pissn X eissn PUBLIC HEALTH WEEKLY REPORT, PHWR Vol.12, No. 11, 2019 CONTENTS 년사우디아라비아메르스발생현황

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1 pissn X eissn PUBLIC HEALTH WEEKLY REPORT, PHWR Vol.12, No. 11, 219 CONTENTS 년사우디아라비아메르스발생현황 년국내중증열성혈소판감소증후군 (SFTS) 실험실검사현황 37 통계단신 (QuickStats) 청소년의현재음주및위험음주율추이, 미세먼지안내문미세먼지대비민감계층건강보호수칙 올바른마스크착용법 311 주요감염병통계환자감시 : 전수감시, 표본감시 병원체감시 : 인플루엔자및호흡기바이러스 급성설사질환, 엔테로바이러스

2 주간건강과질병 제 12 권제 11 호 연구단신, Brief report 년사우디아라비아메르스발생현황 질병관리본부긴급상황센터위기분석국제협력과이지아, 이선규 * * 교신저자 : byuly74@korea.kr/ Epidemiological characteristics of MERS cases reported in Saudi Arabia, 218 Lee Jia, Lee Sunkyu Division of Risk Assessment & International Cooperation, Center for Public Health Emergency Preparedness and Response, KCDC Middle East Respiratory Syndrome (MERS) is viral respiratory illness caused by Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and characterized by fever, cough and shortness of breath. Since the first human Middle East respiratory syndrome (MERS) infection in 212, MERS cases have been reported annually, mainly from Saudi Arabia. According to reports from the Saudi Ministry of Health and WHO International Health Regulations (25), 144 MERSconfirmed cases, including 47 deaths, were identified in 218. In reviewing the monthly trend in 218, the highest number of cases was reported in both January and February (23 cases), and the number of cases in 218 was much lower than that of the 3-year average from 215 to 217, except in January. Only 36 secondary infections were identified from 8 small-sized outbreaks, consisting of 3 hospital-related and 5 household events. Most MERS-confirmed cases were male (81.1%), and had underlying diseases (76.9%), with a mean age of 54.9 years and a fatality rate of 32.2%. For high-risk groups, cases with camel contact or hospitalized patients were male dominant, of older age, prone to underlying diseases, and demonstrated a higher fatality rate compared to those with household contact and healthcare providers. Since there are no available vaccines or therapeutics for MERS, prevention is always the key in protecting oneself from MERS infection. Keywords: Middle East respiratory syndrome, Saudi Arabia, Humans 들어가는말 중동호흡기증후군 (Middle East respiratory syndrome; 이하메르스 ) 은 212년 9월인체감염사례가보고된후 218년 12월 31일까지총 27개국에서 2,279명발생, 86명사망보고되고있다 [1]. 이중자국내감염사례가보고된국가는사우디아라비아, 아랍에미리트, 오만, 예멘, 카타르, 쿠웨이트, 요르단, 레바논, 이란, 튀니지, 프랑스, 영국, 한국으로총 13개국이다 [2]. 단봉낙타가메르스의병원소로알려져있으며단봉낙타의주서식지인중동지역아라비아반도, 특히사우디아라비아를중심으로발생하고있다. 감염환자의비말등호흡기분비물과의접촉을통해사람간전파가발생하는것으로확인되어가족간또는의료기관내전파사례가종종보고되고있으며의료기관내전파사례발생시대규모유행의원인이되고있다. 중동지역외국가의메르스 298

3 주간건강과질병 제 12 권제 11 호 발생은중동지역을다녀온여행자의유입과관련된사례로확인되고있다 [3,4]. 메르스는다른호흡기바이러스감염과같이초기비특이적증상으로초기환자발견이어렵다고알려져있다 [3]. 하지만환자의조기발견과신속격리가메르스전파차단의가장중요한방법임이확인되었고 [4] 질병관리본부는국외메르스발생현황모니터링을통해유입사례발생가능성예측등으로대응하고있다. 218년국외메르스환자는총 147명발생, 47명사망으로발생국가는감염지역기준으로총 3개국 ( 사우디아라비아, 아랍에미리트, 오만 ) 이다. 아랍에미리트 1명, 오만 1명, 그리고아직조사진행중에있는 1명을제외하고모두사우디아라비아에서발생한것으로확인되었고 (144명, 전체발생의 98.%), 이번보고서에서는이중사우디아라비아의메르스발생현황에대해분석한내용을공유하고자한다. 일일단위로올라오는자료를바탕으로 [5] 각사례에대한기초역학조사결과는 WHO International Health Regulations(IHR; 국제보건규약 ) 을통해공유받아 [6] 다시확인하는방법으로수집하였다. 사우디아라비아보건부와 WHO IHR 자료를통해성별, 연령, 발생시기및지역, 감염경로, 증상발생여부, 사망여부, 기저질환여부등에대한정보를얻을수있었으며감염지역의경우는최대잠복기로알려진 14일이내체류지역을기준으로결정하였다 [2]. 218년사우디아라비아메르스환자는총 144명발생, 46명사망보고되었다. 월별로는 1 2월이 23명으로가장많이발생하였고, 12월에 5명으로가장적게발생하였다. 낙타접촉등을통한 1차감염의경우총 17명 (74.8%) 으로 1 3월 ( 각 21명, 17명, 13명발생 ) 을제외하고모두 1명이하수준이었고사람간전파를통한 2차감염은 36명 (25.%) 으로월평균 3명의적은수준으로 발생하였다. 215 년부터 217 년 3 년동안의월별평균환자발생 몸말 218 년사우디아라비아메르스환자정보는사우디보건부에서 수와비교해보면 1월을제외하고모두 3년평균보다적은수준으로발생하였음을확인할수있었다 (Figure 1). 218년 2차감염에의한집단발생사례는총 8건이보고되었으며, 이중의료기관전파사례는 3건으로 2월 Hafer 6 Primary Secondary Unknown 3-year average(215-17) 5 No. of cases Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sep. Oct. Nov. Dec. Month Figure 1. Distribution of MERS-confirmed cases by month of reporting in Saudi Arabia 299

4 주간건강과질병 제 12 권제 11 호 Table 1. Characteristics of MERS-confirmed cases in Saudi Arabia, 218 Characteristics Sex Total (n=143) Primary cases (n=17) Secondary cases (n=36) Male 116 (81.1) 89 (83.2) 27 (75.) Female 27 (18.9) 18 (16.8) 9 (25.) Age (yr) Mean 54.9± ± ±15.1 < 5 55 (38.5) 32 (29.9) 23 (63.9) 5 88 (61.5) 75 (7.1) 13 (36.1) Residence (Province level) Riyadh 55 (38.5) 43 (4.2) 12 (33.3) Najran 25 (17.5) 14 (13.1) 11 (3.6) Qassim 14 (9.8) 9 (8.4) 5 (13.9) Al Ahsaa 9 (6.3) 9 (8.4) (.) Jeddah 7 (4.9) 5 (4.7) 2 (5.6) Tabuk 5 (3.5) 5 (4.7) (.) Hafer Albatin 4 (2.8) 1 (.9) 3 (8.3) Others 24 (16.7) 21 (19.6) 3 (8.3) Underlying diseases Yes 11 (76.9) 94 (87.9) 16 (44.4) No 26 (18.2) 11 (1.3) 15 (41.7) Unknown 7 (4.9) 2 (1.9) 5 (13.9) Death Yes 46 (32.2) 41 (38.3) 5 (13.9) No 97 (67.8) 66 (61.7) 31 (86.1) Al-Batin시에서의료진중심으로발생 (4명) 한건과 3월 Riyadh시의료기관중심으로 6명발생, 그리고 9월 Buraidah 시투석센터에서투석환자 2명의감염사례로확인되었다. 가족간전파사례는 5월 Najran시에서 12명의환자발생이있었던유행사례외 Riyadh시, Buraidah시, Afif시, Jeddah시에서 2 3명수준으로발생보고되었다. 메르스전체환자 144명중감염경로가밝혀지지않은 1명을제외하고 143명의일반적특성을보면남성이여성에비해약 4배이상많이발생하였고이는 1차감염과 2차감염에서도비슷한양상을보였다. 연령별로는전체평균연령 54.9세로 5세이상에서많이발생하였다. 1차감염자의평균연령은약간높은 58.2세로 5세이상의비율이상당히높았으며, 2차감염의 경우는평균연령 44.6세로 5세미만에서더많이발생한것으로확인되었다. 지역별로는 Riaydh주에서가장많이발생하였고 Najran주, Qassim주순으로 1, 2차감염모두동일한결과를나타냈다. 1차감염의경우여러지역에서골고루분포하는것에비해 2차감염의경우사례발생지역에집중적으로발생하는경향을나타내었다. 대부분의환자들 (76.9%) 이기저질환을가지고있는것으로확인되었으나 2차감염의경우기저질환을가지고있는사례와가지고있지않는사례수의차이가크지않았다. 사망자는전체발생의 32.2% 를차지하였고대부분 1차감염환자로확인되었다 (Table 1). 메르스위험요인으로알려진낙타접촉, 가족간전파, 의료기관내전파사례 ( 의료진, 입원환자 ) 에대하여분석한 3

5 주간건강과질병 제 12 권제 11 호 Table 2. Transmission routes of MERS-confirmed cases by high-risk group in Saudi Arabia, 218 Characteristics Sex Camel contact (n=44) Household contact (n=23) Healthcare provider (n=4) Healthcare-acquired Patient at hospital (n=9) Male 41 (93.2) 17 (73.9) 1 (25.) 9 (1.) Female 3 (6.8) 6 (26.1) 3 (75.) (.) Age (yr) Mean 59.8± ± ± ±16.3 < 5 14 (31.8) 1 (43.5) 4 (1.) 2 (22.2) 5 3 (68.2) 13 (56.5) (.) 7 (77.8) Symptoms Yes 44 (1.) 22 (95.7) (.) 9 (1.) No (.) 1 (4.3) 4 (1.) (.) Underlying diseases Yes 38 (86.4) 8 (34.8) (.) 8 (88.9) No 4 (9.1) 14 (6.9) 1 (25.) (.) Unknown 1 (2.3) 1 (4.3) 3 (75.) 1 (11.1) Death Yes 18 (4.9) (.) (.) 5 (55.6) No 25(56.8) 23(1.) 4(1.) 4(44.4) 결과, 낙타접촉이확인된사례는전체메르스발생 143건중 44건 (3.8%) 을차지하였고남성에서압도적으로많이발생하였다. 평균연령은 59.8세로가장높게나타났고기저질환을가지고있는비율도 86.4% 로높았으며이러한특징은병원입원환자의경우도유사하게나타났다. 의료진은총 4명으로전체메르스환자의 2.8% 를차지하였으며모두 5세미만으로무증상이었다. 가족간전파및의료진에서는사망환자가없었으며입원환자의경우치명률이 55.6% 로가장높게나타났다 (Table 2). 대한연구와경험을통한사우디아라비아내대응역량의강화에의한것으로판단된다. 예전발생양상을보면의료기관내전파발생시대규모유행으로이어졌던양상을고려하면 218년에대규모의료기관내유행사례가없었던것은대응역량이많이향상되었기때문인것으로생각된다. 또한환자특성분석결과는메르스발생의고위험군으로알려진고령, 남성, 기저질환자에서더많이발생한것을다시한번확인하였고, 치명률도 3% 이상으로여전히높은것으로나타났다 [2,3,4]. 메르스는아직백신및치료제가없어감염이되지않게 맺는말 메르스는 212년첫인체감염환자발생후사우디아라비아를포함한중동지역에서연중지속적으로발생하고있어전세계가예의주시하고있는감염병중의하나이다. 218년에는예년에비해사우디아라비아내발생수가현저히감소하였고이는메르스에 예방을하는것이가장중요하다. 특히고위험군으로알려진고령, 특히당뇨, 고혈압등기저질환이있는사람의경우중동지역여행시낙타접촉, 호흡기증상자접촉등에대한주의가필요하고, 항상손씻기등개인위생준수가요구되고, 호흡기증상이있을시마스크를착용하여야한다 [2]. 또한질병관리본부에서는중동지역여행후 14일이내에발열, 기침, 호흡곤란등증상이있을시에질병관리본부콜센터 1339를통해신고를당부하여환자를조기에 31

6 주간건강과질병 제 12 권제 11 호 발견하고신속히대응할수있도록힘쓰고있으며그로인한대규모 발생을사전예방하기위해메르스감시체계를강화해운영하고 있다. 참고문헌 1. WHO 질병관리본부. 218년메르스 (MERS) 대응지침 (5-1판) Hui DS, Azhar EI, Kim YJ, et al. MiddleM East respiratory syndrome coronavirus: risk factors and determinants of primary, household, and nosocomial transmission. Lancet Infect Dis. 218;18(8):e Al-Tawfiq JA & Auwaerter PG. Healthcare-associated infections: the hallmark of Middle East respiratory syndrome coronavirus with review of the literature. Journal of Hospital Infection doi.org/1.116/j.jhin Ministry of Health Saudi Arabia. Pages/defaults/aspx 6. WHO MERS-CoV Disease outbreak news. don/archive/disease/coronavirus_infections/en/ 32

7 주간건강과질병 제 12 권제 11 호 연구단신, Brief report 년국내중증열성혈소판감소증후군 (SFTS) 실험실검사현황 질병관리본부감염병분석센터바이러스분석과왕은별, 이혁진, 최우영, 강춘 * * 교신저자 : kangchun@korea.kr, Laboratory-based diagnosis of severe fever with thrombocytopenia syndrome in Korea from 217 to 218 Wang EunByeol, Lee Hyeokjin, Choi Wooyoung, Kang Chun Division of Viral Diseases, Center for Laboratory Control of Infectious Disease, KCDC Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne zoonotic disease, caused by Haemaphysalis longicornis and human-to-human transmission is also possible in contact with the body fluids with SFTS patients. The main manifestations include fever, vomiting, diarrhea, thrombocytopenia, and leukopenia. To investigate the characterization of SFTS virus (SFTSV) in Korea, clinical specimens from suspected SFTS patients from 217 to 218 were examined using realtime RT-PCR (reverse transcription polymerase chain reaction) and/or conventional RT-PCR and analyzing the partial genome sequences of the M segment of 161 Korean SFTSV samples. We found that four different genotypes of the SFTSV were co-circulating in Korea, based on these data from 217 to 218. Our study suggests that continuous monitoring of the genetic diversity of SFTSV in Korea is important for effective prevention and control strategies against SFTS. Keywords: Severe fever with thrombocytopenia syndrome, SFTS virus, Genotype, Phenuiviridae Infections, Zoonoses 들어가는말 중증열성혈소판감소증후군 (Severe fever with thrombocytopenia syndrome, SFTS) 은주로작은소피참진드기 (Haemaphysalis longicornis) 가매개하는바이러스성질환이다. 중증열성혈소판감소증후군바이러스 (Severe fever with thrombocytopenia syndrome virus, SFTSV) 는 Phenuiviridae과 Phlebovirus 속에속하며, 211년중국에서처음환자발생이 SFTS의주요증상은고열, 혈소판감소, 구토, 설사등이나타나고, 중증인경우신경계증상, 출혈증상, 다발성장기손상으로인해 6 3% 의사망률을보인다 [4]. 우리나라에서는 SFTS가 213년에처음확인된이후 218년까지 SFTS 환자 866명, 사망자 173명으로치명률은약 2.% 로보고되었으며, 이글에서는 SFTS 의심환자에대한실험실검사현황및 217년부터 218년까지국내에서발생된 SFTS 바이러스에대한유전자분석결과를기술하고자한다. 보고되었고 [1], 이어서일본, 한국에서도환자발생이보고되었다 [2,3]. 33

8 주간건강과질병 제 12 권제 11 호 몸말 SFTS 실험실검사방법 SFTS 의사환자에대한실험실검사로유전자검출검사, 항체검출검사, 배양검사를수행하고있다. 질병관리본부에서 SFTS로의뢰되는검체중에서발병일로부터약 2주전까지의검체에대해서는유전자검출검사 (Real-time reverse transcriptionpolymerase chain reaction, rrt-pcr) 를수행하고있으며, 항체검출검사는급성기혈청과회복기혈청에서항체가상승여부를 IFA(Immunofluorescence assay) 방법으로확인하고있다. 검체에서 SFTS 확진은바이러스특이유전자가검출되거나, 급성기및회복기혈청비교시항체가상승되거나, 세포배양으로바이러스를분리한경우로판정하고있다. 3,391건으로 217년에비해 218년에는 17.9% 증가하였으며, 이중에서 SFTS 양성건수는 217년 254건, 218년 252건으로확인되었고사망자는 217년 5건, 218년 46건으로나타났다. 그리고질병관리본부및전국 17개시ㆍ도보건환경연구원뿐만아니라민간기관을포함한전국통계에따르면 217년에 272명, 218년에는 259명의 SFTS 환자가발생했고, 사망자는 217년에 54건 ( 치명률 19.9%), 218년에 46건 ( 치명률 17.8%) 으로보고되었다 (Figure 1). 대부분 SFTS 바이러스유전자가검출되어양성으로확인되었으며, 217년도 1건이항체검사에서항체가가 4배이상상승하여양성으로판정되었다 년동안전국 17개시ㆍ도보건환경연구원에서의실험실검사현황은서울보건환경연구원이검사건수 (986건) 가가장많았고, 강원보건환경연구원 (661건), 광주보건환경연구원 (495건), 대구보건환경연구원 (318 건 ) 순으로나타났다. 서울보건환경연구원과 광주보건환경연구원은 218 년에의뢰건수가급격히증가하였고, SFTS 실험실검사현황 질병관리본부및전국 17 개시ㆍ도보건환경연구원에서 나머지지역에서는 217 년과 218 년에비슷한양상을보였다 (Figure 2). SFTS 확진환자는서울 (78 건 ), 강원 (78 건 ), 경기북부 (52 건 ), 대구보건환경연구원 (49 건 ) 순으로나타났다. 수행한 SFTS 실험실검사의뢰건수는 217 년 2,876 건, 218 년 No. of SFTS cases No. of deaths No. of cases Year Figure 1. Annual distribution of severe fever with thrombocytopenia syndrome in Korea,

9 주간건강과질병 제 12 권제 11 호 7 No. of tested cases, 217 No. of SFTS cases, 217 No. of tested cases, 218 No. of SFTS cases, No. of cases Figure 2. Regional distribution of severe fever with thrombocytopenia syndrome in Korea, Table 1. Genetic distribution of severe fever with thrombocytopenia syndrome virus in Korea, Genotype SFTS cases Genotype A 1 (6.2%) Genotype B 128 (79.5%) Genotype D 12 (7.5%) Genotype F 11 (6.8%) Total 161 (1%) SFTS 바이러스유전자분석 SFTS 확진환자의혈청에서 conventional RT-PCR을수행후 SFTS 바이러스 M segment 일부 (56 bp) 를증폭시켜유전자염기서열및유전형을분석하였다 [5] 년동안질병관리본부및 17개시ㆍ도보건환경연구원에서검사한 SFTS 양성검체총 531건중에서 161건 (217년 133건, 218년 28건 ) 에대해 SFTS 바이러스유전형분석결과, 유전형 A 1건 (6.2%), 유전형 B 128건 (79.5%), 유전형 D 12건 (7.5%), Genotype F 11건 (6.8%) 으로나타났으며 (Table 1), 년동안국내에서는유전형 B가대부분을차지하였다. 그리고 218년도나머지양성검체에대해서 맺는말 213년에처음국내에서 SFTS가확인된이후 SFTS 환자가매년증가하고있으며, 환자의대부분이 4 11 월에발생하였다. SFTS 바이러스유전형은 A, B, D, F로다양하게나타났으며, 유전형 B가가장많이확인되었다. 현재 SFTS 실험실검사는질병관리본부에서항체검출검사및바이러스배양검사를수행하고있으며, 17개시ㆍ도보건환경연구원에서유전자검출검사를수행하고있다. 향후바이러스유전자특성분석을통하여국내 SFTS 바이러스의다양한유전학적분석등이가능할것이다. 염기서열분석이진행중이다. 35

10 주간건강과질병 제 12 권제 11 호 참고문헌 1. Yu XJ, Ling MF, Zhang SY, Liu Y, Li JD, Sun YL, et al. Fever with thrombocytopenia associated with a novel bunyavirus in China. N Engl J Med. 211;364: Kim KH, Yi JY, Kim GY, Choi SJ, Jun KI, Kim NH, et al. Severe fever with thrombocytopenia syndrome, South Korea, 212. Emerging Infect Dis. 213;19: Takahashi T, Meada K, Suzuki T, Ishido A, Shigeoka T, Tominaga T, et al. The first identification and retrospective study of severe fever with thrombocytopenia syndrome in Japan. J Infect Dis. 214;29: Gai ZT, Zhang Y, Liang MF, Jin C, Zhang S, Zhu CB, et al. Clinical progress and risk factors for death in severe fever with thrombocytopenia syndrome patients. J Infect Dis. 212;26: Yun SM, Park SJ, Park SW, Choi WY, Jeong HW, Choi YK, et al. Molecular genomic characterization of tick- and human-derived severe fever with thrombocytopenia syndrome virus isolates from South Korea. PLoS Negl Trop Dis. 217;11(9):e

11 주간건강과질병 제 12 권제 11 호 통계단신, QuickStats 청소년의현재음주및위험음주율추이, Trends in prevalence of current and excessive drinking among Korean adolescents, [ 정의 ] 현재음주율 : 최근 3 일동안 1 잔이상술을마신적이있는사람의분율위험음주율 : 최근 3 일동안 1 회평균음주량이중등도이상 ( 남자 : 소주 5 잔이상, 여자 : 소주 3 잔이상 ) 인사람의분율 우리나라청소년의현재음주율은 27 년 27.8% 에서 218 년 16.9% 로 1.9%p 감소하였고, 위험음주율은 27 년 12.8% 에서 218 년 8.9% 로 3.9%p 감소하였음. 218 년기준청소년 1 명중 9 명은위험음주를하는것으로나타남 ( 그림 A). The prevalence of current drinking among adolescents in South Korea decreased from 27.8% in 27 to 16.9% in 218, with the reduction of 1.9 percentage points (%p), and that of excessive drinking also dropped from 12.8% in 27 to 8.9% in 218, with the reduction of 3.9 %p. The 218 data indicated that out of 1 adolescents, nine were found to be drinking excessively (Figure A). 3 drinking Excessive drinking Percentage (%) '7 '8 '9 '1 '11 '12 '13 '14 '15 '16 '17 '18 Survey year Figure A. Trends in prevalence of current and excessive drinking among Korean adolescents, * Prevalence of current drinking: proportion of people who drank 1 glass or more of alcohol for the recent 3 days Prevalence of excessive drinking: proportion of people with excessive drinking (defined as 5 glasses or more of Soju for men, and 3 glasses or more of Soju for women) for the past 3 days Survey population: middle school and high school students in Korea Source: The Korea Youth Risk Behavior Survey (KYRBS), * The Korea Youth Risk Behavior Survey is a national school-based survey to assess the prevalence of and monitor trends in health-risk behaviors among Korean adolescents. Reported by: Division of Chronic Disease Control, Korea Centers for Disease Control and Prevention 37

12 주간건강과질병 제 12 권제 11 호 [ 미세먼지안내문 ] 미세먼지대비민감계층건강보호수칙 미세먼지가증가하면이렇게하세요! 호흡기질환자 천식환자 심혈관질환자 호흡기질환자는미세먼지에노출되지않는것이중요합니다. 실외활동을줄이고, 창문을닫고주로실내에서지내세요. 공기청정기가도움이될수있습니다. 외출시에는천식증상완화제를항상가지고다니세요. 어린이는학교보건실에도맡겨두세요. 식약처인증보건용마스크가도움을줄수있습니다. 의사와상의한후착용해보세요. 부득이외출을해야할경우 COPD 환자는구제약물을반드시소지하고필요할경우사용하세요. 미세먼지가높은날이지나도그영향은수일까지지속되므로, 평소에하던천식유지치료를더욱더철저하게해주세요. 기존질환을적극적으로관리하는것이중요합니다. 기존의호흡기질환치료제를성실히복용하세요. 미세먼지가발생후 6주까지도영향이지속될수있으므로꾸준히관리해야합니다. 부득이외출을해야할경우의사와상의한후얼굴에맞는보건용마스크를착용하세요. 실외활동을자제하고, 창문을닫고주로실내에서지내세요. 공기청정기가도움이될수있습니다. 심장및뇌혈관질환자는장시간의힘든육체활동을줄여주세요. 호흡곤란, 가래, 기침등호흡기증상이악화되는경우에는바로병원으로가세요. 비염등동반질환이있는경우미세먼지의영향이더클수있으니천식이악화되었을때의행동요령을숙지하시고필요시의사와상담하세요. 물을적당히마시는것은몸밖으로노폐물을내보내는효과가있어도움이됩니다. 부적절한마스크착용이위험할수있습니다. 반드시의사와상의한후착용하세요. 착용후두통, 호흡곤란, 어지러움이있으면바로벗으세요. 기침, 호흡곤란, 쌕쌕거림등의천식증상과최대호기유속을측정해천식수첩에기록하세요. 심혈관질환자는미세먼지에노출되지않는것이중요합니다. 실외활동을줄이고, 창문을닫고주로실내에서지내세요. 공기청정기가도움이될수있습니다. 38

13 주간건강과질병 제 12 권제 11 호 [ 미세먼지안내문 ] 올바른마스크착용법 39

14 주간건강과질병 제 12 권제 11 호 31

15 주요감염병통계, Statistics of selected infectious diseases 1.1 환자감시 : 전수감시감염병주간발생현황 (1 주차 ) Table 1. Reported cases of national infectious diseases in Republic of Korea, ending March 9, 219 (1th Week)* Category Ⅰ Category Ⅱ Category Ⅲ Category Ⅳ Classification of disease 219 ly average Total no. of cases by year Cholera Typhoid fever Laos(1) Paratyphoid fever Shigellosis EHEC Viral hepatitis A 284 1, ,451 4,419 4,679 1,84 1,37 Pertussis Unit: No. of cases Imported cases of current : Country (no. of cases) Tetanus Measles Vietnam(3) Mumps 33 2, ,251 16,924 17,57 23,448 25,286 Philippines(1) Rubella Viral hepatitis B (Acute) Japanese encephalitis Varicella 1,83 17, ,47 8,92 54,6 46,33 44,45 Haemophilus influenza 2 3 type b Streptococcus pneumoniae Malaria Mozambique(1), Uganda(1), Equatorial Guinea(1) Scarlet fever 16 1, ,781 22,838 11,911 7,2 5,89 Meningococcal meningitis Legionellosis Vibrio vulnificus sepsis Murine typhus Scrub typhus ,752 1,528 11,15 9,513 8,13 Leptospirosis Brucellosis Rabies HFRS Syphilis ,27 2,148 1,569 1,6 1,15 Uzbekistan(1) CJD/vCJD Tuberculosis 574 5, ,553 28,161 3,892 32,181 34,869 HIV/AIDS ,9 1,62 1,18 1,81 Viral hepatitis C 182 1,795-11,23 6, VRSA CRE 25 2,435-11,923 5, Dengue fever United States of America(1), Vietnam(1), Indonesia(1), Thailand(1) Q fever West Nile fever Lyme Borreliosis Melioidosis Chikungunya fever Indonesia(1) SFTS MERS Zika virus infection French Polynesia(1) Abbreviation: EHEC= Enterohemorrhagic Escherichia coli, HFRS= Hemorrhagic fever with renal syndrome, CJD/vCJD= Creutzfeldt-Jacob Disease / variant Creutzfeldt-Jacob Disease, VRSA= Vancomycin-resistant Staphylococcus aureus, CRE= Carbapenem-resistant Enterobacteriaceae, SFTS= Severe fever with thrombocytopenia syndrome, MERS-CoV= Middle East Respiratory Syndrome Coronavirus. Cum: Cumulative counts from 1st to current in a year. * The reported data for year 217, 218 are provisional but the data from 213 to 216 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, 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, 212. 문의 : (43)

16 Table 2. Reported cases of infectious diseases by geography, ending March 9, 219 (1th Week)* Diseases of Category Ⅰ Unit: No. of cases Reporting area Cholera Typhoid fever Paratyphoid fever Shigellosis Overall Seoul Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju 1 Cum: Cumulative counts from 1st to current in a year * The reported data for year 218, 219 are provisional but the data from 214 to 217 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 1st to current for 5 preceding years

17 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending March 9, 219 (1th Week)* Unit: No. of cases Diseases of Category Ⅰ Diseases of Category Ⅱ Reporting area Enterohemorrhagic Escherichia coli Viral hepatitis A Pertussis Tetanus Overall , Seoul Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year 218, 219 are provisional but the data from 214 to 217 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 1st to current for 5 preceding years

18 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending March 9, 219 (1th Week)* Diseases of Category Ⅱ Unit: No. of cases Reporting area Measles Mumps Rubella Viral hepatitis B (Acute) Overall ,531 3, Seoul Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year 218, 219 are provisional but the data from 214 to 217 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 1st to current for 5 preceding years

19 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending March 9, 219 (1th Week)* Unit: No. of cases Diseases of Category Ⅱ Diseases of Category Ⅲ Reporting area Japanese encephalitis Varicella Malaria Scarlet fever Overall 1,83 17,448 11, ,559 2,565 Seoul 143 1,891 1, Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi 293 4,593 3, Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk 64 1, Gyeongnam 127 2, Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year 218, 219 are provisional but the data from 214 to 217 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 1st to current for 5 preceding years

20 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending March 9, 219 (1th Week)* Diseases of Category Ⅲ Unit: No. of cases Reporting area Meningococcal meningitis Legionellosis Vibrio vulnificus sepsis Murine typhus Overall Seoul Busan 4 2 Daegu 3 1 Incheon 5 2 Gwangju Daejeon Ulsan 1 1 Sejong Gyonggi Gangwon Chungbuk Chungnam Jeonbuk Jeonnam 2 Gyeongbuk Gyeongnam Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year 218, 219 are provisional but the data from 214 to 217 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 1st to current for 5 preceding years

21 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending March 9, 219 (1th Week)* Diseases of Category Ⅲ Unit: No. of cases Reporting area Scrub typhus Leptospirosis Brucellosis Hemorrhagic fever with renal syndrome 219 Overall Seoul Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong 1 Gyonggi Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year 218, 219 are provisional but the data from 214 to 217 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 1st to current for 5 preceding years

22 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending March 9, 219 (1th Week)* Unit: No. of cases Diseases of Category Ⅲ Diseases of Category Ⅳ Reporting area Syphilis CJD/vCJD Tuberculosis Dengue fever Overall ,12 5, Seoul , Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi ,14 1, Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year 218, 219 are provisional but the data from 214 to 217 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 1st to current for 5 preceding years

23 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending March 9, 219 (1th Week)* Diseases of Category Ⅳ Unit: No. of cases Reporting area Q fever Lyme Borreliosis SFTS Zika virus infection Overall Seoul Busan Daegu Incheon Gwangju Daejeon 2 - Ulsan Sejong - Gyonggi Gangwon 1 - Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju - Cum: Cumulative counts from 1st to current in a year * The reported data for year 218, 219 are provisional but the data from 214 to 217 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 1st to current for 5 preceding years

24 1.2 환자감시 : 표본감시감염병주간발생현황 (1 주차 ) 1. Influenza, Republic of Korea, s ending March 9, 219 (1th ) 219 년도제 1 주인플루엔자표본감시 ( 전국 2 개표본감시기관 ) 결과, 의사환자분율은외래환자 1, 명당 9.1 명으로지난주 (8.3 명 ) 대비증가 절기유행기준은 6.3 명 (/1,) ILI per 1, Figure 1. Weekly proportion of influenza-like illness per 1, outpatients, to flu seasons 2. Hand, Foot and Mouth Disease(HFMD), Republic of Korea, s ending March 9, 219 (1th ) 219 년도제 1 주차수족구병표본감시 ( 전국 95 개의료기관 ) 결과, 의사환자분율은외래환자 1, 명당 1.2 명으로전주와동일 수족구병은 29 년 6 월법정감염병으로지정되어표본감시체계로운영 No. of outpatients / 1, Figure 2. Weekly proportion of hand, foot and mouth disease per 1, outpatients,

25 3. Ophthalmologic infectious disease, Republic of Korea, s ending March 9, 219 (1th ) 219 년도제 1 주차유행성각결막염표본감시 ( 전국 92 개의료기관 ) 결과, 외래환자 1, 명당분율은 14.5 명으로전주 14.8 명대비감소 동기간급성출혈성결막염의환자분율은.6 명으로전주와동일 6 5 No. of outpatients / 1, Figure 3. Weekly proportion of epidemic keratoconjunctivitis per 1, outpatients 5 4 No. of outpatients / 1, Figure 4. Weekly proportion of acute hemorrhagic conjunctivitis per 1, outpatients 321

26 4. Sexually Transmitted Diseases, Republic of Korea, s ending March 9, 219 (1th ) 219 년도제 1 주성매개감염병표본감시기관 ( 전국보건소및의료기관 59 개참여 ) 에서신고기관당첨규콘딜롬 2.5 건, 클라미디아감염증 2.3 건, 성기단순포진 2.1 건, 임질 1.3 건발생을신고함. 제 1 주차신고의료기관수 : 임질 13 개, 클라미디아 55 개, 성기단순포진 36 개, 첨규콘딜롬 25 개 Unit: No. of cases/sentinels Gonorrhea Chlamydia Genital herpes Condyloma acuminata Cum: Cumulative counts from 1st 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 1st to current for 5 preceding years. 문의 : (43) , 수인성및식품매개감염병집단발생주간현황 (1 주차 ) Waterborne and foodborne disease outbreaks, Republic of Korea, s ending March 9, 219 (1th ) 219 년도제 1 주에집단발생이 15 건 ( 사례수 255 명 ) 이발생하였으며누적발생건수는 94 건 ( 사례수 1,33 명 ) 이발생함 No. of outbreaks Average no. of cases in last 5 years( ) Figure 5. Number of waterborne and foodborne disease outbreaks reported by,

27 2.1 병원체감시 : 인플루엔자및호흡기바이러스주간감시현황 (1 주차 ) 1. Influenza viruses, Republic of Korea, s ending March 9, 219 (1th ) 219 년도제 1 주에전국 52 개감시사업참여의료기관에서의뢰된호흡기검체 217 건중양성 23 건 (A/H1N1pdm9 1 건, A/H3N2 15 건, B 형 7 건 ). No. of positives A(H3N2) A(not subtyped) A(H1N1)pdm9 B Percent positive Percent positives (%) Figure 6. Number of specimens positive for influenza by subtype, flu season 2. Respiratory viruses, Republic of Korea, s ending March 9, 219 (1th ) 219 년도제 1 주호흡기검체 (217 건 ) 에대한유전자검사결과 49.3% 의호흡기바이러스가검출되었음. ( 최근 4 주평균 222 개의호흡기검체에대한유전자검사결과를나타내고있음 ) 주별통계는잠정통계이므로변동가능 219 () Weekly total Detection rate (%) No. of samples 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 February 1, 219. March 9, 219, (Average no. of detected cases is 222 last 4 s) 218 : the rate of detected cases between January 1, December 29, 218 자세히보기 : 질병관리본부 질병 건강 주간질병감시정보 323

28 2.2 병원체감시 : 급성설사질환실험실표본주간감시현황 (9 주차 ) Acute gastroenteritis-causing viruses and bacteria, Republic of Korea, s ending March 2, 219 (9th ) 219년도제9주실험실표본감시 (17 개시 도보건환경연구원및 7개의료기관 ) 급성설사질환유발바이러스검출건수는 27건 (48.2%), 세균검출건수는 13건 (1.2%) 이었음. Acute gastroenteritis-causing viruses Week No. of sample No. of detection (Detection rate, %) Norovirus Group A Rotavirus Enteric Adenovirus Astrovirus Sapovirus Total (28.) 8 (16.) 1 (2.) 1 (2.) (.) 24 (48.) (31.5) 4 (5.5) (.) (.) (.) 27 (37.) (18.8) 8 (12.5) (.) 4 (6.3) 1 (1.6) 25 (39.1) (28.6) 8 (14.3) 1 (1.8) 2 (3.6) (.) 27 (48.2) (33.8) 44 (8.3) 2 (.4) 12 (2.3) 2 (.4) 238 (45.2) * 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 (3.) 1 (.6) () () () 3 (1.8) 3 (1.8) 3 (1.8) () 16 (9.6) (1.7) 2 (1.1) () () () 3 (1.7) 4 (2.3) 4 (2.3) 1 (.6) 17 (9.7) (.6) 1 (.6) () () () () 2 (1.1) 3 (1.7) 3 (1.7) 1 (5.7) (1.6) 5 (3.9) () () () () 3 (2.3) 2 (1.6) 1 (.8) 13 (1.2) 1,495 2 (1.3) 24 (1.6) () () () 1 (.7) 34 (2.3) 29 (1.9) 11 (.7) 129 (8.6) * 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 218 (7 hospitals) 자세히보기 : 질병관리본부 질병 건강 주간질병감시정보 324

29 2.3 병원체감시 : 엔테로바이러스실험실주간감시현황 (9 주차 ) Enterovirus, Republic of Korea, s ending March 2, 219 (9th ) 219년도제9주실험실표본감시 (14 개시 도보건환경연구원, 전국 57개참여병원 ) 결과, 엔테로바이러스검출률 14.3%(3건양성 /21 검체 ), 219년누적양성률 9.%(13 건양성 /144 검체 ) 임. - 무균성수막염 2건 (219 년누적 6건 ), 수족구병및포진성구협염 1건 (219 년누적 6건 ), 합병증동반수족구 건 (219 년누적 건 ), 기타 건 (219 년누적 1건 ) 임. Aseptic meningitis 8 No. of cases Enterovirus detection cases 218 Enterovirus detection cases Figure 7. Detection cases of enterovirus in aseptic meningitis patients from 218 to 219 HFMD and Herpangina No. of cases Enterovirus detection cases 218 Enterovirus detection cases Figure 8. Detection cases of enterovirus in HFMD and herpangina patients from 218 to 219 HFMD with Complications No. of cases Enterovirus detection cases 218 Enterovirus detection cases Figure 9. Detection cases of enterovirus in HFMD with complications patients from 218 to

30 주요통계이해하기 < 통계표 1> 은지난 5년간발생한법정감염병과 218 년해당주발생현황을비교한표로, 금주환자수 ( ) 는 218 년해당주의신고건수를나타내며, 218 년누계환자수 ( 218) 는 218년 1주부터해당주까지의누계건수, 그리고 5년주평균환자수 ( ly average) 는지난 5년 ( 년 ) 해당주의신고건수와이전 2주, 이후 2주의신고건수 ( 총 25주 ) 평균으로계산된다. 그러므로금주환자수 ( ) 와 5년주평균환자수 ( ly average) 의신고건수를비교하면해당주단위시점과예년의신고수준을비교해볼수있다. 연도별환자수 (Total no. of cases by year) 는지난 5년간해당감염병현황을나타내는확정통계이며연도별현황을비교해볼수있다. 예 ) 218 년 12 주의 5년주평균환자수 ( ly average) 는 213 년부터 217 년의 1 주부터 14 주까지의신고건수를 총 25주로나눈값으로구해진다. * 5년주평균환자수 ( ly average)=(x1 + X2 + + X25)/25 1주 11주 12주 13주 14주 218년 해당주 217년 X1 X2 X3 X4 X5 216년 X6 X7 X8 X9 X1 215년 X11 X12 X13 X14 X15 214년 X16 X17 X18 X19 X2 213년 X21 X22 X23 X24 X25 < 통계표 2> 는 17 개시 도별로구분한법정감염병보고현황을보여주고있으며, 각감염병별로최근 5년누계평균환자수 (Cum, average) 와 218년누계환자수 (Cum, 218) 를비교해보면최근까지의누적신고건수에대한이전 5년동안해당주까지의평균신고건수와비교가가능하다. 최근 5년누계평균환자수 (Cum, average) 는지난 5년 ( 년 ) 동안의동기간신고누계평균으로계산된다. 기타표본감시감염병에대한신고현황그림과통계는최근발생양상을신속하게파악하는데도움이된다.

31 발간등록번호 주간건강과질병, PHWR 은질병관리본부에서시행되는조사사업을통해생성된감시및연구자료를기반으로근거중심의건강및질병관련정보를제공하고자최선을다할것이며, 제공되는정보는질병관리본부의특정의사와는무관함을알립니다. 본간행물에서제공되는감염병통계는 감염병의예방및관리에관한법률 에의거, 국가감염병감시체계를통해신고된자료를기반으로집계된것으로집계된당해년도자료는의사환자단계에서신고된것이며확진결과시혹은다른병으로확인될경우수정될수있는잠정통계임을알립니다. 주간건강과질병, PHWR 은질병관리본부홈페이지를통해주간단위로게시되고있으며, 정기적구독을원하시는분은 이메일을통해보내지는본간행물의정기적구독요청시구독자의성명, 연락처, 직업및이메일주소가요구됨을알려드립니다. 주간건강과질병 발간관련문의 : kcdc215@korea.kr/ /33 창 발 간 : 28 년 4 월 4 일 행 : 219 년 3 월 14 일 발행인 : 정은경 편집인 : 지영미 편집위원 : 최영실, 김기순, 조신형, 조성범, 김봉조, 구수경, 김용우, 조은희, 이은규, 윤여란, 신영림, 김청식, 권효진 편 집 : 질병관리본부유전체센터의과학지식관리과 충북청주시흥덕구오송읍오송생명 2 로 187 오송보건의료행정타운 ( 우 )28159 Tel. (43) /33 Fax. (43)