Prevention and Control. Outbreak of aseptic meningitis associated with multiple enterovirus serotypes
  • Jan 1999
  • 669-671
Centers for Disease Prevention and Control. Outbreak of aseptic meningitis associated with multiple enterovirus serotypes, Romania, 1999. MMWR 2000; 49(29):669-71.