This narrative review systematically analyzes the longitudinal evolution of South Korea’s legal and institutional frameworks from the 2015 MERS outbreak through the COVID-19 pandemic. The study introduces the “Pandemic Response Pentad,” an original conceptual model positioning Legislation as the foundational core, mediated by Governance, to drive three interconnected field operations. Based on this framework, Korea’s infectious disease control system is evaluated across four operational domains: (1) governance reform and personnel structure enhancement, (2) epidemiological response capabilities and data utilization, (3) medical response system, including vaccination programs and supply stockpiling, and (4) social response mechanisms, encompassing social distancing and the protection of vulnerable populations. While rapid legislative enactments enabled effective disease control, they also generated profound ethical tensions regarding fundamental human rights. To mitigate these unintended socioeconomic consequences, Korea institutionalized extensive statutory compensation mechanisms for healthcare facilities, small business owners, and vaccine injuries. The findings highlight that advancing national research infrastructure and establishing policy-oriented think tanks for future pandemic preparedness strictly require proactive legislative backing. Ultimately, this study provides valuable insights into the critical interplay between legal mandates and institutional resilience in global health crisis management.

BACKGROUND & AIMS:We evaluated the association between hepatitis C virus (HCV) infection and the risk of intrahepatic and extrahepatic cancers. Specifically, we compared "1st" versus "1st or 2nd" primary cancers to capture the true disease burden, which is often underestimated in conventional analyses. Additionally, we evaluated the chemopreventive effect of direct-acting antiviral (DAA) therapy on these risks. METHODS:Using the Korean National Health Insurance database (2005-2023), we compared 119 565 HCV-infected individuals with 2 267 700 controls. Adjusted subdistribution hazard ratios (aHRs) were calculated using competing risk models. Direct-acting antivirals (DAA) effectiveness was evaluated in a sub-cohort of 23 147 patients (2016-2020) using time-dependent Cox models to account for immortal time bias. RESULTS:In the analysis of 1st or 2nd cancers, HCV infection significantly increased the risk of intrahepatic (aHR 16.35; 95% CI, 15.81-16.90) and extrahepatic cancers (aHR 1.14; 95% CI, 1.12-1.16). Notably, expanding the endpoint to include 2nd cancers increased the aHR for extrahepatic cancer from 1.09 to 1.14, indicating that traditional analyses underestimate the true burden. Significant risk elevations were observed for haematological, biliary, pancreatic, and renal cancers. In the DAA sub-cohort analysis using the time-dependent model, DAA treatment significantly reduced the risk of intrahepatic cancer (aHR 0.54-0.61) and extrahepatic cancers (aHR 0.77) after adjusting for competing risks. CONCLUSIONS:HCV infection significantly increases both intrahepatic and extrahepatic cancer risks. Excluding 2nd cancer underestimates this burden. Given that DAA therapy significantly reduces the risk of both intrahepatic and extrahepatic cancers, accelerating HCV elimination policies is imperative.

Introduction:Hepatitis C virus (HCV), a major cause of chronic liver disease, shows decreasing prevalence in Korea, yet regional disparities persist. This study aimed to examine the impact and temporal changes in individual characteristics and regional health inequalities on HCV infection to provide a framework for HCV elimination and management. Methods:This nationwide population-based multilevel case-control study analysed 252 993 patients with HCV and 4 000 000 controls using National Health Insurance Service (NHIS) and population census data from 2005, 2010, 2015 and 2020. The Area Deprivation Index (ADI) was calculated for each area (region/town) using population census data. Sex-standardised and age-standardised HCV prevalences were estimated for each area using NHIS data. The association between area-level HCV and ADI was examined using correlation and linear regression analyses. Individual-level and area-level HCV infection risks were estimated using logistic regression and multilevel logistic regression models incorporating sex, age, HCV prevalence and ADI. Results:The HCV prevalence (per 100 000) decreased from 151 to 117 (2005-2020). The maximum inter-area ADI gap decreased modestly (34.64 to 32.50). Although the correlation between ADI and HCV prevalence was weak across all areas, it was markedly stronger in high-prevalence areas (≥200/100 000). In logistic regression, residents of the most deprived areas had elevated risks vs the least deprived (2020 adjusted OR 1.37). Multilevel models showed age (individual level) and area HCV prevalence (area level) were dominant determinants. Deprivation increased an individual's odds of HCV case status in ADI-only models; however, this association was not statistically significant after adjusting for area-level HCV prevalence and individual factors. Conclusions:Effective HCV elimination requires tailored screening and treatment strategies that prioritise socioeconomically vulnerable areas among the high-prevalence areas.

OBJECTIVES:Cervical cancer is the most prevalent cancer in Uganda, posing a significant burden with high mortality rates. Early detection through screening is crucial to reduce cervical cancer mortality. This study aimed to investigate the awareness, knowledge, and attitudes toward cervical cancer and its screening among residents in the central and western regions of Uganda. STUDY DESIGN:Cross-sectional study. METHODS:A cross-sectional study was conducted through face-to-face interviews using a structured questionnaire, during October and November 2023 in Kampala City, Mbarara City, and Mbarara District. A total of 2000 men and women aged ≥20 years participated in the study. RESULTS:Among the respondents, 95 % were aware of cervical cancer, 85.1 % knew about cervical cancer screening, 37.8 % had heard of the human papillomavirus (HPV), and only 18.9 % recognized HPV as a major risk factor. Among females, 35 % had undergone cervical cancer screening. The most significant barrier preventing access to screening was a lack of knowledge (74.1 %). More than half of the respondents considered cervical cancer to be a fatal disease (52.9 %), and 93.7 % of females expressed willingness to undergo screening if provided for free. CONCLUSION:While awareness of cervical cancer and its screening was high, knowledge of HPV and actual cervical cancer screening rates were low, despite a high willingness to undergo screening. Increased investment in education and awareness campaigns, along with an organized cervical cancer screening program, is warranted to promote screening and reduce the cervical cancer burden in Uganda.

BACKGROUND:Viral hepatitis, recognized as a significant global public health threat by the World Health Organization (WHO), has spurred efforts to establish elimination goals by 2030. In Republic of Korea (Korea), the prevalence of Hepatitis C virus (HCV) infection exhibits significant regional disparities, necessitating tailored infection control measures at the regional level. This study aimed to analyze the HCV prevalence trend by area (region/town) in Korea, from 2005 to 2022, and identify the areas requiring priority management. METHODS:A comprehensive analysis of HCV prevalence trends across different geographical regions and towns from 2005 to 2022 was conducted. Using data from the National Health Insurance Service, individuals diagnosed with acute or chronic HCV during this period were included in the analysis. HCV prevalence was adjusted by area, year, sex, and age. Additionally, trends in annual percent changes (APC) and average APC (AAPC) in HCV prevalence were examined using Joinpoint regression analysis. RESULTS:Age, sex, and region adjusted HCV prevalence per 100,000 people declined from 151 in 2005 to 98 in 2022. During the 18 years, the highest HCV prevalence was recorded in the southern regions of Korea (Busan, Jeonnam, and Gyeongnam) and in the towns of Namhae-gun of Gyeongnam, Boeun-gun of Chungbuk, and Sunchang-gun of Jeonbuk. The age-, sex-, and region-adjusted annual HCV prevalence decreased significantly at an APC of -2.5% (95% confidence interval [CI]: -3.5, -1.4) and AAPC of -2.7% (95%CI: -4.3, -1.0). By town, the prevalence decreased the most in Boeun-gun of Chungbuk (AAPC: -23.7%; 95%CI: -30.2, -16.5) and increased the most in Gunwi-gun of Gyeongbuk (AAPC: 3.0%; 95%CI: 1.1, 4.9). CONCLUSIONS:Over 18 years, a notable decline in HCV prevalence was observed in Korea, although this trend exhibited regional disparities. To effectively achieve the WHO hepatitis elimination goals by 2030, targeted interventions should prioritize areas with persistent or emerging prevalence.

Background/Aims Hepatitis B virus (HBV) mother-to-child transmission (MTCT) remains a global health concern, with over 90% of perinatal infections leading to chronic HBV. To evaluate long-term trends in MTCT rates and associated factors within Korea’s national program. Methods Population-based cohort study using linked data from the Perinatal Hepatitis B Prevention Program (PHBPP) and National Health Insurance Service in Korea. The study included HBsAg-positive mother-infant pairs with post-vaccination serologic results from 2002 to 2021. Results Among the 154,478 mother-infant pairs, the overall MTCT rate after prophylaxis was 2.3%. Antiviral use lowered MTCT rates (0.9% vs. 2.4%) particularly in HBeAg-positivity (1.0% vs. 5.9%; adjusted odds ratio [aOR] 0.21; 95% confidence interval [CI] 0.14–0.32). Lower MTCT rates were observed for cesarean section vs. vaginal delivery (1.9% vs. 2.6%; aOR 0.78; 95% CI 0.73–0.84) and breastfeeding vs. formula feeding (1.8% vs. 2.8%; aOR 0.65; 95% CI 0.56–0.76). Annual MTCT rates decreased from 3.6% (2002–2005) to 1.3% (2018–2021). Antivirals reduced MTCT rates; initiation at 14–27 weeks (0.39%), or 28–32 weeks (0.44%) vs. ≥33 weeks (1.47%); postpartum continuation (0.55%) vs. antepartum discontinuation (1.44%); use ≥61 days (0.51%) vs. 1–60 days (1.67%). Lower MTCT risk was associated with maternal (old age, high income) and infant (female sex, preterm birth) factors. Conclusions This comprehensive analysis of the PHBPP in Korea demonstrates that the use of antivirals, breastfeeding, and cesarean section, combined with conventional immunoprophylaxis, has significantly reduced MTCT rates. These results are crucial for global HBV elimination and can help to guide HBV MTCT prevention strategies.

Background:Hepatitis C virus (HCV) infection causes extrahepatic manifestations involving B-cell dysregulation and autoantibody production. This study aimed to elucidate the positivity rates of four autoantibodies [anti-nuclear antibody (ANA), anti-smooth muscle antibody (ASMA), anti-liver kidney microsomal type 1 (anti-LKM1), and anti-mitochondrial antibody (AMA)] in patients with chronic hepatitis C (CHC) before and after direct-acting antiviral (DAA) therapy compared to those in healthy controls. Methods:This study enrolled prospectively collected plasma samples from 201 CHC patients [median age, 62 years; 49.8% women; 100% sustained virological response (SVR)] from eight hospitals before and after DAA therapy and 127 healthy individuals. Autoantibodies were detected using indirect immunofluorescence. Results:The positivity rate of ANA was higher in CHC patients than in healthy controls (32.3% vs. 21.3%, P=0.03) at pretreatment (PreTx) and decreased at SVR (32.3% vs. 23.9%, P=0.009). Female sex and higher globulin levels were related to ANA positivity in the control and CHC patient groups. Thirty-seven (57%) of 65 patients with ANA-positive HCV at PreTx maintained ANA-positivity at SVR. Among the 136 ANA-negative patients at PreTx, 11 (8%) showed newly positive ANA conversion at SVR. Patients with ANA positivity at SVR (n=48) were older and had a higher proportion of advanced liver disease than ANA-negative patients (n=153). Conclusions:ANA positivity was observed in one-third of CHC patients at PreTx, which was significantly higher than that in healthy controls and decreased after SVR. CHC patients with ANA positivity after SVR were older and had more advanced liver disease than those with ANA negativity, suggesting persistent immune dysregulation after cure.

BACKGROUND:This study examines Hepatitis C virus (HCV) screening scenarios to meet World Health Organization (WHO) elimination targets (incidence ≤5 per 100,000, mortality ≤2 per 100,000) and assesses their timeframes and cost-effectiveness. METHODS:A closed cohort model of Koreans aged 30-79 in 2020 projected HCV incidence and mortality over 20 years. Economic evaluations used a dynamic transmission model, considering prevalent and annual incident cases. This approach addresses the limitations of previous models that neglected annual new HCV infections. Nine scenarios with varying screening intervals were created considering health checkup uptake, treatment rates, and HCV incidence reduction. Economic evaluations from the healthcare system's perspective employed cost-utility and cost-benefit analyses. RESULTS:Without national HCV screening, incidence slightly decreases, whereas mortality triples over 20 years. Introducing HCV screening offers five scenarios to meet WHO targets in 20 years. The quickest, involving biennial screening, high uptake, and a 30% incidence reduction, meets the incidence target at 6 years and mortality target at 14 years. For the most cost-efficient scenario, screening every 4 years with moderate uptake and a 20% incidence reduction meets the incidence target at 17 years and mortality target at 18 years. The Incremental Cost-Effectiveness Ratio (ICER) is $8,867 per quality-adjusted life-year (QALY), with a Benefit-Cost Ratio (BCR) of 1.60. CONCLUSION:The absence of HCV screening impedes elimination goals and increases mortality. Biennial screening, with high participation and treatment rates, rapidly achieves targets but is less economically efficient. Screening every 4 years with moderate uptake and treatment rates is economically feasible and meets elimination goals within 20 years. Rapid screening implementation is crucial for effective HCV elimination.

While individual lifestyle behaviors have been associated with cancer risk, combined impact of these factors remains understudied. This research explores relationships between lifestyle risk score trajectories and cancer risk within the Korean population. A cohort of 3,451,189 cancer-free men and women who participated in a health examination between 2002 and 2003, provided by the National Health Insurance, was studied. Lifestyle risk score trajectories were determined using group-based trajectory modeling based on total score of four modifiable unhealthy behaviors: current smoking, heavy alcohol drinking, excess body weight, and physical inactivity repeatedly observed three times between 2002 and 2007. Scores ranged between 0 (low risk) and 8 (high risk). The Cox proportional hazards model was applied to examine the association between these trajectories and cancer incidence. During the follow-up time (2008-2019), 312,075 cancer cases were identified. Among men, seven trajectories were identified, and trajectories of high lifestyle risk scores increased cancer risk of all cancer combined, cancer subgroupings, upper aero-digestive, stomach, colorectal, liver, gallbladder, pancreatic, lung, and bladder cancer, but inverse relation was observed for prostate cancer. Among women, four trajectory groups showed similar trends. Maintaining a healthy lifestyle and avoiding unhealthy behaviors are essential for cancer prevention.

In this study, we examined the difference in the vaginal microbiota of women infected with human papillomavirus (HPV), according to menopausal status. A total of 75 cervicovaginal swab samples from 38 pre- and 37 postmenopausal women with HPV infection were obtained from the Korean HPV cohort. Vaginal microbiota analysis, including microbial diversity and specific bacterial abundances, was performed using 16S rRNA gene sequencing. The mean age of the pre- and postmenopausal women were 29.5 and 55.8 years, respectively ( p < 0.0001). Lactobacillus spp . were predominant in both groups; however, a marked decrease was observed in postmenopausal women compared to premenopausal women (44.3% vs. 74.2%). Various anaerobic bacteria also showed a relatively high abundance in the postmenopausal group; Atopobium vagina and Gardnerella vaginalis significantly increased in postmenopausal women. Interestingly, no significant differences in bacterial richness were observed between the two groups. However, significant differences in beta-diversity were observed using the Bray–Curtis ( p = 0.001), Generalized UniFrac ( p = 0.002), Jensen-Shannon ( p = 0.001), and UniFrac algorithms ( p = 0.002). Theres results indicate that postmenopausal women with HPV infection exhibited a higher degree of vaginal dysbiosis than premenopausal women. Further, HPV-infected postmenopausal women had increased vaginal microbial diversity, characterized by an increase in anaerobic bacteria and concomitant depletion of Lactobacillus spp.

Abstract Purpose: Earlier in 2009, National Cancer Center Korea estimated population attributable fraction (PAF) of cancer incidence due to infectious agents as 24.5% in men and 15.4% in women. This study aimed to investigate the proportion of cancer incidence attributable to infectious agents in the Korean population as of 2020. Materials and Methods: We organized the Consensus Committee to establish strategy and methodology of PAF estimation. Based on the consensus, infectious agents and cancer sites for PAF estimation were selected according to the IARC List of classification with sufficient evidence in human. As a result, infectious agents included hepatitis B and C virus (HBV and HCV), Helicobacter pylori (H. pylori), human papilloma virus (HPV), Clonorchis sinensis (C.sinensis), Epstein Barr virus, and human immunodeficiency virus, and cancer sites included hepatocellular carcinoma (HCC), cholangiocarcinoma (CCC), gastric cancer, pancreatic cancer, cervical cancer, and non-Hodgkin lymphoma. The PAF was calculated by using Levin’s formula including exposure prevalence and relative risks (RRs). Exposure prevalence data were collected from literature review of studies in Korean population in 2005 or earlier, assuming at least 15 years of latent period from risk exposure to cancer development. We performed systematic review for cohort studies and case-control studies which investigated RRs or ORs of cancer due to infectious agents in Korean population. Pooled RRs were estimated by meta-analysis of RRs or ORs by using random-effects model. Results: The fractions of all cancer incidence attributable to infectious agents were estimated to be 13.5% and 7.1% in men and women, respectively. The reduction in PAFs of cancer incidence due to infection in 2020 compared to 2009 is considered due to decrease in exposure prevalence. The major findings regarding infectious agents with large PAFs are as the following. We found that the fractions of HCC cases attributable to HBV infection were 47.7% and 38.4% for cancer incidence in men and women, respectively. The estimated PAFs of gastric cancer due to H. pylori were 40.4% in men and 38.2% in women. C. sinensis was related to 9.8% of CCC cases in men and 5.2% in women. A total of 77.7% of cervical cancer incidence was attributed to HPV infection. Conclusion: Although the total PAF due to infection has decreased over the last decade, infection still contributes a substantial fraction to cancer incidence in Korea. These recent estimates of cancer burden due to infection are important for planning and evaluating the national cancer prevention programs. Citation Format: Kyung-Shin Lee, Hwa Jin Lee, Yoon-Jung Choi, Moran Ki, Aesun Shin, Jong-Hun Kim, Sue-Kyung Park, So-Seul Sung, Sung Ji Moon, Hong Gwan Seo, Jin-Kyoung Oh, Jeong-Soo Im. Population attributable fraction of cancer incidence due to infectious agents in 2020 in the Republic of Korea [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 845.

Background: Wilson's disease (WD) is an autosomal recessive disorder in which copper (Cu) accumulates in organs, particularly in the liver and central nervous system. This study aimed to investigate the prevalence, incidence, and treatment patterns of WD patients in Korea. Methods: National Health Insurance System (NHIS) claims data from 2010 to 2020 were analyzed. patients with WD as a primary or additional diagnosis at least once were identified using the International Classification of Diseases (ICD)-10 disease code E83.0 and a record for a registration program for rare intractable diseases in Korea. Results: The average age- and sex-adjusted prevalence and incidence of WD between 2010 and 2020 were 3.06/100,000 and 0.11/100,000, respectively. The mean age of the patients with newly diagnosed WD was 21.0 +/- 15.9 years. Among the 622 WD incident cases during the study period, 19.3% of the patients had liver cirrhosis and 9.2% had received liver transplantation. Psychological and neurological diseases were present in 40.7% and 48.1% of the patients, respectively. Regarding the diagnosis of WD, liver biopsy was performed in only 51.6% of new cases. D-penicillamine, trientine, or zinc were prescribed in 81.5% of the incident cases, and the treatment uptake rates decreased with increasing age. Conclusion: The prevalence of WD in Korea is 3.06/100,000 and approximately 1,800 patients use medical services annually. A significant proportion of patients are diagnosed at the cirrhotic stage and not treated with Cu-chelating therapeutics, suggesting the need for early diagnosis and adequate treatment to improve prognosis.

ABSTRACT:Human papillomavirus (HPV) vaccination was introduced in the National Immunization Program (NIP) in Korea targeting girls aged 12 years to receive two doses of HPV vaccine to prevent cervical cancer. This study aimed to evaluate the factors that may influence parental decision to inoculate their daughters in Korea. A cross-sectional survey was conducted in 2020 by interviewing the parents of 2,000 nationally representative girls eligible for HPV NIP. By the daughters' status of HPV vaccination, the probabilities for each variable were compared with evaluate the factors that could affect parents' decision to inoculate their daughters with HPV vaccines. Compared with parents who were not vaccinated with HPV, parents who were vaccinated with HPV were 2.40 times more likely to decide to vaccinate their daughters with HPV. Parents who regularly undergo cervical cancer screening were 1.39 times more likely to decide to vaccinate their daughters with HPV than parents who do not receive regular checkups. Parents' perceived knowledge and perceived risk had a significant impact on their decision to vaccinate their daughters with HPV vaccines. Parents who had strong belief that HPV vaccine is safe in terms of adverse effects were 10 times more likely to decide to vaccinate their daughters against HPV. Parental factors including HPV-related health behavior and awareness were found to be associated with parental decision to vaccinate their daughters against HPV. To improve HPV vaccine uptake at 12 years, it is required to improve parental awareness on HPV through public communication supported by scientific-based evidence.PREVENTION RELEVANCE:Parental HPV vaccination and maternal regular cervical cancer screening were positively associated with parental decision to vaccinate their daughters against HPV. Parents' perceived knowledge of HPV vaccination and perceived risk of cervical cancer play an important role in determining whether their 12-year-old daughters will be vaccinated against HPV.

BackgroundThere are no longitudinal studies on the epidemiology of primary biliary cholangitis (PBC) in Korea. This study aimed to elucidate the temporal trends in the epidemiology and outcomes of PBC in South Korea between 2009 and 2019.MethodsThe epidemiology and outcomes of PBC were estimated using data from the Korean National Health Service database. Temporal trends in the PBC incidence and prevalence were analyzed using join-point regression. Transplant-free survival was analyzed according to age, sex, and ursodeoxycholic acid (UDCA) treatment using Kaplan-Meier and Cox regression analyses.ResultsThe age and sex-standardized incidence between 2010 and 2019 (total patients, 4230) was 1.03 per 100,000 per year on average and increased from 0.71 to 1.14 per 100,000 with an annual percent change (APC) of 5.5. The age and sex-standardized prevalence between 2009 and 2019 was 8.21 per 100,000 on average and increased from 4.30 to 12.32 per 100,000 with an APC of 10.9. The increasing trend in prevalence was prominent in males and elderly individuals. Among patients with PBC, 98.2% received UDCA with 77.3% adherence. The 5-year transplant-free overall survival rate was 87.8%. Male sex and low adherence to UDCA were associated with all-cause death or transplantation (hazard ratios of 1.59 and 1.89, respectively), and liver-related death or transplantation (hazard ratios of 1.43 and 1.87, respectively).ConclusionsThe incidence and prevalence of PBC in Korea increased significantly between 2009 and 2019. Male sex and low adherence to UDCA were poor prognostic factors for PBC.

OBJECTIVES: In an era when the average life expectancy and overall mortality rate have improved, Korea remains at risk for infectious disease outbreaks that place substantial burdens on the healthcare system. This study investigated trends in mortality and the economic burden of infectious diseases.METHODS: Healthcare data from the Health Insurance Review and Assessment Service (2009-2019) and the Korean Statistics Information Service (1997-2019) were used. We selected 10 infectious disease groups (intestinal infections, tuberculosis, vaccine- preventable diseases, sepsis, viral hepatitis, HIV-related diseases, central nervous system infections, rheumatic heart diseases, respiratory tract infections, and arthropod-borne viral diseases).RESULTS: The age-standardized mortality rate for infectious diseases increased from 27.2 per 100,000 population in 1997 to 37.1 per 100,000 population in 2019 and has had an upward trend since 2004. During this same period, significant increases were seen in respiratory tract infections and among elderly persons, especially those aged ≥85 years. The costs for infectious diseases increased from 4.126 billion US dollar (USD) in 2009 to 6.612 billion USD in 2019, with respiratory tract infections accounting for 3.699 billion USD (69%). The annual cost per patient for visits for medical care due to infectious diseases increased from 131 USD in 2009 to 204 USD in 2019.CONCLUSIONS: Mortality among elderly persons and those with respiratory tract infections increased during the study period. The economic burden of infectious diseases has consistently increased, especially for respiratory tract infections. It is therefore essential to establish effective management policies that considers specific infectious diseases and patient groups.