주간건강과질병 제 권제 호 국내에서수행중인 26 년도국제항생제내성감시체계 (WHO Global Antimicrobial Surveillance System) 소개 질병관리본부감염병센터약제내성과김일환, 김승현, 이광준, 박찬 * * 교신저자 :

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1 ISSN:25-8X PUBLIC HEALTH WEEKLY REPORT, PHWR Vol. No. CONTENTS 234 국내에서수행중인 26 년도국제항생제내성감시체계 (WHO Global Antimicrobial Surveillance System) 소개 년참진드기전국분포조사현황 246 주요통계환자감시 / 전수감시, 표본감시 병원체감시 / 인플루엔자및호흡기바이러스 급성설사질환, 엔테로바이러스

2 주간건강과질병 제 권제 호 국내에서수행중인 26 년도국제항생제내성감시체계 (WHO Global Antimicrobial Surveillance System) 소개 질병관리본부감염병센터약제내성과김일환, 김승현, 이광준, 박찬 * * 교신저자 : chanpark@korea.kr, Introduction of WHO Global Antimicrobial Surveillance System (GLASS) in Korea, 26 Division of Antimicrobial Resistance, Center for Infectious Disease, NIH, CDC Kim Il-Hwan, Kim Seung Hyun, Lee Kwang-Jun, Park Chan In May 25, the 68th World Health Assembly adopted the Global Action Plan on Antimicrobial Resistance (AMR), which reflected the global consensus that AMR threatens human health. Accordingly, the WHO has developed the Global Antimicrobial Resistance Surveillance System (GLASS) to promote standardized AMR surveillance globally. The goal of GLASS is to enable standardized, comparable and validated data on AMR to be collected, analyzed and shared with countries. Since May 26, the Centers for Disease Control and Prevention has established the AMR surveillance system for general hospitals in six large cities and provinces in Korea, which is compatible with GLASS of WHO. From the defined specimens (blood, urine, feces, urethral and cervical swabs), the priority pathogens are isolated, and the antimicrobial susceptibility of all the priority pathogens is determined. This study may produce meaningful data at a global level to enable analysis of the occurrence and trends of AMR, and establish prevention and control programmes against AMR. 항생제내성 (Antimicrobial resistance, AMR) 이란항생제에대해감수성을지닌세균이항생제에노출되어도생존할수있는내성을획득하는것이다. 다양한원인균에서의항생제내성은국내를포함한여러나라와수많은지역의공중보건에상당한위협이되고있는데, 특히여러가지항생제에내성을나타내는다제내성세균의급속한확산은우리나라뿐만아니라전세계에서심각한문제가되고있다. WHO에서는 25년 5월, 68차세계보건총회를통해항생제내성이인류보건에심각한위협이된다는세계적합의를반영하여 234

3 주간건강과질병 제 권제 호 국제적인대응을촉구하는항생제내성국제행동계획 (Global Action Plan on Antimicrobial Resistance) 을채택하였다. 항생제내성국제행동계획의 5가지전략적목표중하나는 국제적감시및연구확대를통해증거기반을강화 하는것이다 []. 이를위해 WHO는국제적으로공유할수있는항생제내성에대한표준화된정보나감시체계가부족함을인식하고, 항생제내성국제행동계획을지원하는국제항생제내성감시체계 (Global Antimicrobial Surveillance System, GLASS) 를개발하였다 [2]. GLASS 사업의목표는국가감시시스템을통해표준화되고비교가능하며검증된항생제내성자료를수집 분석하고이를국가들간에공유하는것이다. WHO는 GLASS의구현을위해 5개년 로드맵을마련하여지속적으로 WHO 회원국의참여비율을높이고있다. GLASS에참여하는각나라는통상적인임상검체 ( 혈액, 뇨, 변및생식기도말검체 ) 로부터감염과관련이있는병원균분리주 (E. coli, K. pneumoniae, A. baumannii, S. aureus, S. pneumoniae, Salmonella spp. Shigella spp., N. gonorrhoeae) 를감시하고특정병원균과항생제조합에따른감수성결과를분석하며, 해당국가의전체인구, 감시기관의외래 입원환자수및환자의기본임상정보 ( 나이, 성별, 의료관련감염또는지역사회감염여부등 ) 등통계분석을위한역학자료를종합하여정기적으로 년마다 WHO에보고하게된다 (Table, Table 2). 우리나라는 26년 4월일본에서개최된 항생제내성 Table. Priority specimens and pathogens for surveillance of AMR Specimen Laboratory case definition Priority pathogens for surveillance Surveillance type and sampling setting Blood Urine Faeces Isolation of pathogen from blood a Significant growth in urine specimen b Isolation of Salmonella spp. c or Shigella spp. from stools E. coli K. pneumoniae A. baumannii S. aureus S. pneumoniae Salmonella spp. E. coli K. pneumoniae Salmonella spp. Shigella spp. Urethral and cervical swabs Isolation of N. gonorrhoeae N. gonorrhoeae Selected sites or national coverage Continuous Patients in hospital and in the community a Any pathogen isolated from a blood culture may be significant for surveillance locally and nationally; only the prioritized pathogens for global surveillance are listed here. b Pure culture according to local laboratory practice. Catheter samples should be excluded if possible. c Diarrheal surveillance is for non-typhoid salmonella species; for local clinical purposes, typhoid and paratyphoid should be included. Table 2. Pathogen antimicrobial combinations on which GLASS will gather data Escherichia coli Pathogen Antibacterial class Antibacterial agents that may be used for AST a,b Klebsiellapneumoniae Acinetobacter baumannii Sulfonamides and trimethoprim Fluoroquinolones Third-generation cephalosporins Fourth-generation cephalosporins Carbapenems c Polymyxins Penicillins Sulfonamides and trimethoprim Fluoroquinolones Third-generation cephalosporins Fourth-generation cephalosporins Carbapenems c Polymyxins Tetracyclines Aminoglycosides Carbapenems c Polymyxins Staphylococcus aureus Penicillinase-stable beta-lactams Cefoxitin d Co-trimoxazole Ciprofloxacin or levofloxacin Ceftriaxone or cefotaxime and ceftazidime Cefepime Imipenem, meropenem, ertapenem or doripenem Colistin Ampicillin Co-trimoxazole Ciprofloxacin or levofloxacin Ceftriaxone or cefotaxime and ceftazidime Cefepime Imipenem, meropenem, ertapenem or doripenem Colistin Tigecycline or minocycline Gentamicin and amikacin Imipenem, meropenem, ertapenem or doripenem Colistin 235

4 주간건강과질병 제 권제 호 Streptococcus pneumoniae Salmonella spp. Shigella spp. Neisseria gonorrhoeae Penicillins Sulfonamides and trimethoprim Third-generation cephalosporins Fluoroquinolones Third-generation cephalosporins Carbapenems c Fluoroquinolones Third-generation cephalosporins Macrolides Third-generation cephalosporins Macrolides Aminocyclitols Fluoroquinolones Aminoglycosides Oxacillin e Penicillin G Co-trimoxazole Ceftriaxone or cefotaxime Ciprofloxacin or levofloxacin Ceftriaxone or cefotaxime and ceftazidime Imipenem, meropenem, ertapenem or doripenem Ciprofloxacin or levofloxacin Ceftriaxone or cefotaxime and ceftazidime Azithromycin Cefixime Ceftriaxone Azithromycin Spectinomycin Ciprofloxacin Gentamicin a The listed substances are priorities for surveillance of resistance in each pathogen, although they may not be first-line options for treatment. One or more of the drugs listed may be tested. b One or more of the drugs listed may be tested in countries. S, I, R and nominator and denominator data for each shall be reported separately. c Imipenem or meropenem is preferred to represent the group when available. d Cefoxitin is a surrogate for testing susceptibility to oxacillin (methicillin, nafcillin); the AST report to clinicians should state susceptibility or resistance to oxacillin. e Oxacillin is a surrogate for testing reduced susceptibility or resistance to penicillin; the AST report to clinicians should state reduced susceptibility or resistance to penicillin. 아시아보건장관회의 에서국내항생제내성관리대책의일환으로 GLASS 가입의사를표명하였고, 이후질병관리본부에서 WHO와실무를거쳐 26년 7월 2일에가입완료하였다. 질병관리본부는 GL ASS 감시체계의국제표준자료산출을위해 6 년 5월부터다제내성균감시사업을착수하여전국권역별 6개종합병원 ( 서울, 경기, 강원, 경남, 충북, 전남 ) 을대상으로 GLASS 참여조건을고려한전국표본감시체계를구축하였다. 국가조정센터 (National Coordination Center, NCC) 역할을하는의료감염관리태스크포스 (task force, TF) 는국가항생제내성감시체계를구성및운영하고 수집 분석된데이터를 WHO에제공한다. 국가표준실험실 (National Reference Laboratory, NRL) 인약제내성과는실험실결과의표준화를위한지침제공, 기술지원및정도관리를수행한다. 항생제내성감시사이트 (AMR surveillance site) 는종합병원으로조사대상병원균의임상 역학정보및내성정보등을수집 분석하는역할을수행한다. 종합병원은의료관련감염병표본감시병원중 5-, 병상의규모를지니고, 임상미생물전공진단검사의학전문의가근무하여균주수집및데이터의정확성을담보할수있는지역거점의료기관으로구성하였다 (Figure ). 또한국내실정에 Organization of AMR surveillance system National protocol A (Seoul, 85 beds) CDC B (Gyeonggi-do, 742 beds) D (Gangwon-do, beds) NCC National Coordinating Center NRL National Reference Laboratory HAI AMR Control Team Verification of data quality Collection and analysis of national data Division of Antimicrobial Resistance WHO (GLASS) E (Chungcheongbuk-do, 655 beds) AMR Surveillance Sites Technical support, quality management Isolates, clinical and laboratory data Health Care Facilities Feedback of results F (Gyeongsangnam-do, 9 beds) C (Jeollanam-do, 965 beds) Regional based tertiary hospitals Figure. Schematic view of GLASS in Korea 236

5 주간건강과질병 제 권제 호 맞는감시자료를수집하기위해, GLASS에서제안한조사항목외에도국내에서문제시되는병원균및관련항생제감수성시험을감시대상에추가하였고, 주요내성기전규명및분자역학적분석을위한유전자검사항목도병원균별로추가하였다. 감시대상병원체는 GLASS 참여병원체 8종과국내법정감염병으로지정된병원체 3종을포함한총 종으로 Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Staphylococcus aureus, Streptococcus pneumoniae, Salmonella spp., Shigella spp., Neisseria gonorrhoeae, Enterococcus faecalis, Enterococcus faecium, Pseudomonas aeruginosa 가있다. GLASS 에서제시한방법에따라검체별우선순위병원체를지정하였으며, 혈액, 소변, 대변, 요도또는자궁경부도말등에서해당병원체를전수조사하여항생제감수성시험과내성유전자검사를수행하고있다. 분리주의항생제감수성시험은 CLSI 또는 EUCAST 기준에따라디스크확산법을사용하되균종및항생제에따라액체배지미량희석법및한천배지희석법등을별도수행하고있다 (Table 3). 본감시사업은전국권역별감시대상종합병원을 26년 6개소에서 년경기남부와제주지역을포함한 8개소로확대하여 Table 3. Pathogens, antimicrobial agents and target genes for surveillance of AMR in Korea Pathogens Antimicrobial agents Target genes Escherichia coli Klebsiella pneumoniae Pseudomonas aeruginosa Acinetobacter baumannii Staphylococcus aureus Enterococcus faecalis Enterococcus faecium Neisseria gonorrhoeae Streptococcus pneumoniae Ampicillin, Piperacillin, Ampicillin-sulbactam, Cefazolin, Cefotaxime, Ceftazidime, Cefepime, Aztreonam, Cefoxitin, Imipenem, Meropenem, Ertapenem, Amikacin, Gentamicin, Ciprofloxacin, Trimethoprim-sulfamethoxazole, Tigecycline, Colistin Piperacillin, Ampicillin-sulbactam, Cefazolin, Cefotaxime, Ceftazidime, Cefepime, Aztreonam, Cefoxitin, Imipenem, Meropenem, Ertapenem, Amikacin, Gentamicin, Ciprofloxacin, Trimethoprim-sulfamethoxazole, Tigecycline, Colistin Piperacillin, Piperacillin-Tazobactam, Ceftazidime, Cefepime, Imipenem, Meropenem, Amikacin, Gentamicin, Tobramycin, Ciprofloxacin, Colistin Piperacillin, Ampicillin-sulbactam, Ceftazidime, Cefepime, Imipenem, Meropenem, Amikacin, Gentamicin, Tobramycin, Ciprofloxacin, Minocycline, Tigecycline, Colistin Cefoxitin, Vancomycin, Teicoplanin, Linezolid, Tigecycline, Erythromycin, Clindamycin, Quinupstin-dalfopristin, Trimethoprime-sulfamethoxazole, Mupirocin Ampicillin, Gentamicin (High-level), Streptomycin (Highlevel), Ciprofloxacin, Tetracycline, Quinupostin-dalfopristin, Vancomycin, Teicoplanin, Linezolid, Tigecycline Ampicillin, Gentamicin (High-level), Streptomycin (Highlevel), Ciprofloxacin, Tetracycline, Quinupostin-dalfopristin, Vancomycin, Teicoplanin, Linezolid, Tigecycline Azithromycin, Cefixime, Cefpodoxime, Ceftriaxone, Ciprofloxacin, Gentamicin, Nalidixic acid, Penicillin G, Spectinomycin, Tetracycline Amoxicillin-clavulanate, Cefotaxime, Ceftriaxonee, Cefuroxim, Co-trimoxazole, Erythromycin, Levofloxacin, Oxacillin, Penicillin TEM, SHV, CTX-M, DHA, CMY, KPC, NDM, OXA-48, VIM, IMP, GES, mcr-, MLST-ST, icd, gyrb, adk, reca, mdh, pura, fumc TEM, SHV, CTX-M, DHA, CMY, VIM, IMP, KPC, NDM, OXA-48, GES, mcr-, MLST-ST, rpob, gapa, mdh, pgi, phoe, imfb, tonb VIM, IMP, KPC, NDM, OXA-48, GES, MLST-ST, acsa, aroe, guaa, mutl, nuod, ppsa, trpe VIM, IMP, KPC, NDM, OXA-48, GES, MLST-ST, cpn6, fusa, glta, pyrg, reca, rplb, rpob meca, mecc, pvl, TSST- agr, SCCmec, spa, type, sea, seb, sec, sed, see, seg, seh, sei, sej, MLST-ST, arcc, aroe, glpf, gmk, pta, tpi, yqil vana, vanb, vanm, MLVA, MLST-ST, gdh, gyd, psts, gki, aroe, xpt, yqil, Plasmid analysis, Tn546 vana, vanb, vanm, MLVA, MLST-ST, AtpA, Ddl, Gdh, PurK, Gyd, PstS, Adk, Plasmid analysis, Tn546 pena type, pena, mtrr, porb, pona, pilq, 6S rrna, rpse, 23S rrna, ermb, ermc, ermf, mef, NG-MAST ST, porb, tbpb,mlst-st, abcz, adk, aroe, fumc, gdh, pdhc, pgm - Salmonella spp. Azithromycin, Cefotaxime, Ceftazidime, Ciprofloxacin, Imipenem blactx-m Shigella spp. Azithromycin, Cefotaxime, Ceftazidime, Ciprofloxacin, Imipenem blactx-m Disc diffusion Broth microdilution Agar dilution Etest Additional pathogens or antimicrobial agents in Korea 237

6 주간건강과질병 제 권제 호 수행하게된다. 항생제내성균표준검사센터를운영하여신뢰성있는결과를도출함은물론, 종에대해연간 만주이상의병원체를수집 분석함으로써국내항생제내성균에대한의료기관내발생률과지역사회발생률, 인구비례별내성률, 성별 연령별내성률등정확한내성실태를파악하여항생제내성관리및대책마련을위한중요한근거자료로활용될것으로생각된다. 참고문헌. World Health Organization. 25. Global action plan on antimicrobial resistance. 2. World Health Organization. 25. Global Antimicrobial Resistance Surveillance System - Manual for Early Implementation

7 주간건강과질병 제 권제 호 25 년참진드기전국분포조사현황 질병관리본부국립보건연구원면역병리센터질병매개곤충과송봉구, 이욱교, 주영란 * * 교신저자 : juyran@korea.kr, Geographical distribution of Ixodid ticks in the Republic of Korea, 25 Division of Medical Entomology, Center for Immunology and Pathology, NIH, CDC Song Bong-Goo, Lee Wook-Gyo and Ju Young-Ran BACKGROUND: Ixodid ticks play an important role in the transmission of viral, rickettsial, bacterial and parasitic pathogens which cause spotted fever, Lyme disease, severe fever with thrombocytopenia syndrome (SFTS), and Q fever. To prevent the potential spread of tick-borne diseases, we have monitored the distribution of ticks and their abundance every year at several sites since 2. However, a recent increasing trend in reported cases of the tick-borne diseases has shown a need to establish nationwide surveillance for ticks. This investigation was conducted to estimate the monthly prevalence and distribution patterns of Ixodid ticks in 25. METHODOLOGY/RESULTS: From April to November 25, Ixodid ticks were collected at 29 sites in areas in the Republic of Korea. We investigated the distribution of ticks using dry-ice bait traps and a flagging method. A total of 29,992 ixodid ticks were composed of three genera and seven species. Among them, the Genus Haemaphysalis, Ixodes, and Amblyomma accounted for 29,75 (99.2%), 223 (.7%) and 8 (.%), respectively. The highest number of ticks (n=6,54, 2.8%) was collected in the region around the Seoul capital area, followed by the Chungbuk area (n=5,49, 6.8%). Based on the different environmental conditions, the Genus Haemaphysalis was mostly collected in grassland sites, whereas Genus Ixodes was collected in coniferous forest sites. CONCLUSION: This survey was conducted nationwide in 25. Haemaphysalis longicornis, known as a SFTS main vector, was widely distributed throughout the whole country. The species was prevalent in most environmental conditions, and its high activity was mainly observed from May to September. Hence, wearing personal protective apparel against tick-borne diseases is advised during these months. In addition, we need to continuously expand the areas of investigation and monitoring periods on the tick populations to ensure public health. 들어가는말 4 쌍이고날개가없는절지동물이다. 세계적으로약 5, 종이상의 진드기가보고되었고, 참진드기과 (Family: Ixodidae) 의진드기는 진드기는분류상거미강 (Class: Arachnida) 에속하며, 다리가 약 7 종을차지하고있으며, 국내에서는 5 속 27 종이보고되었다 []

8 주간건강과질병 제 권제 호 참진드기는바이러스, 세균, 리케치아및기생충등다양한병원체를전파하는질병매개체이다. 국내에서식하고있는참진드기가매개하는질병은진드기매개티프스 (tick-borne typhus), 진드기매개뇌염 (tickborne encephalitis), 아나플라즈마증 (anaplasmosis), 에르리히증 (Ehrlichiosis), 야토병 (tularemia), 쥐바베스열원충증 (babesiosis), 범안열원충증 (theileriasis) 등이있다 [2,3,4]. 국내에서식하는참진드기에서는작은소피참진드기 (Haemaphysalis longicornis), 개피참진드기 (H. flava), 일본참진드기 (Ixodes nipponensis) 가주요종으로확인되었으며, 이들종에서 Rickettsia spp., 진드기매개뇌염바이러스, SFTS 바이러스유전자검출이보고되었다 [4,5]. 최근중증열성혈소판감소증후군 (severe fever with thrombocytopenia syndrome, SFTS) 이국내에서 23 년첫환자발생이후로 36건, 4년 55건, 5년 79건, 6년 62건으로점차증가하고있는추세이다 [6]. 라임병 (Lyme disease) 도 22년첫환자발생이후로계속증가하고있다. 따라서질병관리본부질병매개곤충과에서는매개체전파질환의효율적인예방 관리를위해감염병매개체발생밀도및분포, 병원체감염률에대한기초자료를확보하고자지역거점센터를구축하여지속적인조사감시체계를구축 운영중에있다. 본글에서는 25 년거점센터에서수행한참진드기전국분포현황을분석하여참진드기매개질환의예방및관리를위한기초자료를제공하고자한다. 몸말 기후변화대응감염병매개체조사감시사업의일환으로참진드기채집을통한전국발생밀도및분포조사를수행하였다 (25년). 조사지역은강원 5개지역 ( 삼척, 속초, 영월, 춘천, 평창 ), 경기 2개지역 ( 광주, 철원 ), 수도 2개지역 ( 강화, 화성 ), 충북 개지역 ( 보은 ), 충남 3개지역 ( 보령, 당진, 천안 ), 전북 2개지역 ( 고창, 군산 ), 전남 4개지역 ( 곡성, 보성, 영암, 완도 ), 경북 3개지역 ( 상주, 안동, 울진 ), 경남 5개지역 ( 거제, 밀양, 울주, 진주, 함양 ), 제주 2개지역 ( 서귀포, 제주 ) 으로총 개권역 29개지역을대상으로실시하였다. 월별발생밀도조사는 25년 4월부터 월까지지역별로 4개의서식환경 ( 잡목림, 초지, 침엽수림, 활엽수림 ) 을선정하여환경별로 3개의드라이아이스유인트랩 (dry-ice bait trap) 으로월 회채집하였으며성장단계별로분포현황을분석하였다. 분포조사는 7월과 8월에지역별로 5개의서식환경 ( 잡목림, 초지, 침엽수림, 활엽수림, 묘지 ) 을선정하여환경별로 flagging 방법 ( 채집용 flag: m m) 을이용하여월 회채집 ( 각조사장소 : 2m2 ) 을수행하였다. 전국발생밀도및분포조사를수행한결과, 과 3속 7종의참진드기총 29,992개체가채집되었으며, 개권역중에서는수도권 (6,54 개체, 2.8%) 과충북권 (5,49 개체, 6.8%) 에서가장많이채집된것으로나타났으며, 지역별로차이가있는것으로확인되었다 (Table ). 채집된참진드기의종별분포를보면작은소피참진드기 Table. Species diversity and abundance of ticks collected from areas in 25 Area Species Genus Amblyomma Genus Haemaphysalis Genus Ixodes testudinarium japonica flava longicornis granulatus nipponensis persulcatus Total Gangwon - 5() 572(8.8),339(5.) - 5(9.2) 59() 2,36(6.8) Gyeonggi (3.2) 872(3.3) - 96(58.9) -,64(3.5) Seoul capital (2.5) 6,45(24.2) - 2(7.4) - 6,54(2.8) Chungbuk (26.8) 4,23(5.9) - 5(3.) - 5,49(6.8) Chungnam (2.9) 2,885(.8) - 3(8.) - 2,985(.) Jeonbuk 2(66.7) - 33(.9),749(6.6) - (.6) - 2,93(7.) Jeonnam (5.6) - 364(2.),492(5.6) - (.6) -,858(6.2) Gyeongbuk (.9) 3,492(3.) - 7(4.3) - 3,557(.9) Gyeongnam 5(27.8) - 273(9.) 2,75(.2) () 3(8.) - 3,7(.) Jeju (2.),436(5.4) - - -,83(6.) Total 8 5 3,39 26, ,992 Total in Genus 8 29, ,

9 주간건강과질병 제 권제 호 (Haemaphysalis longicornis), 개피참진드기 (H. flava), 일본참진드기 (Ixodes nipponensis), 산림참진드기 (I. persulcatus), 사슴피참진드기 (H. japonica), 뭉뚝참진드기 (Amblyomma testudinarium), 남방참진드기 (I. granulatus) 순으로확인되었으며작은소피참진드기가 88.9% 의분포율로국내우점종임이확인되었다 (Figure ). trap으로조사한결과, 과 3속 4종, 총 4,352개체가채집되었다. 지역별로는충북권에서가장많은개체가채집되었으며, 종별로는작은소피참진드기 3, 개체 (9.6%), 개피참진드기,3 개체 (9.%), 일본참진드기 35개체 (.2%), 뭉뚝참진드기 6개체 (.%) 순으로작은소피참진드기가우점종으로확인되었다 (Table 2). 월별 발생밀도의정점시기는충북권 4 월과 5 월, 수도권 8 월과 9 월, ) 월별발생밀도조사 4 월부터 월까지, 개권역 개지역에서 dry-ice bait 충남권 5 월로지역별차이가있었으나전체적으로 5 월에높은 밀도를보였다 (Figure 2). Figure. The percent of each species based on three genus groups Figure 2. Monthly fluctuation of ticks collected from areas, 25 Table 2. Species diversity and abundance of ticks collected from areas using dry-ice bait traps from April to November in 25 Area Species Genus Amblyomma Genus Haemaphysalis Genus Ixodes testudinarium flava longicornis nipponensis Total Gangwon - 66(2.8) 348(2.7) 3(8.6) 57(3.6) Gyeonggi - 7(.3) 26(.) - 43(.) Seoul capital - 7(5.5) 4,27(3.) - 4,98(28.6) Chungbuk - 4(3.6) 3,694(28.4) 5(4.3) 4,(28.6) Chungnam - 87(6.7) 2,27(7.5) 3(37.) 2,37(6.5) Jeonbuk (62.5) 6(.2) 5(3.8) - 526(3.7) Jeonnam (6.3) 69(5.3) 43(3.3) (2.9) 5(3.5) Gyeongbuk - 4(3.2) 68(4.8) (2.9) 66(4.6) Gyeongnam 5(3.3) 262(2.) 473(3.6) 2(34.3) 752(5.2) Jeju - 6(2.4) 53(3.9) - 674(4.7) Total 6,3 3, 35 4,352 Total in Genus 6 4,3 35 4,

10 주간건강과질병 제 권제 호 ) - 성장단계별월별발생밀도변이채집된주요 2종 (H. longicornis and H. flava) 의성장단계별월별밀도변이를분석한결과, 작은소피참진드기의경우성충은 7월, 약충은 5월, 유충은 9월에정점을나타낸반면, 개피참진드기는성충은 9월, 약충은 월, 유충은 9월에정점을나타낸것으로확인되었다 (Figure 3). 전체개체수로보면작은소피참진드기는 5월과 7월, 개피참진드기는 9월과 월에정점을나타내어종에따른월별발생분포차이를확인할수있었다. 2) 분포조사 25년 7월과 8월사이에, 개권역 29개지역에서 flagging 방법으로조사를수행한결과, 과 3속 7종, 총 5,64개체가채집되었다. 지역별로는경북권에서가장많은개체가채집되었으며, 종별로는작은소피참진드기 3,66개체 (87.3%), 개피참진드기,738개체 (.%), 일본참진드기 28개체 (.8%), 산림참진드기 59개체 (.4%), 사슴피참진드기 5개체 (.3%), 뭉뚝참진드기 2개체 (<.5%), 남방참진드기 개체 (<.%) 순으로작은소피참진드기가우점종으로확인되었다 (Table 3). 특히 Figure 3. Comparison of monthly distributions of two species according to developmental stages (A: H. longicornis B: H. flava) Table 3. Species diversity and abundance of ticks collected from areas using flagging methods between July and August in 25 Species Area Genus Amblyomma Genus Haemaphysalis Genus Ixodes testudinarium japonica flava longicornis granulatus nipponensis persulcatus Total Gangwon - 5() 46(23.4) 99(7.3) - 2(9.4) 59(),59(9.7) Gyeonggi (4.5) 746(5.5) - 96(75.) - 92(5.9) Seoul capital - - 6(.3) 2,424(7.7) - 2(9.4) - 2,442(5.6) Chungbuk (23.2) 536(3.9) (6.) Chungnam (4.5) (3.9) Jeonbuk 2() - 35(8.),249(9.) - (.8) -,567(.) Jeonnam (7.),62(7.8) - - -,357(8.7) Gyeongbuk - - 7(.) 2,874(2.) - 6(4.7) - 2,897(8.5) Gyeongnam - - (.6) 2,242(6.4) () (.8) - 2,255(4.4) Jeju (.9) 923(6.8) - - -,29(7.2) Total 2 5,738 3, ,64 Total in Genus 2 5, ,

11 주간건강과질병 제 권제 호 사슴피참진드기와산림참진드기는강원권역에서, 남방참진드기는 경남권역에서, 뭉뚝참진드기는전북권역에서채집되어지역별로 종에따른분포차이가있는것으로확인되었다 (Figure 4 A-G). 3) 서식환경별종분포도 Dry-ice bait trap 에의한월별발생밀도조사 (4 월 - 월 ) 의 경우, 4 개의서식환경 ( 잡목림, 초지, 침엽수림, 활엽수림 ) 에서 A. H. longicornis B. H. flava C. H. japonica D. I. nipponensis E. I. persulcatus F. I. granulatus G. A. testudinarium Figure 4. Geographical distribution of 7 tick species in

12 주간건강과질병 제 권제 호 작은소피참진드기와개피참진드기가대부분채집되었으며, 이중작은소피참진드기는초지 (95.3%), 잡목림 (92.6%), 침엽수림 (74.2%), 활엽수림 (86.5%) 에서모두높은분포를나타냈다. 개피참진드기는침엽수림 (25.2%) 과활엽수림 (3.%) 에서비교적높은분포를보였다 (Figure 5). flagging 방법에의한분포조사 (7-8월 ) 에서도 5개의서식환경 ( 잡목림, 초지, 침엽수림, 활엽수림, 묘지 ) 에서월별밀도조사결과와비슷한양상을나타냈다. 다만, 개피참진드기가초지 (4.7%), 활엽수림 (8.7%) 에서, 일본참진드기가침엽수림 (2.5%) 에서좀더높은분포를나타냈다 (Figure 6). 매개체전파질환들을신속하고효율적으로대응하기위해전국에거점센터를구축 운영하여감염병매개체들에대한조사감시를수행하고있다. 2년 3개권역 ( 영남권, 호남권, 제주권 ) 을시작으로매년확대하여 26년 개권역이구축되었다. 국내에서참진드기로인해발생되는중중열성혈소판감소증후군 (SFTS) 은 23년에첫환자가발생한이후매년환자발생및사망자수가지속적으로증가추세에있고, 또한최근참진드기매개질환인라임병, 아나플라즈마증등의환자도발생하고있다. 향후기후 환경변화에의해감염병매개체의서식 분포가확대됨에따라 매개체전파질환의대유행가능성에대한대비가필요하다. 따라서 맺는말 질병관리본부에서는기후변화에의해발생할수있는다양한 현재 SFTS 위주의참진드기감시체계를라임병, 아나플라즈마증등도포함된감시체계확대 구축이필요하다. SFTS 주요매개종으로알려진작은소피참진드기는이번조사에서전국적으로광범위하게높은분포를나타낸것으로 Figure 5. Abundance (percentage of total individuals) of four species of ticks collected from dry-ice bait traps Figure 6. Abundance (percentage of total individuals) of seven species of ticks collected from a flagging method 244

13 주간건강과질병 제 권제 호 확인되었으며, 개피참진드기와일본참진드기도채집된개체수는적으나전국적으로분포하는것으로조사되었다. 특히작은소피참진드기는주활동시기가 5 9월사이에집중되는것으로나타났을뿐만아니라서식환경별분포에서도다양한환경에서높은발생밀도를보이고있어야외활동이활발한시기인 5 9월에참진드기에물리지않도록보다적극적인홍보를통한예방 관리의강화가필요할것이다. 그러나 SFTS를비롯한여러참진드기매개질환에대한방제및예방 관리전략등을수립하는기초자료로활용하기위해서는감시기간확대등지속적인조사 감시가필요할것으로사료된다. 참고문헌 교상사례, 주간건강과질병,7(6), Kim JY, Cho SH, Joo HN, Tsuji M, Cho SR, Park IJ, et al. (27) First case of human babesiosis in Korea: detection and characterization of a novel type of babesia sp. (KO) similar to ovine babesia. J Clin Microbiol. 9(): Kim KH, Yi J, Kim G. (22) Severe fever with thrombocytopenia syndrome. Emerg Infect Dis. 9(): Moon SJ, Gwack J, Hwang KJ, Kwon DK, Kim SY, Noh YT, Roh JY, Shin E-H, Jeong KJ, Seok WS, Youn SK. (23) Autochthonous Lyme Borreliosis in Humans and Ticks in Korea. PHRP., 4(): Kim CH-M, Yi Y-H, Yu D-H, Lee M-J, Cho M-R, Atul R. Desai, Smriti Shringi, Terry A. Klein, Kim H-CH, Song J-W, Baek L-J, Chong S-T, Monica L. O Guinn, John S. Lee I-Y, Park J-H, Janet Foley, and Chae J-S. (26) Tick-Borne Rickettsial Pathogens in Ticks and Small Mammals in Korea. Appl Environ Microbiol., 72(9): Korea Centers for Disease Control and Prevention (KCDC). Disease Web Statistics System. Cheong-ju si, Republic of Korea. go.kr/dstat/jsp/stat/stat.jsp.. 신이현 (24). 중증열성혈소판감소증후군매개참진드기의종류와인체 245

14 status of selected infectious diseases. 환자감시 / 전수감시감염병주간발생현황 (9th ) Table. Reported cases of national infectious diseases in Republic of Korea, ending March 4, (9th )* Group Ⅰ Group Ⅱ Group Ⅲ Group Ⅳ Classification of disease ly average Total no. of cases by year 26* Cholera Typhoid fever unit: no. of cases Imported cases of current : Country(no. of cases) Paratyphoid fever India(2) Shigellosis Philippines(2), Laos() EHEC Philippines() Viral hepatitis A ,677,84,37 867,97 Pertussis Tetanus Measles Mumps 249 2,3 62 7,6 23,448 25,286 7,24 7,492 Rubella Viral hepatitis B (Acute) Japanese encephalitis Varicella 864, ,62 46,33 44,45 37,36 27,763 Streptococcus pneumoniae Malaria Scarlet fever 3 3,43 6,93 7,2 5,89 3, Meningococcal meningitis Legionellosis Vibrio vulnificus sepsis Murine typhus Scrub typhus ,5 9,53 8,3,365 8,64 Leptospirosis Brucellosis Rabies HFRS Syphilis ,568,6, CJD/vCJD Tuberculosis 53 4, ,339 32,8 34,869 36,89 39,545 HIV/AIDS 8 5 6,59,8,8,3 868 Dengue fever Q fever West Nile fever Lyme Borreliosis Melioidosis Chikungunya fever SFTS MERS Zika virus infection Cameroon(), Vietnam(), Africa() Indonesia(4), Vietnam(4), Ethiopia(), Malaysia(), Philippines(), Singapore(), Sri Lanka() Abbreviation: EHEC= Enterohemorrhagic Escherichia coli, HFRS= Hemorrhagic fever with renal syndrome, CJD/vCJD= Creutzfeldt-Jacob Disease / variant Creutzfeldt-Jacob Disease, SFTS= Severe fever with thrombocytopenia syndrome, MERS-CoV= Middle East Respiratory Syndrome Coronavirus. Cum: Cumulative counts from st to current in a year. * The reported data for year 26, are provisional but the data from 22 to 25 are finalized data. According to surveillance data, the reported cases may include all of the cases such as confirmed, suspected, and asymptomatic carrier in the group. The reported surveillance data excluded Hansen s disease and no incidence data such as Diphtheria, Poliomyelitis, Haemophilus influenzae type b, Epidemic typhus, Anthrax, Plague, Yellow fever, Viral hemorrhagic fever, Smallpox, Severe Acute Respiratory Syndrome, Animal influenza infection in humans, Novel Influenza, Tularemia, Newly emerging infectious disease syndrome and Tick-borne Encephalitis. Data on scarlet fever included both cases of confirmed and suspected since September 27, 22. 문의 : (43)

15 Table 2. Reported cases of national infectious diseases in Republic of Korea, ending March 4, (9th )* unit: no. of cases Provinces Cholera Typhoid fever Paratyphoid fever Shigellosis Enterohemorrhagic Escherichia coli Viral hepatitis A Pertussis Tetanus Total Seoul Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi Gangwon 9 Chungbuk 25 4 Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju Cum: Cumulative counts from st to current in a year * The reported data for year 26, are provisional but the data from 2 to 25 are finalized data. According to surveillance data, the reported cases may include all of the cases such as confirmed, suspected, and asymptomatic carrier in the group. average is mean value calculated by cumulative counts from st to current for 5 preceding years

16 Table 2. Reported cases of national infectious diseases in Republic of Korea, ending March 4, (9th )* unit: no. of cases Provinces Measles Mumps Rubella Viral hepatitis B (Acute) Japanese encephalitis Varicella Malaria Scarlet fever Total ,3, ,94 7, , Seoul Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi ,22, Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju Cum: Cumulative counts from st to current in a year * The reported data for year 26, are provisional but the data from 2 to 25 are finalized data. According to surveillance data, the reported cases may include all of the cases such as confirmed, suspected, and asymptomatic carrier in the group. average is mean value calculated by cumulative counts from st to current for 5 preceding years. Data on scarlet fever included both cases of confirmed and suspected since September 27,

17 Table 2. Reported cases of national infectious diseases in Republic of Korea, ending March 4, (9th )* unit: no. of cases Provinces Meningococcal meningitis Legionellosis Vibrio vulnificus sepsis Murine typhus Scrub typhus Leptospirosis Brucellosis Hemorrhagic fever with renal syndrome Total Seoul Busan Daegu 2 Incheon 2 3 Gwangju 2 Daejeon 2 3 Ulsan 3 Sejong Gyonggi Gangwon Chungbuk 2 Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju 3 Cum: Cumulative counts from st to current in a year * The reported data for year 26, are provisional but the data from 2 to 25 are finalized data. According to surveillance data, the reported cases may include all of the cases such as confirmed, suspected, and asymptomatic carrier in the group. Calculated by averaging the cumulative counts from st to current, for a total of 5 preceding years 249

18 Table 2. Reported cases of national infectious diseases in Republic of Korea, ending March 4, (9th )* unit: no. of cases Syphilis CJD/vCJD Dengue fever Q fever Lyme Borreliosis SFTS Zika virus infection Tuberculosis Provinces 3-year 3-year Total ,994 5,546 Seoul ,5 Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong 3-3 Gyonggi ,64,3 Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju Cum: Cumulative counts from st to current in a year * The reported data for year 26, are provisional but the data from 2 to 25 are finalized data. According to surveillance data, the reported cases may include all of the cases such as confirmed, suspected, and asymptomatic carrier in the group. 5(3)-year average is mean value calculated by cumulative counts from st to current for 5(3) preceding years. 25

19 .2 환자감시 / 표본감시감염병주간발생현황 (9th ). Influenza, Republic of Korea, ending March 4, (9th ) 년도제 9 주인플루엔자의사환자분율은외래환자, 명당 6. 명으로지난주 (6.7) 대비감소 26- 절기유행기준은 8.9 명 (/,) 인플루엔자유행주의보발령 : 26 년 2 월 8 일 ( 목 ) ILI per, Figure. The ly proportion of Influenza-Like Illness per, outpatients, to 26- flu seasons 2. Hand, Foot and Mouth Disease(HFMD), Republic of Korea, ending March 4, (9th ) 년도제 9 주수족구병의사환자분율은외래환자, 명당.5 명으로지난주 (.4) 대비. 명증가 수족구병은 29 년 6 월법정감염병으로지정되어표본감시체계로운영 수족구병환자분율 (%) Figure 2. The status of HFMD sentinel surveillance,

20 3. Ophthalmologic, Republic of Korea, ending March 4, (9th ) 년도제 9 주유행성각결막염의외래환자, 명당분율은 3.9 명으로지난주 5 명보다감소하였음 동기간급성출혈성결막염의환자분율은.5 명으로지난주.4 명보다증가하였음 6 5, 명당외래환자수 Figure 3. The ly proportion of Epidemic keratoconjunctivitis per, outpatients 5 4, 명당외래환자수 Figure 4. The ly proportion of Acute hemorrhagic conjunctivitis per, outpatients 252

21 4. Reported cases of national sentinel surveillance disease in the Republic of Korea, ending March 4, (9th ) unit: no. of cases/sentinels Viral hepatitis Sexually Transmitted Diseases Hepatitis C Gonorrhea Chlamydia Genital herpes Condyloma acuminata Total Cum: Cumulative counts from st to current in a year According to surveillance data, the reported cases may include all of the cases such as confirmed, suspected, and asymptomatic carrier in the group. average is mean value calculated by cumulative counts from st to current for 5 preceding years. 문의 : (43)79-775, 778, 738 자세히보기 : 질병관리본부 정책 / 사업 감염병감시 표본감시주간소식지.3 수인성및식품매개감염병집단발생주간현황 (9th ) Waterborne & Foodborne disease outbreaks, Republic of Korea, ending March 4, (9th ) 년도제 9 주에집단발생이 건이발생하였으며누적발생건수는 68 건 ( 환례수 54 명 ) 이발생함 년도 26 년도 4 년평균발생건수 (-4 년 ) Figure 5. Number of Waterborne & Foodborne disease outbreaks reported by,

22 2. 병원체감시 / 인플루엔자및호흡기바이러스주간감시현황 (9th ). Influenza, Republic of Korea, ending March 4, (9th ) 제 9 주에의뢰된호흡기검체 236 건중인플루엔자바이러스 3 건 (5.5%)[A(H3N2) 형 건, B 형 2 건 ] No. of Positive Percent positive(%) A/H3N2 A(not subtyped) A/HNpdm9 B percent positive Figure 6. The ly proportion of Influenza-Like Illness per, outpatients, to 26- flu seasons 2. Respiratory viruses, Republic of Korea, ending March 4, (9th ) 년도제9주호흡기검체에대한유전자검사결과 52.5% 의호흡기바이러스가검출되었음 ( 최근 4주평균 247개의호흡기검체에대한유전자검사결과를나타내고있음 ) 주별통계는잠정통계이므로변동가능 26- () Weekly total Detection rate (%) HAdV HPIV HRSV IFV HCoV HRV HBoV HMPV HAdV : human Adenovirus, HPIV : human Parainfluenza virus, HRSV : human Respiratory syncytial virus, IFV : Influenza virus, HCoV : human Coronavirus, HRV : human Rhinovirus, HBoV : human Bocavirus, HMPV : human Metapneumovirus : the rate of detected cases between Jan.. - Mar. 4., (Average No. of detected cases is 247 in last 4 ) 26 : the rate of detected cases between Dec Dec 자세히보기 : 질병관리본부 알림 주간질병감시정보 254

23 2.2 병원체감시 / 급성설사질환실험실표본주간감시현황 (8th ) Acute gastroenteritis causing virus No. of sample No. of detection (Detection rate, %) Group A Rotavirus Norovirus Enteric Adenovirus Astrovirus Total (9.8) 6 (3.4) (.) (.) 2 (4.2) (2.) 24 (33.8) (.) 2 (2.8) 4 (57.7) (.9) (26.2) 3 (7.) (.) 9 (45.2) (27.6) 5 (7.2) (.) (3.4) 4 (48.3) (4.5) 25 (28.8) 9 (2.) (2.3) 27 (47.7) * The samples were collected from children <5 years of sporadic acute gastroenteritis > in Korea. Acute gastroenteritis causing bacteria Week No. of Sample Salmonella Pathogenic spp. E.coli Shigella spp. No. of isolation (Isolation rate, %) V.parahaem V. cholerae Campylobacter C.perfringens S. aureus B. cereus Total olyticus spp (.74) (.74) () () () 2 (.47) 3 (2.2) 2 (.47) (.74) (7.35) (2.26) 4 (2.26) (.56) (.56) () () (.56) 4 (2.26) (.56) 6 (9.4) 7 9 (.52) 3 (.57) () () () (.52) () 2 (.5) (.52) 8 (4.9) 8 38 (.72) (.72) () () () () (.72) 2 (.45) 2 (.45) 7 (5.7),255 4 (.2) 9 (.5) (.8) (.8) () 5 (.4) 9 (.5) 22 (.75) 6 (.27) 97 (7.73) * Bacterial Pathogens ; Salmonella spp., E. coli (EHEC, ETEC, EPEC, EIEC), Shigella spp., Vibrio parahaemolyticus, Vibrio cholerae, Campylobacter spp., Clostridium perfringens, Staphylococcus aureus, Bacillus cereus, Listeria monocytogenes, Yersinia enterocolitica. * hospital participating in Laboratory surveillance in 26 (7 hospitals) 자세히보기 : 질병관리본부 알림 주간질병감시정보 255

24 2.3 병원체감시 / 엔테로바이러스실험실주간감시현황 (8th ) The detection rate of Enterovirus in enterovirus sentinel surveillance, Republic of Korea, ending February 25, (8th ) 년도제 8 주실험실표본감시결과엔테로바이러스검출건수는 3 건이며, 년도누적발생건수는 건임 Aseptic meningitis Enterovirus detection rate (%) Enterovirus detection rate (%) Figure 7. Detection rate of enterovirus in Aseptic meningitis patients from 26 to HFMD and Herpangina Enterovirus detection rate (%) Enterovirus detection rate (%) HFMD with Complications Figure 8. Detection rate of enterovirus in HFMD and Herpangina patients from 26 to Enterovirus detection rate (%) Enterovirus detection rate (%) Figure 9. Detection rate of enterovirus in HFMD with Complications patients from 26 to 256

25 주요통계이해하기 <Table > 은지난 5년간발생한법정감염병과 년해당주발생현황을비교한표로, 는 년해당주의신고건수를나타내며, 은 년 주부터해당주까지의누계건수, 그리고 ly average 는지난 5년 (2-25 년 ) 해당주의신고건수와이전 2주, 이후 2주의신고건수 ( 총 25주 ) 평균으로계산된다. 그러므로 과 ly average 의신고건수를비교하면해당주단위시점과예년의신고수준을비교해볼수있다. Total no. of cases by year 는지난 5년간해당감염병현황을나타내는확정통계이며연도별현황을비교해볼수있다. 예 ) 년 2 주의 ly average(5 년간주평균 ) 는 2 년부터 25 년의 주부터 4 주까지의신고건수를 총 25 주로나눈값으로구해진다. * ly average(5 년주평균 )=(X + X2 + + X25)/25 주 주 2주 3주 4주 25년 해당주 24년 X X2 X3 X4 X5 23년 X6 X7 X8 X9 X 22년 X X2 X3 X4 X5 2년 X6 X7 X8 X9 X2 2년 X2 X22 X23 X24 X25 <Table 2> 는 7 개시 도별로구분한법정감염병보고현황을보여주고있으며, 각감염병별로 Cum, average 와 Cum, 을비교해보면최근까지의누적신고건수에대한이전 5년동안해당주까지의평균신고건수와비교가가능하다. Cum, average 는지난 5년 (2-25 년 ) 동안의동기간신고누계평균으로계산된다. <Table 3> 은표본감시감염병에대한신고현황으로, 최근발생양상을신속하게파악하는데도움이된다.

26 발간등록번호 주간건강과질병, PHWR 은질병관리본부에서시행되는조사사업을통해생성된감시및연구자료를기반으로근거중심의건강및질병관련정보를제공하고자최선을다할것이며, 제공되는정보는질병관리본부의특정의사와는무관함을알립니다. 본간행물에서제공되는감염병통계는 감염병의예방및관리에관한법률 에의거, 국가감염병감시체계를통해신고된자료를기반으로집계된것으로집계된당해년도자료는의사환자단계에서신고된것이며확진결과시혹은다른병으로확인될경우수정될수있는잠정통계임을알립니다. 주간건강과질병, PHWR 은질병관리본부홈페이지를통해주간단위로게시되고있으며, 정기적구독을원하시는분은 이메일을통해보내지는본간행물의정기적구독요청시구독자의성명, 연락처, 직업및이메일주소가요구됨을알려드립니다. 주간건강과질병 발간관련문의 : kcdcnids@korea.kr/ 창 발 간 : 28 년 4 월 4 일 행 : 년 3 월 9 일 발행인 : 정기석 편집인 : 정은경 편집위원 : 최영실, 김기순, 최병선, 조신형, 조성범, 김봉조, 구수경, 김용우, 이동한, 김희숙 편 집 : 질병관리본부감염병관리센터감염병감시과 충북청주시흥덕구오송읍오송생명 2 로 87 오송보건의료행정타운 ( 우 )2859 Tel. (43) Fax. (43)