Characteristics and Factors Associated with Death among Patients Hospitalized for Severe Fever with Thrombocytopenia Syndrome, South Korea, 2013.

In South Korea, nationwide surveillance for severe fever with thrombocytopenia syndrome (SFTS) began during 2013. Among 301 surveillance cases, 35 hospitalized case-patients in 25 areas were confirmed by using virologic testing, and 16 (46%) case-patients subsequently died. The SFTS cases occurred during May-November and peaked during June (9 cases, 26%). The incidence of SFTS was higher in the southern regions of South Korea. Age and neurologic symptoms, including decreased level of consciousness and slurred speech, were heavily associated with death; neurologic symptoms during the first week after disease onset were also associated with death. Although melena was common among patients who died, no other hemorrhagic manifestations were substantively more common among those who died. No effective treatments, including ribavirin, were identified. Expansion of SFTS surveillance to include the outpatient sector and development of an antibody test would enhance completeness of SFTS detection in South Korea.

Humidifier disinfectant-associated children's interstitial lung disease.

RATIONALE: Beginning in 2006, epidemics of a fatal lung injury of unknown cause in children were observed in Korea every spring. A recent study demonstrated that this type of children's interstitial lung disease (chILD) is associated with humidifier disinfectant use. OBJECTIVES: To determine the clinical characteristics of this type of chILD and to assess whether the nationwide suspension of humidifier disinfectant sales in the autumn of 2011 affected its incidence. METHODS: The clinical characteristics of suspected cases between 2006 and 2011 were determined by a nationwide retrospective study. The potential causal relationship with humidifier disinfectants was examined by a prospective surveillance study after humidifier disinfectant sales were suspended. MEASUREMENTS AND MAIN RESULTS: In total, 138 children were diagnosed with this type of chILD, which was characterized by rapid progression, high mortality, predominance in the spring season, and a familial tendency. The annual incidence increased in 2011 and then dropped to zero in 2012. The children were on average 30.4 months old. The most frequent symptoms at admission were cough and dyspnea. As the disease progressed, the typical complication was spontaneous air leak. Eighty children (58%) died. Two years after humidifier disinfectant-sale suspension, no more new cases were found. CONCLUSIONS: This study suggests that humidifier disinfectant inhalation causes an idiopathic type of chILD that is characterized by spontaneous air leak, rapid progression, lack of response to treatment, and high mortality. Further safety studies must be performed on common environmental compounds, particularly those that enter the human body by an unusual route.

The composite anterolateral thigh flap for achilles tendon and soft tissue defect reconstruction with tendon repair by fascia with double or triple folding technique.

BACKGROUND: Rupture of the Achilles tendon is usually managed by surgical intervention. Recurrent tendon ruptures, segmental tendon defects, and overlying soft tissue defects render reconstructive procedures challenging. In this report, we present double or triple folding technique of the anterolateral thigh (ALT) free flap, and report the clinical outcomes of the reconstruction of combined defects, including the Achilles tendon and overlying soft tissue. METHOD: From 2008 to 2013, 7 patients underwent reconstruction of combined Achilles tendon and soft tissue defects. The sizes of the soft tissue defects ranged from 9 × 5 to 12 × 5 cm(2) . Combined defects were reconstructed with ALT free flap including the vastus lateralis fascia and rectus femoris fascia, using a double or triple folding technique. The ALT free flap covered the soft tissue defect and the fascia was folded two or three times into a tendon-like structure. Three patients had full-layer defects of the Achilles tendon, and four patients had partial defects over half the layer. RESULT: The dimension of the skin paddle of the ALT flap was 12 × 6 to 16 × 8 cm(2), and the dimension of the fascia was 12 × 8 to 16 × 10 cm(2). All the donor sites were closed primarily. All the flaps survived completely without complication. The mean follow-up period was 14.9 months. All patients were able to stand and ambulate. CONCLUSION: The double or triple folding technique of the ALT free flap represents simple, economical use of tissue, with minimal donor site morbidity. Thus, this technique may be useful and versatile reconstructive option for combined defects.

A cluster of lung injury cases associated with home humidifier use: an epidemiological investigation.

BACKGROUND: In April 2011 a tertiary hospital in Seoul, Korea reported several cases of severe respiratory distress of unknown origin in young adults. METHODS: To find the route of transmission, causative agent and patient risk factors of the outbreak, an investigation of the epidemic was initiated. Clinicopathological conferences led to the suspicion that the cases related to an inhalation injury. An age- and sex-matched case-control study was therefore performed to examine the inhalation exposure of the patients to various agents. RESULTS: Of the 28 confirmed cases, 18 agreed to participate. A total of 121 age- and sex-matched controls with pulmonary, allergic or obstetric disease were selected. All patients and controls completed questionnaires with questions about exposure to various inhalants. The crude ORs for patient exposure to indoor mould, humidifier use, humidifier detergent use and insecticide use were 4.4 (95% CI 1.5 to 13.1), 13.7 (95% CI 1.8 to 106.3), 47.3 (95% CI 6.1 to 369.7) and 3.9 (95% CI 1.3 to 11.7), respectively. However, when considered concurrently, indoor mould and insecticide use lost statistical significance. Moreover, humidifier use was ruled out as the cause because of a lack of biological plausibility and the weak strength of the association. This suggested that humidifier disinfectant was the cause of the outbreak. This information led the Korean government to order the removal of humidifier detergents from the market. In the years following the ban, no additional cases were detected. CONCLUSIONS: Epidemiological evidence strongly suggests that the lung injury outbreak was caused by humidifier detergent use at home.

Diarrheal outbreak caused by atypical enteropathogenic Escherichia coli O157:H45 in South Korea.

UNLABELLED: Background: In May 2013, an outbreak of gastroenteritis occurred in a high school in Incheon, South Korea. We investigated the outbreak in order to identify the pathogen and mode of transmission. MATERIALS AND METHODS: A case-control study was performed using standardized questionnaires with a case definition of illness with diarrhea. Stool samples, environmental samples, and samples from preserved food items were collected to test pathogens. Pulsed-field gel electrophoresis (PFGE) was performed on the outbreak-related Escherichia coli strains. RESULTS: Thirty-three people (attack rate: 2.5%) met the case definition, and the pattern of the epidemic curve suggested a point-source outbreak. The common symptoms of cases were diarrhea (100.0%), abdominal pain (75.8%), chills (45.5%), and nausea (39.4%). Cases were found to be 8.26 times more likely to have eaten spicy fish soup with cod (95% confidence interval: 1.05-65.01). Consumption of egg soup with spring onions or braised eggs with razor clam flesh was significantly associated with illness. Atypical enteropathogenic E. coli O157:H45 was isolated from samples of 9 cases (27.3%) and tuna bibimbap. PFGE patterns of all tested isolates of O157 serotype were indistinguishable. CONCLUSIONS: This outbreak was caused by atypical enteropathogenic E. coli O157:H45 and the food vehicle was suspected to be tuna bibimbap. The statistical analysis was not in concordance with the microbiologic tests, probably owing to low pathogenicity of atypical enteropathogenic E. coli O157. This is the first report of an outbreak caused by atypical enteropathogenic E. coli O157.

Decreasing incidence of Plasmodium vivax in the Republic of Korea during 2010-2012.

BACKGROUND: After the re-emergence of Plasmodium vivax in 1993, a total of 31,254 cases of vivax malaria were reported between 1993-2012 in the Republic of Korea (ROK). The purpose of this study was to review Korea Centers for Disease Control and Prevention records to investigate the transmission of malaria from 2010-2012. METHODS: Reporting of microscopy-diagnosed cases of malaria is mandatory in the ROK. In this study, all available records of malaria cases and malaria vectors collected from 2010 - 2012 in Cheorwon County, Gangwon Province and Ganghwa County, Incheon Metropolitan City, were reviewed. RESULTS: Although the number of cases of malaria peaked a third time in 2010 (1,772 cases) since the re-emergence of P. vivax, the incidence decreased two-fold to 838 in 2011 and three-fold to 555 in 2012. The number of cases decreased 52.7% in 2011 compared with that in 2010 and 33.8% in 2012 compared with that in 2011. However, the number of cases increased in Incheon Metropolitan City (15.3%) and Gyeongnam Province (23.1%) in 2012 compared with 2011. Of the 3,165 cases of vivax malaria in 2010-2012, 798 (25.2%) were in ROK military personnel, 519 (16.4%) in veterans, and 1,848 (58.4%) in civilians. In total, there were 2,666 male patients and 499 female patients, and the ratio of female to male patients increased from 1:7.9 in 2011 to 1:4.1 in 2012. CONCLUSIONS: A rapid decrease in the incidence of malaria was observed in most areas from 2010 to 2012, but the incidence increased again in the western part of the demilitarized zone. Therefore, more intensive surveillance is needed throughout high risk areas to identify factors responsible for increase/decrease in the incidence of malaria in the ROK.

Epidemiological characteristics of the first water-borne outbreak of cryptosporidiosis in Seoul, Korea.

The first case of human cryptosporidiosis was reported in Korea in 1995; however, an outbreak of Cryptosporidium has not been reported in Korea until now. This paper describes the first outbreak of cryptosporidiosis in Korea. On May 24, 2012, a local public health center filed a report on 126 residents with gastrointestinal symptoms in an old apartment complex in Seoul. Epidemiological investigations were implemented on 125 of the 126 patients. The patients were reported continuously over a period of 22 days. Diarrhea was the most common clinical symptom, and lasted for 5 days on average. The tap water was the only common exposure of the patients. During the environmental investigation it was discovered that the water and septic tanks were situated closely and that the waste water pipes were corroded where they passed over the water pipes. Cryptosporidium parvum was detected in 3 of the 7 stool specimens by PCR-RFLP. A number of Cryptosporidium oocysts were also detected in the water specimens from the water tank. In conclusion, Cryptosporidium parvum was the key causal pathogen of this outbreak. It is presumed that the tap water was contaminated by a sewage leak from the aged pipelines.

Management of an unusual craniofacial impalement injury by a metallic foreign body.

Craniofacial penetrating injuries caused by foreign bodies other than bullets or glass from traffic crashes are quite rare. Hence, there is a lack of knowledge regarding systematic management strategies or analysis of complications for craniomaxillofacial surgeons. Between 2002 and 2010, 82 patients underwent surgery for penetrating craniofacial injuries in 2 craniomaxillofacial trauma centers. Among these patients, we included patients who had retained foreign metallic bodies. Data regarding age, sex, injury materials, entrance, injured structures, operative records, and complications were reviewed retrospectively for 8 patients. All of the patients were evaluated precisely in the emergency department without removal of retained materials, and a multidisciplinary team approach was performed for the removal of the foreign body under general anesthesia.In this study, 6 men and 2 women presented with penetrating injuries that retained metal objects. The mean age of the patients was 44.3 years. All of the patients were hemodynamically stable, and no active bleeding was found. However, all of the patients had postoperative complications. Three patients had damaged vascular structures, and 3 patients had injuries to facial nerve branches. Seven patients had posttraumatic stress disorder. Two patients underwent subsequent emergent procedures because of massive bleeding and cerebrospinal fluid leakage.Penetrating injuries in the head and neck regions are complicated. Although a multidisciplinary team approach was performed from initial management to outpatient management in patients with unusual impalement injuries, numerous postoperative complications still remained. Preoperative patient informed consent was important.

Treatment of the severely infected frontal sinus with latissimus dorsi myocutaneous free flaps.

In trauma patients with severe intracranial hemorrhaging, diagnosing facial bone fractures can be delayed. In frontal sinus fractures with nasofrontal duct obstruction, obliteration of the nasofrontal duct and the sinus is the current treatment of choice. But with inadequate management, ascending infections happen, and widely spread infections can involve the entire frontal soft tissues, which result in meningitis, encephalitis, and subcutaneous abscess pockets creating skin defects. In the treatment of these infections, radical debridement of all infected tissues including galea, pericranium, and surrounding soft tissues is obligatory; hence, available local vascularized flap options for obliteration of the postdebridement defect are scarce. In these situations, free-tissue transfer can be a treatment option. Although there have been numerous reports of using nonvascularized materials for obliteration of the frontal sinus, the material itself can serve as a nidus for infection, and it is generally accepted that well-vascularized tissues have greater ability to withstand local soft-tissue infection and osteomyelitis. Hence, we report 3 cases where we performed latissimus dorsi myocutaneous flaps for severe frontal sinus infections after frontal cranioplasty for severe hemorrhaging. Large bulks of muscle obliterated the nasofrontal duct and the dead space surrounding the entire frontal sinus. The latissimus dorsi myocutaneous flap is not a permanent solution for frontal sinus reconstruction, which requires a secondary bony reconstruction. However, when we face acute stages of intractable infections of the frontal sinus, it can control the infection and result in saving the patient's life.

Epidemiological Characterization of Opportunistic Mycoses between the Years 2006 and 2010 in Korea.

In order to perform an epidemiological characterization of opportunistic mycosis infections, we collected health insurance data between the years 2006 and 2010 from the Health Insurance Corporation and analyzed the data to determine the prevalence of opportunistic mycoses and treatment management of opportunistic mycoses. The prevalence within the study increased consecutively by 0.02% to 0.12% every year. The annual prevalence of opportunistic mycoses increased from 2.437% in 2006 to 2.709% in 2010. The average annual prevalence was 2.605%. Candidiasis occurred the most frequently, followed by aspergillosis, zygomycosis, and cryptococcosis. The regions with the highest incidences were the capital areas, Gyeonggi and Seoul. By sex, the prevalence in females (4.851%) was 14 times higher than that in males (0.352%). Interestingly, the adults from the 20- to 49-year-old age group showed higher prevalence than children and the elderly. The average duration of hospitalized treatment was 17.31 days and of outpatient treatment was 2.21 days; 3,577 hundred million won was used in total for medical expenses. This study provides useful data to study trends of opportunistic mycoses.

Humidifier Disinfectants Are a Cause of Lung Injury among Adults in South Korea: A Community-Based Case-Control Study.

BACKGROUNDS: An outbreak of lung injury among South Korean adults was examined in a hospital-based case-control study, and the suspected cause was exposure to humidifier disinfectant (HD). However, a case-control study with community-dwelling controls was needed to validate the previous study's findings, and to confirm the exposure-response relationship between HD and lung injury. METHODS: Each case of lung injury was matched with four community-dwelling controls, according to age (±3 years), sex, residence, and history of childbirth since 2006 (for women). Environmental risk factors, which included type and use of humidifier and HD, were investigated using a structured questionnaire during August 2011. The exposure to HD was calculated for both cases and controls, and the corresponding risks of lung injury were compared. RESULTS: Among 28 eligible cases, 16 patients agreed to participate, and 60 matched controls were considered eligible for this study. The cases were more likely to have been exposed to HD (odds ratio: 116.1, 95% confidence interval: 6.5-2,063.7). All cases were exposed to HDs containing polyhexamethyleneguanidine phosphate, and the risk of lung injury increased with the cumulative exposure, duration of exposure, and exposure per day. CONCLUSIONS: This study revealed a statistically significant exposure-response relationship between HD and lung injury. Therefore, continuous monitoring and stricter evaluation of environmental chemicals' safety should be conducted.

Epidemiological features and clinical manifestations of Lyme borreliosis in Korea during the period 2005-2012.

Lyme borreliosis is one of the most common tick-borne infections in the northern hemisphere. However, the epidemiological features and clinical manifestations of this disease in Korea are unknown. The present study is the first to investigate the characteristics of Lyme borreliosis in Korea. We traced suspected cases of Lyme borreliosis during the period 2005-2012. Of the 16 identified patients with the disease, 11 had acquired autochthonous infection within Korea, while 5 patients were infected outside Korea. The history of past exposure was investigated in 8 of the 11 patients with autochthonous infection; 5 of these 8 patients (62.5%) were suspected to have acquired the infection in the northeastern alpine region. Clinically, of 11 patients with autochthonous infection, 6 (54.5%) showed early skin manifestations, 4 (36.4%) showed neurological manifestations, and 1 (9.1%) showed acrodermatitis chronica atrophicans. In conclusion, Lyme borreliosis could be endemic in the northeastern alpine region of Korea, and neurological and early skin manifestations are likely to be the major clinical characteristics of autochthonous Lyme borreliosis in Korea.

Current situation of scrub typhus in South Korea from 2001-2013.

BACKGROUND: The bacteria Orientia tsutsugamushi is the causative agent of scrub typhus, mite-borne disease, which causes an acute febrile illness in patients. An epidemiologic study was conducted to understand the characteristics of scrub typhus in South Korea. FINDINGS: Reporting of tsutsugamushi disease is mandatory in South Korea since 1994. To investigate the prevalence of tsutsugamushi disease from 2001 to 2013, medical records from the Korea Center for Disease Control and Prevention were reviewed. In total, 70,914 cases were reported during 2001-2013. Of these, 37.16% (26,349) were male and 62.84% (44,565) were female. The highest number of cases was in the 60-69-year-old age group (19,484; 27.48%), and 72.22% (51,212) were in the 50-79-year-old age group. There were 65,100 cases (91.80%) reported during October (24,964; 35.20%) and November (40,136; 56.60%). An almost four-fold increase in the number of patients was observed in 2013 (10,485 cases) compared to 2001 (2,637 cases). The highest number of patients was reported in the Jeonbuk (9,425; 13.29%) and lowest in the Jeju (362; 0.51%). CONCLUSIONS: A rapid increase in the incidence of patients with tsutsugamushi disease was observed in most areas from 2001 to 2013, with the majority of cases reported in the western and southern coast.

Epidemiological Characterization of Skin Fungal Infections Between the Years 2006 and 2010 in Korea.

OBJECTIVES: The purpose of this study was to build and provide a basic database of skin fungal infections for the effective management of skin fungal infections in the future. METHODS: We collected health insurance data between the years 2006 and 2010 from the Health Insurance Corporation (Seoul, Korea) and analyzed the data to determine the prevalence and treatment management of skin fungal infections. RESULTS: Skin fungal infections were divided into two groups: namely dermatophytosis and other superficial mycoses. Dermatophytosis showed a higher prevalence (16,035,399 cases) than the other superficial mycoses (794,847 cases) within the study period. The prevalence rate decreased consecutively by 0.01% to 0.19% every year. The prevalence according to region showed that Jeolla-do had a high prevalence distribution. The prevalences in men and women were similar (7.01% vs. 6.26%). It is interesting to note that adults from the 50-79-year age group showed a higher prevalence than children and young adults. The average convalescence time (days) of dermatophytosis was longer than that of other superficial mycoses. The total medical expenses were also much higher in dermatophytosis than in the other superficial mycoses. CONCLUSION: This study provides useful data for study trends of skin fungal infections.

An outbreak of joint and cutaneous infections caused by non-tuberculous mycobacteria after corticosteroid injection.

OBJECTIVES: An outbreak of joint and cutaneous infections among patients who had been injected at a single clinic in South Korea was investigated. METHODS: In this retrospective case-control study, 61 cases were diagnosed based on symptoms and signs of septic arthritis or cutaneous infection that developed after injections at the clinic between April and September 2012; 64 controls were investigated by administering questionnaires on risk factors and analyzing the clinic medical records. An environmental investigation was performed, and clinical specimens of the cases were analyzed by pulsed-field gel electrophoresis. RESULTS: All cases were injected with triamcinolone. A greater number of triamcinolone injections (adjusted odds ratio 4.3, 95% confidence interval 1.5-12.1 for six or more visits, compared with one or two visits) was associated with the development of an infection. In the clinic, only the triamcinolone injection was prepared by mixing with lidocaine and normal saline, and an alcohol swab was prepared using boiled tap water by members of the clinic staff. Although injected medications and environmental cultures were not found to be responsible, a single strain of Mycobacterium massiliense was isolated from the affected sites of 16 cases. CONCLUSIONS: Repeated injection of triamcinolone contaminated with NTM from the clinic environment may have caused this post-injection outbreak.

Epidemiology of scrub typhus and the eschars patterns in South Korea from 2008 to 2012.

In South Korea, scrub typhus is the most common acute febrile illness in autumn. We analyzed scrub typhus cases reported from 2008 to 2012 to describe the epidemiology of scrub typhus as well as eschar patterns. A total of 30,478 cases were reported from 2008 to 2012; the incidence rates were higher in the southern and western regions of South Korea. The common clinical symptoms of confirmed scrub typhus cases from 2010 to 2012 were fever/chills (95.2%), eschars (78.9%), and myalgia (61.7%). The primary sites of eschars were the lower extremities (19.0%), abdomen/waist (13.4%), and axilla (11.5%) in men and the shoulder/frontal chest (15.1%), lower extremities (14.5%), and abdomen/waist (13.6%) in women. Regardless of gender, eschars tended to be more on the lower extremities among the leisure activities group. Among the occupational farm work group, who usually lived in rural areas, eschars appeared most frequently on the abdomen/waist in men and on the shoulder/frontal chest in women. Eschar patterns were influenced by gender and activities. These results could facilitate the prevention of scrub typhus and clarify the current status of scrub typhus in South Korea.

Regional distribution of hepatitis C virus infection in the Republic of Korea, 2007-2011.

BACKGROUND/AIMS: In Korea, hepatitis C is included as an infectious disease in a sentinel surveillance system. Recently, a large variation in hepatitis C incidence between different regions in Korea has been noticed. The current study verified the nationwide distribution of hepatitis C infection for effective prevention and management. METHODS: We counted the number of hepatitis C patients who visited a hospital per county using the National Health Insurance database from 2007 to 2011. The age-adjusted prevalence ratio was used, and the age adjustment method was used as an indirect standardization method. Disease mapping and spatial analysis were conducted using a geographic information system. RESULTS: The annual prevalence of diagnosed hepatitis C was approximately 0.12% to 0.13% in Korea. The age-adjusted prevalence ratios in Busan, Jeonnam, and Gyeongnam were high (1.75, 1.4, and 1.3, respectively). The three regions in the southern coastal area of the Korean Peninsula were identified as a high-prevalence cluster (Moran's index, 0.3636). CONCLUSIONS: The present study showed that hepatitis C infection has very large regional variation, and there are several high-risk areas. Preventive measures focusing on these areas should be applied to block the transmission of hepatitis C and reduce the disease burden.

Emerging Pathogens and Vehicles of Food- and Water-borne Disease Outbreaks in Korea, 2007-2012.

OBJECTIVES: Food- and water-borne disease outbreaks (FBDOs) are an important public health problem worldwide. This study investigated the trends in FBDOs in Korea and established emerging causal pathogens and causal vehicles. METHODS: We analyzed FBDOs in Korea by year, location, causal pathogens, and causal vehicles from 2007 to 2012. Information was collected from the FBDOs database in the Korean Centers for Disease Control and Prevention. RESULTS: During 2007-2012, a total of 1794 FBDOs and 48,897 patients were reported. After 2007, FBDOs and patient numbers steadily decreased over the next 2 years and then plateaued until 2011. However, in 2012, FBDOs increased slightly accompanied by a large increase in the number of affected patients. Our results highlight the emergence of norovirus and pathogenic Escherichia coli other than enterohemorrhagic E. coli (EHEC) in schools in 2012. We found that pickled vegetables is an emerging causal vehicle responsible for this problem. CONCLUSION: On the basis of this study we recommend intensified inspections of pickled vegetable manufacturers and the strengthening of laboratory surveillance of relevant pathogens.

Are there spatial and temporal correlations in the incidence distribution of scrub typhus in Korea?

OBJECTIVES: A hierarchical generalized linear model (HGLM) was applied to estimate the transmission pattern of scrub typhus from 2001 to 2011 in the Republic of Korea, based on spatial and temporal correlation. METHODS: Based on the descriptive statistics of scrub typhus incidence from 2001 to 2011 reported to the Korean Centers for Disease Control and Prevention, the spatial and temporal correlations were estimated by HGLM. Incidences according to age, sex, and year were also estimated by the best-fit model out of nine HGLMs. A disease map was drawn to view the annual regional spread of the disease. RESULTS: The total number of scrub typhus cases reported from 2001 to 2011 was 51,136: male, 18,628 (36.4%); female, 32,508 (63.6%). The best-fit model selected was a combination of the spatial model (Markov random-field model) and temporal model (first order autoregressive model) of scrub typhus transmission. The peak incidence was 28.80 per 100,000 persons in early October and the peak incidence was 40.17 per 100,000 persons in those aged 63.3 years old by the best-fit HGLM. The disease map showed the spread of disease from the southern central area to a nationwide area, excepting Gangwon-do (province), Gyeongsangbuk-do (province), and Seoul. CONCLUSION: In the transmission of scrub typhus in Korea, there was a correlation to the incidence of adjacent areas, as well as that of the previous year. According to the disease map, we are unlikely to see any decrease in the incidence in the near future, unless ongoing aggressive measures to prevent the exposure to the vector, chigger mites, in rural areas, are put into place.

Epidemiological characteristics of imported shigellosis in Korea, 2010-2011.

Shigellosis is a global disease as food poisoning by infection of Shigella spp (S. dysenteriae, S. flexneri, S. boydii and S. sonnei). In Korea, approximately 500 cases of shigellosis have reported every year since 2004, and imported shigellosis is increasing gradually from 2006 in particular. According to increase of numbers of overseas travelers, the numbers of patients diseased with imported shigellosis is also increasing. We need continuous surveillance studies network (SSN) for control of imported shigellosis. We studied epidemiological characteristic of imported shigellosis by using database of Korea Centers for Disease Control and Prevention (KCDC) from 2010 to 2011. The imported shigellosis is analyzed on correlation with variable factors such as sex, age, symptom, visited country as well as Shigella spp in the database. Total 399 patients diseased with shigellosis have been reported between 2010 and 2011, The 212 patients (53.1%) among them were disease with imported shigellosis and the 205 patients (96.7%) were diagnosed as definite shigellosis. Shigella sonnei (65.6%) and Shigella flexneri (20.3%) were isolated in order. Clinical symptoms of the shigellosis were diarrhea (96.5%), abdominal pain (54.7%), fever (52.8%), chill (31.6%), and weakness (21.7% etc) in order. Duration of diarrhea was 1 to 5 days, the number of diarrhea was mostly more than 10 times, and type of stool was almost yellow stool. Almost shigellosis was occurred in the travelers visited to Asia (98.1%). Particularly, the occurrence rate of shigellosis was highest in traveler visited to Southeast Asia which is India (21.7%), Cambodia (19.8%), Philippines (17.9%), and Vietnam (9.0%) in order. According to increase of traveler to Southeast Asia, imported Shigellosis also increased. We need to strengthen the public health and hygiene, which is infection prevention rules, eating properly-cook food, washing hands, drinking boiled water, for traveler to Asia. The quarantine and surveillance system to control imported shigellosis is need continually in Korea.