건강과질병-6권27호.indd

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1 27 년 7 월 5 일제 6 권 / 제 27 호 / ISSN: X 국내 B 형간염수혈감염역추적조사결과분석 Hepatitis B Virus Lookback Results in Korea 질병관리본부장기이식관리센터혈액안전감시과신지연, 정경은, 서초롱, 최영실 CONTENTS 529 국내 B형간염수혈감염역추적조사결과분석 532 우리나라노인의영양소섭취현황 540 수술의예방적항생제사용에대한체계적검토및증거기반의지침 에관한 ECDC 보고서소개 541 주요통계 Ⅰ. 들어가는말 B 형간염바이러스 (Hepatitis B Virus, 이하, HBV) 는 간에감염을일으키는바이러스로만성간염, 간경변, 간암을일으킬수있다. 아마존, 동남아시아, 중앙유럽등이 B형간염유행국가로꼽히고있으며, 전세계적으로약 20억명이 HBV에감염되었고매년약 60만명이 B형간염으로사망하고있다. B형간염의주된전파경로는수직감염, 안전하지않은주사기사용및수혈, 성관계등이다 [1]. 1970년대이전대량수혈 (multi-transfusion) 환자의약 6% 가수혈로인해 B형간염에감염되었으나, 검사 법이발전함에따라수혈감염은꾸준히감소하고있다. 그럼에도 B형간염은검사법의항원 항체미형성기, 변이가능성, 잠재감염 (Occult hepatitis B virus infection, OBI) 으로인해수혈전파감염의주요위험요인이다 [2]. 이에따라일본, 독일, 프랑스, 이탈리아, 스페인, 폴란드등에서는수혈감염잔존위험도를줄이기위해헌혈혈액선별검사로 B형간염핵산증폭검사 (HBV-NAT) 를도입하고있고일본, 폴란드, 오스트리아등은검사법의항원 항체미형성기, 잠재감염으로인한수혈감염자를조기에발견하기위해 B형간염수혈감염역추적조사 (HBV lookback) 를실시하고있다 [3]. 우리나라는 B형간염선별검사로써 B형간염표면항원검사 (HBsAg) 만을실시하였으나, 한마음혈액원과대한적십자사혈액원이각각 2011년 5월, 2012년 6월개별 B형간염핵산증폭검사 (ID HBV-NAT) 를도입하면서 B형간염유전자검사가전면실시되었다. 질병관리본부는 B형간염수혈감염자의조기발견을위해 2011년 5월부터 B형간염수혈감염역추적조사를실시하였다. 이글에서는 2011년 5월에서 년 5월까지실시한 B형간염수혈감염역추적조사결과를분석하고자한다.

2 530 PUBLIC HEALTH WEEKLY REPORT, KCDC Ⅱ. 몸말질병관리본부는혈액원으로부터 HBV 양성헌혈자의과거헌혈혈액보관검체검사결과 (HBsAg, HBV- NAT) 를통보받는다. 보관검체검사는가장최근헌혈혈액보관검체부터실시하고, 양성인경우이전보관검체에서음성이확인될때까지순차적으로수행한다. 질병관리본부는시 도 ( 시 군 구보건소 ) 를통해보관검체양성혈액수혈자인적사항을파악하고, 수혈자의동의를받아채혈조사를실시하여감염여부를확인한다. 채혈조사검사항목은 HBsAg, B형간염유전자검사 (HBV DNA), B형간염핵심항체 (Anti-HBc IgM, total), B형간염표면항체 (Anti-HBs) 이다. 사망자의경우사인을조사하여 B형간염관련질환 1) 으로사망시의무기록조사를실시한다. 조사결과는수혈부작용소위원회및혈액관리위원회에보고한다 (Figure 1). 2011년 5월에서 년 5월까지 HBV 양성헌혈자 1,742명 ( 초회헌혈자 1,318명, 다회헌혈자 424명 ) 중보관검체검사에서양성으로확인된헌혈자는 59명이었고이들의평균헌혈횟수는 17.1회였다. 보관검체검사결과양성으로확인된 95건중 93건 (97.8%) 은선별검사와보관검체검사모두 HBsAg 음성, HBV-NAT 양성이었다. 204단위혈액수혈자조사결과의무기록보관기간경과로인한확인불가 4명, 채혈검사음성 5명, 기저질환으로인한사망 102명, 채혈불능 ( 채혈거부및거주지불명 ) 35명, 수혈전 B형간염감염자 (HBsAg 음성, anti-hbs 양성, HBcAb 양성, anti-hbc IgM 음성, HBV DNA 음성 ) 9명, 수혈전 B형간염면역획득자 (Anti-HBs 양성, HBcAb 음성 ) 10명, 조사중이 39명이었다 (Table 3). 조사결과, 현재까지 B형간염수혈감염사례는확인되지않았다. 1) 간혼수도없고델타 - 병원체도없는급성 B 형간염, 혼수가없는상세불명의바이러스간염, 급성간염을동반한독성간질환, 달리분류되지않은간염을동반한독성간질환, 급성및아급성간기능상실, 상세불명의간기능상실, 상세불명의염증성간질환, 간의중심성출혈성괴사, 문맥고혈압, 간신증후군, 기타명시된간질환, 상세불명의간질환 (2010 년 12 월 27 일제 7 차혈액관리위원회심의결과 ) Identification of HBV patients during donor screening tests Inquiry of donor s blood donation history & laboratory test of follow-up samples Negative test result : Termination of investigation Identify reciplents from medical record in hospital Inquiry of causes of death if recipients died Follow-up test on recipient Review medical records of recipient offered by hospital and HIRA Notify recipients of test results Report of Investigation results Figure 1. HBV look-back process Abbreviation: HIRA= Health Insurance Review and Assessment Service

3 주간건강과질병 531 Table 1. Characteristics of lookback donors from May 2011 to May Age Sex Mode Number(%) Donors 59(100.0) 19 2(3.4) (15.3) (11.9) (11.9) (35.6) 60 13(22.0) Sub total 59(100.0) Male Donors 53(89.8) Female Donors 6(10.2) Sub total 59(100.0) Mean of donations 17.1 positive samples of follow-up test 95 Recipients who were subjected to the lookback study 204 Table 2. Results of screening test and follow-up samples of the lookback study donors Results of screening test Results of follow-up samples Number(%) HBsAg-, HBV-NAT+ HBsAg-, HBV-NAT+ 93(97.8) HBsAg-, HBV-NAT+ HBsAg+, HBV-NAT+ 1(1.1) HBsAg+, HBV-NAT+ HBsAg-, HBV-NAT+ 1(1.1) Total 95(100.0) Table 3. Results of HBV lookback in Korea from May 2011 to May Result Number(%) Negative 5(2.4) Positive before transfusion 9(4.4) Immunization before transfusion 10(4.9) Death 102(50.0) Incomplete follow-up 35(17.2) Not identified recipients 4(2.0) Under investigation 39(19.1) Total 204(100.00) Ⅲ. 맺는말 B 형간염수혈감염역추적조사결과, 보관검체검사에서 양성으로확인된 204단위의혈액을수혈받은사람중현재까지 B형간염수혈감염사례는확인되지않았다. 우리나라는 B형간염유병률이높으나지속적인영유아예방접종및 B형간염주산기감염예방사업등으로 B형간염표면항원양성률 ( 만 10세이상, 표준화 ) 이꾸준히감소하여 1998년 4.6% 에서 2011년 3.0% 로감소하였다. B형간염표면항원양성률은연령이증가함에따라높아져 50대의경우 5% 에달했다 [4]. HBV-NAT 양성으로확인된헌혈자중 50대이상이 57.6% 를차지했고, 수혈전이미 B형간염에감염된수혈자 9명또한모두 50대이상으로, 연령에따라 B형간염표면항원양성률이높아지는것과관련이있다고생각된다 (Figure 2) Positive recipients before transfusion(n) HBsAg positive rate(%) Figure 2. HBsAg positive recipients before transfusion and HBsAg positive rate according to the age in Korea * Data source of HBsAg positive rate: Korea Centers for Disease control&prevention. Korea Health Statistics 2011: Korea National Health and Nutrition Examination Survey(KNHANES V-2). 2012

4 532 PUBLIC HEALTH WEEKLY REPORT, KCDC 또한조사대상혈액헌혈자중 97.8% 는선별검사및 보관검체검사결과 HBsAg 음성, HBV-NAT 양성으로, B형간염잠재감염기 (OBI) 에해당한다. 기존연구에따르면, OBI 혈액은바이러스량 (viral loads) 가적기때문에감염력이낮을수있고, 특히 anti-hbs를가진 OBI 혈액은감염성이낮다고보고되었다 [2, 5]. 2009년 1월에서 12월건강검진기관을방문한우리나라 20세이상성인 290,212명을대상으로실시한연구에서연령, 성별, 지역을보정한 B형간염표면항체율 (seroprevalence of anti-hbs) 는 73.5% 였다 [6]. 이번조사에서헌혈자의 anti-hbs 역가, 바이러스수치는조사되지않아보관검체검사에서양성으로확인된혈액수혈자에서감염이되지않은정확한원인을밝히기에는어려움이있다. 향후헌혈자 anti-hbs 역가및바이러스수치와 OBI 혈액의감염력에관한조사가추가적으로시행되어야할것이다. 결과적으로보관검체검사에서양성으로확인된혈액은대부분이 OBI 혈액이었고, 국내 B형간염표면항체율이높았기때문에역추적조사에서 B형간염수혈감염사례는확인되지않은것으로생각된다. Ⅳ. 참고문헌 1. World Health Organization. Hepatitis Available at 2. Candotti D, Allain JP. Transfusion-transmitted hepatitis B virus infection. Journal of Hepatology 2009;51: Reesink HW et al. Occult hepatitis B infection in blood donors. Vox Sanguinis 2008;94: 질병관리본부. 2011년국민건강통계 Allain JP et al. Infectivity of blood products from donors with occult hepatitis B virus infection. Transfusion. Article first published online: 30 JAN. 6. Lee BS et al. Nationwide Seroepidemiology of Hepatitis B virus Infection in South Korea in 2009 Emphasized the Coexistence of HBsAg and Anti-HBs. Journal of Medical Virology ;85: 우리나라노인의영양소섭취현황 Nutrient intakes status of the elderly in Korea 질병관리본부질병예방센터건강영양조사과윤성하 I. 들어가는말우리나라의 65세이상노인인구는 1960년 73만명 ( 총인구의 2.7%) 에서 2010년 545만명 ( 총인구의 11%) 으로증가하였고, 2030년에는 1,269만명 ( 총인구의 24.3%) 으로증가할것으로예측되어초고령사회로의진입을전망하고있다 [1]. 노년기영양섭취는사회경제적수준, 신체적건강, 정서적상태등다양한요인의영향을받는동시에노년기건강을결정하는주요요인으로작용한다 [2]. 노년기에는생리적기능저하, 소화기능저하, 치아상태불량, 은퇴이후경제적인어려움, 노년기우울증등으로인해영양섭취가불량해지기쉬우며, 불량한영양섭취는면역능력의감소, 신체활동능력감소, 이환율증가등건강위험의증가와관련되어있다 [2]. 우리나라노인의영양섭취는다른연령층에비해매우불량한것으로보고되어왔고 [3], 사회경제적위치가낮을수록, 신체적또는심리적건강상태가좋지않을수록더불량한것으로보고되었다 [4-6]. 따라서노인의영양적위험및건강위험을조기에발견하기위해서는영양섭취에대한지속적인평가가필요하며영양문제를야기할수있는요인에대한파악도병행되어야할것으로보인다. 이글은제5기 1, 2차년도 (2010, 2011) 국민건강영양조사에참여한 65세이상을대상으로최근우리나라노인의영양소섭취현황및영양소섭취에영향을미치는요인에대해분석하였고그결과를소개하고자한다. Ⅱ. 몸말 질병관리본부는 국민건강증진법 제16조에근거하여국민의건강및영양상태를파악하고, 보건정책수립과평가에필요한통계자료를산출하기위해매년 192개

5 주간건강과질병 533 지역의 20가구를대상으로국민건강영양조사를실시하고있다. 이연구는국민건강영양조사제5기 1, 2차년도 (2010, 2011) 에참여한 65세이상대상자중영양 조사를완료한 2,876명 ( 남자 1,236명, 여자 1,640명 ) 을대상으로하였다 (Table 1). Table 1. General characteristics of the elderly aged 65 years and over in the fifth Korea National Health and Nutrition Examination Survey the first and second years (2010, 2011) Unit : number (%) Total (n=2,876) Men (n=1,236) Women (n=1,640) Age group years 2,399 (83.4) 1,065 (86.2) 1,334 (81.3) 80 years and over 477 (16.6) 171 (13.8) 306 (18.7) Income 1) Q1 (lowest) 722 (25.4) 310 (25.3) 412 (25.6) Q2 724 (25.5) 314 (25.6) 410 (25.4) Q3 726 (25.6) 309 (25.1) 417 (25.9) Q4 (highest) 667 (23.5) 294 (24.0) 373 (23.1) Education Elementary school 1,814 (68.2) 550 (47.6) 1,264 (84.0) Middle school 313 (11.8) 194 (16.8) 119 (8.0) High school 533 (20.0) 412 (35.6) 121 (8.0) Living alone No 2,403 (83.6) 1,153 (93.3) 1,250 (76.2) Yes 473 (16.4) 83 (6.7) 390 (23.8) Status of chronic disease Diabetes 2) No 1,801 (77.9) 801 (77.8) 1,000 (77.9) Yes 512 (22.1) 229 (22.2) 283 (22.1) Hypertension 3) No 1,008 (37.9) 506 (43.8) 502 (33.4) Yes 1,651 (62.1) 648 (56.2) 1,003 (66.6) Hypercholesterolemia 4) No 1,852 (80.0) 895 (86.6) 957 (74.7) Yes 463 (20.0) 138 (13.4) 325 (25.3) Awareness of chronic disease 5) No 604 (22.7) 350 (30.3) 254 (16.9) Yes 2,116 (77.3) 806 (69.7) 1,253 (83.1) Limitation of activity 6) No 1,983 (74.5) 909 (78.6) 1,074 (71.3) Yes 679 (25.5) 247 (21.4) 432 (28.7) Difficulty of chewing 7) No 1,523 (56.0) 675 (57.3) 848 (55.1) Yes 1,195 (44.0) 504 (42.7) 691 (44.9) Experience of depression symptoms 8) No 2,251 (84.7) 1,035 (89.8) 1,216 (80.9) Yes 406 (15.3) 118 (10.2) 288 (19.1) 1) Income: Equivalent income of household= monthly household income / No. of a household member 2) Hypertension: systolic blood pressure 140 mmhg, diastolic blood pressure 90 mmhg, or drug treatment 3) Diabetes: fasting plasma glucose 126 mg/dl or drug treatment (the use of oral antihyperglycemic agents or insulin injections) 4) Hypercholesterolemia: total cholesterol 200 mg/dl or drug treatment 5) Awareness of chronic disease: people who had been diagnosed with diabetes, hypertension, hypercholesterolemia, stroke, myocardial infarction, angina, cancer, osteoarthritis, rheumatoid arthritis, asthma, thyroid gland disease, renal failure, or liver cirrhosis by a physician 6) Limitation of activity: experience of limitations of usual or social activity due to a health problem or physical/mental difficulties 7) Difficulty of chewing: experience of difficulty of chewing due to problems with teeth, dentures, gums, or other areas inside the mouth 8) Experience of depression symptoms: experience of sadness or hopeless with stopping daily life for 2 s or more during the last 1 year

6 534 PUBLIC HEALTH WEEKLY REPORT, KCDC 영양소섭취량산출은 24시간회상법을이용한식품섭취조사자료를분석하여산출하였다. 식품섭취조사는 질병관리본부전문조사수행팀 이가구에방문하여조사바로전하루동안의섭취음식의종류및섭취량과가정내조리음식의조리법을응답하게하는방법으로수행되었다. 영양성분데이터베이스는 식품성분표제7차개정판 을기본으로하였으며 [7], 일부가공식품및수입식품에대해서는한국보건산업진흥원에서구축한 DB를활용하였다 [8]. 영양소섭취의부족과과잉분율은 2010 한국인영양섭취기준 을기반으로하였다 [9]. 영양섭취기준은평균필요량, 권장섭취량, 충분섭취량, 상한섭취량으로구성되어있다. 평균필요량은대상집단을구성하는건강한사람들의절반에해당하는사람들의일일필요량을충족시키는값으로대상집단의필요량분포치중앙값으로부터산출하고, 권장섭취량은평균필요량에표준편차의 2배를더한값이다. 충분섭취량은영양소필요량에대한정확한자료가부족한경우제시하는값으로, 주로역학조사에서관찰된건강한사람들의영양소섭취량을기준으로설정된다. 상한섭취량은인체건강에유해영향이나타나지않는최대영양소섭취수준이다. 그외에너지의경우평균필요량에해당하는값으로에너지필요추정량이제시되어있고, 탄수화물과지질의경우에너지적정비율을영양섭취기준으로설정되어있다. 나트륨의경우국내의나트륨섭취수준이매우높은점을감안하여목표섭취량이추가로제시되어있다 [9]. 이연구에서는부족섭취자와과잉섭취자기준으로에너지필요추정량의 75% 미만으로섭취한경우를부족으로, 125% 이상섭취한경우과잉으로정의하였고, 나트륨은목표섭취량이상을섭취한경우과잉섭취자로정의하였다. 그외영양소는평균필요량미만으로섭취한경우부족섭취자로, 상한섭취량이상을섭취한경우과잉섭취자로정의하였다. 국민건강증진종합계획 2020 에정의된기준대로에너지섭취수준이필요추정량의 75% 미만이면서칼슘, 철, 비타민 A, 리보플라빈의섭취량이모두평균필요량미만인대상자를영양섭취부족자로정의하였다. 영양섭취관련요인은사회경제적요인으로소득수준과교육수준, 독거여부를포함하였고, 소득수준은 월가구소득을가구원수의제곱근으로나눈월가구균등화소득 ( 월가구소득 / 가구원수) 을성별, 연령별 (5세단위 ) 로하, 중하, 중상, 상으로분류하였고, 교육수준은초등학교졸업이하, 중학교졸업, 고등학교졸업이상으로분류하였다. 신체적건강요인과관련하여당뇨병은공복혈당이 126mg/dL 이상이거나의사진단을받았거나혈당강하제복용또는인슐린을투여받는경우로정의하였으며, 고혈압은수축기혈압이 140mmHg 이상이거나이완기혈압이 90mmHg 이상또는고혈압약물을복용하는경우, 고콜레스테롤혈증은총콜레스테롤이 240mg/dL 이상이거나콜레스테롤강하제를복용하는경우로정의하였다. 그외만성질환유병여부를의사진단을통해본인이인지하고있는지여부와현재건강상의문제나신체혹은정신적장애로일상생활및사회활동에제한을받는지여부, 현재치아나틀니, 잇몸등입안의문제로인해저작불편을느끼고있는지여부를분석에포함하였다. 심리적요인으로최근 1년동안연속적으로 2주이상일상생활에지장이있을정도로슬프거나절망감등을느꼈다고응답한경우우울증상경험자로분류하였다. 모든통계분석에는표본추출률, 응답률, 우리나라전체인구수및가구수를반영한가중치를적용하였다. 영양소섭취에영양을미치는요인들과영양소섭취와의관련성은교차분석 (Proc Surveyfreq) 과로지스틱회귀분석 (Proc Surveylogistic) 을이용하여분석하였다. 모든통계분석은 SAS 프로그램 9.3버전 (SAS Institute, Cary, NC, USA) 을이용하였다. 분석결과우리나라 65세이상노인의에너지섭취량은평균 ±18.4 kcal 이었다. 영양소별에너지섭취분율은단백질 12.7%, 지방 11.3%, 탄수화물 76.0% 로탄수화물은에너지적정비율 (55-70%) 의상한선 (70%) 이상을, 지방은에너지적정비율 (15-25%) 의하한선 (25%) 미만을섭취하고있었다 (Table 2). 우리나라 65세이상노인의 32.7% 가에너지의필요추정량의 75% 미만으로섭취하고있었고, 단백질, 인, 철을제외한나머지영양소의경우평균필요량미만섭취자분율이 50% 를넘는것으로나타났다. 특히칼슘, 리보플라빈은 70% 이상이평균필요량미만섭취자

7 주간건강과질병 535 Table 2. Daily energy and nutrient intakes of the elderly aged 65 years and over in the fifth Korea National Health and Nutrition Examination Survey the first and second years (2010, 2011) Nutrients Total (n=2,876) Men (n=1,236) Women (n=1,640) Energy (kcal/d) (18.4) (26.9) (17.5) Protein (g/d) 52.2 (0.7) 64.1 (1.2) 44.0 (0.7) Fat (g/d) 21.4 (0.4) 28.0 (0.7) 16.8 (0.4) Carbohydrate (g/d) (3.6) (5.1) (3.6) Crude fiber (g/d) 6.8 (0.3) 8.2 (0.7) 5.8 (0.1) Calcium (mg/d) (8.1) (11.7) (8.7) Phosphorus (mg/d) (10.9) (16.7) (11.0) Iron (mg/d) 13.1 (0.4) 15.1 (0.5) 11.8 (0.4) Sodium (mg/d) (73.4) (120.7) (71.9) Potassium (mg/d) (38.0) (51.3) (41.7) Vitamin A (μgre/d) (20.2) (26.1) (22.2) Thiamin (mg/d) 0.99 (0.01) 1.19 (0.02) 0.84 (0.01) Riboflavin (mg/d) 0.85 (0.03) 1.07 (0.06) 0.70 (0.01) Niacin (mg/d) 12.5 (0.2) 15.4 (0.3) 10.5 (0.2) Vitamin C (mg/d) 81.9 (2.3) 92.9 (2.7) 74.4 (2.7) Percent of total energy (%(se)) From protein 12.7 (0.1) 13.5 (0.1) 12.2 (0.1) From fat 11.3 (0.2) 12.8 (0.2) 10.2 (0.2) From carbohydrate 76.0 (0.2) 73.7 (0.3) 77.6 (0.3) *Mean (standard error) 였다. 이러한양상은남녀모두에서유사했으나, 여자의에너지및영양소부족분율이남자보다높은것으로나타났다 (Table 3). 에너지와나트륨을제외한대부분영양소의과잉분율은 5% 미만으로나타나, 이연구에서는에너지와나트륨의과잉분율만나타냈다 (Table 3). 대상자의 15.3% 는에너지필요추정량의 125% 이상을섭취하고있었고, 나트륨은 70% 이상이목표섭취량 (2000mg/ day) 이상으로섭취하고있었다. 에너지와나트륨의과잉섭취분율은여자보다남자에서더높았다. 에너지섭취수준이필요추정량의 75% 미만이면서칼슘, 철, 비타민A, 리보플라빈의섭취량이모두평균필요량미만섭취자로정의된영양섭취부족자분율은 15.6%( 남자 11.1%, 여자 18.6%) 이었다. 영양섭취부족자분율은연령이높을수록, 소득수준및교육수준이낮을 수록유의하게높았고, 현재활동에제한이있거나, 저작에불편을겪고있는경우, 우울증상을경험한경우유의하게높았다 (Table 4). 사회경제적요인, 신체적, 심리적건강요인과영양섭취부족의관련성을연령보정하여분석한결과, 영양섭취부족의위험은소득수준과교육수준이낮을수록유의하게높은것으로나타났고, 현재활동에제한이있거나 (OR, 95% CI: 1.60, ), 우울증상을경험한경우 (OR, 95%CI: 1.45, ), 저작불편이있는경우 (OR, 95% CI: 1.88, 2.66) 유의하게높은것으로나타났다. 연령과소득수준, 교육수준을함께보정한결과에서는활동제한 (OR 95% CI: 1.48, ) 과우울증상경험 (OR, 95% CI: ) 만영양섭취부족과유의한관련성을보였다 (Table 5).

8 536 PUBLIC HEALTH WEEKLY REPORT, KCDC Table 3. Prevalence of people with inadequate nutrient intakes compared to Korean Dietary Reference Intake for the elderly aged 65 years and over in the fifth Korea National Health and Nutrition Examination Survey the first and second years (2010, 2011) Unit : % (standard error) Total (n=2,876) Men (n=1,236) Women (n=1,640) Insufficient intakes 1) Energy 32.7 (1.2) 28.1 (1.6) 35.9 (1.6) Protein 32.9 (1.1) 22.2 (1.4) 40.3 (1.4) Calcium 78.0 (1.1) 71.0 (1.7) 82.9 (1.2) Phosphorus 19.8 (1.0) 9.0 (1.1) 27.2 (1.4) Iron 24.8 (1.1) 18.8 (1.3) 28.9 (1.5) Vitamin A 56.4 (1.2) 52.0 (1.7) 59.4 (1.5) Thiamin 57.3 (1.2) 46.6 (1.7) 64.6 (1.5) Riboflavin 79.5 (1.0) 76.3 (1.5) 81.7 (1.1) Niacin 53.8 (1.3) 40.4 (1.7) 63.1 (1.5) Vitamin C 59.9 (1.3) 52.7 (1.8) 64.9 (1.5) Excessive intakes 2) Energy 15.3 (0.9) 18.7 (1.4) 13.0 (1.1) Sodium 74.0 (1.1) 85.3 (1.2) 66.1 (1.6) Insufficient intakes of energy, calcium, iron, 15.6 (0.9) 11.1 (1.1) 18.6 (1.3) vitamin A and riboflavin 3) 1) Insufficient intakes - energy intake: < 75% of Estimated Energy Requirements - other nutrient intakes: < Estimated Average Requirement 2) Prevalence of excess of energy and sodium intakes - energy intake: 125% of Estimated Energy Requirements - sodium intake: 2,000mg - other nutrient intakes: Tolerable Upper Intake Level 3) Insufficient nutrient intakes: energy intake of < 75% of Estimated Energy Requirements and calcium, iron, vitamin A and riboflavin intake of < Estimated Average Requirement III. 맺는말국민건강영양조사제1-4기 (1998, 2001, 2005, ) 결과와이연구결과를비교해볼때우리나라노인들의영양섭취는다소향상된것으로보이나 ( 영양섭취부족자분율 : 1998년 28.7%, 년 15.6%) 여전히대부분이영양소를부족하게섭취하고있는것으로나타났다 [3]. 특히칼슘과리보플라빈의부족분율이 70% 이상으로부족이가장심각한영양소였으며, 비타민 A, 티아민, 나이아신, 비타민 C도 50% 이상이평균필요량미만으로섭취하고있었다. 반면우리나라노인의나트륨섭취량은약 4,000mg으로, 이는충분섭취량의 3배, 목표섭취량의 2배이상에해당하는양이고, 이또한개선없이계속유지되고있는실정 이다. 노년기의영양상태는건강을결정하는주요한요인으로균형잡힌식사를섭취할경우당뇨, 고혈압, 심혈관계질환등의만성질환및골다공증등의만성퇴행성질환의발병을예방할수있다고보고되어왔다 [10]. 우리나라노인의영양섭취부족의위험은연령이높을수록소득수준과교육수준이낮을수록, 활동제한이나우울증상경험이있는경우높은것으로나타났다. 이러한결과는노인의영양섭취부족의영향을미치는요인을분석했던선행연구들의결과와도유사하다 [4-6]. 노인의영양섭취향상을위해서는영양섭취부족위험요인의해결방안이모색되어야할것이다. 노인의영양섭취에영향을미치는요인을분석했던대부분의선행연구들은영양섭취부족에주목하여왔고

9 주간건강과질병 537 Table 4. Prevalence of people with insufficient nutrient 1) intakes by factors related to nutrient intakes among the elderly aged 65 years and over in the fifth Korea National Health and Nutrition Examination Survey the first and second years (2010, 2011) Total (n=2,876) Men (n=1,236) Women (n=1,640) n % (SE) P-value n % (SE) P-value n % (SE) P-value Total 2, (0.9) 1, (1.1) 1, (1.3) Age group years 2, (0.9) < , (1.1) < , (1.4) years and over (2.6) (4.0) (3.1) Income level Q1 (lowest) (2.0) (2.8) (2.6) Q (1.7) (2.0) (2.5) Q (1.8) (1.9) (2.7) Q4 (highest) (1.9) (2.0) (2.7) Education level Elementary school 1, (1.2) < (1.7) , (1.5) Middle school (1.8) (1.9) (3.9) High school (1.7) (2.1) (1.5) Living alone No 2, (0.9) , (1.1) , (1.5) Yes (2.5) (4.7) (2.7) Chronic disease Diabetes No 1, (1.1) (1.4) , (1.6) Yes (2.0) (2.6) (2.9) Hypertension No 1, (1.4) (1.8) (2.1) Yes 1, (1.1) (1.5) 1, (1.6) Hypercholesterolemia No 1, (1.1) (1.3) (1.7) Yes (2.1) (3.8) (2.5) Awareness of chronic disease No (2.0) (2.5) (3.1) Yes 2, (1.1) (1.3) 1, (1.6) Limitation of activity No 1, (1.0) (1.2) , (1.5) Yes (2.2) (3.2) (2.9) Difficulty of chewing No 1, (1.2) (1.3) (1.8) Yes 1, (1.4) (1.8) (2.0) Experience of depression symptoms No 2, (1.0) , (1.2) , (1.5) Yes (2.6) (4.4) (3.4) *Prevalence (standard error) 1) Insufficient nutrient intakes: energy intake of < 75% of Estimated Energy Requirements and calcium, iron, vitamin A and riboflavin intake of < Estimated Average Requirement

10 538 PUBLIC HEALTH WEEKLY REPORT, KCDC Table 5. Risk for insufficient nutrient intakes 1) by factors related to nutrient intakes among the elderly aged 65 years and over in the fifth Korea National Health and Nutrition Examination Survey the first and second years (2010, 2011) Model 1 2) Model 2 3) Total (n=2,876) Men (n=1,236) Women (n=1,640) Total (n=2,876) Men (n=1,236) Women (n=1,640) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) Age group years years and over 2.23 ( ) 3.23 ( ) 1.78 ( ) Income level Q1 (lowest) Q ( ) 0.57 ( ) 1.00 ( ) Q ( ) 0.38 ( ) 0.98 ( ) Q4 (highest) 0.63 ( ) 0.36 ( ) 0.84 ( ) Education level Elementary school Middle school 0.47 ( ) 0.45 ( ) 0.62 ( ) High school 0.42 ( ) 0.60 ( ) 0.18 ( ) Living alone No Yes 1.12 ( ) 1.39 ( ) 0.94 ( ) 0.91 ( ) 1.12 ( ) 0.86 ( ) Chronic disease Diabetes No Yes 0.92 ( ) 1.10 ( ) 0.83 ( ) 0.94 ( ) 1.14 ( ) 0.82 ( ) Hypertension No Yes 1.09 ( ) 1.19 ( ) 0.95 ( ) 1.07 ( ) 1.27 ( ) 0.92 ( ) Hypercholesterolemia No Yes 1.25 ( ) 1.71 ( ) 1.00 ( ) 1.24 ( ) 2.10 ( ) 0.99 ( ) Awareness of chronic disease No Yes 0.99 ( ) 0.95 ( ) 0.84 ( ) 0.97 ( ) 0.99 ( ) 0.85 ( ) Limitation of activity No Yes 1.60 ( ) 1.87 ( ) 1.42 ( ) 1.48 ( ) 1.64 ( ) 1.39 ( ) Difficulty of Chewing No Yes 1.45 (1.11,1.89) 1.59 ( ) 1.38 ( ) 1.28 ( ) 1.36 ( ) 1.22 ( ) Experience of depression symptoms No Yes 1.88 (1.33,2.66) 2.28 ( ) 1.62 ( ) 1.73 ( ) 2.25 ( ) 1.60 ( ) 1) Insufficient nutrient intakes: energy intake of < 75% of Estimated Energy Requirements and calcium, iron, vitamin A and riboflavin intake of < Estimated Average Requirement 2) Model 1: adjusted for age except age group 3) Model 2: adjusted for age, income level, and education level Abbreviations: OR (95% CI), odds ratios (95% confidence intervals)

11 주간건강과질병 539 [4-6], 이조사또한섭취부족의측면에서위험요인과의관련성을분석한제한점이있다. 그러나노인의영양섭취에있어나트륨의경우과잉섭취가문제점으로늘지적되어왔다 [3]. 세계보건기구 (WHO) 는나트륨목표섭취량 2,000mg으로설정하였으나우리나라노인의 70% 이상이목표섭취량이상으로섭취하고있었다. 영양섭취부족의위험요인파악과동시에나트륨과잉섭취를야기할수있는위험요인파악에대한후속연구와이를근거로한중재프로그램개발이필요할것으로보인다. IV. 참고문헌 1. 통계청. 장래인구추계 Brownie S. Why are elderly individuals at risk of nutritional deficiency? Int J Nurs Pract 2006;12(3): 보건복지부 국민건강통계 권성옥등. 저소득층노인에서식품불안정과사회경제적지표, 건강상태, 영양소섭취와의관련성. 한국영양학회지 2007;40(8): 최윤정등. 서울및경기지역노인의건강자가평가에따른기능적건강및영양위험평가. 한국영양학회지 2004;37(3): 임경숙. 노인의영양섭취상태에영향을미치는인구사회학적요인분석. 한국영양학회지 2004;37(3): 농촌자원개발연구소. 식품성분표제7개정판I 보건복지부. 식품별영양성분분석자료의데이터베이스추가구축사업결과보고서 한국영양학회. 한국인의영양섭취기준개정판 Keller HH. Nutritional and health-related quality of life in frail older adults. J Nutr Health Aging 2004;8(4):

12 540 PUBLIC HEALTH WEEKLY REPORT, KCDC 수술의예방적항생제사용에대한체계적검토및증거기반의지침 에관한 ECDC 보고서소개 ECDC Report for Systematic review and evidence-based guidance on perioperative antibiotic prophylaxis 질병관리본부감염병관리센터감염병감시과 항생제 (Antibiotics) 는미생물에의해생산되는화학 물질로서다른미생물의증식을억제하거나사멸시키는물질이다. 페니실린을시작으로 4,000여가지이상의항생제가발견되었고, 현재 50여종이실제임상에서사용되고있다. 항생제의작용은병원성세균의활동을저해하거나, 사멸또는대사경로에이상을일으켜발육에필요한단백질합성등을저해하여질병을치료또는예방하도록한다. 이글은유럽질병관리본부 (Euro pean Center for Disease Prevention and Control, ECDC) 에서발표한보고서 수술의예방적항생제사용에대한체계적검토및증거기반의지침 (Systematic review and evidence-based guidance on perioper ative antibiotic prophylaxis) 의사업에대하여간략히소개한것이다. 수술의예방적항생제사용 (Perioperative Antibiotic Prophylaxis, PAP) 1) 이수술부위감염 (Surgical Site Infections, SSIs) 2) 의예방에효과적인수단으로알려져있다 PAP는병원에서사용되고있는항생제의상당부분을차지하고있고, 특별한이유없이수술환자의 50% 이상에서수술후 24시간이상투여되고있어 (2006년) 항생제내성및의료비용증가와관련이있는것으로도보고되고있다. 이에 ECDC는 PAP의장점및정확한사용법의중요성때문에 수술의예방적항생제투여에대한체계적검토및증거기반의지침 이라는프로젝트를실시하였다. 이사업의목적은 1) 체계적인문헌검토를통해 PAP 주요양식 (Key Modalitis) 의효과성을확인하고, 2) 5가지 PAP 양식의개발과과학적 근거와전문가의조언을바탕으로개발된 5가지양식의수행을모니터링하기위한지표를개발하는것이다. PAP 주요양식의효과성은체계적인문헌검토를통해의료인이수술부위감염 (SSIs) 예방을위해 PAP의적절한투약, 시간, 용량, 기간에대한이행이개선되었는지를보여준 5가지주요항목을확인하였다. 5가지항목은 1) PAP 프로토콜을개발, 이행, 개정하고, 수행감사를실시하고, 피드백을제공해줄다학제적팀구성 2) 수술 1시간이내에 PAP 투여보장 3) 마취과의사에게시기적절한 PAP 투여의책임부여 4) PAP의 1회접종량 (Single dose) 만투여 5) 수술종료시단계에서 PAP 투여중단이다. 의료기관에서 PAP의주요양식에대한이행이중요하므로 5가지양식선정에이어전문가의합의에의해과정지표들이개발되었다. 마취과의사또는다른지원의료인에의한 PAP 투여수, 다학제적팀의구성여부, 회의개최건수등이행향상을위한지표들이포함되어있다. 주요 PAP 양식을유럽연합에적용하는데잠재적장애는교육부족, 심리적장애물, 소송에대한두려움, 지역적항생제내성패턴에대한인식부족, 조직내상하구조적문제, 전문적규정의부재등이다. 이같은잠재적장벽을밝혀내는것은유럽전역에서 PAP를표준화된방법으로적용할수있는길을열어줄수있을것이다. 항생제사용에대한지역정책을수립할때이러한 5가지주요양식과과정지표를채택하고적용하는것은유럽연합전체의병원에게있어부적절한 PAP 투여를감소시키는중요한계기가될것이다. 5가지모든양식은병원에서의 PAP 투여와이에대한인식제고의조화를추구하며, 궁극적으로는항생제사용감소및항생제내성감소로이어질것이다. 또한, 양식과지표모두수행되는데장벽들을고심해봐야한다. 중앙행정부는지방행정부를지원해야하며, 논의되어진 PAP 양식이전유럽으로수행되는데국가적또는유럽연합의전략이장벽을극복하는데도움이될것이라고하였다. 이보고서의자세한내용은 ECDC(European Centre for Disease Prevention and Control) 의홈페이지 ( ecdc.europa.eu) 에서볼수있다. 1) Perioperative Antibiotic Prophylaxis: 수술전또는수술중전신적항생제투여를말함. 2) 수술부위의감염 (Surgical Site Infections, SSIs) 은의료기관획득감염중 3 번째로흔한유형이며, 전체의료기관획득감염의약 17% 를차지하며, 감염의대부분이환자의장내미생물총의이동에의한이루어짐.

13 주간건강과질병 ( 주요통계 ) 541 status of selected infectious diseases 1. Ophthalmologic, Republic of Korea, s ending June 29, (26th ) 년도제 26 주유행성각결막염의기관당주간평균환자수는 13.6 명으로지난주 13.8 명보다감소하였음. 동기간급성출혈성결막염의기관당주간평균환자수는 4.1 명으로지난주 3.4 명보다증가하였음 Case//sentinel Case//sentinel Figure 1. The mean of patient visits to sentinel physicians for Epidemic keratoconjunctivitis by, Figure 2. The mean of patient visits to sentinel physicians for acute hemorrhagic conjunctivitis by, Hand, Foot and Mouth Disease(HFMD) Republic of Korea, s ending June 29, (26th Week)* 년도제 26 주수족구병의사환자분율은외래환자 1,000 명당 17.4 명이며, 2012 년동기간수족구병의사환자분율 15.5 명보다높은수준임 년 - 년자료는잠정통계이므로변동가능함. 수족구병은 2009 년 6 월법정감염병으로지정되어표본감시체계로운영되고있음. No. of HFMD per 1,000 consutltation Figure 1. The status of HFMD sentinel surveillance, Influenza, Republic of Korea, s ending June 29, (26th ) 년도제 26 주인플루엔자의사환자분율은외래환자 1,000 명당 2.2 명으로지난주 (2.2) 와동일하였으며유행판단기준 (4.0/1,000 명 ) 보다낮은수준임. ILI per 1, Baseline(4.0/1,000) Figure 1. The ly proportion of influenza-like illness visits per 1,000 patients, season season

14 542 PUBLIC HEALTH WEEKLY REPORT, KCDC Table 1. Provisional cases of reported notifiable diseases-republic of Korea, ending Jun 29, (26th Week)* Disease ly average Total cases reported for previous years Cholera Typhoid fever Paratyphoid fever Shigellosis EHEC Viral hepatitis A ,197 5, Pertussis Tetanus Measles Mumps 437 6, ,492 6,137 6,094 6,399 4,542 Rubella Viral hepatitis B ** 58 1, ,767 1, Japanese encephalitis Varicella , ,763 36,249 24,400 25,197 22,849 Japan(1) Malaria ,772 1,345 1,052 Maldives(1) Scarlet fever 71 1, Meningococcal meningitis Legionellosis Vibrio vulnificus sepsis Murine typhus Scrub typhus ,604 5,151 5,671 4,995 6,057 Leptospirosis Brucellosis Rabies HFRS Syphilis CJD/vCJD Dengue fever Botulism Q fever West Nile fever Lyme Borreliosis Melioidosis Tuberculosis , ,966 39,557 36,305 35,845 34,157 HIV/AIDS Unit: reported case Imported cases of current : Country (reported case) Philippines(2), Ghana(1), Cambodia(1), singapore(1) -: No reported cases. Cum: Cumulative counts of the year from 1st to current. EHEC: Enterohemorrhagic Escherichia coli. HFRS: Hemorrhagic fever with renal syndrome. CJD/vCJD: Creutzfeldt-Jacob Disease / variant Creutzfeldt-Jacob Disease. * Incidence data for reporting year 2012, is provisional, whereas data for 2008, 2009, 2010 and 2011 are finalized. Reported cases contain all case classifications(confirmed, Suspected, Asymptomatic carrier) of the disease respectively. Excluding Hansen s disease, diseases reported through the Sentinel Surveillance System(Data for Sentinel Surveillance System are available in Table III), and diseases no case reported(diphtheria, Poliomyelitis, Epidemic typhus, Anthrax, Plague, Yellow fever, Viral hemorrhagic fever, Smallpox, Severe Acute Respiratory Syndrome, Avian influenza infection and humans, Novel Influenza, Tularemia, Newly emerging infectious disease syndrome, Tick-borne Encephalitis, Chikungunya fever) Surveillance system for Viral hepatitis A, Viral hepatitis B, Syphilis, CJD/vCJD, West Nile fever was altered from Sentinel Surveillance System to National Infectious Disease Surveillance System as of December 30,2010. Calculated by summing the incidence counts for the current, the 2 s preceding the current, and the 2 s following the current, for a total of 5 preceding years(for Viral hepatitis A, Viral hepatitis B, Syphilis, CJD/vCJD, West Nile fever, Lyme Borreliosis, Melioidosis, this calculation used 2 year data(2011, 2012) only, because of being designated as of December 30,2010). ** Viral hepatitis B comprises acute Viral hepatitis B, HBsAg positive maternity, Perinatal hepatitis B virus infection. Scarlet fever s case classifications contain confirmed cases to confirmed and suspected cases since September 27, 2012.Table 2. Provisional cases of selected notifiable diseases, Republic of Korea, s ending Jun 29, (26th Week)*

15 주간건강과질병 543 Table 2. Provisional cases of selected notifiable diseases, Republic of Korea, s ending Jun 29, (26th Week)* unit: reported case Reporting area Cholera Typhoid fever Paratyphoid fever Shigellosis Enterohemorrhagic Escherichia coli Viral hepatitis A Pertussis Tetanus 2-year average Total , Seoul Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju : No reported cases. Cum: Cumulative counts of the year from 1st to current. * Incidence data for reporting years 2012, is provisional, whereas data for 2008, 2009, 2010 and 2011 are finalized. Reported cases contain all case classifications (Confirmed, Suspected, Asymptomatic carrier) of the disease, respectively. Surveillance system for Viral hepatitis A was altered from Sentinel Surveillance System to National Infectious Disease Surveillance System as of December 30,2010. Calculated by averaging the cumulative counts from 1st to current, for a total of 5 preceding years.

16 544 년제 27 주 ( ) Table 3. Provisional cases of selected notifiable diseases, Republic of Korea, s ending Jun 29, (26th Week)* unit: reported case Reporting area Measles Mumps Rubella Viral hepatitis B Japanese encephalitis Varicella Malaria Scarlet fever 2-year average Total ,110 2, , ,962 14, , Seoul ,746 1, Busan ,346 1, Daegu , Incheon ,376 1, Gwangju Daejeon Ulsan Sejong Gyonggi , ,114 3, Gangwon ,531 1, Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam , Jeju : No reported cases. Cum: Cumulative counts of the year from 1st to current. * Incidence data for reporting years 2012, is provisional, whereas data for 2008, 2009, 2010 and 2011 are finalized. Reported cases contain all case classifications (Confirmed, Suspected, Asymptomatic carrier) of the disease, respectively. Surveillance system for Viral hepatitis B was altered from Sentinel Surveillance System to National Infectious Disease Surveillance System as of December 30,2010. Calculated by averaging the cumulative counts from 1st to current, for a total of 5 preceding years. Scarlet fever s case classifications contain confirmed cases to confirmed and suspected cases since September 27, 2012.

17 주간건강과질병 545 Table 4. Provisional cases of selected notifiable diseases, Republic of Korea, s ending Jun 29, (26th Week)* unit: reported case Reporting area Meningococcal meningitis Legionellosis Vibrio vulnificus sepsis Murine typhus Scrub typhus Leptospirosis Brucellosis Rabies Total Seoul Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju : No reported cases. Cum: Cumulative counts of the year from 1st to current. * Incidence data for reporting years 2012, is provisional, whereas data for 2008, 2009, 2010 and 2011 are finalized. Reported cases contain all case classifications (Confirmed, Suspected, Asymptomatic carrier) of the disease, respectively. Calculated by averaging the cumulative counts from 1st to current, for a total of 5 preceding years.

18 546 년제 27 주 ( ) Table 5. Provisional cases of selected notifiable diseases, Republic of Korea, s ending Jun 29, (26th Week)* unit: reported case Reporting area Hemorrhagic fever with renal syndrome Syphilis CJD/vCJD Dengue fever Q fever Lyme Borreliosis Melioidosis Tuberculosis 2-year average 2-year average 2-year average 2-year average Total ,233 18,450 Seoul ,055 4,795 Busan ,580 1,744 Daegu ,305 1,312 Incheon Gwangju Daejeon Ulsan Sejong Gyonggi ,511 2,881 Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam ,109 1,128 Jeju unknown : No reported cases. Cum: Cumulative counts of the year from 1st to current. * Incidence data for reporting years 2012, is provisional, whereas data for 2008, 2009, 2010 and 2011 are finalized. Reported cases contain all case classifications (Confirmed, Suspected, Asymptomatic carrier) of the disease, respectively. Surveillance system for Syphilis, CJD/vCJD was altered from Sentinel Surveillance System to National Infectious Disease Surveillance System as of December 30,2010. Calculated by averaging the cumulative counts from 1st to current, for a total of 5 preceding years.

19 주간건강과질병 547 Table 5. Provisional cases of reported sentinel surveillance disease, Republic of Korea, s ending June 22, (25th Week)* Viral hepatitis Sexually Transmitted Diseases unit: case /sentinel Hepatitis C Gonorrhea Chlamydia Genital herpes Condyloma acuminata 5 year 5 year 5 year 5 year 5 year Total Hand, Foot and Mouth Disease(HFMD) : No reported cases. Cum: Cumulative counts of the year from 1st to current. * Above data for reporting years 2012 and are provisional. Reported cases contain all case classifications (Confirmed, Suspected, Asymptomatic carrier) of the disease, respectively. Calculated by averaging the cumulative counts from 1st to current, for a total of 5 preceding unit: case per 1,000 outpatients 주요통계이해하기 <Table 1> 은법정감염병의지난 5년간발생과해당주의발생현황을비교한표로, 는해당주의보고건수를나타내며, 은 년 1주부터해당주까지의누계건수, 그리고 ly average 는지난 5년 ( 년 ) 의해당주의보고건수와이전 2주, 이후 2주동안의보고건수 ( 총 25주 ) 평균으로계산된다. 그러므로 와 ly average 에서의보고건수를비교하면주단위로해당시점에서의보고수준을예년의보고수준과비교해볼수있다. Total cases reported for previous years 는지난 5년간해당감염병의보고총수를나타내는확정통계이며연도별보고건수현황을비교해볼수있다. 예 ) 년 12주의 ly average(5년간주평균 ) 는 2008년부터 2012년의 10주부터 14주까지의보고건수를총 25주로나눈값으로구해진다. * ly average(5 년주평균 )=(X1 + X2 + + X25)/25 10주 11주 12주 13주 14주 년 해당주 2012년 X1 X2 X3 X4 X5 2011년 X6 X7 X8 X9 X 년 X11 X12 X13 X14 X 년 X16 X17 X18 X19 X 년 X21 X22 X23 X24 X25 <Table 2> 는 16개시 도별로구분한법정감염병보고현황을보여주고있으며, 각감염병별로 Cum, average 와 Cum, 를비교해보면최근까지의누적보고건수에대한이전 5년동안해당주까지의평균보고건수와의비교가가능하다. Cum, average 는지난 5년 ( 년) 동안의동기간보고누계평균으로계산된다. <Table 3> 은주요표본감시대상감염병에대한보고현황을보여주는데, 표본감시대상감염병통계산출단위인 case/total outpatient( 환자분율 ) 는수족구병환자수를전체외래방문자수로나눈값으로계산되며, Cum, 2012 와 Cum, 2011 은각각 2012년과 2011년 1주부터해당주까지누계건수에대한환자분율로계산된다. <Table 3> 은표본감시감염병들의최근발생양성을신속하게파악하는데도움이된다.

20 년 7 월 5 일제 6 권 / 제 27 호 / ISSN: X PUBLIC HEALTH WEEKLY REPORT, KCDC 주간건강과질병은질병관리본부가보유한각종감시및조사사업, 연구자료에대한종합, 분석을통하여근거에기반한질병과건강관련정보를제공하고자최선을다하고있습니다. 주간건강과질병에서제공되는감염병통계는 감염병의예방및관리에관한법률 에의거하여국가감염병감시체계를통해신고된자료를기초로집계된것이며, 당해년도자료는의사환자단계에서신고된후확진결과가나오거나다른병으로확인되는경우수정되므로변동가능한잠정통계입니다. 동간행물은인터넷 ( 에주간단위로게시되며이메일을통해정기적인구독을원하시는분은 phwr@korea.kr로신청하여주시기바랍니다. 주간건강과질병에대하여궁금하신사항은 phwr@korea.kr로문의하여주시기바랍니다. 창간 : 2008년 4월 4일발행 : 년 7월 5일발행인 : 이덕형편집인 : 조명찬, 한순영, 이주실, 한복기편집위원 : 강춘, 김성수, 김성순, 김영택, 고운영, 박미선, 박옥, 박현영, 박혜경, 송지현, 윤승기, 이종영, 이영선, 배근량, 최혜련, 박선희, 인혜경, 최수영편집 : 질병관리본부감염병관리센터감염병감시과 충북청원군오송읍오송생명 2 로 187 오송보건의료행정타운 ( 우 ) Tel. (043) , 7164 Fax. (043)