pissn X eissn PUBLIC HEALTH WEEKLY REPORT, PHWR Vol.11, No CONTENTS 0564 국내에서분리된비브리오패혈증균의유전학적다양성 0570 국내소아천식의클

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1 pissn X eissn PUBLIC HEALTH WEEKLY REPORT, PHWR Vol.11, No CONTENTS 564 국내에서분리된비브리오패혈증균의유전학적다양성 57 국내소아천식의클러스터와장기전향적연구의필요성 575 통계단신 (QuickStats) 고혈압유병률 ( 만 3 세이상 ) 577 주요감염병통계환자감시 : 전수감시, 표본감시 병원체감시 : 인플루엔자및호흡기바이러스 급성설사질환, 엔테로바이러스 매개체감시 : 말라리아매개모기, 일본뇌염매개모기

2 주간건강과질병 제 11 권제 18 호 연구논문, Research article 국내에서분리된비브리오패혈증균의유전학적다양성 질병관리본부감염병분석센터세균분석과홍사현, 정수미, 윤영선, 나혜영, 강병학, 김재옥 * * 교신저자 : kimjo7@korea.kr, Genetic diversity of Vibrio vulnificus strains isolated in Korea Hong Sa-hyun, Jung Su-Mi, Yun Young Sun, Na Hae-Young, Kang Byung Haek, Kim Jae Ok Division of Bacterial Diseases, Center for Laboratory Control of Infectious Diseases, KCDC Background: Vibrio vulnificus is a pathogenic bacterium naturally occurring in coastal and estuarine water worldwide that can cause life-threatening diseases by wound infection or food poisoning. The genetic background of V. vulnificus isolates thriving in Korea remains undefined. Methodology: In this study, 42 isolates (25 clinical and 17 environmental) were considered for examining their genetic relationship and diversity in Korea between 214 and 215. Multilocus sequence typing (MLST) method was used to study the prevalence and population structure of clinical strains. PCR conditions of the ten housekeeping genes and sequence type (ST) determination of all isolates were followed as described in PubMLST. Conventional PCR assay was performed to determine the presence of vvha and rtxa genes and for 16S rrna typing. Genetic diversity analysis was carried out using the MEGA 6 software. Based on the related STs, the isolates were analyzed by neighbor-joining method. Results: The 42 tested isolates belonged to 4 STs, each of which was new to the MLST database. The nucleotide diversity ranged from.17 (pnta) to.36 (lysa), and presented the largest number of variable sites (9.25%). Clinical and environmental (sea water) strains were distinguished by neighbor-joining tree constructed from STs. Conclusion: Forty-two V. vulnificus clinical isolates showed 4 different STs, which were stored in PubMLST as new STs, suggesting a high level of genetic diversity. These results revealed genetic differences between the clinical and environmental strains. Keywords: Vibrio vulnificus, Multilocus sequence typing (MLST), Housekeeping genes, Genetic diversity, Foodborne diseases 564

3 주간건강과질병 제 11 권제 18 호 들어가는말 비브리오패혈증균 (Vibrio vulnificus) 은호염성세균으로운동성이있는그람음성간균이며, 비브리오콜레라 (Vibrio cholera), 장염비브리오균 (Vibrio parahaemolyticus) 등과함께해안지역에광범위하게분포되어있다고알려져있다 [1]. 비브리오패혈증균은간기능이저하되었거나기저질환으로면역기능이저하된환자에서심각한패혈증을일으키는비브리오패혈증의원인균으로보고되어있다 [2,3]. 비브리오패혈증은원인균에의한상처감염이나조리하지않은오염된해산물섭취로발병하고, 피부괴사를일으키며치명률은 5% 이상으로높게보고되고있다 [4]. 해수온도가 15 C 이상으로상승하는초여름부터활발하게증식하며, 이에따라여름부터늦가을까지해양생태계에존재한다 [5]. 비브리오패혈증균의병원성요소로 vvha, rtxa 등의 비브리오패혈증균의생물형은세종류이다. 생물형 1은사람이나환경에서주로발견되는균주로사람에게질병을유발시킨다. Indole과 ornithine 탈탄산효소양성이다. 생물형 2는비브리오패혈증균에감염된뱀장어에서처음분리되었고 indole과 ornithine 탈탄산효소를생산하지않는다. 생물형 3은동일한증상으로, 양식에서자란물고기 (tilapia, 아프리카동남부가원산인민물고기 ) 에노출되어감염된환자의상처부위와패혈증을일으킨혈액에서분리보고되었고이스라엘에서만보고되었다 [9]. 이글에서는 214년부터 215년까지 2년간국내각지역에서발생한패혈증환자로부터분리된비브리오패혈증균과해양환경 ( 해수 ) 에서분리된비브리오패혈증균을대상으로생물형과 16S rrna 유전자 typing, Multilocus sequence typing(mlst) 법으로유전형을분석하고독소유전자의 (rtxa) 유무를파악하여국내에유행하는균주의유전적특성을파악하고자하였다. 독소유전자들이알려져있으며, 임상분리주와환경분리주간에 16S rrna의 sequence polymorphism이존재한다는사실이알려져있어, 이에따라 Mutiplex PCR을이용한 16S rrna 유전자의증폭산물에따라임상형 (Clinical type) 과환경형 (Environmental type) 을구분하는분자역학적분류방법등이알려져있다 [6-8]. 몸말 연구에사용된균주는 2 년간 (214~215 년 ) 전국의비브리오 Table 1. Genetic loci of 42 Vibrio vulnificus analyzed in this study Locus ChromosomeⅠ ChromosomeⅡ Fragment size (bp) No. of alleles No. of variable site (%) Nucleotide diversity glp (6.25).21 gyrb (3.5).18 mdh (4.9).18 metg (4.66).19 purm (4.95).19 dtds (7.19).25 lysa (9.25).36 pnta (4.4).17 pyrc (7.56).29 tnaa (6.48)

4 주간건강과질병 제 11 권제 18 호 Table 2. Genetic characterization of Vibrio vulnificus strains isolated in Korea ST (sequence type) No. of isolates Bio type Isolation sources Virulence genes 16S rrna type rtxa vvha Clinic Clinical type Clinic Environmental type Clinic Environmental type Clinic Clinical type Clinic Clinical type Clinic Clinical type Clinic Clinical type Clinic Clinical type Clinic Clinical type Clinic Clinical type Clinic Clinical type Clinic Clinical type Clinic Clinical type Clinic Clinical type Clinic Clinical type Clinic Clinical type Clinic Environmental type Clinic Clinical type Clinic Clinical type Clinic Environmental type Clinic Clinical type Clinic Clinical type Clinic Clinical type Clinic Clinical type Environment Clinical type Environment Environmental type Environment Clinical type Environment Clinical type Environment Clinical type Environment Clinical type Environment Environmental type Environment Clinical type Environment Environmental type Environment Clinical type Environment Clinical type Environment Clinical type Environment Clinical type Environment Environmental type Environment Clinical type Environment Clinical type

5 주간건강과질병 제 11 권제 18 호 패혈증환자로부터분리된 25주의비브리오패혈증균과동일기간해안가의해양환경 ( 해수 ) 으로부터분리된 17주의비브리오패혈증균총 42균주를대상으로하였다. 패혈증균을분리하기위해환자의대변또는직장도말에서대변검체를채취한후 TCBS(Thiosulfate citrate bile salts sucrose agar) 와 Chrom agar Vibrio 선택배지에접종하여, 각각짙은녹색과옅은파란색을나타내는집락을선별하였다 [9]. API2E kit를이용한생화학적검사와중합효소연쇄반응 (PCR) 으로종특이유전자 (Vibrio vulnificus haemolysin A, vvha) 보유여부를확인하는분자생물학적검사를통하여비브리오패혈증균을동정하였다 [1]. 또한, API2E kit 결과에서실험에사용된 42균주는 indole을생산하는생물형 1형임을확인하였다. 유전형분석법으로다양한분자생물학적분석법중 MLST는분리균주들의 ST(Sequence type) 와 CC(Clonal complex) 정보를공유할수있어균종들의역학적기원및진화적배경들을추정할수있다는장점이있다. 16S rrna 증폭산물에따른분류에서는임상분리균주 25주중 21주 (84.%) 가임상형 (Clinical type) 이었고 4주 (16.%) 가환경형 (Environmental type) 이었다. 해수분리균주는 17주중 12주 (7.6%) 가임상형 (Clinical type) 이었고, 5주 (29.4%) 가환경형 (Environmental type) 이었다. 한편, 독소유전자분석결과는임상분리균주 25주중 19주 (76.%) 가 rtxa 유전자를보유하고있었고해수분리균주는 17주중 13주 (76.5%) 가보유하고있었다. vvha 독소유전자는실험한 42주모두보유하고있었다. 국내비브리오패혈증균이나타낸 4개의 ST 간의상관관계를분리원에따라 ( 임상분리균주 :, 환경분리균주 : ) Figure 1에나타내었다. ST의분석을위해 MEGA 6에서 neighbor-joining 방법을이용하여 tree를그려분석한결과두가지그룹으로구분되었다. Cluster 1에속한 ST는임상분리균주 (9주) 와환경분리균주 (14 주 ) 를포함하고있었으며, cluster 2는두개의 ST를제외하고모두환자로부터분리된임상분리균주였다. 비브리오패혈증균 MLST 실험법은 PubMLST 웹사이트 ( 에제시된방법에따라 1개의 housekeeping 유전자 glp, gyrb, mdh, metg, purm(chromosomeⅠ), dtds, lysa, pnta, pyrc, tnaa(chromosomeⅡ) 를 PCR로증폭하고염기서열을분석하였으며, PubMLST 데이터베이스 (DB) 에서새로운유전자염기서열에대해서는관련정보와함께 DB에등록하였다 (ST-29 ST-364). MLST 유전자별로염기서열을분석한결과, 각 allele는 16~25가지타입으로나타났으며, variable site 수는 MEGA 6 software를사용하여 14~32개범위를확인하였다 (Table 1). 가장많은 variable site를가진유전자는 chromosomeⅠ과 chromosomeⅡ에서각각 48 bp 중 3개의염기서열이다른 glp와 465 bp 중 43개의염기서열이다른 lysa이었다. Nucleotide diversity 도마찬가지로 glp와 lysa 유전자가각각.21,.36 으로다른유전자들에비해높은값을보였다. MLST 분석결과, 국내비브리오패혈증균 42주는 4개의 ST로확인되었으며, 이중 4개가새로운유형이었다 (Table 2). 한가지이상의유형은 ST-294, ST-355 두유형으로나머지균주는각기다른 sequence type이었다. 비브리오패혈증균의 맺는말 이연구에서는국내패혈증환자와해수에서분리된비브리오패혈증균에대한생물형, 16S rrna type, 독소유전자 (rtxa) 존재유무, MLST 유형분석을통해국내유행균주의양상을파악하고자하였다. 분리된모든균주는생물형 1에속했으며, MLST 균주유형은 ST-11~364 등 4개 ST로기존의 DB에등록되어있지않는유형으로각균주당새로운 ST형을부여받음으로써국내분리비브리오패혈증균의유전적배경이매우다양함을알수있었다. MLST 균주유형은 (ST) 임상과해양환경분리원에따라부분적으로두개의그룹으로구분됨을알수있었다 ( 환경분리균주와임상분리균주가혼재되어있는그룹과대부분이임상분리주인그룹 ). 이는임상에서분리되는비브리오패혈증균의유전학적공통분자가명확하지않으며, 해양환경에서분리되는균주와차이가크지않음을나타낸다고판단된다. 16S rrna type에따른분류결과임상분리균주에서 84.% 의임상형이확인되었고, 환경분리균주에서도임상형이 7.6% 이었다

6 주간건강과질병 제 11 권제 18 호 Cluster 1 Cluster 2 Clinical isolates Environmental isolates Figure 1. Phylogenetic relationships between clinical isolates and environmental isolates Neighbor-joining tree constructed from STs. indicates clinical isolates; indicates environmental isolates. 패혈증증상을일으키는데중요한역할을하는 rtxa 독소유전자 양성률은임상분리균주 (76.%) 와환경분리균주 (76.5%) 에서 비슷하게확인되었다. 따라서해양환경에서분리되는비브리오 패혈증균의 7.6% 가임상형이며, rtxa 독소유전자양성률이 568

7 주간건강과질병 제 11 권제 18 호 76.5% 로높기때문에국내해양환경에존재하는비브리오패혈증균에대한각별한주의가필요하겠다. 비브리오패혈증균은매우다양한유전적배경을가지고있어여러가지방법의유전적분석및분류가연구되고있지만, 뚜렷한인자를도출하지못하고있다. 따라서앞으로도임상과해양환경에서주기적으로비브리오패혈증균을모니터링하고균주를확보하여다양한분자역학적인분석을지속하는모니터링이필요하다고판단된다. 참고문헌 1. Colwell R. R., Kaper J., Joseph S. W. Vibrio cholerae, Vibrio parahaemolyticus and other vibrios: occurrence and distribution in Chesapeake Bay. Science. 1977;198: Blake PA, Merson MH, Weaver RE, Hollis DG, Heublein PC, Disease caused by a marine Vibrio. The N Engl J Med. 1979;3: Oliver JD: vibrio vulnificus Jn Doyle MP, ed. Food-borne bacterial pathogens. NewYork, Marcel Dekker, Frank C, Littman M, Alpers K, Hallauer J. Vibrio vulnificus wound infections after contact with the Baltic Sea, Germany. Euro Surveill. 26;11(7): 나혜영, 홍사현, 정경태 년국내해양환경분리병원성비브리오균의분포와환경인자와의연관성분석. 주간건강과질병. 216;9(9): Nilsson WB, Paranjype RN, DePaola A, Strom MS. Sequence polymorphism of the 16S rrna gene of Vibrio vulnificus is a possible indicator of strain virulence. J Clin Microbiol. 23;41: Panicker G, Vickery MCL, Bej AK. Multiplex PCR detection of clinical and environmental strains of Vibrio vulnificus in shellfish. Can J Microbiol. 24;5: Han F, Pu S, Hou A, Ge B. Characterization of clinical and environmental types of Vibrio vulnificus isolates from Louisiana oysters. Foodborne Pathog Dis. 29;6: doi: 1.189/fpd A Review of Important Virulence Factors of Vibrio vulnificus Research. Journal of Biological Sciences. 214;6(2): 질병관리본부, 수인성식품매개질환실험실진단실무지침,

8 주간건강과질병 제 11 권제 18 호 연구단신, Brief report 국내소아천식의클러스터와장기전향적연구의필요성 서울아산병원소아청소년과 유진호 질병관리본부국립보건연구원생명의과학센터호흡기 알레르기질환과장우성, 이점규 * * 교신저자 : nihdot@korea.kr, Korean childhood asthma clusters and the necessity for a longitudinal prospective study Yu Jinho Department of Pediatrics, Asan Medical Center Chang Woo-Sung, Lee Jeom-Kyu Division of Allergy and Chronic Resipiratory Diseases, Center for Biomedical Science, KNIH, KCDC Asthma can be classified into heterogeneous groups with various pathophysiologies, and its course and prognosis may differ depending on phenotypes. However, there are no studies that reveal the clinical characteristics and natural course of asthma according to phenotypes. We have been conducting a nationwide pediatric asthma cohort study (Korean childhood Asthma Study, KAS) involving 2 hospitals since July 216, for which a total of 473 children with asthma were recruited and are currently being tracked. Cluster analysis revealed four clusters (cluster 1: male-dominant atopic asthma; cluster 2: highly atopic asthma with atopic dermatitis; cluster 3: female-dominant, puberty-onset, atopic asthma; cluster 4: relatively nonatopic asthma). These childhood asthma clusters were determined by atopy, sex, puberty, and allergic comorbidities. It is necessary to clarify which clusters exacerbate or progress into uncontrolled asthma, how to prevent such an exacerbation, and how to effectively intervene in the progress of asthma, through longitudinal follow-up study. Keywords: Childhood asthma, Prospective study, Cluster analysis, Subtype, Phenotype 들어가는말 소아천식은기침, 천명, 호흡곤란의증상을보이는만성호흡기 질환으로소아를대상으로한만성비감염성질환에서비만과 함께가장높은유병률을보이며, 21년까지는증가하는추세를보였다 [1]. 소아천식은치료비를포함한직접의료비뿐만아니라, 학교결석에따른문제그리고자녀의병원방문을위한부모의직장결근등간접적부문에서상당한사회 경제적부담을초래한다. 57

9 주간건강과질병 제 11 권제 18 호 천식은알레르기와연관성을가지며이로인한기도염증이만성적으로발생하고, 기도염증은기도과민성을초래해서기도폐쇄증상까지유발하기때문에알레르기여부파악, 기도과민성측정, 기도염증을조절하는일련의과정이진단및치료에있어서필수적이다. 그러나다양한연구들을통해천식이이러한병태생리의한가지개념으로설명될수없으며만성적인가역적기도폐쇄를보이는다양한질환군들의집합체임을알게됨에따라현재천식은이질적인질환 (Heterogeneous disease) 으로인식되고다양한천식아형들 (Subtypes) 을구분하여개별적치료 (Precision medicine) 를하고자하는개념이대두되었다. 따라서다양한표현형 (Phenotype) 과내재형 (Endotype) 을반영한천식에대한연구가필요하며, 성인천식의상당수가소아기부터시작하는것을고려하여소아천식의다양한아형을반영하는추적연구에대한필요성이제기되고있다. 소아천식의경우, 표현형에따라질병양상과그경과및예후가다를수있을것으로예상되지만아직까지클러스터분석을통한각표현형에따라질병의양상과경과를보여준연구는없다. 소아천식의다양한아형들을고려할때, 효과적인국가소아천식예방및관리를위해서는다양한아형군에대한개별적인대응방안을마련하는것이효과적일것으로생각되나국내의경우, 소아천식환자군코호트연구는없으며, 일반인구를대상으로위험인자노출과알레르기질환의발생연관성규명을목적으로하는출생코호트연구가진행되고있다. 하지만소아천식의유병률을고려할때출생코호트를통해확보되는소아천식환자수는소수가될것으로예상되고, 출생코호트연구범위가제한적일수있어소아천식고위험군및환자군을대상으로한전향적코호트연구가필요하다. 한편, 소아천식은지속적인증상보다간헐적인바이러스감염, 환경인자와관련된천식발작을보이는경우가많고응급실 방문과반복적인입원에따른비용등으로인한질병부담이큰 몸말 그동안국외에서알레르기질환과관련한많은코호트가수행되어왔지만, 주로일반인구집단또는알레르기위험군을모집하고추적관찰을통해알레르기질환의발생과경과를관찰하였기때문에소아천식의경과에초점을맞추지못했다. 대표적인소아천식코호트는 199년대후반에시작된 Childhood Asthma Management Program(CAMP) 인데이코호트의주목적은흡입용스테로이드의효과성확인으로다른약물과의비교를위한디자인에따르고있어소아천식의다양성을반영하지못했고이로인해다양한아형군에따른천식의질병양상과경과를보여주지못하였으며, 추적에따른폐기능의변화등을제한적으로보여주었다 [2]. 최근클러스터분석 (Cluster analysis) 을통한다양한표현형관련연구가진행되고있으나아직까지소아를대상으로한연구는시작단계이다. 미국국립보건원의 Severe Asthma Research Program(SARP) 결과, 소아천식에서 4개의클러스터가보고되었고천식약물치료에대한반응의차이를보여주고자노력하였으나그결과를임상에적용하기에는아직미약한수준이었다 [3]. 특히 질환이며최근에는미세먼지로인한소아천식의악화및발생에미치는영향에대한관심이증가하고있다. 일부연구에서미세먼지등대기오염이천식의악화인자임이보고되었으나천식의악화는임상적인중증도, 표현형, 생활환경여건등에따라악화인자가다양하므로소아천식을잘관리하기위해서는위험계층에따라악화인자를파악하여중재를시도하는것이필요하다. 또한환자중심의치료법개발은천식의다양한표현형을구분할수있는장점이있는반면, 전향적추적을포함하는코호트연구에의해서만가능하다는점에서전향적코호트연구가필요하다고할수있다. 소아천식은성인천식과달리, 예후가매우좋은질환으로알려져있으나, 그결과는해석하는데주의가필요하다. 7세의소아천식을 33세까지추적한연구결과를보면 [4], 약 35% 는완전관해 (Remission, 천식진단받은후증상이호전되어 2년간천식증상이나타나지않고, 천식치료약을쓰지않은경우 ) 를보이고, 5% 에서는성인기까지천식이지속되며, 6% 에서는천식악화와완화를반복하면서성인기에도나타나는것으로관찰되었다. 지속적인천식은전체의 5% 이지만악화와완화를반복하는천식의특징을고려한다면 65% 는완전관해없이성인천식까지이행된다고할수있다. 또한최근 CAMP 코호트의소아 571

10 주간건강과질병 제 11 권제 18 호 Table 1. Baseline characteristics of subject in Korean childhood Asthma Study (KAS) Variable n (%) Sex Male 327 (69.1) Female 146 (3.9) Puberty Ⅰ 353 (74.6) Ⅱ 57 (12.1) Ⅲ 21 (4.4) Ⅳ 19 (4.) Ⅴ 7 (1.5) No answer 16 (3.4) Co-morbidities Allergic rhinitis 387 (81.8) Atopic dermatitis 122 (25.8) Food allergy 56 (11.8) Severity Mild intermittent 19 (4.2) Mild persistent 163 (34.5) Moderate persistent 112 (23.7) Severe persistent 1 (.2) No answer 7 (1.5) ICS group None 179 (37.8) Low dose ICS 23 (48.6) Medium dose ICS 52 (11.) High dose ICS 3 (.6) No answer 9 (1.9) Asthma controller medication None 13 (27.5) Montelukast monotherapy 53 (11.2) ICS monotherapy 88 (18.6) ICS plus montelukast 41 (8.7) ICS plus LABA 51 (1.8) ICS plus montelukast and LABA 16 (22.4) Oral corticosteroids (.) Omalizumab (.) No answer 4 (.8) Atopy 1 on skin prick test 351 (74.2) * Multiple choice ICS: Inhaled corticosteroids 천식환자추적을통해 23세 ~3세의폐기능을측정하였더니그중 22% 가 modified Global initiative for chronic Obstructive Lung Disease(GOLD) criteria에따른만성폐쇄성폐질환 (Chronic obstructive pulmonary disease, COPD) 로진단되어소아천식환자의상당수가성인기 COPD와연관이있음을알수있었다. 따라서소아천식의중재가이후성인기의호흡기질환을예방하는지에대한연구가필요하다. 또한높은중증도의기도과민성등이천식지속의위험인자로알려져있으나해당천식환자의자연경과에따른예후를예측할만한인자는명확히규명되지않았기때문에자연경과에따른폐기능의변화이외에 572

11 주간건강과질병 제 11 권제 18 호 Table 2. Cluster analysis of children with asthma in Korean childhood Asthma Study (KAS) Variable Cluster 1 (n=182) Cluster 2 (n=59) Cluster 3 (n=34) Cluster 4 (n=48) Male, n (%) 138 (75.8) 38 (64.4) 12 (35.3) 3 (62.5) Age, mean±sd 8.63± ± ± ±1.76 Allergic rhinitis, n (%) 175 (96.2) 59 (1.) 28 (82.4) (.) Atopic dermatitis, n (%) 1 (5.5) 58 (98.3) 9 (26.5) 4 (8.3) History of bronchiolitis n (%) 71 (39.) 22 (37.3) 3 (8.8) 12 (25.) Puberty, n (%) Ⅰ 164 (9.1) 48 (81.4) 1 (2.9) 47 (97.9) Ⅱ 17 (9.3) 8 (13.6) 7 (2.6) 1 (2.1) Ⅲ 1 (.5) 2 (3.4) 6 (17.7) (.) Ⅳ (.) 1 (1.7) 16 (47.1) (.) Ⅴ (.) (.) 4 (11.8) (.) Onset, n (%) <3 years of age 34 (18.7) 11 (18.6) 1 (2.9) 14 (29.2) 3-6 years of age 65 (35.7) 26 (44.1) 5 (14.7) 15 (31.3) 6-9 years of age 57 (31.3) 16 (27.1) 2 (5.9) 13 (27.1) 9 12 years of age 24 (13.2) 5 (8.5) 1 (29.4) 6 (12.5) >12 years of age 2 (1.1) 1 (1.7) 16 (47.1) (.) Methacholine PC2, mean (95% CI) 1.63 (.33-8.) 1.99 ( ) 2.23 ( ) 1.63 ( ) Atopy, n (%) 142 (78.) 59 (1.) 27 (79.4) 27 (56.3) 염증반영지표등표현형의변화를반영할수있는다양한지표를장기추적조사하고평가하여중재기술을개발할필요가있다. 자연경과에따른소아천식의표현형변화등을반영한국내소아천식의특성을조사하기위하여질병관리본부는소아천식장기추적조사연구용역사업 ( 소아천식환자의질병양상특성분석및중재기술기반연구, 연구책임자유진호 ) 을수행하고있다. 216년 7월부터전국 2개병원을기반으로소아천식환자모집을시작하여 218년말까지약 1,명의천식환자에대한전향적추적관찰조사연구를진행하고자하며, 데이터입력이완료된소아천식환자 473명을대상으로분석한중간결과는다음과같다. 조사대상의성별에서남자가 69.1%(327명 ) 를차지하였고, 사춘기이전환자가 74.6%(353 명 ) 에해당되었다. 알레르기질환동반여부조사결과, 알레르기비염 81.8%(387 명 ), 아토피피부염 25.8%(122 명 ), 식품알레르기 11.8%(56 명 ) 로상당히높은비율의알레르기질환을함께가지고있는것으로조사되었다. 미국 National Asthma Education and Prevention Program(NAEPP) 가이드라인에근거한천식중증도조사는경증간헐적천식 4.2%(19 명 ), 경증지속성 34.5%(163 명 ), 중등도지속성 23.7%(112 명 ), 중증지속성.2%(1명 ) 로대부분 (74.6%, 353명 ) 은경증이었고, 지속성은 58.4%(276명 ) 로나타났으며, Global Initiative for Asthma(GINA) 가이드라인 step 2이상의치료는 6.5%(286 명 ) 를차지하였다. 피부단자시험에서최소하나의알레르기항원에양성인아토피비율은 74.2%(351 명 ) 를보여비아토피성천식이 25.8%(122 명 ) 에해당하였다 (Table 1). 환자의임상 역학적특성을고려한클러스터분석을통해국내소아천식의아형을분류한결과, 4개의클러스터가도출되었고, 각클러스터의대표적특징은다음과같다 (Table 2). 클러스터 1(Male-dominant atopic asthma) 은남아이면서아토피양성인대상군을중심으로클러스터가형성되었으며, 클러스터 2(Highly atopic asthma with atopic dermatitis) 는전원이아토피양성이면서 98.3%(58명 ) 가아토피피부염을보이는대상군들로클러스터가형성되었음이관찰되었다. 또한클러스터 3(Female-dominant, puberty-onset, atopic asthma) 은여아이면서사춘기시작시기인아토피양성군을중심으로클러스터가형성되었고, 클러스터 4(Relatively non-atopic asthma) 는다른 573

12 주간건강과질병 제 11 권제 18 호 클러스터에비해상대적으로아토피양성이낮은대상군들로 전향적추적연구가필요하다하겠다. 클러스터가형성되었음이관찰되었다. 이러한 4 개의클러스터는 연구자의의도가개입되지않고각정보들의연관성에기반한 계층적분석을통해도출된것이라는데의미가있다고할수있다. 한편, 6 개월추적데이터를바탕으로천식조절군과비조절군의 변화를중간분석한결과, 천식조절군에서비조절군으로변화하는 세계천식의날세계천식기구 (Global Initiative for Asthma) 는천식에대한인식과관심증진을위해 1998년부터매년 5월첫번째화요일을 세계천식의날 (World Asthma Day) 로지정하여캠페인등활동을하는데올해는 5월 1일이다. 군은 5.9%, 지속적으로비조절군을유지하는군은 4.4% 로서약 1.3% 의대상군이향후중재를위한취약계층이될수있음을확인하였으며, 이러한결과는추적조사종료시점에추적데이터가충분히확보된뒤에다시한번확인할예정이다. 맺는말 소아천식추적연구의중간분석결과, 국내소아천식은아토피, 사춘기, 알레르기질환의동반이주요연관인자임을알수있었고, 천식조절군과비조절군의변화추이를확인할수있었다. 어떤클러스터가천식악화및진행에있어서취약하고, 악화의위험인자가어떻게다르고, 중재의방법을달리해야하는지에대해서는후속적인추적연구에서분석될예정이다. 이연구와같은소아천식환자의전향적장기추적연구는소아천식의아형별질병양상의변화를반영할수있어보다적합한치료및중재법마련에 참고문헌 1. 대한천식알레르기학회천식진료지침 Panettieri RA, Covar R, Grant E, Hillyer EV, Bacharier L. Natural history of asthma: persistence versus progression-does the beginning predict the end? J Allergy Clinical Immunol. 28;121: Jarjour NN, Erzurum SC, Bleecker ER, Calhoun WJ, Castro M, Comhair SA, et al. Severe asthma: Lessons learned from the National Heart, Lung, and Blood Institute Severe Asthma Research Program. Am J Respir Crit Care Med. 212:185: Strachan DP, Butland BK, Anderson HR. Incidence and prognosis of asthma and wheezing illness from early childhood to age 33 in a national British cohort. BMJ. 1996;312: McGeachie MJ, Yates KP, Zhou X, Guo F, Sternberg AL, Van Natta ML, et al. Patterns of Growth and Decline in Lung Function in Persistent Childhood Asthma. N Engl J Med. 216;374: 필요한근거자료를창출할수있을것으로기대된다. 천식은이질적인질환 (Heterogeneous disease) 이므로천식환자의표현형과내재형을반영한다양한아형들 (Subtypes) 을구분하여각아형에적합한중재와치료를하는것이중요하다. 특히소아천식은임상적인중증도, 표현형, 생활환경여건등에따라질병양상과그경과및예후가다르며, 성장후성인천식등호흡기질환으로이환될수있으므로소아천식환자를대상으로클러스터분석을실시하여아형을분류하고각아형에적합한치료와중재법을적용하는것이효과적인소아천식예방및관리를위한방안이라생각한다. 즉, 국가차원의소아천식예방 관리정책수립에필요한근거창출및환자중심의의료서비스질향상을위해서는소아천식고위험군이나환자군을대상으로한장기적인 574

13 통계단신, QuickStats 주간건강과질병 제 11 권제 18 호 고혈압유병률 ( 만 3 세이상 ) Prevalence rates of hypertension(aged 3 years or over), * Republic of Korea 5 Overall Male Female Prevalence rates (%) Year Figure A. Trends in age-standardized prevalence rates of hypertension, Prevalence rates (%) Male Female Age Figure B. Prevalence rates of hypertension by sex and age, 216 * Hypertension: Systolic pressure 14 mmhg, or diastolic pressure 9 mmhg, or on anti-hypertensive treatment in Korean population aged 3 years or over Age-standardized using the estimated population of 25. 3세이상고혈압유병률은 27년 24.5% 에서 216년 29.1% 로 4.6%p 증가하였음 ( 남자는 26.8% 에서 35.% 로 8.2%p 증가하고, 여자는 21.7% 에서 22.9% 로 1.2%p 증가하였음, 그림 A). 216년조사기준남자고혈압유병률이여자에비해 1.5배높았고, 연령이증가할수록유병률이높았음. 여자의경우, 45-49세연령부터급증하기시작하여남자유병률증가폭보다높은경향을보였음 ( 그림 B). During , the age-standardized prevalence rate of hypertension for the Korean population aged 3 years or over increased from 24.5 to 29.1% (4.6%p increase): 26.8 to 35.% (8.2%p increase) for male and 21.7 to 22.9% (1.2%p increase) for female (Figure A). In 216, the rate for male was 1.5 times higher than that for female and increased with age (Figure B). Source : Korea Health Statistics 216, Korea National Health and Nutrition Examination Survey, Reported by : Division of Chronic Disease Control, Korea Centers for Disease Control and Prevention 575

14 576

15 주요감염병통계, Statistics of selected infectious diseases 1.1 환자감시 : 전수감시감염병주간발생현황 (17th Week) Table 1. Reported cases of national infectious diseases in Republic of Korea, ending April 28, 218 (17th Week)* Category Ⅰ Category Ⅱ Category Ⅲ Category Ⅳ Classification of disease 218 ly average Total no. of cases by year Cholera Imported cases of current : Country (no. of cases) Typhoid fever Vietnam(1), China(1) Paratyphoid fever Shigellosis EHEC Viral hepatitis A 6 1,73 7 4,419 4,679 1,84 1, Pertussis Tetanus Measles Netherlands(1) Mumps 669 5, ,924 17,57 23,448 25,286 17,24 Rubella Viral hepatitis B (Acute) Japanese encephalitis Varicella 2,257 22,1 1,43 8,92 54,6 46,33 44,45 37,361 Streptococcus pneumoniae Malaria Equatorial Guinea(1) Scarlet fever 538 7, ,838 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 Brucellosis Rabies HFRS Syphilis ,148 1,569 1,6 1, CJD/vCJD Tuberculosis 596 9, ,161 3,892 32,181 34,869 36,89 HIV/AIDS ,5 1,62 1,18 1,81 1,13 Viral hepatitis C 231 3,838-6, China(1) VRSA CRE 214 3,358-5, Dengue fever Thailand(5), United States of America(1), Myanmar(1), Vietnam(1), Japan(1) Q fever West Nile fever Lyme Borreliosis Melioidosis Chikungunya fever 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, 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, 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)

16 Table 2. Reported cases of infectious diseases by geography, ending April 28, 218 (17th 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 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. 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 April 28, 218 (17th Week)* Unit: No. of cases Diseases of Category Ⅰ Diseases of Category Ⅱ Reporting area Enterohemorrhagic Escherichia coli 218 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, 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. 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 28, 218 (17th Week)* Diseases of Category Ⅱ Unit: No. of cases Reporting area Measles Mumps Rubella Viral hepatitis B (Acute) 218 Overall ,463 4, Seoul Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi ,469 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, 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. average is mean value calculated by cumulative counts from 1st to current for 5 preceding years. 58

19 Table 2. (Continued) Reported cases of infectious diseases by geography, ending April 28, 218 (17th Week)* Unit: No. of cases Diseases of Category Ⅱ Diseases of Category Ⅲ Reporting area Japanese encephalitis Varicella Malaria Scarlet fever Overall 2,257 22,1 14, ,287 3,223 Seoul 194 2,654 1, , Busan 154 1,192 1, Daegu 86 1, Incheon 85 1, Gwangju Daejeon Ulsan Sejong Gyonggi 66 5,96 4, , Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam 215 1,574 1, Jeju 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. 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 28, 218 (17th Week)* Diseases of Category Ⅲ Unit: No. of cases Reporting area Meningococcal meningitis Legionellosis Vibrio vulnificus sepsis Murine typhus Overall Seoul Busan 1 1 Daegu 4 1 Incheon Gwangju Daejeon 2 Ulsan 2 1 Sejong Gyonggi Gangwon 1 2 Chungbuk 4 Chungnam Jeonbuk 1 1 Jeonnam 1 Gyeongbuk 14 1 Gyeongnam Jeju 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. 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 28, 218 (17th Week)* Diseases of Category Ⅲ Unit: No. of cases Reporting area Scrub typhus Leptospirosis Brucellosis Hemorrhagic fever with renal syndrome 218 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, 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. 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 28, 218 (17th Week)* Unit: No. of cases Diseases of Category Ⅲ Diseases of Category Ⅳ Reporting area Syphilis CJD/vCJD Tuberculosis Dengue fever Overall ,472 1, Seoul ,639 2, Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi ,61 2, Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju 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. 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, ending April 28, 218 (17th Week)* Diseases of Category Ⅳ Unit: No. of cases Reporting area Q fever Lyme Borreliosis SFTS Zika virus infection year year Overall Seoul Busan Daegu Incheon Gwangju 4 - Daejeon 1 - Ulsan Sejong 6 - Gyonggi Gangwon 1 - Chungbuk Chungnam Jeonbuk 2 - Jeonnam Gyeongbuk Gyeongnam Jeju 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. average is mean value calculated by cumulative counts from 1st to current for 5 preceding years

24 1.2 환자감시 : 표본감시감염병주간발생현황 (17th ) 1. Influenza, Republic of Korea, s ending April 28, 218 (17th Week)* 218 년도제 17 주인플루엔자표본감시 ( 전국 2 개표본감시기관 ) 결과, 의사환자분율은외래환자 1, 명당 7.6 명으로지난주 (5.8 명 ) 대비증가 절기유행기준은 6.6 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 April 28, 218 (17th ) 218 년도제 17 주차수족구병표본감시 ( 전국 95 개의료기관 ) 결과, 의사환자분율은외래환자 1, 명당.8 명으로전주 (.7 명 ) 대비증가 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 April 28, 218 (17th ) 218 년도제 17 주차유행성각결막염표본감시 ( 전국 92 개의료기관 ) 결과, 외래환자 1, 명당분율은 16.6 명으로전주 15.3 명대비증가 동기간급성출혈성결막염의환자분율은 1. 명으로전주 1.2 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 587

26 4. Sexually Transmitted Diseases, Republic of Korea, s ending April 28, 218 (17th Week) 218 년도제 17 주성매개감염병표본감시기관 ( 전국보건소및의료기관 58 개참여 ) 에서클라미디아감염증 2.1 건, 성기단순포진 2.1 건, 첨규콘딜롬 2.1 건, 임질 1.1 건발생을신고함. 제 17 주차신고의료기관수 : 임질 1 개, 클라미디아 41 개, 성기단순포진 38 개, 첨규콘딜롬 28 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 (17th ) Waterborne and foodborne disease outbreaks, Republic of Korea, s ending April 28, 218 (17th Week) 218 년도제 17 주보고기관 (254 개보건소 ) 에서집단발생이 9 건이발생하였으며누적발생건수는 173 건 ( 사례수 2,419 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 (17th ) 1. Influenza viruses, Republic of Korea, s ending April 28, 218 (17th Week) 218 년도제 17 주에전국 52 개감시사업참여의료기관에서의뢰된호흡기검체 262 건중 11 건양성 (A/H1N1pdm9 11 건, A(H3N2) 건, B 형 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 flu season 2. Respiratory viruses, Republic of Korea, Weeks ending April 28, 218 (17th Week) 218 년도제 17 주호흡기검체 (262 개 ) 에대한유전자검사 (17 개시 도보건환경연구원및 52 개참여기관 ) 결과, 62.2% 의호흡기바이러스가 검출되었음. ( 최근 4 주평균 26 개의호흡기검체에대한유전자검사결과를나타내고있음 ) 주별통계는잠정통계이므로변동가능 218 () 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 April April , (Average No. of detected cases is 26 in last 4 s) 217 : the rate of detected cases between January December 자세히보기 : 질병관리본부 알림 주간질병감시정보 589

28 2.2 병원체감시 : 급성설사질환실험실표본주간감시현황 (16th ) Acute gastroenteritis-causing viruses and bacteria, Republic of Korea, s ending April 21, 218 (16th ) 218 년도제 16 주실험실표본감시 (17 개시 도보건환경연구원및 7 개의료기관 ) 급성설사질환유발바이러스검출건수는 17 건 (36.2%), 세균 검출건수는 15 건 (8.1%) 이었음. Acute gastroenteritis-causing viruses Week No. of sample No. of detection (Detection rate, %) Group A Rotavirus Norovirus Enteric Adenovirus Astrovirus Total (2.) 13 (16.3) 4 (5.) (.) 33 (41.3) (12.2) 9 (12.2) 1 (1.4) 1 (1.4) 2 (27.) (1.6) 11 (16.7) 1 (1.5) (.) 19 (28.8) (12.8) 9 (19.1) (.) 2 (4.3) 17 (36.2) 1, (16.1) 192 (18.6) 22 (2.1) 11 (1.1) 391 (37.9) * 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 (.5) 4 (2.2) () () () () () 3 (1.6) 2 (1.1) 1 (5.4) (4.4) 6 (3.) () () () () 2 (1.) () () 17 (8.4) (1.1) 3 (1.6) () () () () 1 (.5) 5 (2.7) 2 (1.1) 13 (7.1) (3.2) 3 (1.6) () () () 1 (.5) 3 (1.6) 2 (1.1) () 15 (8.1) 2, (1.6) 52 (1.8) 2 (.1) () () 11 (.4) 42 (1.5) 39 (1.4) 22 (.8) 216 (7.6) * 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 알림 주간질병감시정보 59

29 2.3 병원체감시 : 엔테로바이러스실험실주간감시현황 (16th ) Enterovirus, Republic of Korea, s ending April 21, 218 (16th ) 218년도제16주실험실표본감시 (8개시 도보건환경연구원, 전국 63개참여병원 ) 결과, 엔테로바이러스검출률 5.6%(1 건양성 /18검체 ), 218년누적양성률 3.7%(11 건양성 /294 검체 ) 임. - 무균성수막염 건 (218 년누적 2건 ), 수족구병및포진성구협염 건 (218 년누적 2건 ), 합병증동반수족구 건 (218 년누적 건 ), 기타 1건 (218 년누적 7건 ) 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 218 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 218 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

30 3.1 매개체감시 / 말라리아매개모기주간감시현황 (16th ) Vector surveillance : Malaria vector mosquitoes, Republic of Korea, ending April 21, 218 (16th ) 218 년도제 16 주말라리아매개모기주간발생현황 (3 개시 도, 총 2 개채집지점 ) - 전체모기 : 평균 1 개체로평년및전년 1 개체대비동일 - 말라리아매개모기 : 평균 1 개체미만으로평년및전년대비동일 7 6 No. of mosquitoes Week Total Mosquitoes(Average) Malaria Vector Mosquitoes(Average) Total Mosquitoes Malaria Vector Mosquitoes Total Mosquitoes Malaria Vector Mosquitoes Figure 1. Weekly incidences of malaria vector mosquitoes in 매개체감시 / 일본뇌염매개모기주간감시현황 (16th ) Vector surveillance : Japanese encephalitis vector mosquitoes, Republic of Korea, ending April 14, 218 (16th ) 218 년 16 주일본뇌염매개모기주간발생현황 : 1 개시 도보건환경연구원 ( 총 1 개지점 ) - 전체모기 : 평균 2 개체로평년 3 개체대비 1 개체 (33.3%) 및전년 3 개체대비 1 개체 (33.3%) 감소 - 일본뇌염매개모기 ( 작은빨간집모기, Culex tritaeniorhynchus, C.t*) : 평균 개체로평년 1 개체미만및전년 1 개체 (1%) 대비감소 No. of mosquitoes 2, 1,8 1,6 1,4 1,2 1, Week Total C.t* Total C.t* Total C.t* Figure 11. Weekly incidences of Japanese encephalitis vector mosquitoes in 자세히보기 : 질병관리본부 민원 / 정부 3. 사전정보공개

31 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 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 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.

32 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 : 218 년 5 월 3 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)