pissn X eissn PUBLIC HEALTH WEEKLY REPORT, PHWR Vol.10 No CONTENTS 년공수병예방을위한국내동물교상환자감시현황 년

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1 pissn X eissn PUBLIC HEALTH WEEKLY REPORT, PHWR Vol.1 No.27 CONTENTS 년공수병예방을위한국내동물교상환자감시현황 년국내살모넬라균실험실감시현황 71 주요통계환자감시 / 전수감시, 표본감시 병원체감시 / 인플루엔자및호흡기바이러스 급성설사질환, 엔테로바이러스 매개체감시 / 말라리아매개모기, 일본뇌염매개모기

2 주간건강과질병 제 1 권제 27 호 216 년공수병예방을위한국내동물교상환자감시현황 질병관리본부국립보건연구원감염병연구센터세균질환연구과이혜경, 한달무리, 이영선 * * 교신저자 : yslee7@nih.go.kr, Animal Bite Surveillance for Human Rabies Prevention in Korea, 216 Lee Hae Kyung, Han Dalmuri, Lee Yeong Seon* Division of Bacterial Disease Research, Center for Infectious Disease Research, KNIH, KCDC BACKGROUND: In Korea, rabies has occurred mainly in the north of Han river since its re-emergence in However, in 212 and 213, rabies outbreaks occurred in Suwon and Hwaseong of the southern Han river, once again. To prevent and control human rabies in Korea, the national surveillance on animal bites has been implemented since 211. METHODOLOGY: Information, such as demographic data, exposure status, animal bite, and post-exposure prophylaxis (PEP) treatment in 216 were collected through a survey. The Excel software was used for statistical analysis. RESULTS: A total of 82 animal bite cases were reported through the surveillance system in 216. By region, 474 cases from Gyeonggi province and 331 cases from Gangwon province, and 15 cases in other regions were reported respectively. Specifically, the higher number was reported from Yangpyeong county with 269 cases (56.8%) in Gyeonggi province and from Chuncheon city of 122 cases (36.9%) in Gangwon province. Although animal bites were occurred frequently high in June as 11.2% (92 cases), the cases occurred all the year. In demographic distribution, 449 cases (54.8%) of animal bites occurred in male and the highest in those aged 5-59 (23, 24.8%). 723 cases (88.2 %) of animal exposures were due to dogs and the major bite sites were hands and fingers (393, 44.6%). According to the WHO guideline for human rabies, category III cases was 695 (84.8%) of the total and only 69 (9.9%) of them received PEP treatment for category III. CONCLUSION: Human rabies by animal bite is one of the serious diseases in public health, but it is a preventable disease if we get the proper treatment after an animal bite. Therefore, in order to have a rabies free from South Korea, the surveillance for animal bites should be expanded and strengthened in the future. 들어가는말 동물교상에따른인체감염은동물의이빨이피부를관통하였을 때, 타액에있는다양한병원체가침투하면서발생한다. 미국에서는 매년 47 만건의동물교상환자가응급실에서치료를받으며, 이중약 2% 는입원치료가필요하다. 특히, 미국에서동물교상의 688

3 주간건강과질병 제 1 권제 27 호 85 9% 는개에의한것이며, 대부분어린이로주로머리와목을물린다. 고양이에의한교상은 5 1% 로, 대부분성인여성이교상을당한다고보고되고있다 [1]. 교상부위에서검출되는세균은주로 Pasteurella, Staphylococcus, Pseudomonas, Streptococcus, Capnocytophaga, Moraxella 등의호기성세균및 Bacteroides, Fusobacterium과같은혐기성세균이며, 이외에도 Bartonella 에의한고양이할큄에의한감염 (cat-scratch disease, CSD), 파상풍 (tetanus), 공수병 (rabies) 등감염병이발생할수있다 [2]. 이중에서사람공수병은공수병 (rabies) 바이러스에감염되어광견병에걸린동물에게물렸을때, 상처부위가동물의타액에의해오염되어전파되는인수공통감염병으로, 전세계 면역글로불린투여및백신접종과같은신속하고적절한치료를받지못하여모두사망함에따라, 동물교상환자의감시와신속한치료의중요성을인식하기시작하였다 [4]. 질병관리본부에서는 25년에동물에의한교상환자감시체계를구축하였고, 211년부터는국내에서공수병발생을예방하기위하여, 과거광견병또는공수병발생사례가있었던경기도와강원도주요지역을중심으로동물교상환자발생감시웹시스템을개발하여해당시도보건소와협력 운영하고있다 ( 교상환자발생실험실감시시스템, 또한매년동물교상환자감시결과를분석한자료를제공하고있으며, 본글에서는 216년의동물교상환자감시현황을기술하고자한다. 15 개국이상에서매년 35, 명 5, 명이공수병으로 사망한다. 하지만, 공수병은동물교상후에도초기에면역글로불린과공수병예방백신접종으로적절한치료를받는다면, 충분히예방가능한감염병이다. 따라서동물에의한교상감시와교상후적절한치료는공수병예방에매우중요하다 [3]. 우리나라에서공수병발생은 1962년부터공식적인집계가이루어졌으며, 1984년까지간헐적으로발생된이후로발생보고가없었다. 그러나 1999년파주시에서공수병환자가발생된이후로 24년까지화천군, 연천군, 포천군, 고양시에서 6명의환자가개또는너구리에의한교상으로발생하였다. 그러나환자들이 몸말 216년에는총 82건의동물교상환자가발생하였으며, 이중에서경기도는 474건 (57.8%), 강원도는 331건 (4.4%), 기타지역이 15건 (1.8%) 이었다. 경기도에서는양평군이 269건 (56.8%) 으로교상환자가가장많이발생하였고그다음은연천군 52건 (11.%) 이었다. 강원도에서는춘천시가 122건 (36.9%) 으로가장많이발생하였고, 그다음으로는속초시 8건 (24.2%) 이었다 (Figure 1). (A) (B) Pocheon, 4.% Hwaseong, 3.2% Gaoyeong, 3.8% Others, 1.2% Dongducheon, Paju, 5.7% 3.% Hongcheon, 4.2% Others, 1.2% Goseong, 13.9% Yeoju, 2.5% Yeoncheon, 11.% Yangju, 9.9% Chuncheon, 36.9% Sokcho, 24.2% Yangpyeong, 56.8% Cheolwon, 12.1% Yanggu, 1.8% Yangyang, 3.6% Inje, 2.1% Figure 1. Frequency of animal bite cases in Gyeonggi (A) and Gangwon (B) provinces in Korea,

4 주간건강과질병 제 1 권제 27 호 성별에따른교상환자는남자 449건 (54.8%), 여자 371건 (45.2%) 이었다. 연령별로는 5대 23건 (24.8%), 6대 131건 (16.%), 4대 114건 (13.9%) 이었고 1세미만에서는 42건 (5.1%) 이발생하였으며, 평균연령은 5.6세이었다. 월별로는평균 56건 (85%) 이 4월 9월사이에발생하였다 (Figure 2). 교상동물은개 723건 (88.2%), 고양이 82건 (1.%), 너구리 3건 (.4%), 기타야생동물 3건 (.4%) 순이었으며, 교상부위는손과손가락이 393건 (44.6%) 으로가장높았고이외에다리 272건 (3.8%), 팔 124건 (14.1%), 얼굴 3건 (3.4%) 순이었다. 치료형태로는상처소독만한경우가 568건 (69.3%) 으로가장많았고면역글로불린투여및백신접종은 88건 (1.7%), post-exposure prophylaxis(pep) 지침에따른백신접종은 92건 (11.2%), 상처소독및봉합은 36건 (4.4%) 이었으며, 36건 (4.4%) 이적절한처치를하지않았거나, 치료여부를확인할수없었다. 공수병은대부분광견병에걸린동물에게교상을당한경우에전파가능한질병으로, 세계보건기구 (WHO) 에서는동물교상에따라신체접촉유형을 3가지로구분하고그치료방법을 Table 1과같이권고하고있다 [5]. 216년발생한교상환자의경우에는 category III에속하는유형이 696건 (84.8%) 이었고 category II는 13건 (12.6%) 이었으며, 22건 (2.7%) 은정보가기록되지않아알수없었다. 공수병에노출될위험도가높은 category III에속한경우에 69건 (9.9%) 이면역글로불린과백신을모두접종하였으며, 5회접종및 5회미만으로접종한경우는각각 46건 (6.6%) 이였다. 또한, 상처만소독한경우는 47건 (67.6%) 이었으며, 상처소독과 Percent of animal bite Jan Feb Mar Apr May Jun Jlu Aug Sep Oct Nov Dec Month Figure 2. Frequency of animal bite cases according to months in Korea, 216 Table 1. Categories of post-exposure prophylaxis after rabies-infected animal bites recommended by WHO Category Exposure wound Prophylaxis I II III Touching or feeding of animals, licks on intact skin, contact of intact skin with secretions or excretions of a rabid animal or human Minor scratches or abrasions without bleeding and/or nibbling of uncovered skin Single or multiple transdermal bites or scratches, licks on broken skin, contamination of mucous membrane with saliva (i.e. licks) and suspect contacts with bats These are not regarded as exposures, and no post-exposure prophylaxis is required. Vaccine should be injected as soon as possible. Vaccine and rabies immunoglobulin should be administered at distant sites as soon as possible. Immunoglobulin can be administered up to day 7 after injection of the first dose of vaccine 69

5 주간건강과질병 제 1 권제 27 호 함께봉합을한경우는 31 건 (4.5%) 으로나타났다. 치료를하지않은 경우와조치여부를알수없는경우는각각 4 건 (.6%), 29 건 (4.2%) 이었다. 치료, 교육및홍보는무엇보다중요하다. 국내에서 1999 년 24 년에발생한공수병환자 6 명이 모두사망함에따라, 질병관리본부에서는보도자료배포, 지침 개선, 교육등을강화하였고공수병예방을위한대국민홍보를 맺음말 우리나라에서동물광견병발생은 197년에공식적으로처음보고되었으며, 1945년까지매년 2 8건정도가보고되었다. 이후 197년대까지매년 3 91건이보고되면서매년증가추세를보였으나, 1984년에강원도지역의개에서 1건발생된이후 1992년까지는광견병발생은보고되지않았다. 그러나 1993년 9월에강원도철원에서다시발생하면서증가하기시작하였고 적극적으로실시하고있다. 공수병예방을위하여사용되는공수병면역글로불린과공수병예방백신은 26년 7월부터건강보험급여가적용되었다. 또한 216년에동물교상환자감시시스템을개선하여교상환자의등록일기준으로만볼수있었던자료를교상일기준으로도볼수있도록하였다. 아울러동남아해외여행중교상발생증가, 강원도및경기도이외의지역에서교상발생사례증가에따라, 국내의교상환자감시를더욱강화하기위하여 년부터강원도와경기도중심으로운영되었던감시시스템을전국으로점차확대하여운영하고있다. 22 년에는 9 여건의광견병발생보고가있었는데, 주로경기도 및강원도의한강북쪽지역에서개, 소, 너구리, 고양이에서발생하였다. 그러나 212년, 213년에는한강남쪽지역인경기도화성과수원에서재발생하여광견병에대한경각심을갖게되었다 [6-9]. 농림축산식품부 ( 농림축산검역본부 ) 는 21년이후부터우리나라에서광견병을근절시키기위하여기존광견병발생지역이나휴전선접경지역의사육가축, 개, 소에게광견병백신을의무적으로접종하도록하고있다. 또한우리나라의주요광견병전파매개동물인야생너구리와같은야생동물에대한광견병감염실태조사와더불어미끼예방백신 (bait vaccine) 살포, 광견병에대한예방캠페인등을실시하여왔다 [1]. 이렇게다양한국가방역정책을능동적으로실시함에따라, 214년부터광견병발생은보고되고있지않다 [11]. 사람에서공수병은광견병이의심되는동물에게교상을당하더라도, WHO 지침 [5] 이나질병관리본부의공수병예방 관리지침에따라, 교상부위에면역글로불린투여및공수병예방백신접종등신속하고적절한치료를받는다면, 예방가능한감염병이다. 우리나라에서공수병발생은 24년발생이후로현재까지보고되고있지않다. 하지만, 최근들어유기견증가및야생화, 해외여행지에서교상환자발생증가등으로공수병발생가능성이증가되고있기때문에, 공수병예방을위한교상환자감시, 신속한 참고문헌 1. Ellis R and Ellis C Dog and cat bites. Downloaded from the American Family Physician website at 9: Griego, RD, Rosen T, Orengo I F, and Wolf J E Dog, cat, and human bites: A review. The American Academy of Dermatology, Inc. 3. WHO. Human rabies: 216 updates and call for data. Weekly epidemiological record. 92:77-88( resource/who_wer927/en. Accessed April 15, ). 4. Lee JB, Lee HJ, Hyun BH, Bang JH, Nam KO, Jeong YE, Shin YH. 25. Epidmiology and prevention stragegies of rabies in Korea. Korea J Epidemiol. 27: WHO Expert consultation on rabies Second Report, WHO technical report series no Geneva: World Health Organization, Switzerland. 6. Kim CH, Lee CG, Yoon HC, Nam HM, Park CK, Lee JC, Kang MI, and Wee SH. 26. Rabies, an emerging disease in Korea. J. Vet. Med. B. 53: Lee KK. 21. Outbreak and control of animal rabies in Korea. Infect. Chemother. 42(1): Cheong YT, Kim B, Lee KJ, Park DH, Kim WY, Kim HC, Parj EY, Lee HC, Bae CW, Oh CG, Park SY, Song CS, Lee SW, Choi IS, and 691

6 주간건강과질병 제 1 권제 27 호 Lee JB Strategic model of national rabies control in Korea. Clin Exp Vac Res. 3: Oem, JK, Kim, SH, Kim YH, Lee MH, and Lee KK Reemergene of rabies in the southern Han river region, Korea. 5: Yang DK, Kim SY, Oh YI, Lee JA, Cho SD, Lee KW, and Song JY Epidemiological characteristics of rabies in South Korea from January 24 to March 211. J Bacteriol Virol. 41: K AHIS 국가동물방역통합시스템. Accessed April 13,

7 주간건강과질병 제 1 권제 27 호 215 년국내살모넬라균실험실감시현황 질병관리본부감염병분석센터바이러스분석과채수진, 이덕용 질병관리본부감염병분석센터세균분석과강병학, 곽효선 * * 교신저자 : kwakhyos@korea.kr, Annual Report on Salmonella spp. Laboratory Surveillance in the Republic of Korea Chae Su-Jin, Lee Deog-Yong Division of Viral Diseases, Center for Laboratory Control of Infectious Diseases, KCDC Kang Byunghak, and Kwak Hyo Sun* Division of Bacterial Diseases, Center for Laboratory Control of Infectious Diseases, KCDC BACKGROUND: The genus Salmonella is a major pathogen of food and water-borne diseases because it has a wide range of host. Salmonella Typhi infections is classified as Group 1 mandatory notifiable infectious disease in Korea. The Korea Centers for Disease Control and Prevention (KCDC) has published the 215 annual report on laboratory-confirmed human Salmonella infections that it summarize the distributions of Salmonella serovars isolated from EnterNet-Korea and seventeen Provincial Public Health and Environment Laboratories including thirteen National Quarantine laboratories in Korea. CURRENT STATUS: The annual report data demonstrated that 562 isolates from human infections were ranked to be S. Enteritidis (n=134, 23.8%), Salmonella I 4,[5],12: i:- (n=75, 13.3%), S. Bareilly (n=63, 11.2%), S. Typhimurium (n=49, 8.7%). S. Typhi(=31, 5.5%) and other serovars in descending order. The isolation rate of rare serovars within the country has increased with varying serovars in outbreak cases. It also showed that in the past, the serovars had been mainly introduced from abroad, but domestic Salmonella infection outbreaks increased in the recent 5-8 years. PROSPECTIVE FUTURE: KCDC has been striving to collect data from various range of hosts including food and animal isolates through research networks. The accumulated data are expected to be an important resource for the prevention and control of Salmonella infections in Korea. 들어가는말 살모넬라균은수인성 식품매개질환의대표적인세균성 병원체로 Salmon 과 Smith (1886) 에의해처음분리되어보고되었다. Hog Cholera 에감염된돼지에서 Salmonella Cholerasuis (S. Cholerasuis) 가처음분리되었고, 이후장티푸스의원인균으로 693

8 주간건강과질병 제 1 권제 27 호 Salmonella Typhi가확인되면서살모넬라균이관심을받기시작하였다. 인체에감염된살모넬라균에대한조사를수행하는과정에서다양한식품과동물에서도균이분리되었고, 이로인해수인성 식품매개질환뿐만아니라인수공통감염병의원인균으로도주목받게되었다 [1]. 질병관리본부에서는그동안국내에서분리된인체유래살모넬라균의분리현황에대한정보를주간건강과질병 (PHWR; Public Health Weekly Report) 을통해보고서형태로국민들에게제공한바있다 [2]. 그러나 215년에대한정보는최근분리동향및분리주의특성비교와함께연간보고서의형식으로작성하였다. 이글에서는살모넬라균연간보고서에대한간략한소개와함께 215년도국내분리현황에대한정보를제공하여국내연구자등다양한영역의사람들이활용할수있도록하고자한다. 조합에의해결정된혈청형으로구분되기도한다 (Figure 1). 현재까지 58종류의균체항원과 114종류의편모항원이확인된가운데각항원성의조합을통해총 2,659종류의혈청형이알려져있다 [4]. 살모넬라균은사람뿐만아니라포유류, 파충류그리고조류까지넓은숙주영역을갖고있어가축을포함한애완동물과야생동물을통해서도감염될수있어공중보건학적으로매우중요한병원체이다 [1]. 인체감염의경우장티푸스균을제외하면만성보균사례가많지않지만동물과조류에서는보균율이높은것으로알려져있다. 또한각혈청형에따라서숙주특이성, 항균제내성등다양한특성을보여주기도한다. 살모넬라균은오염된음식이나물, 기구등다양한감염원을통해사람이나동물에게전파되어감염을일으킨다. 특히충분히익히지않은계란또는계란함유식품, 생우유또는유제품, 오염된음용수, 육류및육제품을섭취하여 감염된사례가흔히보고된다. 살모넬라균에감염된사람의분변을 몸말 살모넬라균은장내세균과에속하는그람음성간균으로각각의혈청형에따라다른특성을갖고있으나모든혈청형에서사람에게병원성을가진것으로알려져있다 [3]. 살모넬라균속은분류학상 Salmonella enterica (S. enterica) 와 Salmonella bongori (S. bongori) 두종 (species) 으로나뉘는데, 이중에 S. enterica 는생화학적특성에따라다시 6종류의아종 (subspecies) 으로분류된다. 살모넬라균은생화학적분류외에균체항원과편모항원의 통한직접감염도중요한전파원이되기도한다 [3]. 살모넬라감염증은전세계대부분의국가에서공중보건학적문제로여겨지고있다. 미국에서는매년 4백만명이상이살모넬라균에감염되는것으로알려져있으며대부분음식에의한식중독보고사례이다 [5]. 유럽의식중독감염원통계 (21-215년 ) 에서도살모넬라균에의한집단환자감염이 21년부터 5년동안점차감소하고있지만 (Figure 2), 215년한해확인된병원체중약 21.8% 가살모넬라로가장많이발생한것으로보고되고있다 [6]. 우리나라에서는노로바이러스가주요식중독원인병원체로알려져있으나병원성대장균과함께살모넬라균역시높은발병을 Figure 1. Diagram of somatic and flagella antigens of Salmonella enterica serovar Typhimurium 694

9 주간건강과질병 제 1 권제 27 호 Figure 2. Number of food and water-borne outbreaks reported by causative agent in the EU (21-215, EFSA) 일으키는병원체중하나이다 [7]. 살모넬라균에의한집단환자발생이많은북미와유럽의대다수국가에서는살모넬라균에대한분리정보등을연간보고서의형식으로작성하여제공하고있으며, 인체, 식품및환경에서분리된대부분의살모넬라균에대한정보를담고있다. 특히, 미국의 CDC(Centers for Disease Control and Prevention) 에서는주로살모넬라균의혈청형분리현황에초점을두고보고서를작성하고있다 [5]. 인체분리주는지역, 성별, 월별등의기준에따른분리경향을분석하고있으며, 동물분리주는각동물별혈청형의분리율을병원성과비병원성으로구분하여보고하고있다. 유럽의국가들은혈청형별분리현황과더불어주요혈청형 (S. Enteritidis, S. Typhimurium) 의파지형과항균제내성양상등특성분석결과를중요하게다루고있다. 그중영국의 PHE (Public Health of England) 에서발간한연간보고서에는연도별, 월별, 연령대별, 성별, 지역별분리현황등의기본자료와더불어여행객을통한해외유입사례등을상세히다루고있다 [8]. 아일랜드의연간보고서는 국내발생과여행자에의한국내유입을구분지어분리현황을월별로보고하였고, 집단환자발생사례를다각도로분석하여별도로보고하였다 [9]. 이외에도캐나다와유럽의다른국가에서도다른장내세균의분리현황과함께분석한연간보고서를발간하고있으며, 각국의연간보고서는수년간자료를축적하여국가적인자료로서활용되고있다 [6,1]. 우리나라에서는살모넬라균의국내분리현황과항생제내성경향에대한자료를기관지인주간건강과질병 (PHWR; Public Health Weekly Report) 을통해일반인에게제공하였다 [2]. 이번에발간한연간보고서는기존에제공하였던인체감염사례에서분리된살모넬라균의혈청별목록과해외유입사례그리고주요혈청형의항생제내성경향에대한연도별경향과함께최근국내혈청형의변화를토대로 215년도국내에서분리된살모넬라균의주요혈청형분포, 파지형과집단환자발생사례등도추가로분석하여제공하였다. 연간보고서에서분석한균주는질병관리본부에서운영하고있는 급성설사질환실험실감시사업 (EnterNet

10 주간건강과질병 제 1 권제 27 호 Korea) 에서분리된균주와집단환자발생시분리된균주그리고최종확인진단을위해전국 17개시 도보건환경연구원및국립검역소로부터혈청형확인의뢰된균주를대상으로하였다. 대상균주는연도별, 검체별, 월별, 유입형태별, 지역별로나누어분리현황을분석하였고, 주요혈청형 (S. Enteritidis, S. Typhimurium, Salmonella I 4,[5],12:i:-) 에대해서는파지타이핑을진행하여항균제내성경향과같이특성을살펴보았다. 아울러집단환자발생사례와연관된균주는별도로구분하여분석하였다. 연간보고서는살모넬라균의시험방법, 분리현황, 주요혈청형별특성과집단환자발생사례순으로정리하였으며, 세부자료는별첨으로추가하였다. 연간보고서작성에사용된균주는 215년한해질병관리본부에서수집한균주 ( 총 591주 ) 로서, 전년도 (214년, n=996) 에비하면약 4.3% 가감소한수치이다. 이중인체가검물에서분리된균주는 562주 (95%) 로서, 해당균주의주요혈청형은 S. Enteritidis(n=134, 23.8%), S. Typhimurium의 단상편모변이주인 Salmonella I 4,[5],12:i:-(n=75, 13.3%), S. Bareilly(n=63, 11.2%), S. Typhimurium(n=49, 8.7%) 순으로확인되었다 (Table 1). 그동안국내에서분리된살모넬라균의혈청형을연도별로살펴보면, 1996년이전까지는 S. Typhimurium의분리율이가장높았으나이후에는 S. Enteritidis 가가장많이분리되는혈청형으로자리잡았다 (Figure 3). 211년이후 S. Enteritidis 의분리율은점차감소추세에있고, Salmonella I 4,[5],12:i:- 의분리율이 213년부터급격히증가하는등최근주요혈청형의분리빈도에변화를나타냈다. 기존에는 S. Enteritidis와 S. Typhimurium 등주요혈청형에편중되어분리되는유행경향을보였으나, 국내에서처음분리되거나드물게분리되던혈청형들의분리비중이높아지고있다. 215년도에도두혈청형이외에다양한혈청형이분리되는등최근의분리경향에변화가있음을확인할수있다 (Figure 4). 집단환자발생도 S. Enteritidis에의해발생되던일반적인경향에서다양한혈청형으로변한것도하나의특징이라고볼수 Table 1. Top 15 Salmonella serovars isolated from human in Korea, 215 compared with Ranking Serovars Number of cases % of total cases Ranking of Enteritidis I 4,[5],12:i: Bareilly Typhimurium Typhi Infantis Montevideo Stanley Virchow Paratyphi (A,B) Rissen Agona Panama Thompson Newport Other serovars Total

11 주간건강과질병 제 1 권제 27 호 Figure 3. The number of Salmonella serovars reported to KCDC, Top 6 serovars ranked in 215 were only shown in this data. A) All and major two serovars since 1986, B) Other main serovars Figure 4. Rates of Salmonella serovars reported to KCDC, This data was shown about the top 6 serovars in

12 주간건강과질병 제 1 권제 27 호 Table 2. Outbreak cases of Salmonella spp. reported in Korea, 215 Serovars Major phage type Month Regions Total cases Enteritidis RDNC KE1-1* June Incheon 14 I 4,[5],12:i:- DT193 June Incheon 16 Montevideo - Jul Jeonbuk 26 Bareilly - Sep Jeonbuk 6 Enteritidis PT21 Oct Daegu 16 Enteritidis PT21 Nov Gyeongbuk 9 * RDNC KE1-1 was named as a subtype of RDNC that can lyse all phages, except for S. Enteritidis phage 15. 있다. 215년살모넬라균에의한집단환자발생으로밝혀진사례중균주가확보된총 6건의사례에대해분석해보았다 (Table 2). S. Enteritidis에의한사례는총 3건으로이중에 2건은파지형 PT21에의한것으로확인되었다. 파지형 PT21은유럽에서계란및닭고기를통해집단환자발생이많은파지형으로우리나라에서는그동안 PT1형에의한사례가대부분이었다. 나머지한사례에서분리된균주는 RDNC KE1-1 형으로확인되었다. RDNC는파지에반응은있으나파지형을구분할수없는경우에명기하는방법이다. 그러나이번사례에서확인된 RDNC KE1-1형은우리나라에서지속적으로동일하게확인되는형태로별도의명칭을부여하여관리하고있는파지형이다. 또다른사례인 Salmonella I 4,[5],12:i:- 의파지형은 DT193형으로확인되었다. DT193형은 DT12형과함께유럽지역에서다제내성을보이는파지형으로알려져있다. 특히, ampicillin, streptomycin, sulbactam 그리고 tetracycline에공통적으로내성을보여유럽전역에서지속적으로연구하고있는파지형이다. 이번우리나라에서분리된균주도 tetracycline 과 β-lactam 계열의 ampicillin, ampicillin/sulbactam 에내성을보였다. 서울, 경기등수도권지역에서 S. Bareilly 에의한개별감염사례가증가하고있는경향과더불어전북지역에서 S. Bareilly 에의한집단환자발생이있었다. 나머지사례는 S. Montevideo 에의한사례로최근몇년간집단환자발생을지속적으로일으키고있다. 제1군법정감염병인장티푸스 (Salmonella Typhi) 는예년에비해발생이줄어들었으나매년 2명내외의환자가지속적으로발생하고있다. 장티푸스에의한집단환자발생은 28년도경남 있었다 (Figure 4). 국내장티푸스발생의지역별경향을살펴보기위해 214년도와 215년도에우리나라에서분리된장티푸스균의지역별분포를백분위로표시해보았다. 소규모집단발생이있었던 214년도에는경남지역이특히높은발생률을보였던반면특별한집단사례보고가없었던 215년도에는전지역에서고르게장티푸스균이분리되었다. 특히, 충남지역에서는별도의장티푸스발생보고가없었으나전년도에비해분리율이소폭상승하여상대적으로높은분리율을보이기도하였다. 또한서울, 경기, 인천, 경남및부산등대도시에서장티푸스환자발생이많은것으로보고되었으나, 이는인구에비례하여균주분리율이높은것으로사료된다 (Figure 5). 215년한해동안해외유입으로명확히확인된균주는총 25주로, 주로항공이나선박을이용하여국내로입국한여행객의분변 (n=7) 또는입항한선박의가검물 (n=18) 로부터분리되었다. 유입된국가별로살펴보면중국 (n=13), 베트남 (n=8), 캄보디아 (n=2) 그리고홍콩 (n=2) 등주로아시아지역을통해유입되었다. 현재까지전세계적으로알려진혈청형은 2,659종류이지만, 1986년부터 215년까지질병관리본부에서확인하여국내에보고된혈청형은총 241종류이다. 이중에서 215년한해동안처음으로분리및확인된혈청형은모두 9종류 (Abony, Hvittingfoss, Krefeld, Moscow, Oritamerin, Shubra, Uzaramo, I 3,1,[15]:r:-, I 4,12:d:-) 였다. 새로운혈청형이대부분해외로부터유입되던예년과는다르게최근 5년간국내에서자체적으로발생하는비율이평균 86.7% 로대부분을차지한것도큰변화로볼수있다. 합천지역과 214 년경남진주인근지역에서소규모발생보고가 698

13 주간건강과질병 제 1 권제 27 호 Figure 5. Regional distribution of S. Typhi isolated from human in 214 and 215. The isolates ratio was shown by graphical density in the map 맺는말 질병관리본부에서는 215년도국내살모넬라균의특성분석자료를최근의분리경향과비교분석하여연간보고서를작성하였다. 아울러, 세부적인통계자료는다양한영역에서활용할수있도록별도로작성하여첨부하였다. 살모넬라균감염증은다른수인성 식품매개질환과같이질병으로인한개인적인고통이외에도집단환자발생으로인한사회경제적인부담이큰질병으로체계적인관리와감시가필요한질병이다. 향후질병관리본부에서는다양한숙주영역에서분리되는살모넬라균의정보를종합적으로분석하여국가차원에서활용할수있는자료로서활용가치를높이고자한다. 참고문헌 3. 장정옥, 류화정외. 25. 최신식품위생학. 보문각. 4. Grimont PAD, Weill F-X. Antigenic formulae of the Salmonella serovars. 9th ed. Institute Pasteur, WHO Collaborating Centre for Reference and Research on Salmonella. 27: Centers for Disease Control and Prevention (CDC). National Enteric Disease Surveillance: Salmonella Annual Report, : European Food Safety Authority (EFSA), European Centre for Disease Prevention and Control(ECDC). The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 215. EFSA Journal. 216;14(12): 질병관리본부. 16년사업실적및 17년사업계획 : 급성설사질환실험실감시사업 (EnterNet-Korea). : Public Health England (PHE).. Salmonella data 26 to 215, National laboratory data for residents of England and Wales. : National Salmonella, Shigella & Listeria Reference Laboratory (NSSLRL). NSSLRL Report : Public Health Agency of Canada (PHAC). Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) Annual Report. Ch.2 Antimicrobial Resistance. 213: Hoelzer K, Moreno Switt AI, Wiedmann M. Animal contact as a source of human non-typhoidal salmonellosis. Veterinary Research. 211;42(34): 윤영선, 이덕용, 정경태. 215년국내에서분리된살모넬라균의현황및특성분석. 주간건강과질병. 216;9(1):

14 7

15 status of selected infectious diseases 1.1 환자감시 / 전수감시감염병주간발생현황 (26th ) Table 1. Reported cases of national infectious diseases in Republic of Korea, ending July 1, (26th )* Group Ⅰ Group Ⅱ Group Ⅲ Group Ⅳ Classification of disease ly average 71 Total no. of cases by year 216* Cholera Typhoid fever Paratyphoid fever Shigellosis EHEC Viral hepatitis A 13 2, ,679 1,84 1, ,197 Pertussis Tetanus Measles Mumps 452 9, ,57 23,448 25,286 17,24 7,492 Rubella Viral hepatitis B (Acute) Japanese encephalitis Varicella 1,691 37, ,6 46,33 44,45 37,361 27,763 Streptococcus pneumoniae unit: no. of cases Imported cases of current : Country(no. of cases) Malaria Mozambique(1), Pakistan(1), Vietnam(1) Scarlet fever 57 13, ,911 7,2 5,89 3, Meningococcal meningitis Legionellosis Vibrio vulnificus sepsis Murine typhus Scrub typhus ,15 9,513 8,13 1,365 8,64 Leptospirosis Brucellosis Rabies HFRS Syphilis ,569 1,6 1, CJD/vCJD Tuberculosis , ,892 32,181 34,869 36,89 39,545 HIV/AIDS ,62 1,18 1,81 1, Viral hepatitis C 274 1, Kazakhstan(1) VRSA CRE Vietnam(6), Philippines(3), Bangladesh(2), Dengue fever Thailand(2), Brazil(1), India(1), Indonesia(1), 149 Laos(1), Malaysia(1), Myanmar(1), Singapore(1), Sri Lanka(1), Tanzania(1), Southeast Asia(1) Q fever West Nile fever 1 Lyme Borreliosis China(1), United States(1) Melioidosis Chikungunya fever Vietnam(2) 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 are provisional but the data from 212 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 national infectious diseases in Republic of Korea, ending July 1, (26th )* unit: no. of cases Provinces Cholera Typhoid fever Paratyphoid fever Shigellosis Enterohemorrhagic Escherichia coli Viral hepatitis A Pertussis Tetanus Total ,733 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 are provisional but the data from 212 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. 72

17 Table 2. Reported cases of national infectious diseases in Republic of Korea, ending July 1, (26th )* unit: no. of cases Provinces Measles Mumps Rubella Viral hepatitis B (Acute) Japanese encephalitis Varicella Malaria Scarlet fever Total ,13 7, ,691 37,332 19, ,354 1,361 Seoul ,6 1, , Busan ,233 1, Daegu ,23 1, Incheon ,29 1, Gwangju , Daejeon Ulsan , Sejong , , ,267 2 Gyonggi , , Gangwon , Chungbuk , Chungnam , Jeonbuk , Jeonnam , Gyeongbuk , ,2 131 Gyeongnam , Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year are provisional but the data from 212 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. Data on scarlet fever included both cases of confirmed and suspected since September 27,

18 Table 2. Reported cases of national infectious diseases in Republic of Korea, ending July 1, (26th )* unit: no. of cases Provinces Meningococcal meningitis Legionellosis Vibrio vulnificus sepsis Murine typhus Scrub typhus Leptospirosis Brucellosis Hemorrhagic fever with renal syndrome Total Seoul Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year are provisional but the data from 212 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. Calculated by averaging the cumulative counts from 1st to current, for a total of 5 preceding years 74

19 Table 2. Reported cases of national infectious diseases in Republic of Korea, ending July 1, (26th )* unit: no. of cases Syphilis CJD/vCJD Dengue fever Q fever Lyme Borreliosis SFTS Zika virus infection Tuberculosis Provinces 3-year 3-year Total ,856 17,664 Seoul ,677 3,53 Busan ,369 Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi ,183 3,62 Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk ,16 1,24 Gyeongnam ,152 Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year are provisional but the data from 212 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. 5(3)-year average is mean value calculated by cumulative counts from 1st to current for 5(3) preceding years. 75

20 1.2 환자감시 / 표본감시감염병주간발생현황 (26th ) 1. Influenza, Republic of Korea, ending July 1, (26th ) 년도제 26 주인플루엔자의사환자분율은외래환자 1, 명당 5.3 명으로지난주 (5.7 명 ) 대비감소 216- 절기유행기준은 8.9 명 (/1,) 인플루엔자유행주의보해제 : 년 6 월 2 일 ( 금 )( 발령 : 216 년 12 월 8 일 ( 목 )) ILI per 1, Figure 1. The ly proportion of Influenza-Like Illness per 1, outpatients, to 216- flu seasons 2. Hand, Foot and Mouth Disease(HFMD), Republic of Korea, ending July 1, (26th ) 년도제 26 주수족구병의사환자분율은외래환자 1, 명당 14.9 명으로지난주 (13.5 명 ) 대비증가 수족구병은 29 년 6 월법정감염병으로지정되어표본감시체계로운영 No. of outpatients / 1, Figure 2. The status of HFMD sentinel surveillance,

21 3. Ophthalmologic infectious disease, Republic of Korea, ending July 1, (26th ) 년도제 26 주유행성각결막염의외래환자 1, 명당분율은 19.1 명으로지난주 2.1 명보다감소하였음. 동기간급성출혈성결막염의환자분율은.2 명으로지난주.2 명과동일 6 5 No. of outpatients / 1, Figure 3. The ly proportion of Epidemic keratoconjunctivitis per 1, outpatients 5 4 No. of outpatients / 1, Figure 4. The ly proportion of Acute hemorrhagic conjunctivitis per 1, outpatients 77

22 4. Sexually Transmitted Diseases, Republic of Korea, ending July 1, (26th ) 년제 26 주보고기관 (586 개 ) 당성기단순포진 2.7 명, 클라미디아 2.1 명, 첨규콘틸롬 1.7 명, 임질 1.3 명발생함. unit: no. of cases/sentinels Sexually Transmitted Diseases Gonorrhea Chlamydia Genital herpes Condyloma acuminata Total 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 (26th ) Waterborne & Foodborne disease outbreaks, Republic of Korea, ending July 1, (26th ) 년도제 26 주에집단발생이 16 건이발생하였으며누적발생건수는 256 건 ( 환례수 3,29 명 ) 이발생함 No. of outbreaks 년도 216 년도 4 년평균발생건수 (11-14 년 ) Figure 5. Number of Waterborne & Foodborne disease outbreaks reported by,

23 2.1 병원체감시 / 인플루엔자및호흡기바이러스주간감시현황 (26th ) 1. Influenza viruses, Republic of Korea, ending July 1, (26th ) 제 26 주에의뢰된호흡기검체 2 건중인플루엔자바이러스 2 건 (1.%)[A/H3N2 2 건 ] 검출되었음. No. of positives Percent positives (%) A/H3N2 A(not subtyped) A/H1N1pdm9 B percent positive Figure 6. Number of specimens positive for influenza by subtype, 216- season 2. Respiratory viruses, Republic of Korea, ending July 1, (26th ) 년도제26주호흡기검체에대한유전자검사결과 39.5% 의호흡기바이러스가검출되었음. ( 최근 4주평균 2개의호흡기검체에대한유전자검사결과를나타내고있음 ) 주별통계는잠정통계이므로변동가능 216- () 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 Jan. 1. July. 1., (Average No. of detected cases is 2 in last 4 s) 216 : the rate of detected cases between Dec Dec 자세히보기 : 질병관리본부 알림 주간질병감시정보 79

24 2.2 병원체감시 / 급성설사질환실험실표본주간감시현황 (25th ) The detection rate of Acute gastroenteritis causing virus and bacteria, Republic of Korea, ending June 24, (25th ) 년도제25주실험실표본감시결과급성설사질환유발바이러스검출건수는 16건 (26.2%), 세균검출건수는 2건 (11.4%) 이었음. Acute gastroenteritis causing virus No. of sample No. of detection (Detection rate, %) Group A Rotavirus Norovirus Enteric Adenovirus Astrovirus Total (8.1) 15 (2.3) 2 (2.7) 3 (4.1) 26 (35.1) (4.8) 12 (19.) 2 (3.2) 1 (1.6) 18 (28.6) (7.2) 6 (8.7) 3 (4.3) 2 (2.9) 16 (23.2) (8.2) 7 (11.5) 1 (1.6) 3 (4.9) 16 (26.2) 1, (17.6) 353 (2.6) 39 (2.3) 54 (3.2) 748 (43.7) * 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 (2.53) 6 (3.3) () () () 1 (.51) 1 (.51) 4 (2.2) 5 (2.53) 23 (11.62) (8.33) 1 (4.63) () () () 4 (1.85) 1 (.46) 4 (1.85) 3 (1.39) 41 (18.98) (2.82) 6 (3.39) () () () 3 (1.69) 3 (1.69) 5 (2.82) 4 (2.26) 27 (15.25) (2.27) 6 (3.41) 1 (.57) () () 1 (.57) 2 (1.14) 2 (1.14) 4 (2.27) 2 (11.36) 4, (2.) 68 (1.64) 3 (.7) 1 (.2) () 33 (.8) 6 (1.45) 63 (1.52) 72 (1.74) 386 (9.31) * 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 216 (7 hospitals) 자세히보기 : 질병관리본부 알림 주간질병감시정보 71

25 2.3 병원체감시 / 엔테로바이러스실험실주간감시현황 (25th ) The detection rate of Enterovirus in enterovirus sentinel surveillance, Republic of Korea, ending June 24, (25th ) 년도제 25 주실험실표본감시결과엔테로바이러스검출건수는 7 건이며, 년도누적발생건수는 86 건임. Aseptic meningitis 8 Detection rate (%) Enterovirus detection rate (%) Enterovirus detection rate (%) Figure 7. Detection rate of enterovirus in Aseptic meningitis patients from 216 to HFMD and Herpangina 25 Detection rate (%) Enterovirus detection rate (%) Enterovirus detection rate (%) HFMD with Complications Figure 8. Detection rate of enterovirus in HFMD and Herpangina patients from 216 to Detection rate (%) Enterovirus detection rate (%) Enterovirus detection rate (%) Figure 9. Detection rate of enterovirus in HFMD with Complications patients from 216 to 711

26 3.1 매개체감시 / 말라리아매개모기주간감시현황 (25th ) Vector surveillance/malaria vector mosquitoes, Republic of Korea, ending June 24, (25th ) 년도제 25 주말라리아매개모기수는평균 2 개체로평년 3 개체대비 1 개체감소 ( 전년 1 개체대비 1 개체증가 ) 년도제 25 주전체모기수는평균 13 개체로평년 11 개체대비 2 개체증가 ( 전년 1 개체대비 3 개체증가 ) 7 6 No. of mosquitoes Total Mosquitoes(Average) Malaria Vector Mosquitoes(Average) Total Mosquitoes Malaria Vector Mosquitoes Total Mosquitoes Malaria Vector Mosquitoes 1 2 Week Figure 1. The ly incidences of malaria vector mosquitoes in 3.2 매개체감시 / 일본뇌염매개모기주간감시현황 (25th ) Vector surveillance/japanese encephalitis vector mosquitoes, Republic of Korea, ending June 24, (25th ) 년 25 주일본뇌염매개모기주간발생현황 - 25 주전체모기수 : 평균 1,52 개체로평년 93 개체대비 149 개체 (16.5%) 증가 ( 전년 575 개체대비 477 개체 (82.9%) 증가 ) - 25 주일본뇌염매개모기 ( 작은빨간집모기, C.t*) 수 : 평균 4 개체로평년 5 개체대비 1 개체 (25.%) 감소 ( 전년 1 개체대비 3 개체 (3%) 증가 ) No. of mosquitoes 2, 1,8 1,6 1,4 1,2 1, Year Total Year C.t* Total C.t* Total C.t* Week Figure 11. The ly incidences of Japanese encephalitis vector mosquitoes in 자세히보기 : 질병관리본부 민원 / 정부 3. 사전정보공개

27 주요통계이해하기 <Table 1> 은지난 5년간발생한법정감염병과 년해당주발생현황을비교한표로, 는 년해당주의신고건수를나타내며, 은 년 1주부터해당주까지의누계건수, 그리고 ly average 는지난 5년 ( 년 ) 해당주의신고건수와이전 2주, 이후 2주의신고건수 ( 총 25주 ) 평균으로계산된다. 그러므로 과 ly average 의신고건수를비교하면해당주단위시점과예년의신고수준을비교해볼수있다. Total no. of cases by year 는지난 5년간해당감염병현황을나타내는확정통계이며연도별현황을비교해볼수있다. 예 ) 년 12 주의 ly average(5 년간주평균 ) 는 211 년부터 215 년의 1 주부터 14 주까지의신고건수를 총 25 주로나눈값으로구해진다. * ly average(5 년주평균 )=(X1 + X2 + + X25)/25 1주 11주 12주 13주 14주 215년 해당주 214년 X1 X2 X3 X4 X5 213년 X6 X7 X8 X9 X1 212년 X11 X12 X13 X14 X15 211년 X16 X17 X18 X19 X2 21년 X21 X22 X23 X24 X25 <Table 2> 는 17 개시 도별로구분한법정감염병보고현황을보여주고있으며, 각감염병별로 Cum, average 와 Cum, 을비교해보면최근까지의누적신고건수에대한이전 5년동안해당주까지의평균신고건수와비교가가능하다. Cum, average 는지난 5년 ( 년 ) 동안의동기간신고누계평균으로계산된다. <Table 3> 은표본감시감염병에대한신고현황으로, 최근발생양상을신속하게파악하는데도움이된다.

28 발간등록번호 주간건강과질병, PHWR 은질병관리본부에서시행되는조사사업을통해생성된감시및연구자료를기반으로근거중심의건강및질병관련정보를제공하고자최선을다할것이며, 제공되는정보는질병관리본부의특정의사와는무관함을알립니다. 본간행물에서제공되는감염병통계는 감염병의예방및관리에관한법률 에의거, 국가감염병감시체계를통해신고된자료를기반으로집계된것으로집계된당해년도자료는의사환자단계에서신고된것이며확진결과시혹은다른병으로확인될경우수정될수있는잠정통계임을알립니다. 주간건강과질병, PHWR 은질병관리본부홈페이지를통해주간단위로게시되고있으며, 정기적구독을원하시는분은 이메일을통해보내지는본간행물의정기적구독요청시구독자의성명, 연락처, 직업및이메일주소가요구됨을알려드립니다. 주간건강과질병 발간관련문의 : kcdc215@korea.kr/ /33 창 발 간 : 28 년 4 월 4 일 행 : 년 7 월 6 일 발행인 : 정기석 편집인 : 박도준 편집위원 : 최영실, 김기순, 최병선, 조신형, 조성범, 김봉조, 구수경, 김용우, 이동한, 조은희, 이은규, 신영림, 김청식, 권효진, 김호용 편 집 : 질병관리본부유전체센터의과학지식관리과 충북청주시흥덕구오송읍오송생명 2 로 187 오송보건의료행정타운 ( 우 )28159 Tel. (43) /33 Fax. (43)