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KMID : 0383919750120000225
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Report of National Institute of Health
1975 Volume.12 No. 0 p.225 ~ p.234
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Studies on Haemorrhagic Nephrosonephrits (Korean Haemorrhagic Fever)
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Abstract
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Haemorrhagic Nephrosonephritis or Korean Haemorrhagic Fever (KHF) was first repo rted from the Republic. of Korea when observed during spring 1951 in TN Forces operation in the central sector close to the 380th parallel, which now forms they Demilitarized zone.{DMZ)
Through 1954, more than 2, 400 cases of KHF had been recorded " in UK Forces, but only, a,few cases were observed in the Korean Army over the same period.
This created the impression that Korean possessed some form of acquired or natural immunity to the disease. However, in 1953. a US/Army research team studied the incidence of the disease in mixed American /Korean infantry units and found very similar. incidence rated per 1,000 troops among the Korean (1.4 cases) and among American (1.7)
When in 1956, Korean troops replaced UN Forces in the central MIZ area, KHF cases started to occur in these troops and the case number has increased significantly since 1960.
As the, disease had largely been confined to the central´ DMZ area, close to the 38" th parallel, and as cases occuring in troops and the civilian population living in this area were being take case of by military hospital facilities,the disease haduntil recently been the sole concern of military authorities and had not yet become a notifiable disease.
Apart from the fact that sporadic cases seem to occur in most areas of the republic, little knowledge was available regarding the extend of the disease in the civilian population livingoutside the endemic arc a.
A conspicuous increase in the number of KHF cases observed in late,-1970., These observations stimulated to study, the extent of -the disease in the civilian´ population of thee_ Republic in 1971 by Department of Virology, The National, Institute of´14ealth, Seoul. this, analysis of data on 448 cases which occurred in the civilian population during 1975 revealed-more cases occurred compared with previous years and some interesting information such as changing patterns of the occupation of patients, ´seasonal occurrence and geographical distribution.
A drawback in any study of the epidemiological pattern of the disease at this point in. time is the absence of specific diagnostic tests. Thus, cases can only be identified by their. clinical symptomatology and it can not be excluded that some case. of other diseases with a. renal syndrom might inadve~´tently be included among thecases "regarded as haemorrhaj´´. nephrosonephritis. Wh:´.ch the disease -in its severe form of infections seem to result in light´ clinical manifestations which pass undiagnosed.
1. Seasonal ` Occurrance: While usually a Jew cases arise throughout the year, an accumu-Iation of cases can be observed in May-June and October-December. As seen in,,the: Table 1 and .Figure´ 1, only 5 cases were occurred in the May and June but 382 cases-(S5.26%) were occurred in October-December among the total of 448 cases in the year-of 1975.
2. Distribution by Age and Sex: From Table 2 it can be,seen that the disease appears to affect most frequently the age group 21-50 (621.26%). Only .3 cases (0.66561) ..in the-youngest age group (0-10) and 4 cases in the older age people above 70- years of age-were found. Although cases occur in both sexes, the disease is significantly more. frequent in males than females and males cases are.more than twice the number of female cases.
3. Case Fatality: ~.ccording .to records maintained at hospitals and private clinics, 43 cases. (9. 59%) died from the-disease in 1975. As relatives are inclined to remove moribund, patients from hospitals, it can be assumed with reasonable certainty that the ´actual: . case fatally rate is considerably higher than indicated by the available data
+During this same period the case fatality rate. in _Korean soldiers was´ only, 5. 1%.: Such low case fatality cbserved in the ROK Army is likely due to early diagnosis and the availability of a specialized intensive case unit.
The risk of dying from the disease is increased with increasing age but no significant differences between male _(9.64%)and female (9.48%) patients in the overall fatality rate (Table 2).
4. Geographical Distribution: Morbidity rates calculated for each Gun (Table 3) was plotted on the attached map and clearly indicate that KHF is spreading southward from its original endemic focus in the central area of the DMZ and sporadic cases occurred in the most areas of the Republic:
Three hyperendemic areas can be clearly recognized:´ One is Pa-Ju-Gun (morbidity rate 19. 65 per 100, 000) where the near of 38 th parallel and one area is situated-South-east of the original endemic area such us surrounding Cheong-Ju-City (14. 17), and Cheong-Weon-Gun - (21. 51) the other one area is Gang-Neung-City in Gang-Weon-
Do province.
In 1975 two additional southern provinces such as Jeon-La-Bug-Do and Jeon-La-N arn
Do not previously known to be infected, eight cases were reported.:
These provinces seen to have developed KHF cases over the last´´ few years very-s-poradically according to local physicians interviewed.
5. Analysis of the patients by occupation:In the past, vast majority cases of the disease were farmers and still nowthe most patients are occurred in the agricultural field or. mountain areas:
Result of the analysis of the KHF patients by occupation in 1975 revealed that 73.21".o of the total cases were farmers and the other patients were composed those withmerchant (6.25%) student (´5.35%) goverment-employee(4.01%) and housewife (6.02%)etc. (Table 4 ai~d.Figure, 3).
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KEYWORD
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