PHWR Public Health Weekly Report

Outbreaks of infectious diseases threaten population health and safety and lead to substantial socioeconomic losses. Therefore, it is critical to identify the source through early detection and to mount a rapid response so as to minimize the scale of transmission. Accordingly, the Chungcheong Regional Disease Response Center periodically conducts infectious disease response training programs for local-government personnel to maintain proactive preparedness during routine periods and continuously strengthen response capacity. From 2021 to 2024, 31 training sessions were conducted in total for local-government infectious disease response personnel and 12 sessions for quarantine station staff. In addition, the first training targeting local-government epidemiologic investigation teams in the Chungcheong region was conducted on June 26, 2025.

In the course of responding to public health emergencies, infectious disease control activities of local governments are essential for preventing community transmission [1]. Infectious disease response units of public health centers directly conduct case ascertainment, contact tracing, and management of individuals under isolation, and collaboration among various organizations, including healthcare facilities, municipal and provincial disease control offices, and regional disease response centers, is crucial. Fostering commitment within infectious disease response units of public health centers facilitates efficient infectious disease control and management and is expected to positively affect the national capacity to respond to public health emergencies [2]. Therefore, training designed to strengthen the infectious disease response capacity of local-government epidemiologic investigation teams is highly necessary [3].

This simulation exercise used the training scenario and budget provided by the Division for Disease Management Capacity Development, Korea Disease Control and Prevention Agency (KDCA), with the aim of assessing crisis management systems and strengthening the initial response capacity of local-government epidemiologic investigation teams.

This manuscript was prepared based on “2025 Chungcheong Regional Local-government Epidemiologic Investigation Team Training Results” [4].

1. Participating Organizations and Roles

The Chungcheong Regional Center for Disease Control and Prevention planned and conducted the training for epidemiologic investigation teams from four metropolitan/provincial governments, 32 cities/counties/districts, and four provincial Infectious Disease Control Support Groups in the Chungcheong region. Related agencies in attendance included the Division of Health and Social Disaster Response of the Ministry of the Interior and Safety and the KDCA Division for Disease Management Capacity Development.

2. Training Topic

The training topic was selected by examining infectious diseases with a high likelihood of importation, given the gradual increase in international travel following the coronavirus disease 2019 pandemic. Measles was selected as the topic because, since Republic of Korea was certified as having eliminated measles in 2014, cases have occurred predominantly as imported or import-related events [5].

3. Training Components

The exercise consisted of lectures, discussion-based training, video viewing, team-based interviews with suspected patients, a survey, and a general review with a closing. The program began with lectures on domestic and international measles trends and response guidelines. The discussion-based component simulated a response to a suspected imported case and included tasks that required answers regarding case recognition by public health centers, interpretation of laboratory results, the need for additional testing, and contact tracing and management (Figure 1). The scenario depicted a family’s overseas travel to visit parents and for sightseeing, their return to Republic of Korea, and a subsequent measles diagnosis, presenting symptoms, day-by-day movements, and test results. In addition, after viewing one video on the domestic measles situation and one World Health Organization video providing information on measles, participants conducted role-play interviews, including impromptu questions, in pairs as suspected patients and local-government epidemiologic investigation teams. The survey was administered using a quick response code, and the exercise concluded with a general review and closing.

Figure 1. Flow chart of training

4. Training Evaluation

For the evaluation, both local-government epidemiologic investigation teams and related-agency participants completed a satisfaction survey and a self-assessment questionnaire. The questionnaire broadly comprised questions on training satisfaction and a self-assessment domain addressing improvements in field response capacity (Table 1). A 7-point Likert scale was used to assess the items on training satisfaction and improvement in field response capacity, where a score of 1 indicated strong disagreement and that of 7 indicated strong agreement. Within the field response capacity domain, the pre-training responses comprised two items on baseline understanding and the post-training responses consisted of two items each on field data collection and management, field investigation capacity, situational analysis and problem-solving, and communication and collaboration, totaling 10 items across the pre- and post-training periods.

Table 1 Overview of training evaluation

Category	Content of evaluation	Composition of the item
Satisfaction survey	Evaluation of the appropriateness of the training program. -. Appropriateness of the training content, method and operation, etc.	5 questions. On a 7-point scale (not at all–very much so). Out of 7.
Self-assessment	Evaluation of the improvement of field response capabilities. -. Preliminary understanding. -. Field data collection and management, field investigation capabilities, situation analysis and problem solving, communication and cooperation capabilities, etc..	10 questions. On a 7-point scale (not at all–very much so). Out of 7.

5. Analytic Methods for Data Evaluation

Statistical analyses were performed using R-4.5.0 for Windows (R Foundation for Statistical Computing). After a Shapiro–Wilk test for normality, differences between pre- and post-training scores were evaluated using the Wilcoxon signed-rank test, and the significance threshold was set at α=0.05.

The 2025 training for the Chungcheong regional local-government epidemiologic investigation teams was held on June 26, with a total of 66 participants completing the survey, yielding 66 valid responses (100.0%) that were analyzed.

1. Participant Characteristics

Among the 66 participants, 52 were females (78.8%), constituting the majority; the mean participant age was 37.4 years. By age group, most participants were in their 30s (50.0%), followed by those in their 40s (19.7%) and 20s (16.7%). By occupation, administration and health roles accounted for 52 individuals (78.8%), the largest group. The average tenure at the current institution was 19.3 months. Tenure categories were 6 to <12 months for 21 participants (31.8%), 24 to <60 months for 18 (27.3%), and 12 to <24 months for 16 (24.2%). The number of field responses to infectious disease events in the previous 2 years was 1 to <5 for 29 participants (43.9%) and 0 for 28 (42.4%) (Table 2).

Table 2 Characteristics of training attendees

Category	Case (n)	Proportion (%)
Sex
Male	14	21.2
Female	52	78.8
Age group (yr)
20s	11	16.7
30s	33	50.0
40s	13	19.7
50s	9	13.6
Affiliation
Province	6	9.1
County	51	77.3
Infectious disease management support team	6	9.1
The others	3	4.5
Occupational category (group)
Epidemiology	8	12.1
Research	6	9.1
Administration and health	52	78.8
A career in the present institution (mo)
<6	7	10.6
6–11	21	31.8
12–23	16	24.2
24–59	18	27.3
≥60	4	6.1
Number of field experience related to infectious diseases within the past 2 yr
None	28	42.4
1–4	29	43.9
5–10	5	7.6
≥11	4	6.1
Total	66	100.0

2. Evaluation Findings

On the 7-point satisfaction survey evaluating the helpfulness of infectious disease work, alignment of content with training objectives, appropriateness of understanding and performance, suitability of instructional methods, and adequacy of guidance and support, the mean scores by item ranged from 6.3 to 6.5, indicating generally favorable responses (Figure 2).

Figure 2. Results of satisfaction with the training of the local government epidemiological investigation team in the Chungcheong region in Republic of Korea, 2025

Regarding the evaluation of improvement in field response capacity, the scores for baseline understanding (pre-training) ranged from 4.4 to 4.8, while post-training scores for field data collection and management, field investigation capacity, situational analysis and problem-solving, and communication and collaboration were 5.9–6.0, 6.0–6.1, 6.0, and 6.1–6.2, respectively (Figure 3). Normality test results for each survey item were not statistically significant. Statistically significant differences were observed between the pre-training baseline understanding and each of the four post-training domains: field data collection and management, field investigation capacity, situational analysis and problem-solving, and communication and collaboration (Table 3).

Figure 3. Results of the evaluation of the improvement of field response capabilities

Table 3 Statistic analysis of the results of the evaluation of the improvement of field response capabilities (n=660)

Category	Item	Case (n)	Mean	Standard deviation	Shapiro-Wilk test		p-valuea)
					W	p-value
Pre-understanding	A	66	4.76	1.36	0.90775	<0.001	Ref
	B	66	4.39	1.46	0.93820	0.002	Ref
Collecting and managing field data	A	66	5.94	0.99	0.84743	<0.001	<0.001
	B	66	5.97	1.02	0.82611	<0.001	<0.001
Field investigation skills	A	66	5.98	1.02	0.81604	<0.001	<0.001
	B	66	6.09	0.96	0.80057	<0.001	<0.001
Situation analysis and problem solving	A	66	6.03	0.98	0.82656	<0.001	<0.001
	B	66	5.97	1.04	0.81784	<0.001	<0.001
Communication and cooperation skills	A	66	6.09	0.96	0.81325	<0.001	<0.001
	B	66	6.22	0.84	0.75953	<0.001	<0.001

^a)Wilcoxon signed-rank test..

This training for local-government epidemiologic investigation teams in the Chungcheong region employed scenarios to assess crisis management systems and strengthen the initial response capacity. It also confirmed and shared the respective roles of the Chungcheong Regional Center for Disease Control and Prevention, local governments in the region, and the Infectious Disease Control Support Groups, and achieved the objective of reaffirming inter-agency contact networks and reviewing inter-institutional roles.

As the first training for local-government epidemiologic investigation team members in the Chungcheong region, the implications of this exercise were as follows.

1. Ongoing Need for Training of Local-government Epidemiologic Investigation Teams

Epidemiologic investigation is a core function for a rapid and accurate response during outbreaks, and without regular training, there is concern for diminished capability and expertise. This training builds response capacity for public health emergencies and provides practice for handling unforeseen situations, enabling flexible problem-solving.

Considering the literature on local-government infectious disease responses, the findings from this training, and personnel conditions of local teams, sustained education and training for local-government epidemiologic investigation teams are highly necessary. First, although multi-agency exercises are important and widely conducted, it is also well established that capacity building focused on local-government epidemiologic investigation teams, which are central to the infectious disease response of local governments, is equally necessary [1-3]. Second, with regard to participant characteristics, the number of field responses to infectious disease events in the previous 2 years was 0 for 28 individuals (42.4%) and 1 to <5 for 29 (43.9%), indicating relatively low exposure. Overall, low numbers of responses may indicate a limited initial response capacity; however, participation in training can strengthen initial response capabilities. Third, the results for baseline understanding and for improvement in field response capacity showed positive effects of the training, suggesting that confidence and competencies among local-government teams can be enhanced through training. Fourth, rotational assignments within local governments aim to improve job competence, accumulate diverse experience, and increase job satisfaction, and they help prevent drift toward rigid routines or bias toward particular departments that may occur with prolonged tenure. However, frequent personnel changes may reduce expertise, disrupt continuity, and decrease morale among members of epidemiologic investigation teams, which requires consideration.

2. Areas for Improvement in the Chungcheong Regional Local-government Training

Sustained capacity-building for local-government epidemiologic investigation teams requires adequate budget and resources. If budget and resources are insufficient, reducing the scale of the training or delivering it via webinars or online workshops is possible. However, such formats may lessen engagement and capacity-building effects, so their implementation should be weighed carefully in light of available resources.

Using the scenario provided by the KDCA Division for Disease Management Capacity Development confers the advantage that evaluation findings are not confined to a single context but can be applied more broadly, and a representative scenario that reflects real-world conditions can have a positive effect in terms of reducing judgment errors based on highly available information that differs from the actual situation. Internal discussions also addressed modifying the scenario; however, several concerns were identified regarding the potential consequences of such revisions. The risks include overlooking some scenarios that are important but have low likelihood by focusing on the most probable scenario, generating incorrect predictions and decisions if scenarios are built on inappropriate assumptions or biased perspectives, and increased complexity and time consumption in scenario development and analysis owing to the need to consider diverse real-world variables and possibilities. Continued consideration of scenario revisions is warranted.

To facilitate understanding among local-government team members, the training materials were supplemented with videos and role-play. Videos provide visual information that helps make complex content easier to understand [6]. Role-play is effective because participants directly engage, experience the situation, and deepen understanding [7]. These two modalities were added because operating the program with lectures and discussion alone could lessen motivation and sustained attention among participants; satisfaction survey results supported the decision to incorporate appropriate supplementary methods. Additional educational methods were explored for potential application in future training. Among various approaches, flipped learning is suitable for pre-session study followed by discussion or problem-solving, and game-based learning can facilitate the training process [8,9]. Therefore, for future training of local-government epidemiologic investigation teams, the application of flipped learning (with online pre-learning) and game-based learning will be considered to enhance engagement and motivation and to improve practical applicability and understanding.

Strengthening the capacity of local-government epidemiologic investigation teams is essential for protecting public health by enabling effective responses when cases occur during emergencies and preventing the transmission of infectious diseases. Thus, it is necessary to conduct such training on a continuing basis, make ongoing improvements to program delivery, and encourage active participation by local governments.

Ethics Statement: Not applicable.

Funding Source: None.

Acknowledgments: We would like to express our sincere gratitude to local government epidemiological investigation team in Chungcheong region and division of disease control capacity building.

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

Author Contributions: Conceptualization: YJS, JRK, YAK. Data curation: YJS, HLL, JMP. Formal analysis: YJS. Investigation: YJS. Methodology: YJS. Resources: YJS. Software: YJS. Supervision: YAK. Validation: HLL, JMP, HYL, SWP, JRK. Visualization: YJS. Writing – original draft: YJS. Writing – review & editing: JRK, YAK.