Sublingual immunotherapy (SLIT) has been developed to prevent the severe adverse effects and anaphylaxis associated with subcutaneous immunotherapy (SCIT) in the early 1980s in European countries. Allergic Rhinitis and its Impact on Asthma (ARIA) expanded the indications for SLIT to include children in its 2001 guidelines. Many studies have proved that SLIT has therapeutic effects and successful immunologic tolerance in allergic patients, especially those with allergic rhinitis/conjunctivitis and asthma. SLIT is associated with a much lower frequency of anaphylaxis and generalized adverse effects and is easier to use than SCIT. The 2010 ARIA guidelines recommended SLIT for use in adults with seasonal and perennial allergic rhinitis (AR) and children with seasonal, but not perennial, AR. The US Agency for Healthcare Research and Quality states that the superiority of administration between SCIT and SLIT is not known, but moderate grade evidence from 2013 favors SCIT over SLIT for allergic nasal and/or eye symptom control. SLIT is a very safe way to correct Th2-mediated allergic diseases; however, more studies are needed to fully measure its therapeutic effects.
Adult ; Anaphylaxis ; Asthma ; Child ; Health Services Research ; Humans ; Immunotherapy ; Rhinitis ; Seasons ; Sublingual Immunotherapy

The outbreak of Middle East respiratory syndrome coronavirus(MERS-CoV) infection in South Korea has become a public health threat. There are many confirmed cases of MERS in healthcare workers. Understanding the nature of the infection and the mechanismof transmission will be a useful lesson. This paper gathers data from the press records in KCDC from May 20thto June 26th 2015to identify the age, sex, occupation and etiologic exposure of exposed healthcare workersin order to come up with a response plan. By June 26th, 2015, there were 181 confirmed cases of MERS-CoV infection in Korea. 36 (19.9%) of them were healthcare workers. These healthcare workers were exposed to MERS-CoV across 12 healthcare facilities, including Samsung Medical Center and Dae-Chung Hospital;threewere infected inside ambulances. Their occupational categories are as follows: 7 doctors (19.4%), 12 nurses (33.3%), 9 caregivers orgeriatric care assistants(25.0%), and 8 others (22.2%). These healthcare workers were infected by 12 super-spreaders. 30 of the workers(83.3%) were infected without being aware of their contact withMERS patients, while 6 (16.7%) were aware of this contact at the time of infection. The high number of confirmed cases of MERS-CoV inhealthcare workers is direct proof of the failure of crisis communication in South Korea, and the delay in the diagnosis of the index case was due to the lack of risk communication regardingthe threatof a MERS outbreak. Because the spread of MERS usually occursvia healthcare-associated transmission, infection control inhealthcare facilities must be strengthened.
Ambulances ; Caregivers ; Coronavirus* ; Delivery of Health Care* ; Diagnosis ; Disease Outbreaks ; Disease Transmission, Infectious ; Humans ; Infection Control* ; Korea ; Middle East* ; Occupations ; Public Health

Otitis media is one of the most common bacterial infectious diseases in children and the most common indication for the prescription of antibiotics in Korea. Otitis media, including acute otitis media (AOM) and otitis media with effusion (OME), is also one of the most common reasons for an illness-related visit to a primary care clinician. The first step in management decisions regarding otitis media must focus on accurate diagnosis to distinguish normal from AOM or OME. In 2010, the Korean Otologic Society published the first version of a set of evidence-based clinical practice guidelines for pediatric otitis media. In 2014, revised clinical practice guidelines were published for otitis media that applied to children under 15 years of age. The guidelines addressed the diagnosis and management of otitis media as well as pain management, choice of antibiotics, and methods for prevention. These guidelines recognized that many episodes of otitis media will resolve on their own without antimicrobial therapy; therefore, one of the recommendations for the initial treatment of otitis media in specified situations is watchful waiting without antibacterial therapy. This study introduces excerpts of the guidelines for the diagnosis and management of otitis media in children. We then briefly discuss the current knowledge about AOM and OME and address the new AOM and OME guidelines point by point. It is important to remember that the actual management of patients with otitis media should depend on the physician's clinical judgment, the symptoms of the individual child, other underlying medical conditions, ready access to adequate follow-up care, and other features.
Acute Disease ; Anti-Bacterial Agents ; Child* ; Communicable Diseases ; Diagnosis* ; Follow-Up Studies ; Humans ; Judgment ; Korea ; Otitis Media with Effusion ; Otitis Media* ; Pain Management ; Prescriptions ; Primary Health Care ; Watchful Waiting

It is widely believed that effective communication is critical for the containment of the spread of emerging infectious diseases. Various media outlets and studies have pointed out communication failure as one of the key components that contributed to the wide and rapid spread of Middle East respiratory syndrome coronavirus in South Korea. To address these concerns, we first outline the definitions of risk and crisis communication and why they are important. We then illustrate communication models and guidelines utilized in three organizations (World Health Organization, US Centers for Disease Control and Prevention, and UK Public Health England) for health or disaster control. By analyzing the current guidelines for infectious diseases in South Korea and they were actually applied during the Middle East respiratory syndrome situation, we will assess what went wrong and what went right. Finally, we will suggest various measures that will help to ensure similar tragedies do not happen again.
Centers for Disease Control and Prevention (U.S.) ; Communicable Diseases ; Communicable Diseases, Emerging ; Containment of Biohazards ; Coronavirus ; Coronavirus Infections ; Disasters ; Korea ; Middle East ; Public Health*

The importance of public healthcare system has been widely recognized since the current Middle East respiratory syndrome epidemic began. However, their capacities are not sufficient in both quantitative and qualitative perspective aspects. When a large-scale outbreak develops, public hospitals and community health centers should be primarily responsible for treatment of patients and isolation of individuals who are likely to infect other people, with the supplemented of private hospitals. Clearly, the central and municipal governments, and public healthcare system has failed to deal with the current Middle East respiratory syndrome epidemic, largely due to lack of expertise and professional staff. The governments at various levels and public hospitals should thoroughly and publicly review the work process and problems revealed in dealing with the current epidemic. Based on such evaluation, they should establish action plans for infectious disease control, and regular training and exercise should be done according to them. In addition, more public hospitals should be established under the regional health planning. It is important for public heathcare facilities to hire physicians on a stable and long-term employment contract, and to train them so that they could play a role in case of epidemic.
Communicable Diseases* ; Community Health Centers ; Delivery of Health Care* ; Employment ; Hospitals, Private ; Hospitals, Public ; Humans ; Middle East ; Regional Health Planning

After the 15 days from the first confirmed case of Middle East respiratory syndrome (MERS) in South Korea on May 20, 2015, the MERS infected case from emergency room (ER) was recognized. I provide the review of characteristics and prevention plan of re-outbreak of a MERS coronavirus at the ER in South Korea. Emergency medical services-related infections with MERS coronavirus have been reported 91 cases (49%) of total 186 cases in South Korea. The first patient was diagnosed with the ER and spent at least 3 days in a busy ER until he was admitted to an isolated room. The causes of MERS's spreading in ER are mainly due to emergency department (ED) overcrowding, long ED stay time, improper infection control system in ED, and a failure of emergency medical service coordination system in South Korea. Early and rapid detection of suspected infected patients with communicable diseases along with appropriate infection control system in ED, reducing the ED overcrowding and ER stay time would help to prevent the disease transmission in ED.
Communicable Diseases ; Coronavirus ; Emergencies ; Emergency Medical Services* ; Emergency Service, Hospital ; Humans ; Infection Control ; Korea ; Middle East*

The experience of the 2015 Middle East respiratory syndrome outbreak in the Republic of Korea showed greater impact on healthcare institutions as compared to the previous epidemic in the Middle East in 2012. However, the Middle East respiratory syndrome coronavirus was biologically identical to that of 2012, without evidence of a mutation that would account for increased transmissibility. Due to the higher population density of Korea and lower medical costs, Korean hospitals are usually crowded with high numbers of both inpatients and outpatients, who function as a reservoir for intra-hospital transmission. The fact that the patient referral system between smaller and larger hospitals is very active and efficient in Korea was one reason for high inter-hospital propagation of the Middle East respiratory syndrome outbreak. To prepare for a future epidemic in Korea, an improved contact tracing policy, improved public hospital facilities for critical care of severe infections, and pre-emptive isolation for unknown respiratory infections should be emphasized.
Communicable Diseases* ; Contact Tracing ; Coronavirus ; Critical Care ; Delivery of Health Care ; Emergency Medical Services ; Hospitals, Public ; Humans ; Inpatients ; Korea ; Middle East ; Outpatients ; Population Density ; Referral and Consultation ; Republic of Korea ; Respiratory Tract Infections

The recent outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infections in South Korea in May 2015 revealed that the Korean healthcare system and hospitals are highly vulnerable to hospital-spread infections. In a short period of time, MERS-CoV infection spread widely across Korea due to the unique characteristics of the Korean healthcare system including 1) hospitals with limited infection control capabilities, 2) a heavy dependency on private caregivers due to a nursing shortage, 3) emergency department overcrowding, and 4) healthcare-related patient behaviour such as hospital shopping. To prevent future outbreaks of emerging infectious diseases similar to MERS-CoV, the Korean healthcare system should be reformed and healthcare-related patient behaviour must change. To improve the performance of hospital infection control, the National Health Insurance service should pay more for hospital infection control services and cover private patient rooms when medically necessary, including for infectious disease patients. To reduce risks of hospital infection related to private caregiving, the nurse staffing level should be increased and hospitals should take full responsibility for inpatient nursing care. To reduce hospital shopping, the National Health Insurance service should introduce a differential fee schedule which pays more when primary care providers care for patients with common conditions and tertiary care providers care for patients with severe conditions. To incentivize patients for appropriate health care use, lower patient out-of-pocket payments should be combined with a differential provider fee schedule.
Caregivers ; Communicable Diseases ; Communicable Diseases, Emerging ; Coronavirus ; Cross Infection* ; Delivery of Health Care* ; Disease Outbreaks ; Emergency Service, Hospital ; Fee Schedules ; Hospital Shops ; Humans ; Infection Control ; Inpatients ; Korea ; Middle East* ; National Health Programs ; Nursing ; Nursing Care ; Patients' Rooms ; Primary Health Care ; Tertiary Healthcare

No abstract available.
Coronavirus* ; Korea ; Middle East*

After the first diagnosis of Middle East Respiratory Syndrome (MERS) in Korea on May 20th, 2015, significant fear and anxiety surrounding infectious diseases has emerged in the community. Using the recent MERS case in Korea as an example, we hope to identify problems in the governance of infectious diseases management and to suggest improvements. Korean Health authorities have demonstrated inadequacy in several areas in preparing for and responding to emerging infectious diseases threats. There is lack of monitoring or education regarding prevention, and there are no systems for monitoring people visiting or residing in infectious disease risk areas. Moreover, operating a continuous monitoring system by the Korea Centers for Diseases Control and Prevention (KCDC) is very difficult due to the lack of permanent support for a clear command and control system and specialists for responding to public health emergencies. The MERS situation has highlighted the importance of risk communication during public health crises. In order to advance the governance of infectious disease management, the KCDC should be improved as a priority. The Korean government should nurture the development of professional personnel who can respond to global health crises. Furthermore, the expansion of medical isolation facilities within hospital wards and emergency departments is needed. However, the cooperation of the public is a critical factor in this campaign. The public should be educated about appropriate action during disasters and public health crises, including strategies for practicing this action in everyday life.
Anxiety ; Communicable Disease Control ; Communicable Diseases* ; Communicable Diseases, Emerging ; Coronavirus Infections ; Diagnosis ; Disasters ; Education ; Emergencies ; Emergency Service, Hospital ; Hope ; Korea ; Middle East* ; Public Health ; Specialization