pissn X eissn PUBLIC HEALTH WEEKLY REPORT, PHWR Vol.11 No CONTENTS 년국내엔테로바이러스실험실표본감시결과 0188 식이보충제복용및영

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1 pissn X eissn PUBLIC HEALTH WEEKLY REPORT, PHWR Vol.11 No CONTENTS 년국내엔테로바이러스실험실표본감시결과 188 식이보충제복용및영양소섭취현황 193 주요감염병통계환자감시 : 전수감시, 표본감시 병원체감시 : 인플루엔자및호흡기바이러스 급성설사질환, 엔테로바이러스

2 주간건강과질병 제 11 권제 7 호 연구논문, Research article 216 년국내엔테로바이러스실험실표본감시결과 질병관리본부감염병분석센터바이러스분석과윤영실, 이용표, 김주애, 최우영, 강춘 * 질병관리본부국립보건연구원감염병연구센터백신연구과이준우, 유정식 * 교신저자 : kangchun@korea.kr, Results of laboratory-based enterovirus sentinel surveillance in Korea, 216 Yoon Youngsil, Lee Yong-Pyo, Kim Jooae, Choi Wooyoung, Kang Chun Division of Viral Diseases, Center for Laboratory control of Infectious Diseases, KCDC Lee June-Woo, Yoo Jung Sik Division of Vaccine Research, Center for Infectious Diseases Research, KNIH, KCDC Background: Human enterovirus (HEV) is the main cause of aseptic meningitis, encephalitis, hand, foot and mouth disease (HFMD) and herpangina. In recent years, enterovirus outbreaks have been frequently associated with some serotypes. This study analyzed the genetic characteristics of enterovirus-associated symptomatic cases in Korea in 216. Methodology/Results: A total of 2,379 clinical specimens were collected from patients who were suspected of enterovirus infections in 216. The detection of HEV was performed by real-time reverse transcription polymerase chain reaction (RT-PCR) and nested RT-PCR, while genotype analysis was evaluated based on VP1 gene expression. The overall HEV-positive rate was 37.2% (884/2,379). Of 884 HEV-positive cases, the most frequently presented genotypes were E18 (61.%), CB5 (7.3%), CA16 (6.2%), and EV71 (5.2%). The detection rate of enterovirus according to symptoms was 42.5% (338/796) for aseptic meningitis, 64.% (142/222) for HFMD and herpangina, and 42.6% (43/11) for HFMD with complications. Conclusion: At present, there are no anti-viral treatments specific to HEV infections. This study may encourage studies for the development for HEV vaccines and therapeutics by providing surveillance data of enterovirus infections. Keywords: Enterovirus, Sentinel surveillance, Aseptic meningitis, Herpangina, Serotypes 182

3 주간건강과질병 제 11 권제 7 호 들어가는말 최근 1년간국내에서엔테로바이러스 (Enterovirus) 에의한인체감염발생이지속적으로보고되고, 29년 5월에는수족구병및신경계합병증으로인한첫사망사례가보고됨에따라그해 6월부터법정감염병으로지정되었다. 엔테로바이러스는피코나바이러스과 (Family Picornaviridae) 에속하며, 혈청형에따라약 7여종으로분류된다. 구조적특징은외피가없고 (nonenveloped) 단일가닥 (single-stranded positive sense) RNA 유전자를갖고있으며, 캡시드 (capsid) 는 VP1, VP2, VP3, VP4의 4종의폴리펩타이드 (polypeptide) 로구성되어있다 [1, 2]. 전세계적으로는매년수백만명의영유아및소아에서주로감염이 발생되며주요증상은무균성수막염, 뇌염, 수족구병, 포진성구협염등이다 [1, 7]. 주된감염경로는분변-경구및호흡기경로이며, 매개물 (fomites) 을통한전파도가능하다. 최근에는모계에서신생아에게로출생전후기 (perinatal period) 수직감염도가능한것으로보고되었다 [3]. 주요발생국가는우리나라를포함한중국, 일본, 대만등서태평양지역국가로알려져있다 [4]. 엔테로바이러스에감염되면특유의발진이나타나며열이없거나미열이동반될수있다. 대부분가벼운임상증상을보이며, 발진은발병약 1주일후에소실된다. 잠복기는 3~6일정도이며, 감염후호흡기에서 1~3주, 분변에서는 7~11 주까지도바이러스가배출된다고알려져있다. 엔테로바이러스중콕사키바이러스 A16과엔테로바이러스 71에의한감염이다수보고되고있다 [4-6]. 특히, Enterovirus Sentinel Surveillance Affilated hospitals Clinical diagnosis Specimen sampling (58 hospitals) Results of test Results of test Division of Viral Diseases, KCDC Management of Enterovirus Sentinel Surveillance and Regional Institutes of Health and Environment Analysis of current situation Providing ly report Diagnosis of enterovirus Specimen collection Input data(system) Specimen transport Regional Institutes of Health and Environment Diagnosis of enterovirus Management of regional clinic system Report of diagnosis result Specimen transport Transport organization of specimen Specimen collection and transport Figure 1. Schematic diagram of enterovirus sentinel surveillance Sentinel reporting sites: 8 city/provincial health and environmental institutes and 58 hospitals/clinics 183

4 주간건강과질병 제 11 권제 7 호 Table 1. Age and sex distribution of human enterovirus (HEV) patients and proportions of enterovirus-positive specimens, 216 No. of consulted patients No. of consulted patients No. of positive HEV (%) Total 2, (37.2) Gender Male 1, (37.8) Female (35.5) Unknown (66.7) Age < (3.6) 1-5 1, (38.8) (48.5) (32.4) > (7.8) Unknown (55.2) HEV cases HEV-positive rate (%) No. of HEV cases HEV-positive rate Week Figure 2. Proportion of enterovirus-positive patients by,

5 주간건강과질병 제 11 권제 7 호 No. of cases CA1 CA16 CA2 CA4 CA5 CA6 CA8 CA9 CB3 CB5 E5 E6 E9 E11 E18 E26 E3 EV71 Enterovirus genotypes Figure 3. Distribution of enterovirus genotypes detected, 216 엔테로바이러스 71 감염에의한수족구병은영유아에서높은비율로신경계합병증을일으키는것으로알려져있고, 경우에따라서뇌간뇌염 (brain stem encephalitis), 신경인성폐부종 (neurogenic pulmonary edema), 폐출혈, 쇼크 (shock) 등의합병증을동반하며, 이로인해사망에이를수있는것으로알려져있다 [5, 6]. 현재까지국내에서엔테로바이러스에대한상용화된백신이없기때문에, 손씻기및소독등개인위생강화에따른예방수칙준수가필요하다. 질병관리본부감염병분석센터바이러스분석과에서는국내급성이완성마비환자및중증엔테로바이러스실험실표본감시를수행하고있다. 이글은국내엔테로바이러스실험실표본감시에서수집한검체로부터엔테로바이러스검출률과국내유행주에대한특성분석결과를정리하였다. 이상에서엔테로바이러스특이유전자가검출되면, 양성으로판정하였다. Real-time RT-PCR법은 WHO에서권장하고있는 Pan_EV primer 및 probe를사용하며, nested RT-PCR법보다민감도가높고신속한진단이가능한장점이있다. Nested RT- PCR을수행하여엔테로바이러스의구조유전자인 VP1을검출한후염기서열분석을통해바이러스의유전형을확인하였다. 유전자검사를수행하기위한적정검체는대변, 인후도찰물및비인후도찰물, 뇌척수액등을전처리하여사용하였다. 대변검체는 2 g당 1 ml의 PBS와 1 g의유리비드를첨가후왕복식진탕기 (stool shaker) 를사용하여진탕하였고 1,5 rpm에서 2분간원심분리후상층액을취하여사용하였다. 인후도찰물 (throat swab) 은바이러스수송배지 (virus transport medium, VTM) 에면봉을담가놓은 뒤소용돌이식진탕기 (vortexing mixer) 로진탕하여사용하였고 몸말 216년국내엔테로바이러스실험실표본감시는질병관리본부바이러스분석과, 전국 8개시 도보건환경연구원, 그리고 58개의료기관이협력네트워크를구축하여진행하였다 (Figure 1). 엔테로바이러스의검출은 real-time RT-PCR법과바이러스특이적 nested RT-PCR법을각각실시하여한가지검사법 뇌척수액 (CSF) 은전처리없이바로사용하였다. 전처리된검체로부터바이러스의 RNA를추출하여앞에서언급한두가지검사법을수행하였다. 216년수행된실험실표본감시에서의뢰된검사건수는 2,379건이며, 그중성별로는남성이 515건으로여성 (353건) 보다많았으며양성검출률도남성이 37.8%(515 건 /1361 검체 ) 로여성 35.5% 보다높았다. 연령별로는 1~5세가 1,464건, 6~1세가 441건으로많은검체가의뢰되었다. 의뢰된검체중엔테로바이러스 185

6 주간건강과질병 제 11 권제 7 호 No. of cases Aseptic meningitis cases Aseptic meningitis HEV-positive cases Week No. of cases HFMD and Herpangina cases HFMD and Herpangina HEV-positive cases Week HFMD with Complications cases HFMD with Complications HEV-positive cases No. of cases Week Figure 4. Detection rates of enterovirus by type of disease, 216 양성검출건수는 884건 (37.2%) 이며연령대별양성검체수는 1~5세가 568건으로가장많았으나양성검출률은 6~1세에서 48.5%(214 건 /441 검체 ) 로가장높았다 (Table 1). 216년검출된엔테로바이러스의연중분포를보면, 늦은봄에서가을인 5~9월사이에많이검출되었으며 (93.5%), 6월 (23~27주) 과 7월 (28~31주) 에각각 34.6%, 3.9% 로높은분포율을보였다 (Figure 2). 216년에검출된유전형은총 18종 (518건) 으로에코바이러스 18(Echovirus 18) 316건 (61.%), 콕사키바이러스 B5(Coxackievirus B5) 38건 (7.3%), 콕사키바이러스 A16(Coxackievirus A16) 32건 (6.2%) 순으로높았다 (Figure 3). 엔테로바이러스로인한임상적특징은주로무균성수막염 (Aseptic meningitis), 수족구병 (HFMD) 및포진성구협염, 합병증을동반한수족구병등인데, 216년도에는무균성수막염증상을보이는환자 42.5%(338 명 ) 와수족구병및포진성구협염증상환자 64.%(142명 ), 합병증을동반한수족구병환자 42.6%(43명 ) 에서엔테로바이러스가검출되었다 (Figure 4). 이중무균성수막염증상을보이는환자에서에코바이러스 18형이 39.6%(134 건 ), 콕사키바이러스 186

7 주간건강과질병 제 11 권제 7 호 B5형이 5.6%(19 건 ), 콕사키바이러스 A9형이 2.4%(8 건 ) 검출되었고, 수족구병및포진성구협염환자에서는에코바이러스 18형이 18.3%(26 건 ), 콕사키바이러스 16형에서 11.3%(16 건 ), 콕사키바이러스 A6형에서 7.%(1건 ) 검출되었다. 그리고합병증동반수족구병환자는에코바이러스 44.2%(19명 ), 에코바이러스 6형이 7.%(3 명 ) 검출되었다. 5. Liu W., et al. Co-circulation and genomic recombination of Coxsackievirus A16 and enterovirus71 during a large outbreak of hand, foot, and mouth disease in Central China. PLos One. 214;9:e Ooi, M., et al. Clinical features, diagnosis, and management of enterovirus 71. Lancet Neurol. 21;9: Glen R. Abedi., et al. Enterovirus and Human Parechovirus Surveillance-United States, MMWR. 215;64:94-3. 맺는말 엔테로바이러스는유전형이다양하고유전자변이가자주나타나기때문에유전형및염기서열변화를지속적으로감시할필요가있다. 본엔테로바이러스실험실표본감시는 216년전국 58개의료기관및 8개시 도보건환경연구원이활발히참여하였으며, 전국에서유행하는엔테로바이러스감시를보다적극적으로수행하기위해질병관리본부의실험실감시망과참여의료기관의임상감시망들의통합을통해감시및검출대상지역을확대하고자한다. 향후본감시사업을통해확보한유행주기및증상별유전형분석결과를기반으로국내유행엔테로바이러스의임상적특징과유전형사이의상관관계를분석하여의료현장에서활용가능한정보를제공해나갈예정이다. 참고문헌 1. Baek, K. A., et al. Molecular and epidemiological characterization of Enteroviruses isolated in Chungnam, Korea from 25 to 26. J Microbiol Biotechnol. 29;19: Hyypiäa, T., et al. Classification of Enteroviruses based on molecular and biological properties. K Gen Virol. 1997;78: Jung, J. S., et al. Vertically transmitted severe Coxsackievirus B infection in four preterm twins presented. Korean J Perinatol. 213;24(4): World Health Organization. A guide to clinical management and public health response for hand, foot and mouth disease (HFMD). WHO

8 주간건강과질병 제 11 권제 7 호 연구단신, Brief report 식이보충제복용및영양소섭취현황 질병관리본부질병예방센터건강영양조사과윤이나, 양지은, 권상희, 오경원 * * 교신저자 : kwoh27@korea.kr, Dietary supplement intake based on the Korea National Health and Nutrition Examination Survey in 215 Yoon Leena, Yang Jieun, Kweon Sanghui, Oh Kyungwon Division of Health and Nutrition Survey, Center for Disease Prevention, KCDC This study was conducted to assess the characteristics of dietary supplement users and to evaluate nutrient intakes from dietary supplements. Using the Korea National Health and Nutrition Examination Survey (KNHANES) IV-3 (215) raw data, a nutrient composition table for dietary supplements was developed and nutrient intakes from food and dietary supplements was estimated. The nutrients included in the composition table for dietary supplements were calcium, phosphorus, iron, vitamin A, thiamin, riboflavin, niacin, and vitamin C. The proportion of dietary supplement user during the recent one year was 41.8%, which was higher in women, and in those aged 1-5 years or 5 years and over. The most frequently consumed supplements was vitamin and mineral product in all age groups, while the second-most frequently consumed supplements were probiotic products in younger individuals and omega-3 fatty acid products in the older individuals. The intakes of calcium, iron, and vitamin C were mg, 17.3 mg, and 115. mg, respectively from food, and mg, 19.9 mg, and mg, respectively from food plus dietary supplement. Although the proportion of subjects with undernutrition was reduced by adding respective dietary supplement use, the proportion of subjects with overnutrition higher than the upper tolerable levels slightly increased. Keywords: Dietary supplement, Korea National Health and Nutrition Examination Survey, Nutrient intakes, Vitamin and mineral, Omega-3 fatty acid products, Probiotic products 188

9 주간건강과질병 제 11 권제 7 호 들어가는말 건강을유지하고적절히성장하기위한영양소나생리활성물질은균형잡힌식단으로충분히섭취할수있고임신부등일부생리적필요가있는대상에대해서만식이보충제를권하는것이일반적이다. 그러나이와상관없이많은사람들이식이보충제를섭취하고있고이는여러나라에서공통적으로나타나고있는현상이다 [1]. 건강에대한관심이높아지면서국내에서유통되는식이보충제의종류도다양해지고판매량또한증가하고있는추세이며 [2], 국민건강영양조사에서도식이보충제를 1년내에복용했다고응답한사람이 4% 를넘어서는것으로보고하고있다 [3]. 국민건강영양조사는식이보충제복용경험조사를실시하고있으며조사 1일전섭취한식이보충제제품에대한정보, 섭취량, 섭취시간및방법등상세한내용을조사하고있다 [4]. 또한, 조사현장에서대상자가섭취한식이보충제실물을구할수있는경우에는포장에적힌정보를사진으로찍어이에기초한식이보충제데이터베이스 (database, DB) 를구축하였다. 조사 1일전섭취한것으로조사된식이보충제는 215년에조사된자료를기준으로 3,16 건이었으며중복자료를제외하고구축된식이보충제 DB 건수는 1,84건이었다. 식이보충제 DB는제품명, 제조사, 판매사, 1회분량, 형태 ( 캡슐, 정제등 ), 원료및함량, 영양표시정보, 생리활성물질등에대해서구축하였으며, 영양소는칼슘, 인, 철, 비타민 A, 티아민, 리보플라빈, 나이아신, 비타민 C 등 8가지가 Table 1. Prevalence of subject taking dietary supplement, 215 Number of subjects Taking dietary supplement in recent one year (%) Taking dietary supplement in the last day (%) All Men Women All Men Women All Men Women Mean (SE) Mean (SE) Mean (SE) Mean (SE) Mean (SE) Mean (SE) All 1) 6,628 2,942 3, (.9) 35.5 (1.2) 48. (1.2) 23.9 (.8) 19.8 (1.) 28. (1.) Age (yr) (4.8) 59.8 (5.9) 5.3 (7.) 39.5 (4.7) 46.1 (6.3) 34. (6.5) (4.2) 57.1 (5.5) 44.5 (5.5) 26.9 (3.6) 29.2 (4.8) 24.1 (4.7) (2.9) 42.9 (3.7) 43.2 (3.6) 17.3 (2.3) 18.6 (3.2) 15.7 (3.) (2.6) 28.1 (3.1) 26.8 (3.7) 12. (1.6) 12.3 (2.2) 11.7 (2.5) (2.2) 2.9 (2.6) 34.6 (3.2) 13. (1.6) 1. (1.7) 16.2 (2.5) , (1.4) 37.5 (2.) 51.5 (1.8) 24. (1.3) 19.6 (1.7) 28.5 (1.7) , (1.5) 37.8 (2.1) 59. (1.8) 31.2 (1.5) 23.6 (1.9) 38.7 (1.9) 65+ 1, (1.8) 38.4 (2.6) 5. (2.) 31.5 (1.7) 27.2 (2.5) 34.6 (1.9) Residence 2) Urban 5,375 2,353 3, (1.1) 36.1 (1.4) 47. (1.2) 23.4 (.9) 19.8 (1.1) 26.8 (1.1) Rural 1, (2.3) 32.6 (2.5) 42.7 (4.1) 19.6 (1.9) 18.2 (2.2) 21.1 (2.5) Income 2,3) Lowest 1, (1.5) 27.7 (2.) 4.6 (2.1) 17.2 (1.3) 13.8 (1.5) 2.7 (1.6) 2nd 1, (1.8) 32.2 (2.5) 45.5 (2.2) 21.3 (1.4) 18.1 (2.) 24.1 (2.) 3rd 1, (1.6) 39.9 (2.) 5.2 (2.2) 25.9 (1.5) 21.7 (1.8) 3.3 (2.) 4th 1, (1.8) 43. (2.1) 48.8 (2.2) 26.6 (1.4) 24.3 (1.9) 28.8 (1.6) 1) subject: 1 year old or over, 215 2) The mean and standard error were calculated using direct standardization method based on 5 population projection. 3) Income - According to the equivalent income of household, subjects were divided into quartile groups within sex and each age stratum - Equivalent income of household = monthly household income / No. of a household members 189

10 주간건강과질병 제 11 권제 7 호 Table 2. Number and proportion of subjects taking dietary supplement by main ingredient, 215 All age (n = 2,672) 1-2 1) (n = 74) 3-5 (n = 77) 6-11 (n = 95) (n = 88) (n = 12) 3-49 (n = 635) 5-64 (n = 844) 65 year old or over (n = 739) n % n % n % n % n % n % n % n % n % Vitamin & Mineral 1, Omega-3 fatty acid Red Ginseng Probiotics Lutein Propolis Spirulina Milk Thistle extract Glucosamin Ginkgo leaf extract Others ) years old 포함되어있다. 이글에서는우리나라국민이주로복용하는식이보충제종류에대해서분석하고식이보충제를통해섭취하는영양소의양을식품으로부터섭취하는양과비교하여제공하려고한다. 제품, 홍삼제품, 프로바이오틱스제품등이상대적으로많았다. 연령별로는소아 청소년 (1~18세) 에서비타민 무기질다음으로프로바이오틱스제품섭취가많았으며 19세이상성인연령에서는오메가-3 지방산함유제품섭취자가많았다. 조사 1 일전식이보충제를섭취했다고응답한 1,694 명의 몸말 국민건강영양조사제6기 3차년도 (215) 원시자료를이용하여식이보충제복용현황분석을실시하였다. 최근 1년내에식이보충제복용경험이있다고응답한분율은 41.8% 였으나조사전날섭취했다고응답한분율은 23.9% 였다. 최근 1년내에식이보충제복용경험과조사전날섭취했다는응답모두에서남자보다여자가높고 1~5세, 5세이상의연령군에서높았다 (Table 1). Table 2는식이보충제종류별섭취자수를나타낸것으로, 연령과관계없이섭취자가가장많은식이보충제는비타민 무기질제 (52.9%) 였으며, 다음으로오메가-3 지방산함유 자료를이용하여영양소섭취수준을분석한결과, 식품으로부터섭취한칼슘은 1일 1인평균 mg이었으나식이보충제로부터섭취한양을합하면 mg을섭취하는것으로조사되었으며, 철은 17.3 mg에서 19.9 mg, 비타민 C는 115. mg에서 mg으로증가하였다 (Table 3). 식이보충제복용에따라섭취량변화가큰영양소는수용성비타민종류였으며, 수용성비타민은지용성비타민이나무기질에비해알려져있는독성이적어일반적인비타민 무기질제에빠짐없이포함되는편이기때문인것으로보인다. 특히비타민 C는해당영양소만제공하는식이보충제의섭취빈도가높고 5~1, mg의고용량제품이많아합산시영향이가장큰것으로보인다. 반면, 칼슘및비타민 A 등상한섭취량이정해진영양소의경우이들이첨가된식이보충제의종류도상대적으로적었다. 식품으로섭취하는영양소양만을 19

11 주간건강과질병 제 11 권제 7 호 Table 3. Intake of nutrients by food and dietary supplement, 215 All (N = 1,694) Food Intake of nutrients Proportion of undernutrition 1) Proportion of overnutrition Food & dietary supplement Food Food & dietary supplement Food Food & dietary supplement Mean (SE) Mean (SE) % (SE) % (SE) % (SE) % (SE) Calcium ( mg /d) (9.4) (1.8) 65.4 (1.3) 57.1 (1.5). ( - ).1 (.) Phosphorus ( mg /d) 1,98.2 (17.5) 1,12.3 (17.5) 11.8 (.9) 11.6 (.9).6 (.3) *.6 (.3) * Iron ( mg /d) 17.3 (.3) 19.9 (.4) 13.2 (1.1) 11. (1.) 1.7 (.4) 3.7 (.5) Vitamin A ( μg RE/d) (25.6) 92.5 (28.) 41.3 (1.4) 32.5 (1.4) 2.3 (.4) 4.8 (.6) Thiamin ( mg /d) 2. (.) 7.9 (.4) 6.7 (.7) 4.4 (.7) - - Riboflavin ( mg /d) 1.4 (.) 5.4 (.4) 36.9 (1.5) 21.8 (1.3) - - Niacin ( mg /d) 16.3 (.3) 24.6 (.7) 29.7 (1.4) 21.1 (1.3).4 (.2) **.8 (.3) * Vitamin C ( mg /d) 115. (5.1) (22.1) 5.6 (1.9) 24.6 (1.4). ( - ) 5.8 (.8) Men (N = 625) Calcium ( mg /d) (16.) (18.) 58.6 (2.2) 52.9 (2.3).1 (.1) **.1 (.1) ** Phosphorus ( mg /d) 1,282.4 (28.6) 1,286.2 (28.7) 5.7 (1.1) 5.4 (1.1).9 (.5) **.9 (.5) ** Iron ( mg /d) 2.2 (.6) 21.5 (.6) 5.8 (1.2) 5.3 (1.1) 3.2 (.8)* 4. (.9) Vitamin A ( μg RE/d) (37.6) 99. (43.1) 36.1 (2.2) 27.8 (2.2) 2.9 (.7) 6.5 (1.) Thiamin ( mg /d) 2.3 (.1) 8.2 (.6) 3.6 (.8) 2.7 (.7) * - - Riboflavin ( mg /d) 1.6 (.) 5.9 (.7) 34.8 (2.2) 21.2 (1.9) - - Niacin ( mg /d) 19. (.5) 28. (1.2) 18.5 (1.9) 13.5 (1.6). ( - ). ( - ) Vitamin C ( mg /d) 16.3 (6.4) (31.9) 5.9 (2.8) 23.1 (2.1). ( - ) 5.8 (1.2) Women (N = 1,69) Calcium ( mg /d) (1.1) 54.1 (12.5) 7.2 (1.7) 6.1 (1.9). ( - ). ( - ) Phosphorus ( mg /d) (18.6) (18.6) 16.2 (1.3) 16. (1.3).4 (.3) **.4 (.3) ** Iron ( mg /d) 15.2 (.3) 18.7 (.6) 18.4 (1.7) 15. (1.6).6 (.3) * 3.4 (.7) Vitamin A ( μg RE/d) (31.7) (33.1) 44.9 (1.7) 35.8 (1.6) 1.8 (.5) * 3.7 (.6) Thiamin ( mg /d) 1.8 (.) 7.7 (.5) 8.8 (1.1) 5.6 (.9) - - Riboflavin ( mg /d) 1.3 (.) 5. (.5) 38.4 (1.9) 22.2 (1.5) - - Niacin ( mg /d) 14.4 (.3) 22.1 (.8) 37.6 (1.6) 26.5 (1.6).6 (.4) ** 1.3 (.5) * Vitamin C ( mg /d) (5.8) (27.5) 5.4 (2.) 25.7 (1.6). ( - ) 5.8 (.9) 1) The proportion of undernutrition means percentage of subjects whose intake of respective nutrient was lower than the estimated average requirements (EAR). The proportion of overnutrition means percentage of subjects whose intake of respective nutrient was equal or higher than the tolerable upper intake level (UL). EAR and UL were from the Dietary Reference Intakes for Koreans, 215 by the Ministry of Health and Welfare 2) When the proportion is under the.5, standard error is not present. 3) * and ** means that the coefficient of variation is 25-5% and 5% above, respectively

12 주간건강과질병 제 11 권제 7 호 고려했을때는비타민 A 섭취가부족한분율이 41.3% 였던것에 반해식이보충제섭취량까지고려하면 32.5% 로감소하였으며, 리보플라빈, 비타민 C 등도상당수준감소하였다. 철, 비타민 A, 기능성성분을주로고려하여분류체계를마련하고각분류별 섭취빈도, 섭취특성등을분석하는등식이보충제조사자료를 효율적으로활용하기위해다양한연구를시도할계획이다. 비타민 C 의상한섭취량이상섭취자분율은다소증가하였는데 비타민 C 의경우식품을통한섭취량에식이보충제를통한섭취량을 합산한경우에만상한섭취량이상을섭취하는대상자가있었다. 참고문헌 맺는말 국민건강영양조사에서식이보충제는일상식사에서부족한영양소를보충하거나건강증진을위해복용하는제품으로, 비타민, 무기질및기능성원료를함유한정제, 캡슐, 분말, 과립, 액상, 환형태의제품을의미하며, 질병치료를목적으로복용하더라도 1. Burnett AJ, Livingstone KM, Woods JL, McNaughton SA. Dietary Supplement Use among Australian Adults: Findings from the National Nutrition and Physical Activity Survey. Nutrients. 217;9: 식품의약처안전처. 216 식품의약품통계연보제18호 질병관리본부. 215 국민건강통계 질병관리본부. 국민건강영양조사제6기 ( ) 영양조사지침서 비타민, 무기질및기능성원료가함유된경우에는식이보충제에포함하여조사하고있다. 식이보충제와식품으로부터섭취하는영양소를동등하게비교할수는없지만식이보충제를복용하는이유중에하나가식품만으로는섭취가부족할수있는영양소를보충한다는것이므로식이보충제복용을통해섭취할수있는영양소양을평가하기위해식이보충제별영양성분 DB를구축하고이를통한섭취량을산출하였다. 식이보충제를통한영양소섭취량을식품으로부터의섭취량에합산할경우, 섭취부족자분율이감소하고, 과잉섭취하는경우가증가하였다 (Table 3). 이는 1일간의섭취량으로평가한결과이므로과잉섭취자분율이과대평가될위험이크지만그럼에도불구하고대부분의영양소에서식이보충제로인한과잉섭취자분율은다행히크게증가하지않았다. 식이보충제의유통주기가짧고, 한해조사되고있는식이보충제 1천여건중 1명이상여러사람이복용한제품은 2여건에불과해제품별 DB를구축 활용하는것이비효율적인측면이있다. 또한식이보충제중에서비타민 무기질제를복용하는사람이많기는하지만제품별영양성분 DB로는영양소외의생리활성물질보충용제품의역할에대한평가가어려워별도의분석방법마련이필요한실정이다. 이러한제한점을보완하기위해식이보충제별 192

13 193

14 주요감염병통계, Statistics of selected infectious diseases 1.1 환자감시 : 전수감시감염병주간발생현황 (6th Week) Table 1. Reported cases of national infectious diseases in Republic of Korea, ending February 1, 218 (6th Week)* Category Ⅰ Category Ⅱ Category Ⅲ Category Ⅳ Classification of disease 218 ly average Total no. of cases by year Imported cases of current : Country (no. of cases) Cholera Typhoid fever Laos(4) Paratyphoid fever Shigellosis Vietnam(11), Philippines(2), Laos(1) EHEC Viral hepatitis A ,429 4,679 1,84 1, Pertussis Tetanus Measles Mumps 274 1, ,922 17,57 23,448 25,286 17,24 Rubella Viral hepatitis B (Acute) Japanese encephalitis Varicella 974 8, ,74 54,6 46,33 44,45 37,361 Streptococcus pneumoniae Malaria Scarlet fever 451 2, ,862 11,911 7,2 5,89 3,678 Meningococcal meningitis Legionellosis Vibrio vulnificus sepsis Murine typhus Scrub typhus ,592 11,15 9,513 8,13 1,365 Indonesia(1) Leptospirosis Brucellosis Rabies HFRS Syphilis ,153 1,569 1,6 1, Unit: No. of cases CJD/vCJD Tuberculosis 621 3, ,577 3,892 32,181 34,869 36,89 HIV/AIDS ,5 1,62 1,18 1,81 1,13 Viral hepatitis C 198 1,437-6, VRSA CRE , Dengue fever Thailand(2), Philippines(2), Laos(2), Republic of South Africa(1), Taiwan(1), Malaysia(1), Vietnam(1), Indonesia(1), Cambodia(1), Tanzania(1) Unknown(1) Q fever West Nile fever Lyme Borreliosis Melioidosis Chikungunya fever Tanzania(1), Thailand(1), Unknown(1) SFTS MERS Zika virus infection 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)

15 Table 2. Reported cases of infectious diseases by geography, ending February 1, 218 (6th Week)* Diseases of Category Ⅰ Unit: No. of cases Reporting area Cholera Typhoid fever Paratyphoid fever Shigellosis Overall Seoul Busan Daegu Incheon Gwangju 1 2 Daejeon Ulsan 3 Sejong 2 Gyonggi Gangwon Chungbuk Chungnam Jeonbuk 1 1 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

16 Table 2. (Continued) Reported cases of infectious diseases by geograohy, s ending February 1, 218 (6th 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 3 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, ending February 1, 218 (6th Week)* Diseases of Category Ⅱ Unit: No. of cases Reporting area Measles Mumps Rubella Viral hepatitis B (Acute) 218 Overall ,41 1, 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 February 1, 218 (6th Week)* Unit: No. of cases Diseases of Category Ⅱ Diseases of Category Ⅲ Reporting area Japanese encephalitis Varicella Malaria Scarlet fever Overall 974 8,662 6, , Seoul 131 1, Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi 26 2,494 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

19 Table 2. (Continued) Reported cases of infectious diseases by geography, ending February 1, 218 (6th Week)* Diseases of Category Ⅲ Unit: No. of cases Reporting area Meningococcal meningitis Legionellosis Vibrio vulnificus sepsis Murine typhus Overall Seoul Busan 1 4 Daegu 1 Incheon 1 1 Gwangju Daejeon 2 Ulsan Sejong Gyonggi Gangwon Chungbuk 2 Chungnam 1 Jeonbuk 1 Jeonnam Gyeongbuk 3 Gyeongnam 1 Jeju 1 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 February 1, 218 (6th Week)* Diseases of Category Ⅲ Unit: No. of cases Reporting area Scrub typhus Leptospirosis Brucellosis Hemorrhagic fever with renal syndrome 218 Overall Seoul Busan 1 3 Daegu 2 Incheon Gwangju Daejeon Ulsan 4 2 Sejong 1 1 Gyonggi Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju 5 2 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. 2

21 Table 2. (Continued) Reported cases of infectious diseases by geography, ending February 1, 218 (6th Week)* Unit: No. of cases Diseases of Category Ⅲ Diseases of Category Ⅳ Reporting area Syphilis CJD/vCJD Tuberculosis Dengue fever Overall ,52 3, Seoul Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year 217, 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

22 Table 2. (Continued) Reported cases of infectious diseases by geography, ending February 1, 218 (6th Week)* Diseases of Category Ⅳ Unit: No. of cases Reporting area Q fever Lyme Borreliosis SFTS Zika virus infection year year Overall Seoul Busan 3 - Daegu 2 - Incheon Gwangju 1 - Daejeon - Ulsan Sejong - Gyonggi Gangwon Chungbuk Chungnam Jeonbuk - Jeonnam - Gyeongbuk Gyeongnam 6 - 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

23 1.2 환자감시 : 표본감시감염병주간발생현황 (6th ) 1. Influenza, Republic of Korea, s ending February 1, 218 (6th ) 218 년도제 6 주인플루엔자표본감시 ( 전국 2 개표본감시기관 ) 결과, 의사환자분율은외래환자 1, 명당 31.7 명으로지난주 (35.3 명 ) 대비감소 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 February 1, 218 (6th ) 218 년도제 6 주차수족구병표본감시 ( 전국 95 개의료기관 ) 결과, 의사환자분율은외래환자 1, 명당.4 명으로전주 (.6 명 ) 대비감소 수족구병은 29 년 6 월법정감염병으로지정되어표본감시체계로운영 No. of outpatients / 1, Figure 2. Weekly proportion of hand, foot and mouth disease per 1, outpatients,

24 3. Ophthalmologic infectious disease, Republic of Korea, s ending February 1, 218 (6th ) 218 년도제 6 주차유행성각결막염의표본감시 ( 전국 92 개의료기관 ) 결과, 외래환자 1, 명당분율은 13.9 명으로전주 11.9 명대비증가 동기간급성출혈성결막염의환자분율은.6 명으로지난주.8 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 24

25 4. Sexually Transmitted Diseases, Republic of Korea, s ending February 1, 218 (6th ) 218 년도제 6 주성매개감염병표본감시기관 ( 전국보건소및의료기관 584 개참여 ) 에서신고기관당클라미디아감염증 2.5 건, 성기단순포진 2.2 건, 임질 1.9 건, 첨규콘딜롬 1.4 건발생을신고함. 제 6 주차신고의료기관수 : 임질 13 개, 클라미디아 48 개, 성기단순포진 36 개, 첨규콘딜롬 26 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 (6th ) Waterborne and foodborne disease outbreaks, Republic of Korea, s ending February 1, 218 (6th ) 218 년도제 6 주보고기관 ( 전국 254 개보건소 ) 에서집단발생이 16 건발생하였으며누적발생건수는 49 건 ( 사례수 398 명 ) 이발생함 No. of outbreaks Average no. of cases in last 5 years( ) Figure 5. Number of waterborne and foodborne disease outbreaks reported by,

26 2.1 병원체감시 : 인플루엔자및호흡기바이러스주간감시현황 (6th ) 1. Influenza viruses, Republic of Korea, s ending February 1, 218 (6th ) 218 년도제 6 주에전국 52 개감시사업참여의료기관에서의뢰된호흡기검체 292 건중 122 건양성 (A/H1N1pdm9 3 건, A(H3N2) 49 건, B 형 7 건 ) No. of positives A(H3N2) A(not subtyped) A(H1N1)pdm9 B Percent positive Percent positives (%) Figure 6. Number of specimens positive for influenza by subtype, to flu season 2. Respiratory viruses, Republic of Korea, Weeks ending February 1, 218 (6th ) 218 년도제 6 주호흡기검체에대한유전자검사 (17 개시 도보건환경연구원및전국 52 개참여기관 ) 결과, 66.4% 의호흡기바이러스가 검출되었음. ( 최근 4 주평균 31 개의호흡기검체에대한유전자검사결과를나타내고있음 ) 주별통계는잠정통계이므로변동가능 218 () Weekly total 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 January February , (Average No. of detected cases is 31 in last 4 s) 217 : the rate of detected cases between January December 자세히보기 : 질병관리본부 알림 주간질병감시정보 26

27 2.2 병원체감시 : 급성설사질환실험실표본주간감시현황 (5th ) Acute gastroenteritis-causing virus and bacteria, Republic of Korea, s ending February 3, 218 (5th ) 218 년도제 5 주실험실표본감시 (17 개시 도보건환경연구원및 7 개의료기관 ) 급성설사질환유발바이러스검출건수는 24 건 (45.3%), 세균 검출건수는 16 건 (9.4%) 이었음. Acute gastroenteritis-causing viruses Week No. of sample No. of detection (Detection rate, %) Group A Rotavirus Norovirus Enteric Adenovirus Astrovirus Total (14.1) 24 (33.8) 3 (4.2) 1 (1.4) 38 (53.5) (15.9) 17 (27.) 1 (1.6) 1 (1.6) 29 (46.) (14.5) 11 (2.) (.) (.) 19 (34.5) (24.5) 1 (18.9) 1 (1.9) (.) 24 (45.3) (14.4) 79 (25.8) 8 (2.6) 3 (1.) 134 (43.8) * The samples were collected from children 5 years of sporadic acute gastroenteritis in Korea. Acute gastroenteritis-causing bacteria Week No. of sample Salmonella Pathogenic spp. E.coli Shigella spp. No. of isolation (Isolation rate, %) V.parahaem V. cholerae Campylobacter C.perfringens S. aureus B. cereus Total olyticus spp (.5) 2 (1.) () () () 1 (.5) 4 (2.) 1 (.5) 1 (.5) 1 (5.2) 3 21 (.) 4 (2.) 1 (.5) () () 3 (1.5) 2 (1.) 2 (1.) () 12 (6.) (.5) 4 (2.1) () () () 1 (.5) 4 (2.1) 5 (2.6) 2 (1.1) 17 (9.) (3.5) 5 (2.9) () () () 1 (.6) 2 (1.2) 1 (.6) 1 (.6) 16 (9.4) (1.1) 15 (1.7) 1 (.2) () () 7 (.8) 14 (1.6) 11 (1.2) 5 (.6) 63 (7.1) * 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 27

28 2.3 병원체감시 : 엔테로바이러스실험실주간감시현황 (5th ) Enterovirus, Republic of Korea, s ending February 3, 218 (5th ) 218년도제5주실험실표본감시 (8개시 도보건환경연구원, 전국 63개참여병원 ) 결과, 새로검출된엔테로바이러스 건 (218 년누적 3건, 양성률 3.8%) 임. - 무균성수막염 건 (218 년누적 1건 ), 수족구병및포진성구협염 건 (218 년누적 1건 ), 합병증동반수족구 건 (218 년누적 건 ), 기타 건 (218 년누적 1건 ). Aseptic meningitis 8 No. of cases Enterovirus detection rate 217 Enterovirus detection rate Figure 7. Detection cases of enterovirus in aseptic meningitis patients from 217 to 218 HFMD and Herpangina 25 2 No. of cases Enterovirus detection rate 217 Enterovirus detection rate Figure 8. Detection cases of enterovirus in HFMD and herpangina patients from 217 to 218 HFMD with Complications No. of cases Enterovirus detection rate 217 Enterovirus detection rate Figure 9. Detection cases of enterovirus in HFMD with complications patients from 217 to

29 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.

30 발간등록번호 주간건강과질병, PHWR 은질병관리본부에서시행되는조사사업을통해생성된감시및연구자료를기반으로근거중심의건강및질병관련정보를제공하고자최선을다할것이며, 제공되는정보는질병관리본부의특정의사와는무관함을알립니다. 본간행물에서제공되는감염병통계는 감염병의예방및관리에관한법률 에의거, 국가감염병감시체계를통해신고된자료를기반으로집계된것으로집계된당해년도자료는의사환자단계에서신고된것이며확진결과시혹은다른병으로확인될경우수정될수있는잠정통계임을알립니다. 주간건강과질병, PHWR 은질병관리본부홈페이지를통해주간단위로게시되고있으며, 정기적구독을원하시는분은 이메일을통해보내지는본간행물의정기적구독요청시구독자의성명, 연락처, 직업및이메일주소가요구됨을알려드립니다. 주간건강과질병 발간관련문의 : kcdc215@korea.kr/ /33 창 발 간 : 28 년 4 월 4 일 행 : 218 년 2 월 15 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)