Ten guidelines for a healthy life: Korean Medical Association statement (2017).
December 15, 2017 148 p (in English)

doi: https://doi.org/10.26604/979-11-5590-078-9-93510-7

Receiving Routine Health Screenings and Immunizations

Receiving Routine Health Screenings and Immunizations

Health is a habit. Get screened and immunized while you’re healthy!

Summary

◆ Background

It is widely recognized that disease prevention is more important than treatment. Currently, a national health screening program, a national cancer screening program, and a national immunization program constitute the major disease prevention programs in South Korea. Utilizing these programs to their full potential will have a positive impact on disease prevention.

◆ Purpose

In reality, screening rates are still relatively low, and some individuals have misconceptions regarding health screenings, such as the perception that they do not need to return for follow-up appointments, even after a positive result. Hence, accurate information needs to be provided regarding health screenings and immunizations.

◆ Contents

1. Participate in a national health screening program at each stage of the life cycle as part of leading a healthy life

The most health benefits can be obtained by keeping up with the health screenings recommended by the national health screening program, national cancer screening program, and other health screening programs that are provided for each stage of the life cycle, such as those for infants, children, adolescents, and the elderly.

2. Make sure that you receive the results of health screenings and practice the appropriate healthy habits

Follow-up exams should be carried out if positive results are found, and efforts should be made to further improve one’s health by making any necessary lifestyle changes, such as quitting smoking, abstaining from alcohol, and exercising. Diseases such as high blood pressure, dyslipidemia, diabetes, and cancer can be caused by smoking, drinking, lack of exercise, improper diet, and obesity. Hence, maintaining healthy habits can prevent a range of diseases.

3. Receive timely immunizations for your own health and that of the community

Immunizations are the most effective way to prevent infectious diseases, and South Korea has a comprehensive national immunization program in place. Receiving immunizations as outlined in the recommendations can simultaneously prevent both epidemics and individual infections through herd immunity.

◆ Expected impact

Following the recommendations of the national health screening program, the national cancer screening program, and the national immunization program reduces the chances of developing diseases (as well as associated mortality), helping citizens to lead long, healthy lives.

Keywords: Mass screening, Early detection of cancer, Mass vaccination, Immunization programs, Preventive health services

Best practices to follow

1. Participate in a national health screening program at each stage of the life cycle as part of leading a healthy life

2. Make sure that you receive the results of health screenings and practice the appropriate healthy habits

3. Receive timely immunizations for your own health and that of the community

Fact Sheet ➊

Participate in a national health screening program at each stage of the life cycle as part of leading a healthy life

1.1 Early detection of diseases through health screenings is the shortcut to good health

As implied in the saying “seng lo byoung sa” (“birth, aging, sickness, and death: the four phases of life”), disease is a part of life. Although ideal in theory, it is impossible to completely prevent disease by merely taking care of one’s health.

Hence, the next best plan is to quickly identify and treat a disease when it occurs without noticeable signs or symptoms, either completely curing the disease or minimizing its complications.

For chronic diseases such as cancer, symptoms do not develop until months or even years after the disease sets in.

The appearance of symptoms of chronic diseases and cancer can indicate that the disease has already progressed significantly. If this is the case, it is best to detect the disease at an early stage.

Screening is designed to reveal whether a patient who appears to be healthy is truly healthy or has a non-apparent disease through selected tests.

Fortunately, South Korea has an active national health screening program that allows subjects to receive health screenings, including cancer screenings, at nearly no expense. A life cycle–based health screening program focusing on the most relevant diseases at each stage in life (infancy/early childhood, childhood/adolescence/young adulthood, adulthood, and old age) is shown in Table 7.1 [1,2].

Table 7.1

Diseases screened for in the life cycle–based national health screening program and other health screenings

(Adapted from Ministry of Health and Welfare [1], National Law Information Center [2])

Category Infancy/Early childhood (0-5 years old) (Infant health screening) Childhood/adolescence/early adulthood (6-18 years old) (Screening for school-age children) (Life transition period [15 years of age-18 years old] screening) Adulthood (19-64) (General check-up) (Life transition period [40 years of age] screening) Old age (65 years old and older) (General check-up) (Life transition period [66 years of age] screening)
Screening intervals The ages of 4, 9, 18, 30, 42, 54, and 66 months (7 examinations in total) Grades 1-4, 7, and 9 (4 screenings total)• For students who do not attend school, between the ages of 15 and 18. Once every 2 years (annually for non-office occupations) Once every 2 years (annually for non-office occupations)

Target illnesses and screening items Basic screening items First screening (4-6 months) Screenings for school-age children Life transition period (15-18 years old) screening for teenagers not in school General check-up Life transition period (40 years of age) screening General check-up Life transition period (66 years of age) screening

• Visual abnormalities (strabismus) • Basic screening items • Identification of potential health risks • Obesity • Obesity • Obesity • Obesity • Obesity
• Growth abnormalities • Hearing abnormalities • Musculoskeletal and spinal diseases • Visual and auditory abnormalities • Visual and auditory abnormalities • Visual and auditory abnormalities • Visual and auditory abnormalities • Visual and auditory abnormalities
• Malnutrition • Sudden infant death syndrome • Eyesight, color blindness, eye diseases • Identification of potential health risks • Identification of potential health risks • Identification of potential health risks • Identification of potential health risks • Identification of potential health risks
• Accident prevention • Hearing abnormalities • Tuberculosis, chest disease • Tuberculosis, chest disease • Tuberculosis, chest disease • Tuberculosis, chest disease • Tuberculosis, chest disease

• Mental health • Hepatitis B • Kidney disease • Kidney disease • Kidney disease • Kidney disease
Second screening (9-12 months) Third screening (18-24 months) • Ear diseases (middle ear infection, otitis) • Anemia • Blood diseases, such as anemia • Blood diseases, such as anemia • Blood diseases, such as anemia • Blood diseases, such as anemia

• Nasal diseases (sinusitis, rhinitis) • High blood pressure • High blood pressure • High blood pressure • High blood pressure • High blood pressure
• Basic screening items • Basic screening items • Throat diseases (tonsillitis, lymph node swelling, thyroid hypertrophy) • Diabetes • Diabetes • Diabetes • Diabetes • Diabetes
• Auditory abnormalities • Auditory abnormalities • Skin diseases (atopic dermatitis, infectious dermatitis) • Dyslipidemia • Dyslipidemia • Dyslipidemia • Dyslipidemia • Dyslipidemia
• Developmental abnormalities • Developmental abnormalities • Proteinuria, occult blood in the urine • Liver disease • Liver diseases • Hepatitis B • Liver disease • Hepatitis B
• Dental development • Knowledge of toilet training • Anemia • Dental examination • Chronic kidney disease • Liver disease • Chronic kidney disease • Liver disease
• Dental caries • Hepatitis B • Dental examination • Chronic kidney disease • Dental examination • Chronic kidney disease

• High blood pressure • Dental examination • Cognitive dysfunction • Dental examination
Fourth screening (30-36 months) Fifth screening (42-48 months) • Diabetes • Depression • Depression

• Dyslipidemia • Lifestyle habits evaluation • Osteoporosis (females)
• Basic screening items • Basic screening items • Liver disease • Senior body function assessment
• Refractive errors (amblyopia) • Refractive errors (amblyopia) • Dental examination (teeth condition, oral condition) • Cognitive dysfunction
• Auditory abnormalities • Auditory abnormalities • Lifestyle habits evaluation
• Obesity • Obesity
• Developmental abnormalities • Developmental abnormalities
• Exposure to digital media • Social development
• Dental caries

Sixth screening (54-60 months) Seventh screening (66-71 months)

• Basic screening items • Basic screening items
• Refractive errors (amblyopia) • Refractive errors (amblyopia)
• Obesity • Obesity
• Developmental abnormalities • Developmental abnormalities
• Personal hygiene • Preparation for school
• Dental caries

Health screenings are important because they can prevent both the occurrence of diseases and the resultant mortality, while also improving quality of life. For example, screening can reduce mortality rates by 25% for breast cancer and 20% for colon cancer, while reducing the occurrence of cervical cancer by 80%.

Compared to those who did not receive National Health Insurance Service (NHIS) health check-ups in Korea, Individuals who did were shown to have a 42% reduced chance of death from cardio-cerebrovascular diseases (myocardial infarction, stroke, etc.), and an 18% reduced chance of occurrence of cardio-cerebrovascular diseases. They also had less costly medical bills [4].

In particular, cancer patients of low socioeconomic status who are diagnosed through the national cancer screening program can receive financial aid from the government for their medical bills (Table 7.2) [5].

Table 7.2

The 5 major national cancer screening programs (Adapted from National Cancer Information Center [3])

Cancer type Groups of people eligible for screenings Screening intervals Screening methods
Stomach cancer Adults 40 years of age and older 2 years Gastroscopy or gastrointestinal contrast

Liver cancer High-risk adults 40 years of age and older (individuals diagnosed with cirrhosis, and those who are hepatitis B virus antigen–positive, or hepatitis C virus antibody–positive) 6 months Liver ultrasound + serum alpha-fetoprotein test

Colon cancer Adults 50 years of age and older 1 year Fecal occult blood test (FOBT): if findings are abnormal, colonoscopy or double contrast barium enema (DCBE)

Breast cancer Female adults 40 years of age and older 2 years Mammography

Cervical cancer Female adults 20 years of age and older 2 years Cervical cytology (Pap smear test)

All individuals eligible for a health screening should receive one in order to benefit from these programs to the greatest extent possible.

Undoubtedly, the health screening rate of the South Korean population should be improved. An analysis of participation rate showed that only 48.3% of the population received cancer screenings, 76.1% received general health screenings, and 69.5% received infant health screenings. Hence, there is a need for more people to participate in health screenings [6].

It must be noted that the cancer screenings provided by the government do not help to prevent all types of cancer. Currently, the national health screening program provides screening only for cervical, breast, colon, stomach, and liver cancer. These 5 types of cancer were chosen because nationwide screening programs have been proven to increase early detection and to reduce the mortality rates for only these types of cancers

Similarly, the national health screening program does not prevent all types of chronic diseases. For example, we can expect only cardiovascular and cerebrovascular disease to be prevented through high blood pressure and diabetes screenings [1,4].

Additionally, the following principles are very important in regard to receiving health screenings. If the recommendation recommends that stomach cancer screenings should be done every 2 years, the screening results are effective only for 2 years, even if the result of the screening is negative. New cancers can occur after this period, and participating in the screening program regularly is necessary to maintain the effect. Finally, screening exams are designed to detect a disease before symptoms arise. Hence, if symptoms do appear, the patient must consult a doctor regardless of the screening schedule.

Even if an individual receives a health screening at each recommended interval, in unusual cases, an apparent disease can be diagnosed between screenings, within the recommended interval. This is a situation in which the screening results are negative, but a disease develops after the screening, causing the results to be a false negative. It is also possible to have a positive screening result, but a negative final diagnosis after diagnostic procedures are conducted. In such circumstances, the screening results are a false positive. Although efforts are being made to minimize such circumstances, false positives and negatives are unavoidable in the screening program.

However, this does not mean that one should receive health screenings as frequently as possible.

As discussed previously, screenings are conducted among all individuals within a certain age group who appear to be healthy; therefore, the impact of adverse effects such as false positives and false negatives will be especially apparent at the beginning of the screening program. As the screening programs continue, however, the ability to detect the occurrence of diseases, thereby reducing mortality, greatly outweighs any adverse effects, making the screening programs worthwhile.

If an individual receives repeated screenings for a disease for which the benefits of such screenings have not been proven, the adverse consequences of the health screenings could potentially outweigh the benefits. Hence, it is wise to consult a doctor if such a screening is required. Likewise, receiving a screening every 6 months when doctors recommend it every 2 years can cause adverse results. Hence, those that do want to receive more frequent screenings should first consult with a doctor.

However, it is sometimes necessary to be screened more often than is generally recommended or at an earlier age. For example, if an individual’s mother or sister has a history of breast cancer, that individual may develop breast cancer at an early age. Hence, under such circumstances, it may be necessary to begin screenings earlier.

Although there is no upper age limit for the elderly in the national screening program, it is wise for the elderly to consult a doctor before undergoing a health screening. Although healthy elderly individuals need to undergo screenings regularly, seniors with failing bodily functions or those who suffer from another disease should consult with a doctor who is aware of their condition, rather than receive isolated general screenings. When positive results are found through screening, follow-ups and possible confirmatory exams are needed in order to determine the presence of a disease, which is the purpose of receiving a health screening.

However, in reality, the follow-up process is often ignored. Studies have shown that 25% of those with positive or suspicious cancer screening results did not receive follow-up procedures. Even for general check-ups, only 30% of those who were requested to follow up did so. One of the reasons for this low follow-up rate may be that screenees may not correctly understand the meaning of suspicious or positive findings from their screenings.

When undergoing a health screening, it is best to know the meaning of positive and negative findings in advance. Negative findings, which are the majority of the findings, indicate that the individual simply needs to maintain healthy habits until they undergo a subsequent screening. However, positive results require the individual to consult with a doctor.

Fact Sheet ➋

Make sure that you receive the results of health screenings and practice the appropriate healthy habits

Abnormal findings are not rare in health screenings. The most common diagnoses are high blood pressure, diabetes, and dyslipidemia. A health screening program should treat these abnormal findings when they are found, through appropriate follow-up.

High blood pressure, dyslipidemia, and diabetes all have common causes: most notably, smoking, drinking, insufficient exercise, improper dietary habits, and obesity. These factors are also major causes of cancer, making the elimination of these factors a critical step to preventing and managing cancer and cardio-cerebrovascular diseases, which are major causes of death in South Korea.

Hence, when diagnosed with a lifestyle-related disease, such as high blood pressure, dyslipidemia, or diabetes, it is important to receive treatment from a doctor and to personally attempt to improve one’s lifestyle habits.

Fortunately, national health screenings are mostly conducted at primary-care medical institutions, making it possible for a patient to receive advice on improving lifestyle habits when consulting a doctor regarding the screening results. A patient can live a long and healthy life by fully implementing a doctor’s advice.

Fact Sheet ➌

Receive timely immunizations for your own health and that of the community

As experienced during the Middle East respiratory syndrome (MERS) epidemic, infectious diseases can have a huge ripple effect. Although there were numerous unavoidable casualties from MERS due to the absence of an effective vaccine, immunizations have been developed for many other infectious diseases. Increasing the immunization rate can maximize disease prevention, on both the individual and national levels.

The success of mass immunization (vaccination) programs has been recognized worldwide [7,8]. The Centers for Disease Control and Prevention of the United States even ranked immunization first among the top 10 public health achievements in the 20th century.

The effect of immunization is not limited to the individual receiving the vaccination. For example, if 80% of the population in a given community has received the immunization, an epidemic of the disease will not occur in the community, even if the remaining 20% of the population has not received the immunization. Hence, increasing the immunization rate is of the utmost importance.

Just 20-30 years ago, the rate of hepatitis B seropositivity in Korea was relatively high (9%), which led to a high rate of chronic hepatitis, cirrhosis, and liver cancer. However, since all infants were given hepatitis B immunizations starting in 1995, the rate of hepatitis B seropositivity has decreased to the low rate of 2%-3%. Rates of cirrhosis and liver cancer have also continued to fall. This is a case of a successful national immunization program—one in which the benefits can be appreciated by the public as a whole [9,10].

Hence, active participation of all citizens in the national immunization program promotes disease prevention at both the individual and community levels and helps to prevent epidemics in South Korea.

3.1 Immunizations can be received free of charge through the national immunization program

In the national immunization program of South Korea, the essential vaccinations are given from birth to 1 month of age, and throughout adulthood, based on the stages of the life cycle (refer to Table 7.3 for details) [11,12]. According to a study of the national immunization rate conducted in 2015, the percentage of children who received all recommended vaccines was high, with rates of 94.3% for children under the age of 1, 92.1% for children under 2, and 88.3% for children under 3 [13].

Table 7.3

Recommended Immunization Schedule for Children (2017)

(Adapted from Korea Centers for Disease Control and Prevention, Korean Medical Association, Korea Advisory Committee on Immunization Practices [11])

Target infectious disease Vaccine type and method Number of doses Birth to 1 month 1 month 2 months 4 months 6 months 12 months 15 months 18 months 19-23 months 24-35 months 4 years old 6 years old 11 years old 12 years old
National immunization program Tuberculosis BCG (intradermal) 1 BCG (intradermal) Single dose

Hepatitis B HepB 3 1st dose 2nd dose 3rd dose

Diphtheria, Tetanus, Pertussis DTaP 5 1st dose 2nd dose 3rd dose 4th dose 5th dose

Td/Tdap 1 6th dose

Polio IPV 4 1st dose 2nd dose 3rd dose 4th dose

Haemophilus influenzae type B PRP-T/ HbOC 4 1st dose 2nd dose 3rd dose 4th dose

Pneumococcus PCV (protein conjugate) 4 1st dose 2nd dose 3rd dose 4th dose

PPSV (polysaccharide) - Only for high-risk groups

Measles, Mumps, Rubella MMR 2 1st dose 2nd dose

Chickenpox Var 1 Single dose

Hepatitis A HepA 2 1st and 2nd doses

Japanese encephalitis IJEV (inactivated) 5 1st-3rd doses (inactivated) 4th dose 5th dose

LJEV (live attenuated) 2 1st and 2nd doses (live attenuated)

Human papillomavirus HpV2/ HpV4 2 1st and 2nd doses

Influenza IIV (inactivated) - Annually

LAIV (live attenuated) - Annually

Other immunizations Tuberculosis① BCG (percutaneous) 1 Single dose (percutaneous)

Rotavirus RV1 2 1st dose 2nd dose

RV5 3 1st dose 2nd dose 3rd dose

The national immunization program: immunization guidelines recommended by the government (through the ‘Infectious Disease Control and Prevention Act,’ the government determines the target infectious diseases and methods of immunization and imposes these methods on the public and health care providers.)

Other immunizations: Immunizations outside the national immunization program that are provided by private medical agencies.

① BCG (Bacillus Calmette-Guérin vaccine): Administer BCG within 4 weeks of birth.

② Hepatitis B: If a pregnant woman is positive for hepatitis B surface antigen (HBsAg), administer hepatitis B immunoglobulin (HBIG) and the hepatitis B vaccine simultaneously within 12 hours of birth. Afterwards, administer the second and third doses of the hepatitis B vaccine at 1 and 6 months of age.

③ DTaP (diphtheria, tetanus, pertussis; combined vaccine): It is possible to administer DTaP – IPV (diphtheria, tetanus, pertussis, polio) combination vaccines.

④ Td/Tdap: Administer additional dose of Td or Tdap at ages 11 through 12 years.

⑤ Polio: Administer the third dose at age 6 months; it can be administered up to age 18 months. Possible to administer DTaP – IPV (diphtheria, tetanus, pertussis, polio) combination vaccines.

※ DTaP-IPV (diphtheria, tetanus, pertussis, polio): It is possible to administer DTaP-IPV combination vaccines instead of DTaP and IPV at ages 2, 4, 6 months, and 4 through 6 years. In such cases, the first 3 doses should be administered with the vaccines made by the same manufacturer, but the DTaP vaccine administered at age 15 months through 18 months can be made by a different manufacturer.

Haemophilus influenzae type B (Hib): Administer to all young children aged 2 months through 5 years; children older than 5 years are given the dose only if they are at increased risk of a Haemophilus influenzae type B infection (sickle cell anemia, splenectomy, compromised immune system after chemotherapy, leukemia, HIV infection, humoral immunodeficiency, etc.).

⑦ Pneumococcal protein conjugate vaccine: mixing the 10-valent and 13-valent protein conjugate vaccines is not recommended.

⑧ Pneumococcal polysaccharide vaccine (PPSV): Administer to patients older than age 2 who have a high risk of pneumococcus, after patient-doctor consultation regarding the health status of the patient.

※ High-risk groups for pneumococcal infection:

- Immunocompromised children: HIV infection, chronic kidney disease and nephrotic syndrome, diseases treated with immunosuppressants or radiation (malignant tumors, leukemia, lymphoma, and Hodgkin disease), solid organ transplant, or congenital immunodeficiency conditions.

- Children with functional or anatomic asplenia: sickle cell anemia or hemoglobinemia, asplenia, or spleen dysfunction.

- Children who have a functional immune system but have one or more of the following conditions: chronic heart disease, chronic lung disease, diabetes, cerebrospinal fluid leakage, or a cochlear implant.

⑨ Measles: It is possible to administer the MMR vaccine at the ages of 6 months through 11 months during an outbreak—in such cases, another immunization is required after the age of 12 months.

⑩ Hepatitis A: Administer the first dose at age 12 months and an additional dose at ages 6 through 18 months (immunization schedule depends on the manufacturer).

⑪ Japanese encephalitis (inactivated): After the first dose, administer the second dose 7-30 days later. Administer the third dose 12 months after the second dose

⑫ Japanese encephalitis (live attenuated): After the first dose, administer the second dose 12 months later.

⑬ Human papillomavirus: Administer twice at a 6-month interval at age 12 (mixing type 2 and 4 vaccines is not recommended).

⑭ Influenza (inactivated): Administer annually to children aged 6 months through 59 months. In such cases, the first immunization should be administered twice at a 1-month interval, and once a year for the remainder (if the influenza immunization is only administered once in the first year, 2 doses should be administered, at a 1-month interval, in the following year).

⑮ Influenza (live attenuated): Administer the dose after the age of 24 months—twice, at a 1-month interval, for the first year, followed by annual immunizations for the remainder (if the influenza immunization is only administered once in the first year, the dose should be administered twice, at a 1-month interval, in the following year).

In the sporadic outbreaks of measles that occurred in South Korea in 2014, the imported cases and unvaccinated children were the primary victims, followed by secondary infections in hospitals and at schools. Hence, ensuring timely and complete immunizations in infants is a critical issue on both the individual level and the national level [14].

The high national immunization rate in South Korea is the result of cumulative efforts to expand free immunization programs, to increase the accessibility of medical facilities, and to send reminders of immunization dates through text messaging. According to a satisfaction survey of the national immunization support program and the guardian perception survey in 2014, 88.8% of the respondents replied that they would allow their children to “receive timely immunizations,” and 77.6% stated it was “not a difficult task” to receive scheduled immunizations, indicating a highly receptive attitude towards receiving immunizations at an appropriate age and in line with the recommended schedule [15].

In addition, adults (aged 65 or older) who are eligible for a free influenza vaccine should check and should follow the correct period. It takes approximately 2 weeks for antibodies to develop after a vaccine is administered; considering that influenza becomes most prevalent after December, individuals at a high risk for influenza should receive immunization within the recommended period [16]. The influenza immunization rate was 81.5% in November 2016 among those who were 65 years old or older.

However, according to the Korea National Health and Nutrition Examination Survey, the influenza vaccination rates remained very low (at only 30%-40%) among non-elderly individuals who should receive an annual influenza vaccination, such as pregnant women and patients with chronic diseases such as diabetes, asthma, chronic pulmonary disease, and cardiovascular disease. In addition, there is a low awareness about the need for immunizations, and this must be addressed promptly (Table 7.4).

Table 7.4

Adult immunization schedule

(Adapted from Korea Centers for Disease Control and Prevention [12])

979-11-5590-078-9-93510-ch7i1.tif All adults within the age range 979-11-5590-078-9-93510-ch7i2.tif At-risk groups

Target infectious disease Vaccine type Aged 19-29 Aged 30-39 Aged 40-49 Aged 50-59 Aged 60-64 Aged 65 and older
Influenza Flu Single dose annually (recommendation level III) Single dose annually (recommendation level I)

Tetanus/diphtheria/pertussis Td/Tdap 1 dose of Td every 10 years, one of which should be a Tdap immunization (recommendation-level I)

Pneumococcus PPSV 1-2 doses for at-risk groups (recommendation level I) Single dose (recommendation level I)

PCV Patients with compromised immune systems, asplenia, cerebrospinal fluid leakage, or cochlear implants (recommendation level II)

Hepatitis A HepA 2 doses (recommendation level II) Immunization after antibody test (recommendation level II) Immunization of at-risk groups after antibody test (recommendation level II)

Hepatitis B HepB If it is uncertain whether the 3-dose series was administered, 1 dose should be administered after an antibody test (recommendation level III)

Chickenpox Var 2 doses for at-risk groups after antibody test recommended (recommendation level II)

Measles/mumps/rubella MMR At least 1 dose for at-risk groups; rubella antibody test recommended for pregnant women (recommendation level II)

Human papillomavirus HPV Females (recommendation level II)

Herpes zoster HZV Single dose (recommendation level III)

Meningococcus MCV 1-2 doses for at-risk groups (recommendation level II)

Recommendation levels

(I) Top-priority recommendation: Can reduce the chance of death, and very cost-effective.

(II) Priority recommendation: Can reduce the chance of death, but may not be cost-effective domestically.

 Mostly recommended in developed countries.

(III) Recommendation: Reduces the chances of disease rather than death, and may not be cost-effective domestically.

❶ Tdap: Used for individuals between the ages of 11 and 64. However, if necessary, such as in a pertussis outbreak, it can be administered to patients older than 65.

❷ Pneumococcal polysaccharide vaccine: Administered to at-risk groups for pneumococcus and should be re-administered to patients with compromised immune systems or asplenia.

※ Pneumococcus risk groups

i) Patients with compromised immune systems due to HIV infection, chronic kidney failure and nephrotic syndrome, or diseases that require immunosuppressants or radiation as a part of treatment (malignant tumors, leukemia, lymphoma, Hodgkin disease).

ii) Functional or anatomic asplenia patients, with sickle cell anemia or hemoglobinemia, asplenia, or spleen dysfunction.

iii) Patients with functional immune systems, but with cerebrospinal fluid leakage or a cochlear implant.

iv) Patients with functional immune systems, but who have the following diseases: chronic heart disease, chronic lung disease, or diabetes.

❸ Pneumococcal protein conjugate vaccine: Of the pneumococcus risk groups given above, patients in groups i), ii), and iii) should be administered a polysaccharide vaccine at least 8 weeks after the pneumococcal protein conjugate vaccine is administered.

❹ Groups at risk for hepatitis A: Chronic liver disease patients, hemophilia patients who receive clotting factors regularly, childcare facility employees, medical or research employees who are at risk of exposure to hepatitis A virus, travelers or individuals planning to work in countries that have a high endemicity of infection, food industry employees who handle food, male homosexuals, drug addicts, and individuals who have come in contact with hepatitis A patients within the last 2 weeks.

❺ Groups at risk for chickenpox: Medical staff who are not immune to chickenpox, guardians of patients with compromised immune systems, school or kindergarten teachers, students, soldiers, prison inmates, females within a fertility window, teenagers or adults living with a child, and international travelers.

❻ Groups at risk for measles/mumps/rubella: Medical staff, travelers to developing countries, family members taking care of a patient with a compromised immune system, and adults living in groups; although antibody tests (especially for measles) can be conducted, it is more economical to administer the dose without testing.

❼ Human papillomavirus: Recommended for females younger than aged 25-26 who did not complete the immunization at ages 11 through 12.

❽ Herpes zoster: Administer to adults at age 60 or above.

❾ High-risk groups for meningococcus: Although a target group has not been clearly established domestically, people typically considered to be at risk for meningococcus are individuals with anatomic or functional asplenia or complement deficiency, soldiers (especially new recruits), laboratory employees who are exposed to meningococcus, and travelers or residents who will be in close contact with locals in an area where an epidemic of meningococcal disease is occurring.

3.2 Immunizations are safe and effective

When millions of people receive a vaccine, an extremely small number of people will inevitably experience adverse reactions. These adverse reactions are miniscule compared to the individual and social benefits of immunizations. The government is also making an effort to minimize adverse reactions; there is a policy in place in which the government reimburses individuals who experience adverse reactions.

Problems arise when adverse reactions are exaggerated in the media and affect the immunization rate. For example, in 1998, a falsified paper stating that vaccines cause autism was published, resulting in a drop in the immunization rates, which in turn led to consequent measles epidemics.

Immunizations are the most effective and cost-effective method of preventing infectious diseases, and the current immunization system is incredibly safe.

References

1 

Ministry of Health and Welfare Guide to the 2017 Health Examination Program 2017

2 

National Law Information Center chool Health Examination Regulation Educational Decree No. 93 2016

3 

National Cancer Information Center National Cancer Control Program Available from URL:http://www.cancer.go.kr/mbs/cancer/subview.jsp?id=cancer_060104020000 (accessed 1 May, 2017)

4 

H Lee J Cho DW Shin Association of cardiovascular health screening with mortality, clinical outcomes, and health care cost: a nationwide cohort study Prev Med 2015 70 19 25

5 

National Health Insurance Service 2017 National Cancer Examination Notice 2017

6 

National Health Insurance Service 2015 National Health Screening Statistical Yearbook 2016

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Centers for Disease Control and Prevention (CDC) Impact of vaccines universally recommended for children-United States, 1990-1998 MMWR Morb Mortal Wkly Rep 1999 48 243 248

8 

O Walter The role of measles elimination in development of a national immunization program Pediatr Infect Dis J 2006 25 1093 1101

9 

R de Franchis A Hadengue G Lau EASL international consensus conference on hepatitis B. 13-14 September, 2002 Geneva, Switzerland. Consensus statement (long version) J Hepatol 2003 39 S3 25

10 

Ministry of Health and Welfare Korea Centers for Disease Control and Prevention Korea Health Statistics 2015 : Korea National Health and Nutrition Examination Survey (KNHANES VI-3) 2016

11 

Korea Centers for Disease Control and Prevention Korean Medical Association Korea Advisory Committee on Immunization Practice Recommended Immunization Schedule for Children (2017) – Toward Healthy Korea with Healthy Children through Immunization 2017

12 

Korea Centers for Disease Control and Prevention Epidemiology and management of vaccine preventable disease 5th ed Chungbuk 2017

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Korea Centers for Disease Control and Prevention National Childhood Vaccination Coverage Among Children Aged 3 years in Korea, 2015 2016

14 

Korea Centers for Disease Control and Prevention Disease Prevention ‘Green Light’: Expanding Free National Immunizations and Increasing Complete Immunization Rates. Press Release (April 22, 2015) Available from URL:http://www.cdc.go.kr/CDC/cms/content/mobile/81/62381_view.html (accessed 1 May, 2017)

15 

JY Ko YS Choi JI Hong [The Trend in the Public’s Awareness and Policy Satisfaction on Immunization] Public Health Weekly Report (PHWR), KCDC 2015 8 638 647

16 

Korea Centers for Disease Control and Prevention Elders, Please Receive Flu Immunizations at Clinics in November. Press Release (Nov. 16, 2016) Available from URL:https://www.gov.kr/portal/ntnadmNews/1248597 (accessed 1 May, 2017)

Notes

[27] Contributing associations:

Korean Medical Practitioners Association

The Korean Society for Preventive Medicine

The Korean Vaccine Society

Contributing experts:

Hee Man Kim, Department of Internal Medicine, Yonsei University Wonju College of Medicine and Wonju Severance Christian Hospital

Yu Jin Paek, Department of Family Medicine, Hallym University Sacred Heart Hospital