주간건강과질병 제 11 권제 15 호 연구논문, Research article 미세먼지의건강영향과건강보호수칙 질병관리본부기획조정부미래감염병대비과조현정, 박성우, 이희일, 이상원 * * 교신저자 : Health effec

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1 pissn X eissn PUBLIC HEALTH WEEKLY REPORT, PHWR Vol.11 No.15 CONTENTS 458 미세먼지의건강영향과건강보호수칙 463 국내도심환경내흰줄숲모기 (Aedes albopictus) 지리적분포조사 47 주요감염병통계환자감시 : 전수감시, 표본감시 병원체감시 : 인플루엔자및호흡기바이러스 급성설사질환, 엔테로바이러스

2 주간건강과질병 제 11 권제 15 호 연구논문, Research article 미세먼지의건강영향과건강보호수칙 질병관리본부기획조정부미래감염병대비과조현정, 박성우, 이희일, 이상원 * * 교신저자 : epilsw@korea.kr, Health effects caused by particulate matter and guidelines for health care Jo Hyun-Jung, Park Seong-Woo, Lee Hee-Il, Lee Sang-Won Division of Strategic Planning for Emerging Infectious Diseases, KCDC Background: Since particulate matter (PM) comprises extremely small particles, it can persist in the atmosphere and penetrates the lungs through the respiratory tract and is transported to different parts of the body through the blood vessels, causing adverse effects on human body. PM mainly affects the respiratory and cardiovascular systems and can induces inflammatory reactions through direct contact with the skin, eyes, nose and throat mucous membranes. Because the annual average concentration of PM in Korea remains continuously high in spring and winter, it is essential to protect human health against its adverse impacts. status: PM can affect the general population, especially those with low immunity, such as children, elderly, pregnant females, and patients with underlying diseases (respiratory diseases, cardiovascular diseases, and asthma), who can be classified as the vulnerable group. Future Perspective: The best precaution against PM is to minimize exposure. Therefore, it is important to check the daily PM concentration and minimize outdoor activity. Wearing of masks by individuals belonging to the vulnerable group may lead to development of symptoms such as dyspnea, headache. In this case, they need to take off it immediately and consult with doctors about the mask wearing. Keywords: Particulate matter, Respiration disorders, Cardiovascular diseases, Inflammation, Mucous membrane 들어가는말 미세먼지 (Particulate Matter, PM) 는대기중에떠다니거나 흩날려내려오는입자상물질인먼지중, 입자가매우작은것으로 지름이 1 μm보다작은경우 (PM 1 ) 와 2.5 μm보다작은경우 (PM 2.5 ) 로나뉜다. 미세먼지를이루는성분은그미세먼지가발생한지역이나계절, 기상조건등에따라달라질수있으나, 일반적으로는대기오염물질이공기중에서반응하여형성된덩어리 ( 황산염, 458

3 주간건강과질병 제 11 권제 15 호 질산염등 ), 석탄 석유등화석연료를태우는과정에서발생하는탄소류와검댕, 지표면흙먼지등에서생기는광물등으로구성된다. 미세먼지발생원은자연적인것과인위적인것으로구분된다. 자연적발생원은흙먼지, 바닷물에서생기는소금, 식물의꽃가루등이있다. 인위적발생원은보일러나발전시설등에서석탄 석유등화석연료를태울때생기는매연, 자동차배기가스, 건설현장등에서발생하는날림먼지, 공장내분말형태의원자재나부자재취급공정에서의가루성분, 그리고소각장연기등이있다. 또한, 가정에서가스레인지, 전기그릴, 오븐등을사용하여조리를할때도발생한다 [1]. 미세먼지는눈에보이지않을만큼매우작기때문에대기중에머물러있다가호흡기를거쳐폐등에침투하거나혈관을따라체내로이동하여들어감으로써인체에나쁜영향을미칠수있다 [2]. 현재까지알려진바에따르면, 미세먼지는일차방어막인피부와눈, 코또는인후점막에직접접촉하여물리적자극과국소염증반응을 나타났으며, 대기오염은뇌졸중, 심장질환, 폐암, 천식을포함한급 만성호흡기질환의질병부담을가중시키는것으로알려져있다. 212년기준 PM 2.5 의노출정도에따른질병부담을파악한결과, 전세계적으로약 3백만명이실외대기오염에의해조기사망하는것으로추정되며, 이중 72% 가심뇌혈관질환, 14% 가만성폐쇄성폐질환 (Chronic Obstructive Pulmonary Disease, COPD) 또는급성하기도감염, 14% 가폐암으로조기사망한것으로추정하였다. 이들 88% 는저소득또는중간소득국가들로서대부분이서태평양지역과동남아시아지역의국가들이었다 [7]. 한편, 216년경제협력개발기구 (Organisation for Economic Co-operation and Development, OECD) 보고서에따르면실외미세먼지와오존으로인한조기사망률이인구백만명당, 중국 (2,52명), 인도 (2,39명), 카스피해인근 (1,11명), 한국 (1,19 명 ) 순으로높았으며, OECD 국가중에서는한국이가장높은조기사망률을보이는것으로나타났다 [8]. 유발한다고알려져있으며, 조직및세포독성의기전으로산화 스트레스증가 (oxidative damage) 가가장대표적이며, 염증반응에의한손상 (inflammatory damage), 및 DNA 손상 (DNA damage) 등이알려져있다. 미세먼지는허혈성심장질환및뇌졸중과같은심혈관계질환및호흡기질환발생에가장큰영향을미치는것으로알려져있으며, 특히 PM 2.5 의경우입자가더작아더많은영향을끼치고이에대한기전및원인에대한연구가보고되고있다 [3]. 213년세계보건기구 (World Health Organization, WHO) 유럽지구보고서에따르면장기간 ( 수개월이상 ) PM 2.5 에노출시, PM 2.5 농도가 1 μg /m 3 증가할때마다심장질환및폐질환으로인한사망률이 몸말 국내연평균미세먼지농도는그간여러미세먼지저감정책수립및적용으로점점줄어들고있는추세이다 [9]. 하지만겨울철과봄철의경우, 미세먼지농도가지속적으로높게나타나고있어국민건강보호를위한대책마련이필요하다. 따라서이글에서는각민감계층별미세먼지에의한건강영향을알아보고, 민감계층의미세먼지에대한건강보호방법을자세히알아보고자한다. 6 13% 증가한다고보고하였다 [4]. 또한이외에도저체중, 조산등 임산부와태아에서의 PM 2.5 의영향에대해보고되고있다 [5]. 1) 미세먼지건강영향 WHO 는미세먼지 (PM 1, PM 2.5 ) 에대한대기질가이드라인을 1987년부터제시해왔고, 213년에는세계보건기구산하의국제암연구소 (International Agency for Research on Cancer, IARC) 에서대기오염과미세먼지 (outdoor air pollution, particulate matter) 를 1군발암물질 (Group 1) 로지정하였다 [6]. 214년기준으로전세계인구의 92% 가 WHO에서제시한대기오염제한기준을초과하는지역에살고있는것으로 미세먼지는일반인을비롯한모든계층에영향을끼칠수있으나, 특히면역력이약한어린이, 어르신, 임산부는미세먼지민감계층으로분류할수있다. 또한미세먼지가주로호흡기계나심혈관계에영향을미치는만큼호흡기질환, 심혈관질환, 천식등의기저질환자도민감계층으로분류할수있다. 어린이의경우, 아직폐를비롯한장기들의발달이다 459

4 주간건강과질병 제 11 권제 15 호 이루어지지않아, 미세먼지가어린이의폐등장기발달및성장을 응급실방문및입원도 29% 증가한것으로보고되었다 [11]. 저해할수있다. 임산부의경우, 아직까지명확하게기전이밝혀지진 않았으나, 산모에게노출되는대기오염물질들이모체의태반을 2) 건강보호수칙 통해그대로태아에게전달될뿐만아니라산소나영양분공급 능력을감소시켜태아의발달과성장에큰악영향을초래할수있어저체중또는조산의원인이될수있다고알려져있다 [1]. 어르신의경우당뇨, 고혈압등기저질환과호흡기질환, 심혈관질환등의중증질환을가지고있는경우가많아미세먼지로인한건강피해가더악화되는것으로보고되고있다. 미세먼지는폐렴, 폐암발생을증가시키고폐기능을저하시키며, 만성호흡기질환자의증상을악화시킬수있다. 특히만성폐쇄성폐질환 (COPD) 의급성악화를유발하기도한다. 질병관리본부연구보고서에따르면, 미세먼지 (PM 1 ) 농도가 1 μg / m3증가할때마다만성폐쇄성폐질환 (COPD) 으로인한입원률이 2.7%, 사망률은 1.1% 증가하고미세먼지 (PM 2.5 ) 농도가 1 μg / m3증가할때마다폐암발생률이 9% 증가하는것으로보고된바있다 [11]. 또한, 미세먼지는혈관등에자극을주어심근경색, 허혈성심질환, 부정맥, 뇌졸중등의심뇌혈관질환자의증상을더욱악화시키는것으로알려져있다. 심지어일반인의경우도미세먼지에장기간노출이될경우, 심근경색과같은허혈성심장질환이나심부전의발생이증가하고심혈관질환으로사망에이르는것으로보고되고있다. 질병관리본부연구보고서에따르면미세먼지에장기간노출시, 평균 PM 2.5 농도 1 μg / m3증가할때사망률이약 1% 증가함을보였고, 이들중심혈관질환연관사망률은 3~76% 까지증가하는것으로보고되었다 [12]. 또한, 미세먼지 (PM 1 ) 농도 1 μg / m3증가시뇌혈관질환사망률이 1% 증가됨이확인되었고, 미세먼지 (PM 2.5 ) 농도 1 μg / m3증가시뇌혈관질환으로인한사망발생위험도가 8% 증가되고뇌졸중또한 2% 이상증가시키며, 뇌혈관질환에의한입원률도증가시킨다는보고가있다 [12-13]. 미세먼지는천식환자에게기침, 쌕쌕거림, 호흡곤란등의 미세먼지에대한최선의예방수칙은노출을최소화하는것이다. 일반인의경우, 외출이나야외활동을할때미세먼지차단마스크를착용하는것이미세먼지노출을최소화할수있는최선의방법이라할수있다. 그러나, 어린이, 임산부, 어르신등미세먼지취약계층과기존기저질환자 ( 호흡기질환, 심뇌혈관질환, 천식 ) 의경우, 미세먼지차단마스크를착용했을시호흡곤란, 두통등의부작용이발생할수있어증상발생시에는마스크를즉각벗어야하며, 기저질환자의경우사전에의사와상담한후마스크착용을결정해야한다. 최근, 미세먼지농도가높아지는계절에는평소에다음과같은예방수칙을실천할필요가있다. 1) 평소일기예보및어플등을통해주거지역의미세먼지농도를수시로파악하고 2) 미세먼지농도가나쁠시외출을자제하는것 ( 미세먼지농도가보통일지라도몸상태가좋지않을때는주의 ) 이좋다. 또한 3) 기저질환자는기존의호흡기질환, 심뇌혈관질환, 천식등에대해적절한치료및관리를꾸준히유지해야하며 4) 의사와상의후미세먼지차단마스크 ( 식약처인증 ) 를착용하여야한다. 미세먼지가건강에미치는영향은수일에서최대 6주까지지속될수있으므로, 5) 미세먼지농도가나쁨이후기저질환증상이악화될경우반드시병원방문또는의사와상담하여야한다. 만성폐쇄성폐질환 (COPD) 환자는미세먼지농도가 나쁨 이상인날부득이하게외출할때에는치료약물 ( 속효성기관지확장제 ) 을준비하는것이바람직하며, 심혈관질환자는심장과혈관에부담을주는힘든육체활동을줄이는것이좋다. 천식환자도외출시천식증상완화제를가지고다니는게좋으며, 어린이천식환자는유치원이나학교보건실에개인증상완화제를맡겨두어필요한경우언제든사용할수있도록하는것이좋다. 천식증상을악화시키고폐기능을저하시킬수있다. 심한경우천식발작을일으켜응급실방문과입원을증가시킬수있다. 질병관리본부연구보고서에따르면미세먼지 1 μg / m3증가시천식악화증상이 29% 증가하는것으로나타났고, 천식악화로인한 46

5 주간건강과질병 제 11 권제 15 호 A. Korean version 장시간육체활동금지 공기여과시스템사용 만성폐쇄성폐질환 (COPD) 환자는외출시구제약물소지 비염등동반질환이있는경우의사와상담 염증 기존질환을적극적관리 호흡기증상악화되는경우바로병원으로 보건용마스크사용이위험할수있으니반드시의사와상의 실외활동되도록피하고창문닫고실내활동 공기좋은때와장소를고려하여꾸준히운동 미세먼지발생후수일간그영향이지속됨 매년인플루엔자 ( 독감 ) 예방접종실시 외출시천식증상완화제휴대, 학교보건실에도보관 천식증상과최대호기유속측정해서천식수첩에기록, 천식악화행동요령숙지 B. English version Guidelines for health care to vulnerable groups COPD patients have relief drug when they go out Cardiovascular patient No more physical activity Use of air filtration system Consult your doctor if you have any disease such as rhinitis IF the respiratory symptoms get worse, consult a physician immediately Inflammatory reaction Respiratory patient Consult your physician to use a health mask Active management of underlying disease Avoiding out door activities, closing the windows and doing indoor activities Allergic patient Exercise only in good air quality and place Effect lasts for several days after particulate matter Asthma patient Getting the Flu vaccination every year Record asthma symptom and Carry out asthma relief when maximal expiratory flow rate in going out, store asthma asthma handbook, remembering symptom relievers in school asthma exacerbation behavior tip health room Figure 1. Guidelines for health care to vulnerable groups of particulate matter 461

6 주간건강과질병 제 11 권제 15 호 맺는말 WHO 대기오염보고서에따르면 212년기준실외대기오염으로연간 3만명이, 실내대기오염으로 35만명이조기사망했다고보고하였다 [7]. 이와같이실내와실외모두미세먼지로부터안전한것은아니며, 실외미세먼지농도가높을시환기를최소화하지만평소에는실내공기를주기적으로환기를해야한다. 특히실내에서는가정에서요리중미세먼지가발생할수있으므로요리중, 요리후반드시환기를해야한다. 한편, 차량이동이많은도로변에위치한주거지의경우, 환기시차량이동이적은시간을이용하거나도로변에위치하지않은창문을이용하여 IARC WHO OECD The economic consequence of outdoor air pollution 9. 환경부국립환경과학원. 대기환경연보 질병관리본부. 대기오염에대한건강피해연계성연구 질병관리본부. 미세먼지황사건강피해예방및관리권고지침개발연구 ( 호흡기질환 ) 질병관리본부. 미세먼지황사건강피해예방및관리권고지침개발연구 ( 심혈관질환 ) Miller KA, Siscovick DS, Sheppard L, Shepherd K, Sullivan JH, Anderson GL and Kaufman JD. Long-term exposure to air pollution and incidence of cardiovascular events in women. The New England journal of medicine. 27;356(5): 환기하는것이적절하다. 우리나라에서는미세먼지에대한국민들의건강피해를낮추기위해, 미세먼지관리종합대책 ( 17.9) 을수립함으로써미세먼지저감대책과민감계층보호대책을마련하고있다. 하지만미세먼지농도가개선되기위해서는장기적으로시간이소요될수있기때문에개인의건강상태, 질환과거력및현재질병여부, 생활환경등을고려하여개인에게맞는건강보호수칙을실천함으로써미세먼지에대한건강보호를해야할것이다. 참고문헌 1. 환경부 바로알면보인다. 미세먼지, 도대체뭘까? 2. Jennifer A. Fine particulate matter air pollution and cognitive function among U.S. older adults. Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 214;7(2): EPA WHO regional office for Europe Health effects of particulate matter. 5. Zhengmin Qian, Shengwen Liang, Shaoping Yang, Edwin T. Zhen Huang, Rong Yang, Jing Wang, Ke Hu, Yiming Zhang, Michael V, Longjiao Shen, Wenjin Liu, Pu Li, Patrick W, Li Yang, Wei Zhang, Wei Chen, Guanghui Dong, Tongzhang Zheng, Shunqing Xu, Bin Zhang. Ambient air pollution and preterm birth: a prospective birth cohort study in Wuhan, China. Int J Hyg Env Health. 215;219:

7 주간건강과질병 제 11 권제 15 호 연구단신, Brief report 국내도심환경내흰줄숲모기 (Aedes albopictus) 지리적분포조사 질병관리본부감염병분석센터매개체분석과양성찬, 이은정, 이욱교, 조신형 * * 교신저자 : cho4u@korea.kr, Geographical distribution of Aedes albopictus around urban areas in Korea Yang Sung-Chan, Lee Eun Jung, Lee Wook-Gyo, Cho Shin-Hyeong Division of Vector and Parasitic Diseases, Center for Laboratory Control of Infectious Disease, KCDC Aedes albopictus (Skuse) is known as the major vector of human arboviruses that can transmit approximately 22 viruses belonging to Togaviridae, Flaviviridae, Bunyaviridae families. Recently, Aedes albopictus has been suggested to be involved in the transmission of Zika virus in several countries, including Southeast Asia. In this study, mosquitoes were collected from 27 cities in Korea during March to November (twice a month) in 216; a total of 12,12 mosquitoes, belonging to 19 species from 8 genera, was collected. Of these, 21,467 mosquitoes were Ae. albopictus : 2,961 (97.6%) were collected by BG-Sentinel trap and 56 (2.4%) by Black-light trap in the urban areas. The trap index (trap per night) of Ae. albopictus was highest in Hamyang (TI: 47.3) and lowest in Taebaek (TI: <.1), where only black-light trap was used. Although a total of 894 pools from the collected Ae. albopictus was performed, Flavivirus including Zika virus was not detected during the study period. During April to September, Ae. albopictus was widely distributed in urban areas in Korea around hills and parks. The results of this study provide basic information about the status of Ae. albopictus in Korea in order to devise strategies to prevent overseas inflow of Zika virus infection. Thus, personal hygiene management after outdoor activities would be critical for the prevention of Zika virus infection. Keywords: Aedes albopictus, Arboviruses, Zika Virus, Disease vectors, Flavivirus 들어가는말 신생아의소두증등을유발하는것으로알려진지카바이러스는 1947 년우간다지카 (Zika) 숲에사는붉은털원숭이에서최초로 확인되었고, 인체감염사례는 1952 년우간다와탄자니아에서처음 보고되었다. 지카바이러스감염증은과거아프리카, 동남아, 태평양 463

8 주간건강과질병 제 11 권제 15 호 Figure 1. Collection areas Figure 2. Species distribution of mosquitoes collected by BG-sentinel trap (A) and Black light trap (B) 섬지역에서주로발생이보고되었으나 215년브라질에서첫보고된이후점차유행지역이확산되어이후 7개이상국가에서지속적으로발생하고있다. 국내의경우브라질여행자였던 43세남자에서해외감염유입이확인된이후 216년 17명, 217년 8명의환자가발생하였다 [1]. 이집트숲모기 (Aedes agypti) 와함께지카바이러스감염증을매개하는것으로알려진흰줄숲모기 (Aedes albopictus) 는지카바이러스를포함한 22종의 arbovirus 전파가가능한것으로알려져있으며열대및아열대지방에서는연중활동하는반면온대지방에서는내한성이높은알로월동을하는 규명하는데매우중요한역할을한다 [3,4]. 이에질병관리본부매개체분석과에서는지카바이러스환자의국내유입이지속적으로발생하고있는시점에서해외유입질병의유입가능성을감시하고자지카바이러스의매개체로알려진흰줄숲모기 (Ae. albopictus) 를중심으로국내서식모기에대한지리적분포조사를실시하였다 [5]. 성충모기가활동하는시기인 3월부터 11월까지사람과의접촉가능성이높은도심지역에서연중감시및분포조사를실시하여향후모기방제및감시체계구축을위한기초자료를제공하고자한다. 것으로알려져있다 [2]. 최근국제교류증가및기온상승을포함한지구온난화로매개체발생분포가확대되고해외에존재하는매개체의국내유입가능성이커짐에따라해외풍토국가로부터해외감염성바이러스 ( 지카바이러스, 뎅기열등 ) 유입가능성이높아지고있으며토착성질환 ( 말라리아, 일본뇌염등 ) 의발생이증가하고있다. 이와같이매개체의지리적분포는감염병발생현황과매개체의전파력을 몸말 질병관리본부감염병분석센터매개체분석과에서는지카바이러스유행에따른국내유입에대비하여 216년 3월부터 11월까지전국 27개도시 53개지점에서 BG-sentinel trap(22개 464

9 주간건강과질병 제 11 권제 15 호 2, 1,8 1,6 1,725.2 Aedes albopictus Total Trap index of mosquitoes 1,4 1,2 1, , Park Hill Dwelling Environment Figure 3. Trap index (TI) of mosquitoes by collection area 지점 ) 과 Black-light trap(21개지점 ) 을이용하여흰줄숲모기 (Ae. albopictus) 를포함한감염병매개모기의국내분포및플라비바이러스감염여부를조사하였다 (Figure 1). 조사결과, 총 8속 19종 12,12개체 (TI: 113.3) 의모기가채집되었는데, BG-sentinel trap에서 86,364개체 (TI: 188.2) 가채집되어전체채집모기의 84.6% 가채집되었으며, Black-light trap에서 15,738 개체 (TI: 34.3) 로 15.4% 가채집되어 BG-sentinel trap에서더많은양의모기가채집되었다 (Figure 2). Figure 2에서보는바와같이채집모기의종별분포를확인한결과빨간집모기류 (Culex pipiens complex) 가평균 53.3개체 (47.1%) 채집되어가장우점종으로나타났으며, 흰줄숲모기 (A e. albopictus) 의경우 23.8개체 (21.3%) 로전체채집모기중두번째로우점종으로나타났다. 빨간집모기류 (Cx. pipiens complex) 의경우 BG-sentinel trap과 Black-light trap에서모두가장높은비율로채집된반면, 흰줄숲모기 (Ae. albopictus) 의경우 BG-sentinel trap에서전체채집모기중 24.3%(2,961개체 ) 로높은비율로채집되어 Black-light trap(56 개체 ) 채집률 (3.2%) 보다약 8배이상높은비율로채집되었다 (Figure 2). Figure 3에서보는바와같이채집된모기를환경별로분석해본결과공원에서평균 1,725.2개체 (49.8%), 야산에서 1,34.7개체 (37.7%), 주거지에서 434.1개체 (12.5%) 순으로높게채집되었다. 흰줄숲모기 (Ae. albopictus) 의경우야산에서평균 466.9개체 (58.1%), 공원에서 322.4개체 (4.1%), 주거지에서 13.8개체 (1.7%) 가각각채집되었다 (Figure 3). 지역별로는전체모기의경우대구광역시 (TI: 197.9) 와충남홍성군 (TI: 14.1) 에서높은밀도로나타났으며, 흰줄숲모기 (Ae. albopictus) 는함양군 (TI: 58.4), 경남진주시 (TI: 46.1), 그리고충남홍성군 (TI: 35.8) 에서높은밀도로채집되었다. 전체채집모기중흰줄숲모기 (Ae. albopictus) 가차지하는비율이한반도남부지역을중심으로높게나타나는경향을확인할수있었다 (Figure 4)

10 주간건강과질병 제 11 권제 15 호 Figure 4. Distribution of mosquitos in urban areas, 216 A: Trap Index of total collecting mosquitoes, B: Trap Index of Ae. albopictus, C: Collection rate of Ae. albopictus. Number of mosquitoes (TI) Collection rate of Ae. albopictus Ae. albopictus Total mosquitoes Collection rate (%) Mar Apr May Jun Jul Aug Sep Oct Nov Month Figure 5. Monthly distribution of collected mosquitoes 466

11 주간 건강과 질병 제11권 제15호 Figure 6. Monthly geographical distribution of Aedes albopictus in Korea 월별 채집밀도 분석 결과, 전체 모기는 6월과 8월에 높게 조금씩 차이를 보였다(Figure 6). 채집되었으나 9월부터 지속적으로 감소하였다. 반면 흰줄숲모기 국내 모 기의 플라비 바 이러스 감 염 여부 및 국내 (Ae. albopictus)는 4월에 첫 출현을 시작하여 8월까지 지속적으로 유입 감시 를 확 인 하고 자 전 체 채 집 된 1 2,1 2 개 체 중 증가하다가 9월부터 감소하는 추세를 보였다(Figure 5). 지리정보 얼룩날개모기류(Anopheles Spp.)를 제외한 1,929개체(5,529 시스템(Arc GIS)을 이용한 월별 및 지역별 분포를 확인한 결과는 pool)와 흰줄숲모기 21,467개체(894 pool)에 대해 유전자검사를 흰줄숲모기(Ae. albopictus )의 경우 4월에 남부지역을 시작으로 실시한 결과 지카바이러스를 포함한 플라비 바이러스는 모두 5월부터는 한반도 대부분의 지역에서 채집이 되는 것을 확인 할 수 음성이었다(Table 1). 있었으며 1월에는 전국에서 채집이 되는 것을 확인할 수 있었다. 흰줄숲모기(Ae. albopictus ) 분포 확산 과정을 보면 남부지방부터 서서히 증가하기 시작하여 점차 북부지방으로 이동하는 경향을 보였으며, 최고 밀도를 나타내는 시기 및 밀도 감소 시기는 지역별로 467

12 주간건강과질병 제 11 권제 15 호 Table 1. Flavivirus detection from collected mosquitoes No. of collected mosquitoes No. of detected mosquitoes No. of pools No. positive for Flavivirus Aedes albopictus 21,467 21, Total mosquitoes 12,12 1,929 5,529 맺는말 지카바이러스등곤충매개감염병의경우매개체의감시와통제가질병의확산과감소에중요한부분으로작용한다. 많은곤충매개체중모기는다양한질병을매개하는것으로알려져있으며, 특히흰줄숲모기 (Ae. albopictus) 의경우 1가지이상의질병을매개하는것으로알려져있다. 흰줄숲모기 (Ae. albopictus) 는야산등지에서서식하며우리나라에전국적으로분포하고있는것으로 영향을미치는것으로판단되었다. 흰줄숲모기 (Ae. albopictus) 의경우도심지역의근린공원과야산을중심으로접촉을피해야하며지카바이러스감염증등질병이해외에서유입될경우성충발생이빨리나타나는남부지방을중심으로감시가강화되어야할것으로보였다. 이결과는지카바이러스를포함한흰줄숲모기 (Ae. albopictus) 매개질병의유입을막기위한일환으로우리나라의지리적분포를조사함으로써모기관리의기초자료를제공하고자실시하였다. 알려져있으나아직도전국적인분포조사는미흡한편이다. 이번 조사는전국 27개도심지역에서 BG-sentinel trap과 Black-light trap을이용하여채집능력을비교한결과이산화탄소를이용하는 BG-sentinel trap이높은포획률을보였으며특히흰줄숲모기의채집비율이높은것을확인할수있었다. 이와같이 BG-sentinel trap이다른방법보다높은이유는가로등과같은인공조명이많은도심환경은빛을이용한방법보다유인제를이용하는채집법이더효과적이라는것을증명할수있었다. 국내에는빨간집모기 (Cx. pipiens complex) 가과거부터현재까지높은우점종을차지하고있으며, 다음은흰줄숲모기 (Ae. albopictus) 가전국적으로높게분포하고있었다. 도심의환경별서식지를야산, 공원, 주거지로구분하여조사한결과주거지보다는야산과공원에서높은밀도의모기가서식하고있음을확인할수있었으며, 특히흰줄숲모기 (Ae. albopictus) 의경우도심지역의야산주변및공원에서접촉확률이 참고문헌 1. [ 감염병웹통계시스템 ] 2. Mitchell, C.J. The role of Aedes albopictus as an arbovirus vector. Parassitologia. 1995;37: Benedict, M. Q., Levine, R. S., Hawley, W. A., Lounibos, L. P. Spread of the tiger: global risk of invasion by the mosquito Aedes albopictus. Vector borne and zoonotic diseases. 27;7: Kim. H.C., Oscar S. F., Jason G. P., Anthony L. S. Seasonal Prevalence of Mosquitoes Collected from Light Traps in the Republic of Korea, 21. Korean Journal of Entomology. 23;33(3): Wong, P. S., Li, M. Z., Chong, C. S., Ng, L. C., and Tan, C. H. Aedes (Stegomyia) albopictus (Skuse): a potential vector of Zika virus in Singapore. PLoS Negl.Trop.Dis. 213;7:e2348. doi: / jjournal.pntd 높음을알수있었다. 흰줄숲모기 (Ae. albopictus) 의경우 3월부터모기가발생하여 8월에가장높은밀도를보였으며다른모기종보다가을철 (9월 ~11월 ) 에높은비율로채집됨을확인할수있었다. 흰줄숲모기 (Ae. albopictus) 는 5월부터전국대부분지역에서채집이되었으며점차북상하는경향을보임에따라기온이발생밀도에큰 468

13 469

14 주요감염병통계, Statistics of selected infectious diseases 1.1 환자감시 : 전수감시감염병주간발생현황 (14th Week) Table 1. Reported cases of national infectious diseases in Republic of Korea, ending April 7, (14th Week)* Category Ⅰ Category Ⅱ Category Ⅲ Category Ⅳ Classification of disease ly average 47 Total no. of cases by year Cholera Typhoid fever Laos(6) Paratyphoid fever Imported cases of current : Country (no. of cases) Shigellosis Cambodia(1) EHEC Viral hepatitis A ,419 4,679 1,84 1, Pertussis Tetanus Measles Mumps 493 3, ,924 17,57 23,448 25,286 17,24 Rubella Viral hepatitis B (Acute) Japanese encephalitis Varicella 1,252 16, ,91 54,6 46,33 44,45 37,361 Streptococcus pneumoniae Malaria Nigeria(1), Sierra Leone(1) Scarlet fever 461 5, ,837 11,911 7,2 5,89 3,678 Meningococcal meningitis Legionellosis Vibrio vulnificus sepsis Murine typhus Scrub typhus ,528 11,15 9,513 8,13 1,365 Leptospirosis Thailand(1) Brucellosis Rabies HFRS Syphilis ,148 1,569 1,6 1, CJD/vCJD Tuberculosis 625 7, ,161 3,892 32,181 34,869 36,89 HIV/AIDS ,5 1,62 1,18 1,81 1,13 Viral hepatitis C 231 3,149-6, VRSA CRE 166 2,316-5, Dengue fever Thailand(2), Cambodia(1), Philippines(1) Q fever Japan(1) West Nile fever Lyme Borreliosis Melioidosis Chikungunya fever Cambodia(1), Thailand(1) SFTS MERS Zika virus infection Unit: No. of cases 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, 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, 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, 212. 문의 : (43)

15 Table 2. Reported cases of infectious diseases by geography, ending April 7, (14th 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 5 Sejong 2 2 Gyonggi Gangwon 8 3 Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju 1 Cum: Cumulative counts from 1st to current in a year * The reported data for year 217, 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. average is mean value calculated by cumulative counts from 1st to current for 5 preceding years

16 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending April 7, (14th 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 217, 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. 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, ending April 7, (14th Week)* Diseases of Category Ⅱ Unit: No. of cases Reporting area Measles Mumps Rubella Viral hepatitis B (Acute) Overall ,889 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 217, 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. 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, ending April 7, (14th Week)* Unit: No. of cases Diseases of Category Ⅱ Diseases of Category Ⅲ Reporting area Japanese encephalitis Varicella Malaria Scarlet fever Overall 1,252 16,423 11, ,791 2,412 Seoul 118 2,125 1, Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi 319 4,42 3, , Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam 137 1, Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year 217, 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. 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, ending April 7, (14th Week)* Diseases of Category Ⅲ Unit: No. of cases Reporting area Meningococcal meningitis Legionellosis Vibrio vulnificus sepsis Murine typhus Overall Seoul Busan 7 1 Daegu 4 1 Incheon Gwangju Daejeon 2 Ulsan 2 1 Sejong Gyonggi Gangwon Chungbuk 2 Chungnam 1 1 Jeonbuk 2 Jeonnam 1 Gyeongbuk 14 1 Gyeongnam Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year 217, 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. 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, ending April 7, (14th Week)* Diseases of Category Ⅲ Unit: No. of cases Reporting area Scrub typhus Leptospirosis Brucellosis Hemorrhagic fever with renal syndrome 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 217, 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. 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, ending April 7, (14th Week)* Unit: No. of cases Diseases of Category Ⅲ Diseases of Category Ⅳ Reporting area Syphilis CJD/vCJD Tuberculosis Dengue fever Overall ,873 8, Seoul ,359 1, Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi ,72 1, Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year 217, 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. 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, ending April 7, (14th Week)* Diseases of Category Ⅳ Unit: No. of cases Reporting area Q fever Lyme Borreliosis SFTS Zika virus infection 3-year 3-year Overall Seoul Busan 6 - Daegu 5 - Incheon 2 - Gwangju 4 - Daejeon Ulsan Sejong 5 - Gyonggi Gangwon 1 - Chungbuk Chungnam Jeonbuk - Jeonnam 1 - Gyeongbuk Gyeongnam Jeju 1 - Cum: Cumulative counts from 1st to current in a year * The reported data for year 217, 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. average is mean value calculated by cumulative counts from 1st to current for 5 preceding years

23 1.2 환자감시 : 표본감시감염병주간발생현황 (14th ) 1. Influenza, Republic of Korea, s ending April 7, (14th ) 년도제 14 주인플루엔자표본감시 ( 전국 2 개표본감시기관 ) 결과, 의사환자분율은외래환자 1, 명당 6.2 명으로지난주 (7.2 명 ) 대비감소 217- 절기유행기준은 6.6 명 (/1,) ILI per 1, Figure 1. Weekly proportion of influenza-like illness per 1, outpatients, to 217- flu seasons 2. Hand, Foot and Mouth Disease(HFMD), Republic of Korea, s ending April 7, (14th ) 년도제 14 주차수족구병표본감시 ( 전국 95 개의료기관 ) 결과, 의사환자분율은외래환자 1, 명당.6 명으로전주 (.5 명 ) 대비증가 수족구병은 29 년 6 월법정감염병으로지정되어표본감시체계로운영 No. of outpatients / 1, Figure 2. Weekly proportion of hand, foot and mouth disease per 1, outpatients,

24 3. Ophthalmologic infectious disease, Republic of Korea, s April 7, (14th ) 년도제 14 주차유행성각결막염표본감시 ( 전국 92 개의료기관 ) 결과, 외래환자 1, 명당분율은 15.1 명으로전주 12.7 명대비증가 동기간급성출혈성결막염의환자분율은.6 명으로전주 1. 명대비감소 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 48

25 4. Sexually Transmitted Diseases, Republic of Korea, s ending April 7, (14th ) 년도제 14 주성매개감염병표본감시기관 ( 전국보건소및의료기관 58 개참여 ) 에서신고기관당성기단순포진 2.3 건, 클라미디아감염증 2.1 건, 첨규콘딜롬 1.7 건, 임질 1.4 건발생을신고함. 제 14 주차신고의료기관수 : 임질 14 개, 클라미디아 34 개, 성기단순포진 34 개, 첨규콘딜롬 23 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) , 7132 자세히보기 : 질병관리본부 정책 / 사업 감염병감시 표본감시주간소식지 1.3 수인성및식품매개감염병집단발생주간현황 (14th ) Waterborne and foodborne disease outbreaks, Republic of Korea, s ending April 7, (14th ) 년도제 14 주보고기관 ( 전국 254 개보건소 ) 에서집단발생이 9 건발생하였으며누적발생건수는 14 건 ( 사례수 1,847 명 ) 이발생함 No. of outbreaks Average no. of cases in last 5 years( ) Figure 5. Number of waterborne and foodborne disease outbreaks reported by,

26 2.1 병원체감시 : 인플루엔자및호흡기바이러스주간감시현황 (14th ) 1. Influenza viruses, Republic of Korea, s ending April 7, (14th ) 년도제 14 주에전국 52 개감시사업참여의료기관에서의뢰된호흡기검체 256 건중 13 건양성 (A/H1N1pdm9 4 건, A(H3N2) 5 건, B 형 4 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, to 217- flu season 2. Respiratory viruses, Republic of Korea, Weeks ending April 7, (14th ) 년도제 14 주호흡기검체 (256 개 ) 에대한유전자검사 (17 개시 도보건환경연구원및 52 개참여기관 ) 결과, 72.3% 의호흡기바이러스가 검출되었음. ( 최근 4 주평균 257 개의호흡기검체에대한유전자검사결과를나타내고있음 ) 주별통계는잠정통계이므로변동가능 () 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 March 11.. April 7., (Average No. of detected cases is 257 in last 4 s) 217 : the rate of detected cases between January December 자세히보기 : 질병관리본부 알림 주간질병감시정보 482

27 2.2 병원체감시 : 급성설사질환실험실표본주간감시현황 (13th ) Acute gastroenteritis-causing viruses and bacteria, Republic of Korea, s ending March 31, (13th ) 년도제 13 주실험실표본감시 (17 개시 도보건환경연구원및 7 개의료기관 ) 급성설사질환유발바이러스검출건수는 27 건 (46.6%), 세균 검출건수는 1 건 (5.4%) 이었음. Acute gastroenteritis-causing viruses Week No. of sample No. of detection (Detection rate, %) Group A Rotavirus Norovirus Enteric Adenovirus Astrovirus Total (14.5) 4 (6.5) (.) (.) 13 (21.) (22.4) 6 (1.3) 1 (1.7) (.) 2 (34.5) (1.2) 4 (8.2) 1 (2.) (.) 1 (2.4) (22.4) 13 (22.4) 1 (1.7) (.) 27 (46.6) (17.1) 16 (19.8) 16 (2.) 8 (1.) 322 (39.8) * 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 (.6) 9 (5.3) () () () 1 (.6) 7 (4.1) 3 (1.8) 7 (4.1) 28 (16.6) () 2 (1.3) () () () () 1 (.7) 6 (3.9) () 9 (5.9) (1.2) 1 (.6) () () () () 1 (.6) 3 (1.9) 2 (1.2) 9 (5.6) (.5) 4 (2.2) () () () () () 3 (1.6) 2 (1.1) 1 (5.4) 2,284 3 (1.3) 4 (1.8) 2 (.1) () () 1 (.4) 36 (1.6) 32 (1.4) 2 (.9) 171 (7.5) * 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 (7 hospitals) 자세히보기 : 질병관리본부 알림 주간질병감시정보 483

28 2.3 병원체감시 : 엔테로바이러스실험실주간감시현황 (13th ) Enterovirus, Republic of Korea, s ending March 31, (13th ) 년도제13주실험실표본감시 (8개시 도보건환경연구원, 전국 63개참여병원 ) 결과, 엔테로바이러스검출률.%( 건양성 /25검체), 년누적양성률 3.8%(9 건양성 /235 검체 ) 임. - 무균성수막염 건 ( 년누적 2건 ), 수족구병및포진성구협염 건 ( 년누적 2건 ), 합병증동반수족구 건 ( 년누적 건 ), 기타 건 ( 년누적 5건 ) 임. Aseptic meningitis 8 No. of cases Enterovirus detection cases 217 Enterovirus detection cases Figure 7. Detection cases of enterovirus in aseptic meningitis patients from 217 to HFMD and Herpangina 25 2 No. of cases Enterovirus detection cases 217 Enterovirus detection cases Figure 8. Detection cases of enterovirus in HFMD and herpangina patients from 217 to HFMD with Complications No. of cases Enterovirus detection cases 217 Enterovirus detection cases Figure 9. Detection cases of enterovirus in HFMD with complications patients from 217 to 484

29 주요통계이해하기 < 통계표 1> 은지난 5년간발생한법정감염병과 년해당주발생현황을비교한표로, 금주환자수 ( ) 는 년해당주의신고건수를나타내며, 년누계환자수 ( ) 는 년 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 ) 년 12 주의 5 년주평균환자수 ( ly average) 는 213 년부터 217 년의 1 주부터 14 주까지의신고건수를 총 25 주로나눈값으로구해진다. * 5 년주평균환자수 ( ly average)=(x1 + X2 + + X25)/25 1주 11주 12주 13주 14주 년 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 년누계환자수 (Cum, ) 를비교해보면최근까지의누적신고건수에대한이전 5년동안해당주까지의평균신고건수와비교가가능하다. 최근 5년누계평균환자수 (Cum, average) 는지난 5년 ( 년 ) 동안의동기간신고누계평균으로계산된다. 기타표본감시감염병에대한신고현황그림과통계는최근발생양상을신속하게파악하는데도움이된다.

30 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 : 년 4 월 12 일 발행인 : 정은경 편집인 : 박도준 편집위원 : 최영실, 김기순, 최병선, 조신형, 조성범, 김봉조, 구수경, 김용우, 이동한, 조은희, 이은규, 신영림, 김청식, 전경아, 권효진 편 집 : 질병관리본부유전체센터의과학지식관리과 충북청주시흥덕구오송읍오송생명 2 로 187 오송보건의료행정타운 ( 우 )28159 Tel. (43) /33 Fax. (43)