주간건강과질병 제 12 권제 1 호 연구단신, Brief report 앙코르와트여행자에서발생한유비저감염사례 질병관리본부감염병관리센터감염병감시과이신영, 이지연, 조은희 * * 교신저자 : A case with melioi

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1 pissn X eissn PUBLIC HEALTH WEEKLY REPORT, PHWR Vol.12, No.1, 219 CONTENTS 2 앙코르와트여행자에서발생한유비저감염사례 7 통계단신 (QuickStats) 급성심장정지환자의생존율및뇌기능회복률추이, 이달의건강이슈 (Monthly health issue) 해마다유행하는인플루엔자 1 인플루엔자안내문인플루엔자바로알기 11 한파대비건강수칙건강한겨울나기이렇게준비하세요! 13 주요감염병통계환자감시 : 전수감시, 표본감시 병원체감시 : 인플루엔자및호흡기바이러스 급성설사질환, 엔테로바이러스

2 주간건강과질병 제 12 권제 1 호 연구단신, Brief report 앙코르와트여행자에서발생한유비저감염사례 질병관리본부감염병관리센터감염병감시과이신영, 이지연, 조은희 * * 교신저자 : cho644@korea.kr, A case with melioidosis after traveling to Angkor Wat, Cambodia Lee Shin Young, Lee Ji Yeon, Cho Eun Hee Division of Infectious Disease Surveillance, Center for Infectious Disease Control, KCDC Melioidosis is caused by the Gram-negative bacillus Burkholderia pseudomallei, and it is commonly found in soil and water in Southeast Asia and Northern Australia. People are mainly infected through direct contact with the pathogens, which is endemic to Southeast Asia and Northern Australia. Melioidosis can be difficult to diagnose because of its diverse clinical manifestations as abscesses of the skin and soft tissue, sepsis, and pneumonia; treatment containing ineffective antimicrobials may then result in a mortality rate of 5%. A 6-year-old man with the history of having traveled to Cambodia s Angkor Wat in 28 complained of a fever, dyspnea and cough, and then was diagnosed as melioidosis through a culture examination of Burkholderia pseudomallei from bronchial aspirate samples obtained by bronchoscopy. This report describes an imported, relapsed melioidosis case that had the antibiotic treatment for unexplained pneumonia after the trip to Angkor Wat, Cambodia in 28. Keywords: Melioidosis, Burkholderia pseudomallei, Pathogen, Pneumonia 들어가는말 유비저는그람음성세균인 Burkholderia pseudomallei가원인이되어발생하는감염병으로 1912년에미얀마양곤에서패혈성질환으로최초보고되었다 [1]. 태국북동부, 싱가포르및호주북부등열대성및아열대기후지역에풍토성경향을보이고 [2], 비풍토성지역의경우우기에풍토성지역을여행하였거나체류한군인, 건설업자등에서발생한다 (Figure 1). 병원체는환경에존재하며, 강우량이많은우기에 25~45 cm의땅속에서지표면으로이동하여 토양과지표수를오염시킨다. 사람과동물은오염물질과직접접촉하거나흡입으로감염된다. 호흡기를통한사람간전파는알려져있지않으나감염된환자의혈액이나체액접촉시감염될수있다. 유비저환자의 8% 이상에서당뇨, 신장질환및알코올중독등의기저질환을한개이상가지고있는데, 이로인해기회감염이증가할수있다 [3]. 유비저잠복기는 1~21일이일반적이며, 62년동안잠복감염상태로지낸후증상이발생한사례도있다 [4]. 유비저환자의임상양상은국소감염에서전신감염까지다양하나폐렴이가장 2

3 주간건강과질병 제 12 권제 1 호 Figure 1. Global evidence consensus and geographic locations of melioidosis occurrence data from 191 to 214 Country colouring is based on evidence-based consensus, with green representing a complete consensus on absence of B. pseudomallei and red a complete consensus on presence of B. pseudomallei. Black dots represent geo-located records of melioidosis cases or presence of B. pseudomallei. (Source: Limmathurotsakul, D. et al. Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis. Nat Microbiol. 216;1(1):158.) 흔하고, 환자의 5% 이상이패혈증으로사망한다. 배양검사가표준진단법으로이용되나민감도가 6% 정도로낮고, 일부생화학적검사방법은유비저원인균을 Burkholderia cephacia 및 Acinetobacter baumanii로오인하는경우도있다. 유비저는임상양상이다양하여임상평가만으로는진단이어렵고, 경험적 사례이다 (Table 1). 아직까지국내발생사례는없는것으로파악되며, 국내자연환경에유비저균의존재여부는밝혀진바없다 [5,18,19]. 이글에서는 28년캄보디아앙코르와트여행력이있는 6대남성에서 1년후인 년에확인된유비저재발사례를소개하고자한다. 항균제에대한유비저균의내성은치료결과에부정적인영향을 미칠수있다 [1,6-1]. 재발은주로항균제치료가부적절할경우발생하며, 재발까지소요되는기간도다양하다 (15~3,757일)[11]. 재발에영향을미치는요인은경구용항균제투여기간으로, 12~16 주간투여할경우재발위험이 9% 이상감소하므로정확한진단과치료가필수적이다 [12]. 국내의경우유비저는 21년 12월 3일제4군법정감염병으로지정하여관리되고있다. 213년이후로는매년 2~4명이내에서발생하며, 모두동남아여행력및거주력이있는해외유입 몸말 유비저재발사례는당뇨환자로 년 5월에발생한호기시호흡곤란, 마른기침, 38.5 이상의고열등의증상으로지역병원을경유하여서울소재 3차의료기관에입원하였다. 입원중시행한흉부컴퓨터단층촬영 (Chest CT) 검사결과결절성결핵 (TB lymphadenopathy) 및폐암이의심되었으나, Table 1. Annual numbers of confirmed melioidosis cases in the Republic of Korea Year * Cases (Imported case) - (Imported case)(imported case)(imported case)(imported case)(imported case)(imported case) * The provisional data were compiled until November 3, and may vary. 3

4 주간건강과질병 제 12 권제 1 호 Table 2. Characteristics of a imported, relapsed case with melioidosis General characteristics 28 Gender Male Age Occupation None None Past history Family history Travel experience DM (1998 diagnosis) None (24) Vietnam, China, Thailand, Japan group tour (28) Vietnam, Cambodia group tour (4 nights 5 days) - During the trip, it was raining in Angkor Wat in Cambodia (213) Western Europe group tours Hematological examination WBC ( mm3 )/Platelet ( mm3 )/Hemoglobin (g/ dl ) 6,15/355,/ ,5/261,/1.3 Glucose (mg/ dl )/HbA1c (%) 229/ /- CRP (mg/ dl ) AST/ALT (IU/L) 2/23 4/23 Arterial blood gas analysis ph pco 2 ( mm Hg) po 2 ( mm Hg) O 2 saturation (%) Radiological examination Chest CT LUL consolidation r/o RUL TB, r/o Lymphadenopathy, r/o Both Lung ca Bronchoscopy Biopsy Chronic inflammation Normal M. Tuberculosis Negative - Bronchial washing culture Negative Burkholderia pseudomallei Diagnosis and Treatment Hospitalization period Sep. 3, 28-Sep. 13, 28 (for 8 days) Jun. 3, -Aug. 3, (for 34 days) Chief complained Coughing, chilling, febrile sensation (respiration, body temperature, blood pressure remain within normal range in the hospitalization) Exhaled dyspnea (28 rates/min), productive coughing, nausea, dizziness, high fever (38.5 ) Oxygenation - 1 L/min per nasal cannula Diagnosis Bacterial pneumonia, r/o pulmonary Tbc, NIDDM Melioidosis Antimicrobial treatment Cravit (oral administration) IV administration (Cefepime, Metronidazole, Levofloxacin, Meropen) Oral administraion (Doxycycline) Anti-tuberculous therapy Discontinue after dizziness, general weakness etc. Discontinue after conformation B. pseudomallei 4

5 주간건강과질병 제 12 권제 1 호 기관지경 (Bronchoscopy) 검사중채취한기관지흡인액 (Bronchial aspirate) 배양결과유비저균 (Burkholderia pseudomallei) 이확인되었고, 질병관리본부에서시행한확진검사결과최종유비저로진단되었다. 진단과정에서고열과함께호흡곤란 (28회/ 분 ) 및동맥혈산소분압 (po 2 ) 저하 (64.1 mmhg) 가나타나비강캐뉼라를통하여분당 1L의산소보조요법을받았고, 혈중 CRP(1.19 mg/ dl ) 및백혈구 (14,5 mm3 ) 수치의상승이있었으나 (Table 2) 항균제치료후회복되어정상퇴원하였다. 감염경로를확인하기위해사례의인구사회학적정보, 질병력, 해외여행력등을조사하였다. 환자의국내거주지는도시개발지역내아파트였고, 주변에농경지가분포되어있으나농사에는참여하지않았다. 28년당시부터최근까지무직이었고, 24년 ( 베트남, 중국, 태국, 일본등 ), 28년 ( 베트남, 캄보디아 ), 213년 ( 서유럽 ) 3회의해외여행을다녀왔다. 특히 28년 7월말 유비저풍토성지역인캄보디아여행중앙코르와트에서비를맞았고, 여행지에서돌아온후약 15일후부터발생한기침, 오한, 발열로지역의료기관에입원하여결핵및세균성폐렴진단하에항균제 (Cravit 5 mg, 1일 1회경구요법 ) 치료를받았으나당시원인균은밝혀지지않았다. 유비저는초기진단시흔히폐결핵또는종양으로오인되어임상에서의료진의판단을어렵게하는것으로알려져있다 [3]. 본사례는당뇨기왕력이있고, 28년캄보디아여행지에서우기에비를맞은적이있으며, 여행후유비저잠복기내에 (1~21 일 ) 폐렴이발생하여경험적항균제치료를받았으나원인균은밝혀지지않았다. 당시임상양상은결핵과유사하였는데, 이또한, 결핵균은검출되지않았다. 유비저는항균제치료후재발까지최대 1년이상소요되는경우가있고, 잠복기는 62년까지가능하다. 이와같은조사내용을종합하여본사례에대해 28년캄보디아여행지에서 Figure 2. Geographic distribution of meloidosis cases in Cambodia, October 25-September 217 Province of residence was available in 889 confirmed cases. Shading represents the total number of culture-confirmed melioidosis cases per province. The numbers represent the count of participating microbiology laboratories per province; one was unable to contribute its culture confirmed cases prior to the meeting. (Source: Sotharith Bory, et al. A report from the Cambodia Training Event for Awareness of Melioidosis (C-TEAM), October 217. Trop Med Infect Dis. Mar;3(1):

6 주간건강과질병 제 12 권제 1 호 유비저에감염되어최근재발한것으로추정하였다. 캄보디아는유비저유행국인태국인접지역임에도불구하고태국에비해적은수의유비저환자가보고되고있다. 1928년첫사례 ( 태국에서감염된러시아인 ) 이후 24년까지환자가발생하지않았고, 25년에시엠레아프 (Siem reaf) 소재앙코르와트어린이병원에진단설비가갖춰지면서정기적으로보고되고있다. 최근모델링기법을적용한한연구에서캄보디아유비저환자는 2,83명 (85~5,451명) 이고, 사망수는 55.2% 인 1,149명 (464~3,42명) 인것으로추정하였다. 이연구에서는발생수와추정수가다른이유를의료진이적절한진단및치료알고리즘에익숙하지않고진단자원이부족하기때문으로설명하고있다. 실제로캄보디아의유비저환자는 25년 5건에서 217년 9월까지 2,592명으로지속적으로증가하였고, 25개지역중 23개지역에서환자가발생하여전국에서유비저가발생하고있는것으로보고있다 (Figure 2). 토양검사는한지역만실시하였고, 물검사는아직실시하지않아어느지역이더위험한지는확인되지않았으나, 전체적으로주로 5월에서 1월까지의우기에발생하였다 [13,14]. 맺는말 국내유비저해외유입사례는매우드물다. 그러나유비저는치료가어렵고, 고농도의항균제정주요법에도치료반응이느리며, 다양한종류의항균제에내성을나타내므로급성전격성패혈증등으로진행하여사망에이를수있다 [17]. 그러므로당뇨와같은기저질환자는여행자정보를통해유행지역을확인하고, 유행지역으로여행할경우에는피부손상및토양이나물과접촉하지않도록주의해야한다. 또한, 여행지에서돌아온후발열및호흡기증상이발생할경우반드시의료기관을방문하여적절한치료를받아야한다. 의료진은유비저위험지역을여행하였거나거주한적이있는당뇨환자가폐결핵, 폐렴, 패혈증등의임상소견을보일경우유비저를의심하고, 유비저로진단될경우최적의치료제와치료기간을선택하여완치율을높이고, 재발되지않도록해야한다. 참고문헌 1. Mandell, Duglas, and Bennett s. Principle and Practice of infectious Diseases, 8th edition. volume 2; Wiersinga W. J, et al. Melioidosis. N Engl J Med. 212;367: Cutaneous melioidosis in a man who was taken as a prisoner of war by the Japanese during World War II. 5. Seung Woo Kim, et al. Imported Meliooidosis in South Korea: A Case Series with a Literature Review. Osong PHRP Melioidosis: Epidemiology, Pathophysiology, and Management 7. Zhiyong Zong, et al. Misidentification of Burkholderia pseudomallei as Burkholderia cepacia by the VITEK 2 system. Journal of Medical Microbiology. 212;61: Rachel C. Greer, et al. Misidentification of Burkholderia pseudomallei as Acinetobacter species in northern Thailand. Trans R Soc Trop Med Hyg. ;: Limmathurotsakul D, Jamsen K, Arayawichanont A, Simpson JA, White LJ, Lee SJ. Defining the true sensitivity of culture for the diagnosis of melioidosis using Bayesian latent class models. PLoS ONE. 21;5:e Lipsitz, R. et al. Workshop on treatment of and postexposure prophylaxis for Burkholderia pseudomallei and B. mallei infection, 21. Emerg. Infect. Dis. 212;18:e Direk, et al. Risk factors for recurrent Melioidosis in Northeast Thailand. CID 26;43 (October ). 12. Bina Maharjan, et al. Recurrent Melioidosis in Patients in Northeast Thailand is frequently due to reinfection rather than relapse. Microbiol Limmathurotsakul, D. et al. Predicted global distribtion of Burkholderia pseudomallei and burden of melioidosis. Nat Microbiol. 216;1(1): Kevin L. Schully, et al. Melioidosis in lower provincial Cambodia: A case series from a prospective study of sepsis in Takeo Province. PLoS ONE, Sotharith Bory, et al. A report from the Cambodia Training Event for Awareness of Melioidosis (C-TEAM), October 217. Trop Med Infect Dis. Mar;3(1): W. Joost Wiersina, et al. Medical progress Melioidosis. N ENGL J MED. 212;367;11: Ja Young Son, et al. Fatal melioidosis in a tourist returning from Cambodia. Korean J Med. 29;77(2): 질병관리본부. 216년도유비저관리지침 질병관리본부. 217 감염병감시연보.. 6

7 주간건강과질병 제 12 권제 1 호 통계단신, QuickStats 급성심장정지환자의생존율및뇌기능회복률추이, Survival and neurological recovery rates among Korean patients with sudden cardiac arrest, [ 정의 ] 급성심장정지 : 심장활동이심각하게저하되거나멈춘상태를말함급성심장정지생존율 : 급성심장정지환자중생존 ( 응급실진료결과퇴원이거나입원후결과가퇴원, 자의퇴원, 전원 ) 한경우의분율뇌기능회복률 : 급성심장정지환자중퇴원당시혼자서일상생활이가능할정도로뇌기능이회복된환자의분율 급성심장정지환자의생존율은 26 년 2.3% 에서 217 년 8.7% 로 3.8 배 (6.4%p) 증가하였고, 뇌기능회복률은 26 년.6% 에서 217 년 5.1% 로 8.5 배 (4.5%p) 증가하였음 ( 그림 A). During , the survival rate among Korean patients with sudden cardiac arrest rose to 8.7%, which was an increment of 6.4 percentage points and 3.8 folds higher than 2.3% in 26. Furthermore, the neurological recovery rate also rose to 5.1% with an increment of 4.5 percentage points and 8.5 folds up from.6% in 26 (Figure A). 1 8 Survival rate of sudden cardiac arrest Rate of neurological recovery Proportion (%) Survey year Figure A. Survival and neurological recovery rates among Korean patients with sudden cardiac arrest, * Sudden cardiac arrest: status of severely impaired or ceased activity of the heart Survival rate of sudden cardiac arrest: proportion of survived cases (with the survival defined as discharge at the emergency room, or discharge, voluntary discharge, or transfer after admission) Rate of neurological recovery: proportion of patients who sufficiently recovered to achieve independence with the tasks of daily living among patients with sudden cardiac arrest Source: Sudden Cardiac Arrest Survey, _type=&q_value=&cid=1421&pagenum= Reported by: Division of Chronic Disease Control, Korea Centers for Disease Control and Prevention 7

8 이달의건강이슈, Monthly health issue 주간건강과질병 제 12 권제 1 호 해마다유행하는인플루엔자이달의건강이슈해마다유행하는치명적인인플루엔자감염병, 그러나예방가능하다 매년겨울철다른유형의바이러스로유행 절기별 WHO 예측바이러스유형 절기 절기 절기 217-절기 -219절기 절기 : 명 /1,명 A/Michigan/45/215 (H1N1)pdm9 A/Singapore/INFIMH-16-19/216 (H3N2) B/Colorado/6/217 (B/Victoria/2/87 lineage) 8. B/Phuket/373/213 (B/Yamagata/16/88 lineage) 절기 : 217- A/Michigan/45/215 (H1N1)pdm9 A/Hong Kong/481/214 (H3N2) 6. 최근 3년은이전보다 B/Brisbane/6/28 절기 : 한달이상앞당겨유행 A/California/7/29 (H1N1)pdm9 A/Hong Kong/481/214 (H3N2) B/Brisbane/6/28 절기 : A/California/7/29 (H1N1)pdm9 A/Switzerland/ /213 (H3N2) B/Phuket/373/213. 절기 : 주 42주 43주 44주 45주 46주 47주 48주 49주 5주 51주 52주 1주 2주 3주 4주 5주 6주 7주 8주 9주 1주 A/California/7/29 (H1N1)pdm9 A/Texas/5/212 (H3N2) 인플루엔자의사환자발생률추이 B/Massachusetts/2/212 출처 : 질병관리본부감염병포탈 국가지원이안되는대상에서더크게유행 15. 세 1-6 세 7-12 세 세 세 5-64 세 65 세이상 명 /1, 명 국가예방접종지원대상이아닌중 고등학생과, 초등학생 * 을중심으로유행 중고등학생 (13-18 세 ) 과초등학생 (7-12 세 ) 에서인플루엔자유행가장심각 * 년부터 6개월 ~12세어린이에대한무료인플루엔자접종확대실시출처 : 질병관리본부감염병포탈 * 국가예방접종지원대상 : 1) 만 65세이상어르신 (12월2일기준접종률 : 84.1%) 2) 생후 6개월이상, 만 12세이하어린이 (12월2일기준접종률 : 72.1%) 출처 : 국민건강영양조사자료 % 주 37 주 38 주 39 주 4 주 41 주 42 주 43 주 44 주 45 주 46 주 47 주 48 주 49 주 5 주 인플루엔자발생이가장많은청소년의예방접종률이가장낮아 세 세전체 12-14세 세 216 아동청소년인플루엔자예방접종률추이 8 연령별인플루엔자의사환자발생률 국가예방접종지원대상인 65세이상어르신접종률은 8% 상회, 전체성인접종률은 4% 미만 % 성인인플루엔자예방접종률추이 65 세이상 19 세이상

9 주간건강과질병 제 12 권제 1 호 백신접종과철저한개인위생으로예방가능 백신접종철저한개인위생 [ 올바른손씻기의생활화 ] 흐르는물에비누로 3초이상손을씻는다 매년유행하는인플루엔자의아형이달라매년백신접종필요 백신접종우선접종대상자 ( 합병증발생고위험군 ) 코를풀거나기침, 재채기후, 외출후, 식사전후등손씻기생활화 65 세이상노인 생후 6~59 개월소아 임산부 만성질환자혹은면역저하자 아스피린을복용하는소아, 청소년 [ 기침예절실천 ] 기침할때휴지로입과코가리기 기침할때옷소매위쪽으로입과코가리기 호흡기증상이있을시마스크착용 기침후반드시올바른손씻기실천 출처 : -219 절기인플루엔자관리지침, 질병관리본부 약 4~6% 인플루엔자예방효과 출처 : 출처 : 질병관리본부, [ 보도참고자료 ] 인플루엔자발생증가, 아동및청소년예방수칙당부 치명률높은감염병 : 환자 1 명중 1 명이상사망 병원입원 중환자실치료 사망 인플루엔자확진자 1 명중 23.8 명 2.4 명 1.3 명 23.8% 2.4% 1.3% 사망 1,249 명 중환자실치료 2,377 명 병원입원 23,327 명 1.% 인플루엔자확진 97,819 명 절기한국성인인플루엔자관련이환및사망구조 출처 : Choi WS, et al. Disease burden of seasonal influenza in adults in Korea. PloS One 217;12(3):e

10 주간건강과질병 제 12 권제 1 호 [ 인플루엔자안내문 ] 인플루엔자바로알기 1

11 주간건강과질병 제 12 권제 1 호 [ 한파대비건강수칙 ] 건강한겨울나기이렇게준비하세요! 11

12 주간건강과질병 제 12 권제 1 호 12

13 주요감염병통계, Statistics of selected infectious diseases 1.1 환자감시 : 전수감시감염병주간발생현황 (52 주차 ) Table 1. Reported cases of national infectious diseases in Republic of Korea, ending December 29, (52nd Week)* Category Ⅰ Category Ⅱ Category Ⅲ Category Ⅳ Classification of disease ly average 13 Total no. of cases by year Cholera Typhoid fever Unit: No. of cases Imported cases of current : Country (no. of cases) Paratyphoid fever Thailand(1) Shigellosis Vietnam(1) EHEC Viral hepatitis A 34 2, ,419 4,679 1,84 1, Pertussis Tetanus Measles Mumps , ,924 17,57 23,448 25,286 17,24 Rubella Viral hepatitis B (Acute) Japanese encephalitis Varicella 2,254 95,41 1,95 8,92 54,6 46,33 44,45 37,361 Haemophilus influenza 2 3 type b Streptococcus pneumoniae Malaria Scarlet fever , ,838 11,911 7,2 5,89 3,678 Meningococcal meningitis Legionellosis Vibrio vulnificus sepsis Murine typhus Scrub typhus 36 6, ,528 11,15 9,513 8,13 1,365 Leptospirosis Brucellosis Rabies HFRS Syphilis 36 2, ,148 1,569 1,6 1, CJD/vCJD Tuberculosis , ,161 3,892 32,181 34,869 36,89 HIV/AIDS ,9 1,62 1,18 1,81 1,13 Viral hepatitis C 153 1,955-6, China(1) VRSA CRE ,793-5, Dengue fever Vietnam(4), Malaysia(1), Philippines(1) Q fever West Nile fever Lyme Borreliosis Melioidosis Chikungunya fever Malaysia(1) SFTS MERS Zika virus infection Indonesia(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, 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)

14 Table 2. Reported cases of infectious diseases by geography, ending December 29, (52nd 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 2 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 are provisional but the data from 213 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. 14

15 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending December 29, (52nd Week)* Unit: No. of cases Diseases of Category Ⅰ Diseases of Category Ⅱ Reporting area Enterohemorrhagic Escherichia coli Viral hepatitis A Pertussis Tetanus Overall ,416 2, 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 are provisional but the data from 213 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. 15

16 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending December 29, (52nd Week)* Diseases of Category Ⅱ Unit: No. of cases Reporting area Measles Mumps Rubella Viral hepatitis B (Acute) Overall ,297 19, Seoul ,38 1, Busan ,158 1, Daegu Incheon Gwangju , Daejeon Ulsan Sejong Gyonggi ,48 4, Gangwon Chungbuk Chungnam Jeonbuk , Jeonnam Gyeongbuk , Gyeongnam ,68 2, Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year are provisional but the data from 213 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. 16

17 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending December 29, (52nd Week)* Unit: No. of cases Diseases of Category Ⅱ Diseases of Category Ⅲ Reporting area Japanese encephalitis Varicella Malaria Scarlet fever Overall ,254 95,41 51, ,782 1,174 Seoul ,882 5, ,364 1,169 Busan ,74 3, , Daegu ,56 2, Incheon ,351 3, Gwangju ,115 1, Daejeon ,159 1, Ulsan 42 2,536 1, Sejong 2 1, Gyonggi ,579 14, ,348 3,12 Gangwon 32 2,289 1, Chungbuk ,193 1, Chungnam ,158 2, Jeonbuk 154 4,286 2, Jeonnam ,869 2, Gyeongbuk ,628 2, Gyeongnam ,55 3, ,4 813 Jeju 47 3,221 1, Cum: Cumulative counts from 1st to current in a year * The reported data for year are provisional but the data from 213 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

18 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending December 29, (52nd Week)* Diseases of Category Ⅲ Unit: No. of cases Reporting area Meningococcal meningitis Legionellosis Vibrio vulnificus sepsis Murine typhus Overall Seoul Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi Gangwon 15 5 Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year are provisional but the data from 213 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

19 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending December 29, (52nd Week)* Diseases of Category Ⅲ Unit: No. of cases Reporting area Scrub typhus Leptospirosis Brucellosis Hemorrhagic fever with renal syndrome Overall 36 6,83 9, Seoul Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi Gangwon Chungbuk Chungnam Jeonbuk , Jeonnam 9 1,8 1, Gyeongbuk Gyeongnam 4 1,254 1, Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year are provisional but the data from 213 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

20 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending December 29, (52nd Week)* Unit: No. of cases Diseases of Category Ⅲ Diseases of Category Ⅳ Reporting area Syphilis CJD/vCJD Tuberculosis Dengue fever Overall 36 2,268 1, ,71 32, Seoul ,782 6, Busan ,795 2, Daegu ,221 1, Incheon ,387 1, Gwangju Daejeon Ulsan Sejong Gyonggi ,733 6, Gangwon ,159 1, Chungbuk Chungnam ,297 1, Jeonbuk ,17 1, Jeonnam ,43 1, Gyeongbuk ,868 2, Gyeongnam ,818 2, Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year are provisional but the data from 213 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. 2

21 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending December 29, (52nd 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 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 are provisional but the data from 213 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

22 1.2 환자감시 : 표본감시감염병주간발생현황 (52 주차 ) 1. Influenza, Republic of Korea, s ending December 29, (52nd ) 년도제 52 주인플루엔자표본감시 ( 전국 2 개표본감시기관 ) 결과, 의사환자분율은외래환자 1, 명당 73.3 명으로지난주 (71.9 명 ) 대비증가 -219 절기유행기준은 6.3 명 (/1,) 의사환자수 / 1, 주 Figure 1. Weekly proportion of influenza-like illness per 1, outpatients, to -219 flu seasons 2. Hand, Foot and Mouth Disease(HFMD), Republic of Korea, s ending December 29, (52nd ) 년도제 52 주수족구병표본감시 ( 전국 95 개의료기관 ) 결과, 의사환자분율은외래환자 1, 명당 1.4 명으로전주 (1.5 명 ) 대비감소 수족구병은 29 년 6 월법정감염병으로지정되어표본감시체계로운영 외래환자수 / 1, 주 Figure 2. Weekly proportion of hand, foot and mouth disease per 1, outpatients,

23 3. Ophthalmologic infectious disease, Republic of Korea, s ending December 29, (52nd ) 년도제 52 주유행성각결막염표본감시 ( 전국 92 개의료기관 ) 결과, 외래환자 1, 명당분율은 2.3 명으로전주 2.3 명대비동일 동기간급성출혈성결막염의환자분율은.9 명으로전주.5 명대비증가 6 5 외래환자수 / 1, 주 Figure 3. Weekly proportion of epidemic keratoconjunctivitis per 1, outpatients 5 4 외래환자수 / 1, 주 Figure 4. Weekly proportion of acute hemorrhagic conjunctivitis per 1, outpatients 23

24 4. Sexually Transmitted Diseases, Republic of Korea, s ending December 29, (52nd ) 년도제 52 주성매개감염병표본감시기관 ( 전국보건소및의료기관 592 개참여 ) 에서신고기관당성기단순포진 2.5 건, 클라미디아감염증 1.8 건, 첨규콘딜롬 1.8 건, 임질 1.7 건발생을신고함. 제 52 주차신고의료기관수 : 임질 15 개, 클라미디아 55 개, 성기단순포진 51 개, 첨규콘딜롬 21 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 (52 주차 ) Waterborne and foodborne disease outbreaks, Republic of Korea, s ending December 29, (52nd ) 년도제 52 주에집단발생이 13 건 ( 사례수 12 명 ) 이발생하였으며누적발생건수는 788 건 ( 사례수 15,652 명 ) 이발생함 집단발생수 주 217 과거 5 년평균발생수 ( ) Figure 5. Number of waterborne and foodborne disease outbreaks reported by,

25 2.1 병원체감시 : 인플루엔자및호흡기바이러스주간감시현황 (52 주차 ) 1. Influenza viruses, Republic of Korea, s ending December 29, (52nd ) 년도제 52 주에전국 52 개감시사업참여의료기관에서의뢰된호흡기검체 269 건중양성 117 건 (A/H1N1pdm9 11 건, A/H3N2 16 건, B 형 건 ). 양성수 주 양성률 (%) A(H3N2) A( 아형없음 ) A(H1N1)pdm9 B 양성률 Figure 6. Number of specimens positive for influenza by subtype, -219 flu season 2. Respiratory viruses, Republic of Korea, s ending December 29, (52nd ) 년도제 52 주호흡기검체 (269 건 ) 에대한유전자검사결과 71.8% 의호흡기바이러스가검출되었음. ( 최근 4 주평균 35 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 December 2, December 29, (Average No. of detected cases is 35 last 4 s) 217 : the rate of detected cases between January December 자세히보기 : 질병관리본부 질병 건강 주간질병감시정보 25

26 2.2 병원체감시 : 급성설사질환실험실표본주간감시현황 (51 주차 ) Acute gastroenteritis-causing viruses and bacteria, Republic of Korea, s ending December 22, (51st ) 년도제51주실험실표본감시 (17 개시 도보건환경연구원및 7개의료기관 ) 급성설사질환유발바이러스검출건수는 18건 (4.9%), 세균검출건수는 14건 (8.8%) 이었음. Acute gastroenteritis-causing viruses Week No. of sample No. of detection (Detection rate, %) Group A Rotavirus Norovirus Enteric Adenovirus Astrovirus Total (4.8) 11 (17.5) 4 (6.3) 2 (3.2) 2 (31.7) (.) 2 (5.4) 2 (5.4) (.) 4 (1.8) (1.8) 1 (17.9) (.) 1 (1.8) 12 (21.4) (4.5) 14 (31.8) 1 (2.3) 1 (2.3) 18 (4.9) 3, (7.) 399 (11.6) 132 (3.8) 87 (2.5) 859 (24.9) * 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) 5 (3.1) () () () () 2 (1.3) 2 (1.3) 2 (1.3) 16 (1.1) (1.1) 6 (3.4) () () () () 2 (1.1) 2 (1.1) 9 (5.) 21 (11.7) (2.9) 3 (2.2) () () () 1 (.7) 7 (5.1) 2 (1.5) 2 (1.5) 2 (14.7) (1.3) 3 (1.9) 1 (.6) () () 2 (1.3) 4 (2.5) () 2 (1.3) 14 (8.8) 9, (3.2) 488 (4.9) 6 (.1) 14 (.1) () 116 (1.2) 119 (1.2) 169 (1.7) 189 (1.9) 1,42 (14.4) * 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 질병 건강 주간질병감시정보 26

27 2.3 병원체감시 : 엔테로바이러스실험실주간감시현황 (51 주차 ) Enterovirus, Republic of Korea, s ending December 22, (51st ) 년도제51주실험실표본감시 (1개시 도보건환경연구원, 전국 53개참여병원 ) 결과, 엔테로바이러스검출률 8.7%(2 건양성 /23 검체 ), 년누적양성률 31.8%(712 건양성 /2,239 검체 ) 임. - 무균성수막염 1건 ( 년누적 226 건 ), 수족구병및포진성구협염 건 ( 년누적 277 건 ), 합병증동반수족구 1건 ( 년누적 26건 ), 기타 건 ( 년누적 183 건 ) 임. Aseptic meningitis 8 6 환자수 주 217 Figure 7. Detection cases of enterovirus in aseptic meningitis patients from 217 to HFMD and Herpangina 환자수 주 217 Figure 8. Detection cases of enterovirus in HFMD and herpangina patients from 217 to HFMD with Complications 환자수 주 217 Figure 9. Detection cases of enterovirus in HFMD with complications patients from 217 to 27

28 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 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 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.

29 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 1 월 3 일 발행인 : 정은경 편집인 : 박도준 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)