PHWR Public Health Weekly Report

The Korea Disease Control and Prevention Agency (KDCA) has been pursuing the Official Development Assistance (ODA) Project (2023–2027) to share information about infectious disease between Republic of Korea (ROK) and Mongolia, strengthen Mongolia’s collaborative infectious disease response, and ultimately reinforce preparedness for public health crises in Northeast Asia. The exercises conducted in this study, as part of the ODA project, were planned in collaboration with Mongolian health authorities to increase the expertise of Mongolian public officers and improve their capacity to respond to infectious diseases.

Mongolia has recently reported recurrent outbreaks of preventable infectious diseases, notably measles and tuberculosis (TB). As of May 21, 2025, Mongolia had 2,682 confirmed measles cases [1-3]. Furthermore, TB remains a major health issue in the country, with an incidence of 452 per 100,000 people, and the incidence of multidrug-resistant/rifampicin-resistant TB has been reported to be 34 per 100,000 people [4-7].

Previous studies have shown that tabletop simulation exercises effectively validate national pandemic preparedness plans while strengthening multisector collaboration, risk communication, and cooperation with local governments [8]. In line with this, Mongolian health authorities requested systematic training from the KDCA to enhance field response capabilities for managing infectious diseases. The training, conducted by the National Center for Communicable Diseases (NCCD) under the Mongolian Ministry of Health on April 24 and 25, 2025. The training was developed with measles and TB as the main themes and was structured around outbreak scenario, allowing participant to systematically practice the stepwise procedures of epidemiological investigation. The objectives were to (1) understand the transmission dynamics of infectious diseases, (2) strengthening the capabilities of contact tracing and quarantine measures, and (3) develop effective response strategies to reduce the impact of outbreaks.

Through scenario-based training, the KDCA shared ROK’s measles and TB response systems with participating Mongolian public officers. The methods and outcomes of the 2025 training are presented herein, thereby contributing to the development and improvement of future international cooperation-based epidemiological investigation training programs.

1. Training Participants

The study participants were 16 public officers from the NCCD in Mongolia, of whom five were graduates of the Mongolian Field Epidemiology Training Program (FETP), three were current FETP trainees, and eight were public health epidemiology and vaccination.

2. Training Structure and Methodology

Training sessions were developed and conducted by three instructors from the KDCA. Focusing on epidemiological investigations and infectious disease response based on measles and TB outbreak scenarios, the participants used a problem-based learning approach to identify and discuss hypothetical epidemic situations, develop and present solutions, and receive feedback from fellow participants and instructors.

Training was provided over 2 days, the first day on TB and the second day on measles. Before the training, representatives from each country presented the respective national infectious disease surveillance and response systems. Then, instructors proceeded to provide participants with key information and assigned missions corresponding to each stage of the training scenario. The participants collectively discussed and completed the missions, after which a group representative presented the results. Thereafter, a debriefing session was held, and the training concluded with a review of the main objectives.

3. Training Tools

1) Scenarios

The KDCA developed TB and measles outbreak scenarios. The scenarios were first translated from Korean to English and then into Mongolian.

The TB scenario was developed based on an outbreak case in an elementary school in the ROK, where the latent TB infection rate was 60% and most contacts were lower-grade students; this rate is approximately eight times higher than the national average of 8.1%. Training was conducted in accordance with local TB management guidelines. The participants were taught step by step how to recognize a TB outbreak in a school setting, assessment of the outbreak situation, establish the investigation period as well as the scope and a management system of contacts, and discuss follow-up measures based on the investigation results.

The measles scenario was assumed an outbreak in a medical facility that had an obstetrics, gynecology and a pediatrics department, in which the classification and management of high-risk groups, such as pregnant women, children, and healthcare workers. The participants completed the missions assigned as the scenario progressed according to the Korean response guidelines. For each mission, the participants had to know how to recognize a measles outbreak, conduct a contact investigation (determine the duration and scope, classify and manage contacts by location, and distinguish between high-risk and susceptible groups). Structured discussions were held on the response strategy to eliminate measles in Mongolia.

2) Self-evaluation questionnaire

The participants completed a self-evaluation questionnaire on their satisfaction with the training and the extent to which their response capabilities improved. The questionnaire was translated into Mongolian and distributed at the end of the training by using Google Forms. Using a 7-point Likert scale, the 21-item questionnaire asked about general characteristics (gender, age, job responsibilities, work experience), training satisfaction, and self-evaluated improvement in competencies. Training satisfaction was evaluated based on the extent to which the objectives were achieved and the appropriateness of the training methods and contents. Pre- and post-evaluations were conducted to assess improvements in capabilities in terms of the characteristics of the infectious diseases (TB and measles), information to be identified during epidemiological investigations, methods for classifying and managing contacts, and response methods to prevent disease spread.

The participants actively completed the missions at each stage of the scenarios, including infectious disease outbreak recognition, case definition, contact investigation and management, and response strategy development to reduce outbreaks. During the discussions, the response systems of ROK and Mongolia were compared, and participants actively deliberated ways to reduce infectious disease outbreaks that could be applied to their own national contexts. In particular, active discussions were held on the need for improved contact management and vaccination timing in order to reduce measles in Mongolia, and the need to improve vaccination policies was raised. Based on these discussions, specific countermeasures such as serological surveys to improve vaccination timing were further addressed during the presentation of the training results. This led to the development of public health response strategies and measures to reduce the occurrence and spread of infectious diseases in Mongolia.

1. General Characteristics

A total of 16 participants were affiliated to the following departments: Field Epidemiology (n=7), TB Surveillance (n=3), Vaccination (n=2), Infectious Disease Surveillance (n=2), Acquired Immunodeficiency Syndrome (AIDS)/Sexually Transmitted Infections Surveillance (n=1), and Laboratory (n=1) (Table 1). Of the 16 participants, 11 completed the questionnaire, while 5 returned to the field duties before the end of the training, resulting a response rate of 68.7%. The mean work experience of participants was 3 years and 10 months (range: 1–12 years). At the time of the training, the participants’ primary responsibilities (multiple responses allowed) included infectious disease surveillance (n=10), infectious disease response (n=6), education (n=2), and immunization management (n=1) (Table 2).

Table 1 General characteristics of participants (n=16)

Category		n (%)
Participants	FETP trainee	3 (18.8)
	FETP graduate	5 (31.2)
	Public health officials	8 (50.0)
Affiliated department	Field epidemiology	7 (43.8)
	Tuberculosis	3 (18.8)
	Vaccination	2 (12.5)
	Surveillance	2 (12.5)
	AIDS, STI	1 (6.2)
	Laboratory	1 (6.2)

FETP=Field Epidemiology Training Program; AIDS=Acquired Immunodeficiency Syndrome; STI=sexually transmitted infection..

Table 2 Demographic characteristics of survey respondents (n=11^a))

Category		n (%)
Gender	Woman	10 (90.9)
	Man	1 (9.1)
Age (yr)	20–29	7 (63.6)
	30–39	3 (27.3)
	≥40	1 (9.1)
Professional experience (yr)	1–3	5 (45.5)
	3–5	3 (27.3)
	5–10	2 (18.2)
	≥10	1 (9.1)
Duties (multiple responses)	Infectious disease surveillance	9 (81.8)
	Infectious disease response	6 (54.5)
	Education and training	2 (18.2)
	Vaccination management	1 (9.1)

^a)Out of the 16 trainees, 5 did not respond..

2. Training Satisfaction

The overall average score for items related to training satisfaction was 6.6 points out of 7 (Table 2). In particular, the average for the item, “I believe the training content achieved the training objectives,” was 6.9 points, with all respondents answering either “strongly agree” (7 points) or “agree” (6 points). The participants evaluated the training as being well organized in both content and methods and appropriate to its objectives, and it was confirmed that they were generally satisfied with the training format and operation. Among the items related to training satisfaction, the average score for the item, “I believe the difficulty level of the education and training was appropriate,” was 6.2 points, which was relatively low compared to that for other items.

3. Pre- and Post-training Evaluation

To evaluate the effectiveness of the training, participants completed a self-evaluation survey in which they retrospectively assessed their understanding of infectious disease response before and after the training. The assessment consisted of five items with identical content before and after the training to allow direct comparison. The mean score for understanding infectious disease response increased from 4.9 out of 7 before the training to 6.3 after, representing an improvement of 1.4 points.

Among the five items, the greatest improvement was observed in contact classification according to the characteristics of measles and TB, which increased by 1.8 points. The items on understanding the characteristics of measles and TB and on key information to be collected during epidemiological investigations each increased by 1.5 points. The item on understanding the duration and methods of contact quarantine increased by 1.3 points, while the item on developing response strategies to prevent the spread of infectious diseases increased by 1.0 point (Table 3).

Table 3 Survey questions and self-evaluation results (n=11)

Survey category	Meana) (range)
Satisfaction with training	6.6
The training content was helpful for me in the infectious disease response tasks.	6.5 (5.0–7.0)
I believe the training content achieved the training objectives.	6.9 (6.0–7.0)
The training method (scenario-based training) was effective in facilitating the learning of the training content.	6.5 (5.0–7.0)
I believe the difficulty level of the education and training was appropriate.	6.2 (1.0–7.0)
It is enough that the facilitator and operator provide clear guidance and support throughout the training.	6.7 (5.0–7.0)
Pre-training evaluation	4.9
I believe I have sufficient understanding of the characteristics of measles and tuberculosis before the training.	4.8 (2.0–7.0)
I was knowledgeable about collecting the information needed in an epidemiological investigation of measles and tuberculosis before the training.	5.1 (2.0–7.0)
I was knowledgeable about the methods of contact classification based on the characteristics of measles and tuberculosis before the training.	4.7 (2.0–7.0)
I was knowledgeable about the management of classified contacts before the training.	5.0 (2.0–7.0)
I was familiar with the response strategies to prevent the spread of measles and tuberculosis before the training.	4.7 (2.0–7.0)
Post-training evaluation	6.3
I think my understanding of the characteristics of measles and tuberculosis has improved after the training.	6.4 (5.0–7.0)
I became familiar with the information to be identified during the epidemiological investigation of measles and tuberculosis after the training.	6.6 (5.0–7.0)
I learned to classify contacts based on the characteristics of measles and tuberculosis after the training.	6.5 (5.0–7.0)
I am able to explain the management methods for contacts that have been classified after the training.	6.3 (5.0–7.0)
I am able to develop response strategies to prevent the spread of measles and tuberculosis after the training.	5.7 (3.0–7.0)

^a)Mean scores on a 7-point Likert scale..

4. Further Remarks

Participants reported that the training, structured around scenarios reflecting actual cases, allowed them to indirectly and realistically experience infectious disease outbreak situations. They also noted that the training helped them understand infectious disease response systems and epidemiological investigation methods, even when the diseases were not part of their own responsibilities. In addition, participants highlighted that the training provided valuable insight into ROK’s infectious disease response system and offered a meaningful opportunity to compare and analyze it with Mongolia’s response system. Suggestions for improving the training included expanding the use of visual materials (e.g., photos and videos), adopting a game-based participatory format, and enhancing the quality of translations (Korean–Mongolian) of training materials.

For future training, participants expressed interest in a variety of topics, including simulation-based education assuming public health crisis scenarios; infectious disease response in shelters during disasters; response training for specific infectious diseases such as acute viral hepatitis, AIDS, meningococcal disease, zoonotic diseases, and rare waterborne infections; statistical analysis and data interpretation for infectious diseases; and ROK’s experiences with vaccination programs. They also emphasized the need to establish training based on international cooperation, enabling comparison and sharing of experiences across different countries.

This training was conducted as a discussion-centered epidemiologic investigation exercise based on scenarios simulating TB and measles outbreaks, with the aim of enhancing participants’ engagement and comprehension and achieving effective learning outcomes. Participants systematically experienced the full process of infectious disease response (recognition, investigation, management, and strategy development) and gained an opportunity to discuss potential improvements to reduce community-level outbreaks.

A questionnaire survey administered immediately after the training showed high satisfaction, with all five items scoring 6 points or higher (out of 7). The item on training difficulty scored relatively lower (6.2 points), indicating the need to sufficiently assess participants’ prior understanding and to adjust the training difficulty more precisely when designing future programs. Results from the post-training self-assessment confirmed that participants’ understanding of epidemiology-centered infectious disease response—covering disease characteristics, contact classification and management, information collection, and strategy development—improved through the training. Despite being a short-term international program, the training was demonstrated to be an effective strategy for strengthening practical field competencies.

This study has several limitations. First, the evaluation of training effectiveness was conducted only immediately after the program, preventing assessment of long-term effects. Second, because the training scenarios were developed based on ROK’s infectious disease response system, they may not have fully reflected Mongolia’s institutional and cultural context. Third, the evaluation relied solely on self-assessment surveys and involved a limited participant group, which constrains the objectivity and generalizability of the results.

Through the training, participants compared and analyzed the response systems of ROK and Mongolia, and identified public health measures applicable to reducing infectious disease outbreaks in Mongolia. Based on satisfaction and competency self-assessments, the KDCA confirmed the effectiveness of stepwise, case-based simulation training in improving learning outcomes.

Participants also expressed a desire for future training covering a wider range of topics. This demand reflects the variety and challenges of infectious disease responses encountered in the field in Mongolia. These suggested topics appear to reflect individual experiences and job responsibilities, highlighting the importance of tailoring training content to participants’ needs and levels, and of establishing a sustainable framework for continuous training.

As infectious diseases are cross-border public health threats, continuous international educational collaboration and the establishment of practical knowledge-sharing systems with neighboring countries are required. The KDCA intends to expand similar ODA-based training programs to other countries, thereby strengthening its role as a global health partner and contributing to enhanced infectious disease response capacity worldwide.

Ethics Statement: Not applicable.

Funding Source: None.

Acknowledgments: None.

Conflict of Interest: The authors have no conflicts of interest to declare.

Author Contributions: Conceptualization: YYK, EKK. Data curation: YYK. Formal analysis: YYK, JAS. Investigation: YYK, JAS. Methodology: YYK, JAS. Project administration: YYK, JAS. Supervision: EKK. Validation: YYK, JAS. Visualization: YYK. Writing – original draft: YYK. Writing – review & editing: EKK.