J Prev Med Public Health.  2019 May;52(3):188-194. 10.3961/jpmph.18.299.

Incidence of Scarlet Fever in Children in Jeju Province, Korea, 2002-2016: An Age-period-cohort Analysis

• Kim J
• Kim JE
• Bae JM

• KMID: 2449815
• DOI: http://doi.org/10.3961/jpmph.18.299

Abstract

OBJECTIVES
Outbreaks of scarlet fever in Mexico in 1999, Hong Kong and mainland China in 2011, and England in 2014-2016 have received global attention, and the number of notified cases in Korean children, including in Jeju Province, has also increased since 2010. To identify relevant hypotheses regarding this emerging outbreak, an age-period-cohort (APC) analysis of scarlet fever incidence was conducted among children in Jeju Province, Korea.
METHODS
This study analyzed data from the nationwide insurance claims database administered by the Korean National Health Insurance Service. The inclusion criteria were children aged ≤14 years residing in Jeju Province, Korea who received any form of healthcare for scarlet fever from 2002 to 2016. The age and year variables were categorized into 5 groups, respectively. After calculating the crude incidence rate (CIR) for age and calendar year groups, the intrinsic estimator (IE) method was applied to conduct the APC analysis.
RESULTS
In total, 2345 cases were identified from 2002 to 2016. Scarlet fever was most common in the 0-2 age group, and boys presented more cases than girls. Since the CIR decreased with age between 2002 and 2016, the age and period effect decreased in all observed years. The IE coefficients suggesting a cohort effect shifted from negative to positive in 2009.
CONCLUSIONS
The results suggest that the recent outbreak of scarlet fever among children in Jeju Province might be explained through the cohort effect. As children born after 2009 showed a higher risk of scarlet fever, further descriptive epidemiological studies are needed.

Keyword

Streptococcus pyogenes; Emm protein; Exotoxins; Scarlet fever; Cohort effect

MeSH Terms

Child*
China
Cohort Effect
Delivery of Health Care
Disease Outbreaks
England
Epidemiologic Studies
Exotoxins
Female
Hong Kong
Humans
Incidence*
Insurance
Korea*
Methods
Mexico
National Health Programs
Scarlet Fever*
Streptococcus pyogenes
Exotoxins