pissn X eissn PUBLIC HEALTH WEEKLY REPORT, PHWR Vol.12, No. 10, 2019 CONTENTS 년예방접종이상반응신고및피해보상현황분석 0274 통계단신

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1 pissn X eissn PUBLIC HEALTH WEEKLY REPORT, PHWR Vol.12, No. 1, 219 CONTENTS 년예방접종이상반응신고및피해보상현황분석 274 통계단신 (QuickStats) 청소년의현재흡연율추이, 이달의건강이슈 (Monthly health issue) 노후에얕봐서는안되는낙상 277 미세먼지안내문미세먼지대비민감계층건강보호수칙 올바른마스크착용법 28 주요감염병통계환자감시 : 전수감시, 표본감시 병원체감시 : 인플루엔자및호흡기바이러스 급성설사질환, 엔테로바이러스

2 주간건강과질병 제 12 권제 1 호 연구단신, Brief report 217 년예방접종이상반응신고및피해보상현황분석 질병관리본부감염병관리센터예방접종관리과김태은, 이연경, 김민경, 김유미 * * 교신저자 : umiver@korea.kr, Surveillance and compensation claims for adverse reactions following immunization in the Republic of Korea, 217 Kim Tae Eun, Lee Yeon Kyeong, Kim Min Kyung, Kim You Mi Division of VPD Control & NIP, Center for Infectious Disease Control, KCDC Immunization is the most effective means of preventing infectious diseases. However, the adverse reactions may inevitably occur after inoculation because of the biological nature of vaccines. These adverse reactions may not only affect the decline of vaccination rate but also incur high social costs. As part of the Korea National Immunization Program, the Korea Centers for Diseases Control and Prevention has been operating the national immunization safety management system; securing high quality vaccines, monitoring adverse reactions, conducting epidemiological investigations of serious adverse reactions, and managing a vaccine injury compensation system. Between 215 and 217, 1,28 vaccine-related adverse reactions (1.8 cases per 1, doses) were reported; 271 cases in 215 (1.5 cases per 1, doses), 318 cases in 216 (1.6 cases per 1, doses), and 439 cases in 217 (2.2 cases per 1, doses). Among them, there were 259 cases applications (25.2%) claiming for compensation, and after the national committee s review and assessment for compensation claims, 149 cases (57.5%) were finally decided to be compensated (59 cases in 215, 47 cases in 216, 43 cases in 217). Keywords: Immunization Program, Vaccination, Vaccines, Safety Management, Immunization 들어가는말 예방접종은감염병예방의가장효과적이고비용효과적인수단으로써오랜기간동안사용되어예방접종대상감염병의발생빈도는현저히감소하였다. 이렇게감염병의예방에효과적인예방접종을지속시키기위해서는무엇보다도안전성을확인하는것이매우중요하다. 그러나다른의약품과마찬가지로어떤백신도 모든사람에게완벽하게안전하다고할수없으며, 불가피한이상반응이발생할수있다 (Figure 1). 우리나라는 1994년에일본뇌염백신접종후인과관계는불분명하지만사망사례가 2건발생하면서국가예방접종안전성관리의필요성이제기되었다. 이에 1995년예방접종피해보상법이제정되었고이후관련제도가단계적으로정비되면서안전한백신공급및접종안전성확보, 이상반응감시, 신속대응과 266

3 주간건강과질병 제 12 권제 1 호 Figure 1. Impact of vaccine safety issues in the life cycle of national immunization programmes Source: WHO Vaccine Safety Communication, 216 역학조사, 예방접종피해국가보상으로구성된국가적인예방접종안전관리체계를마련하게되었다. 이를통해궁극적으로국민들의안전을도모하고국가예방접종사업의신뢰를제고하여높은예방접종률을유지하기위해노력하고있다. 예방접종이상반응신고는예방접종후발생한이상반응을 진료한의사또는환자 보호자신고를통해이루어지고있으며, 21년부터 217년까지 2,84건의신고가있었고평균연 355건의이상반응이신고되고있다. 예방접종이상반응감시는안전한예방접종의모니터링을위해가장기본적인요소로백신안전성에대한모니터링과특정백신의안전성이상의신호를감시하는 Internet report National Immunization Program ( Receipt Patient or guardian Physician Wire report Wire report Public health center Wire report City/province Wire report KCDC Division of VPD Control & NIP Receipt Notification Report Confirmation Report Confirmation Internet report National Immunization Support Program ( Figure 2. Surveillance system for adverse reactions following national immunization 267

4 주간건강과질병 제 12 권제 1 호 Result notification Result feedback Compensation review Patient or guardian Application for adverse reaction damage PHC or city/province Compensationrelated documents, epidemiological investigation KCDC Data collection, Review for adverse reaction damage Committee for immunization damage compensation Compensation payment Figure 3. Scheme of national immunization compensation claims for adverse reactions Table 1. Number of cases with adverse reactions following national immunization by vaccine, 217 (unit: cases) Vaccines Doses Adverse reactions No. of cases per 1, doses Influenza 8,29, BCG 233, PCV 1,568, PPSV23 523, HPV 43, Hib 1,168, JEV 1,855, DTaP-IPV 675, HepB 1,153, MMR 896, DTaP 872, DTaP-IPV/Hib 397, Tdap 343, HepA 88, Var 417, HFRS 92, IPV 4, Td 58, ViCPS 57, Total 2,163,721 1) 439 2) 2.2 1) Source: Immunization Registry Information System in the Korea Centers for Disease Control and Prevention, February 5, 218 2) The number of adverse reactions of the vaccine in each vaccine was different from sum of the vaccine (BCG hepatitis B coincident 1 case is BCG 1 case and Hepatitis B 1 case, respectively) Abbreviation: BCG, Bacillus Calment-Guerin; PCV, Pneumococcal Conjugate Vaccine; PPSV23 23-valent Pneumococcal Polysaccharide Vaccine; HPV, Human papilloma virus; Hib, Haemophilus influenzae type b; JEV, Japanese encephalitis virus; DTaP-IPV, Diphtheria and tetanus toxoids and acellular pertussis adsorbed and inactivated poliovirus vaccine; HepB, Hepatitis B; MMR, Measles-mumps-rubella combined vaccine; DTaP, Diphtheria, Tetanus, Pertussis vaccine; DTaP-IPV/Hib, Diphtheria and tetanus toxoids and acellular pertussis adsorbed, inactivated poliovirus and haemophilus B; Tdap, Tetanus, Diphtheria and Pertussis vaccine; HepA, Hepatitis A; Var, Varicella; HFRS, Haemorrhagic fever with renal syndrome; IPV, Inactivated poliovirus vaccine; Td, Tetanus and diphtheria; ViCPS, Vi Capsular Polysaccharide (Inactivated Typhoid) Vaccine 268

5 주간건강과질병 제 12 권제 1 호 Table 2. Types of adverse reactions, 217 (unit: cases, %) Whole body Total Local Fever, headache, nausea, vomiting (nonspecific) Allergy and skin abnormalities Nervous system Faint Death Etc (39.9) 8 (18.2) 79 (18.) 34 (7.7) 17 (3.9) 2 (.5) 52 (11.8) * Local: Inoculation site abscess, lymphadenitis, etc.; Nervous system: convulsions, encephalopathy, Guillain-Barre syndrome, etc.; Whole body: fever, allergy, etc. 역할을한다 (Figure 2). 한편국가예방접종피해보상제도는이상반응진료로자가부담 3만원이상이발생한경우신청할수있으며, 예방접종피해보상전문위원회에서사례별심의를통해보상여부를결정하고있다 (Figure 3). 21년부터 217년까지 87건의피해보상신청이이루어졌고, 이중약 484건 (55.6%) 에대해 보상하였다. 피해보상제도는일정수준이상의이상반응에대해서국가가무과실도책임을진다는의미로우리국민이안심하고국가예방접종을시행할수있도록하는장치이며, 이상반응관리자로서는입원이필요한이상반응의임상세부내역을확인하는기능도한다. 이글은 217년예방접종후신고된이상반응현황과 Table 3. Characteristics of adverse reactions reported after vaccination, 217 (unit: cases, %) Characteristics Cases (n=439) Age < 1 99 (22.6) (28.2) (9.3) (4.1) (7.3) (1.5) (18.) Sex Men 21 (45.8) Women 238 (54.2) Monthly reporting January 23 (5.2) February 25 (5.7) March 39 (8.9) April 33 (7.5) May 23 (5.2) June 4 (9.1) July 3 (6.8) August 35 (8.) September 39 (8.9) October 58 (13.2) November 48 (1.9) December 46 (1.5) 269

6 주간건강과질병 제 12 권제 1 호 Table 3. (Continued) Characteristics of adverse reactions reported after vaccination, 217 (unit: cases, %) Characteristics Cases (n=439) Reporting institute Public health center 322 (73.3) Medical institute 117 (26.7) Vaccination institute Public health center 212 (48.3) Medical institute 227 (51.7) Adverse reactions reported by region Seoul 86 (19.6) Busan 39 (8.9) Daegu 12 (2.7) Incheon 18 (4.1) Gwangju 11 (2.5) Daejeon 15 (3.4) Ulsan 7 (1.6) Sejong 2 (.5) Gyeonggi 93 (21.2) Gangwon 33 (7.5) Chungbuk 24 (5.5) Chungnam 13 (3.) Jeonbuk 12 (2.7) Jeonnam 17 (3.9) Gyeongbuk 36 (8.2) Gyeongnam 17 (3.9) Jeju 4 (.9) 국가예방접종피해보상제도를통해신청, 심의된사례들을 기술하고분석하였다. 이상반응신고는 215 년 271 건 ( 접종 1 만건당신고건 1.5 건 ), 216 년 318 건 ( 접종 1 만건당신고건 1.6 건 ), 217 년 439 건 ( 접종 1 만건당신고건 2.2 건 ) 이었다. 217 년예방접종후이상반응이 몸말 217 년예방접종후이상반응신고현황 215년부터 217년까지예방접종후이상반응신고는 1,28 건으로이중피해보상신청은 259건 (25.2%) 이었다. 연도별로 신고된백신종류별로는인플루엔자 18건으로가장많았다. 이어 BCG 71건, PCV 59건, PPSV23 58건, HPV 36건순이었다. 그러나 1만예방접종건수대비이상반응신고건수로는 BCG가 3.5건, PPSV 건, HPV가 8.4건순이었고, 전체는 1만건당신고건은 2.2건이었다 (Table 1). 신고된예방접종후이상반응종류로는접종부위농양, 림프절염, 봉와직염등국소이상반응이 175건 (39.9%) 으로가장 27

7 주간건강과질병 제 12 권제 1 호 Table 4. Reported adverse reactions after vaccination and national compensation (unit: cases) Year Reported adverse reactions Subtotal Compensation claims Compensated Disease Disorder Death Rejected Total 1, 많았고, 전신이상반응중에서는발열, 두통등의비특이적 전신반응이 8 건 (18.2%) 으로가장많았고, 그뒤를이어알레르기 및피부이상반응이 79 건 (18.%), 경련, 뇌증, 길랭 - 바레증후군 등의신경계이상반응이 34 건 (7.7%) 으로많았다. 사망신고는 Table 5. Results of vaccination damage compensation applications, 217 (unit: cases, %) Characteristics Total (n=87) Compensated (n=43) Rejected (n=44) Sex Men 52 (59.7) 26 (5.) 26 (5.) Women 35 (4.3) 17 (48.6) 18 (51.4) Age (66.7) 34 (58.6) 24 (41.4) (4.6) (.) 4 (1.) (1.3) 3 (33.3) 6 (66.7) (18.4) 6 (37.5) 1 (62.5) Vaccine type BCG 28 (32.2) 26 (92.8) 2 (7.2) Influenza 17 (19.5) (.) 17 (1.) PPSV23 1 (11.5) 9 (9.) 1 (1.) DTaP-IPV 5 (5.7) 1 (2.) 4 (8.) DTaP 4 (4.6) 1 (25.) 3 (75.) Hib, Pneumococcal 4 (4.6) 2 (5.) 2 (5.) Pneumococcal, Rotavirus 3 (3.5) 2 (66.7) 1 (33.3) BCG, HepB 2 (2.4) 1 (5.) 1 (5.) DTaP-IPV, Hib 2 (2.4) (.) 2 (1.) DTaP, IPV, Hib, Pneumococcal, Rotavirus 1 (1.1) (.) 1 (1.) DTaP-IPV, Hib, Pneumococcal 1 (1.1) (.) 1 (1.) DTaP-IPV/Hib, Pneumococcal 1 (1.1) (.) 1 (1.) HPV, JEV 1 (1.1) (.) 1 (1.) MMR, Var 1 (1.1) (.) 1 (1.) HFRS 1 (1.1) (.) 1 (1.) Influenza, JEV 1 (1.1) 1 (1.) (.) Pneumococcal 1 (1.1) (.) 1 (1.) 271

8 주간건강과질병 제 12 권제 1 호 Table 5. (Continued) Results of vaccination damage compensation applications, 217 (unit: cases, %) Characteristics Vaccination and adverse reactions interval (days) Total (n=87) Compensated (n=43) Rejected (n=44) 26 (29.9) 8 (3.8) 18 (69.2) (2.7) 7 (38.9) 11 (61.1) (13.8) 2 (16.7) 1 (83.3) (4.6) (.) 4 (1.) (2.3) 2 (1.) (.) (4.6) 3 (75.) 1 (25.) 61 2 (23.) 2 (1.) (.) Unknown 1 (1.1) 1 (1.) (.) Underlying disease Yes 26 (29.9) 1 (38.5) 16 (61.5) No 61 (7.1) 33 (54.1) 28 (45.9) Adverse reactions types Locality 42 (48.3) 37 (88.1) 5 (11.9) BCG lymphadenitis 24 (57.1) 23 (95.8) 1 (4.2) Cellulitis (soft tissue inflammation) 11 (26.2) 11 (1.) (.) Others (mosquito nodule, impetigo etc.) 7 (16.7) 3 (42.9) 4 (57.1) Nervous system 21 (24.1) 1 (4.8) 2 (95.2) Convulsion 7 (33.3) (.) 7 (1.) Guillain-Barre syndrome 6 (28.6) (.) 6 (1.) Epilepsy 3 (14.3) (.) 3 (1.) Bell's palsy 2 (9.5) (.) 2 (1.) Ataxia 2 (9.5) (.) 2 (1.) Febrile seizures 1 (4.8) 1 (1.) (.) Whole body 24 (27.6) 5 (2.8) 19 (79.2) Septicemia 5 (2.8) 1 (2.) 4 (8.) Allergy 3 (12.5) 1 (33.3) 2 (66.7) Anaphylaxis, Stevens-Johnson syndrome 1 (4.2) (.) 1 (1.) Others (pertussis, syncope, pneumonia, etc.) 15 (62.5) 3 (2.) 12 (8.) Abbreviation: BCG, Bacillus Calment-Guerin; PPSV23, 23-valent Pneumococcal Polysaccharide Vaccine; DTaP-IPV, Diphtheria and tetanus toxoids and acellular pertussis adsorbed and inactivated poliovirus vaccine; DTaP-IPV/Hib, Diphtheria and tetanus toxoids and acellular pertussis adsorbed, inactivated poliovirus and haemophilus B; DTaP, Diphtheria, Tetanus, Pertussis vaccine; Hib, Haemophilus influenzae type b; HepB, Hepatitis B; HPV, Human papilloma virus; JEV, Japanese encephalitis virus; MMR, Measles-mumps-rubella combined vaccine; Var, Varicella; HFRS, Haemorrhagic fever with renal syndrome 2건 (.5%) 으로두건모두 65세이상노인에서인플루엔자접종후신고되었으며신속대응을통하여예방접종과관련성이낮다고판단하였다 (Table 2). 연령별로는국가예방접종지원사업대상인만12세이하가 264건 (6.1%), 65세이상이 79건 (18.%) 이었다. 성별로는여성 평균 36.6건이며, 1월이후인플루엔자백신이상반응신고가 68건 (44.7%) 으로가장많았다. 기관별신고는보건소신고가 322건 (73.3%), 병의원신고가 117건 (26.7%) 으로보건소신고가많았고, 접종기관별로는보건소접종이 212건 (48.3%), 의료기관접종이 227건 (51.7%) 으로유사하였다 (Table 3). 238 건, 남성 21 건으로여성이다소많았으며, 월별신고현황은 272

9 주간건강과질병 제 12 권제 1 호 217 년예방접종후이상반응피해보상신청현황 예방접종피해보상신청은 215년 99건 ( 신고의 36.5%), 216년 73건 ( 신고의 23.%), 217년 87건 ( 신고의 19.8%) 이었다 (Table 4). 217년예방접종후이상반응에따른피해보상신청 87건중 49.4% 에해당하는 43건이보상을받았으며, 보상유형은모두 건당 1.6건 ), 217년 439건 (1만건당 2.2건 ) 으로 217년에다소증가한것으로나타났다. 또한 215년부터 217년까지예방접종이상반응으로신고된 1,28건중 259건 (25.2%) 이피해보상을신청하였고 149건 (57.5%) 이보상을받았다. 연도별로는 215년피해보상신청 99건에보상이 59건 (59.6%), 216년 73건보상신청에 47건 (64.4%), 217년 87건보상신청에 43건 (49.4%) 이보상을받았다. 질병이었다. 예방접종피해보상신청된사례들을살펴보면, 연령별로는 3세이하가 58건 (13.2%) 으로가장많았고, 다음으로는 65세이상이 16건 (3.6%) 으로많았다. 백신별로는 BCG 단독접종이 28건신청으로가장많았고, 26건 (92.8%) 이보상되었으며, 주요이상반응유형은 BCG 림프절염, 궤양또는농양형성과같이잘알려진부작용이 18건 (69.2%) 으로나타났으며, 그밖에골수염등이있었다. 인플루엔자백신접종피해보상신청은 18건 ( 단독 17건및 참고문헌 1. 질병관리본부. 예방접종대상감염병의역학과관리예방접종실시기준및방법 질병관리통합관리시스템 ( 3. 질병관리본부 ( 동시접종 1건 ) 중 1건 (5.5%) 이다형홍반이상반응으로보상되었으며연령별로는 5세미만 3건, 성인이 14건이고이상반응유형은길랭- 바레증후군이 6건, 폐렴및급성신부전, 다형홍반등이있었으나, 인과성은인정되지않았다. 예방접종과이상반응간격에서는 61일이상이 2건 (23.%) 신청이었고, 2건모두보상되었다. 이상반응유형별로는국소부위증상이 42건 (48.3%), 신경계증상이 21건 (24.1%), 전신증상이 24건 (27.6%) 이었다. 국소부위증상은주로 BCG 백신접종에따른 BCG 림프절염피해보상이 24건이었으며이중 23건이보상되었다. 신경계증상은경련 7건, 길랭-바레증후군 6건, 뇌전증 3건순이었으며전신증상은폐혈증 5건, 알레르기 3건등이었다 (Table 5). 맺음말 국가는양질의백신및접종전문인력확보, 이상반응대한감시ㆍ역학조사및피해보상제도를운영하여예방접종국가안전관리체계를유지하고있다. 215년부터 217년까지예방접종이상반응신고는 1,28 건이고, 1만접종건당신고는 1.8건이었다. 연도별로살펴보면 215년 271건 (1만건당 1.5건 ), 216년 318건 (1만 273

10 주간건강과질병 제 12 권제 1 호 통계단신, QuickStats 청소년의현재흡연율추이, Trends in prevalence of current smoking among Korean adolescents, [ 정의 ] 현재흡연율 : 최근 3 일동안 1 일이상흡연한사람의분율 우리나라청소년의현재흡연율은 27 년 13.3% 에서 218 년 6.7% 로 6.6%p 감소하였음. 218 년기준남학생은 9.4%, 여학생은 3.7% 로남학생의흡연율이 2.5 배더높았으며 ( 그림 A), 중학생 (3.%) 보다고등학생 (9.8%) 이 3.3 배더높은흡연율을 보였음 ( 그림 B). The prevalence of current smoking among adolescents in Korea dropped 6.6 percentage point (%p), from 13.3% in 27 to 6.7% in 218. The 218 data indicated that the prevalence of current smoking was 2.5 folds higher among schoolboys (9.4%) than among schoolgirls (3.7%) (Figure A), and 3.3 folds higher among high school students (9.8%) than among middle school students (3.%) (Figure B). A Percentage (%) Total Schoolboys Schoolgirls B Percentage (%) Middle school students High school students '7 '8 '9 '1 '11 '12 '13 '14 '15 '16 '17 '18 Survey year '7 '8 '9 '1 '11 '12 '13 '14 '15 '16 '17 '18 Survey year Figure A-B. Trends in prevalence of current smoking among Korean adolescents, *Prevalence of current smoking: proportion of those who smoked 1 day or more for the past 3 days Survey population: middle school and high school students in Korea Source: The Korea Youth Risk Behavior Survey (KYRBS), * The Korea Youth Risk Behavior Survey is a national school-based survey to assess the prevalence of and monitor trends in health-risk behaviors among Korean adolescents. Reported by: Division of Chronic Disease Control, Korea Centers for Disease Control and Prevention 274

11 이달의건강이슈, Monthly health issue 주간건강과질병 제 12 권제 1 호 노후에얕봐서는안되는낙상 노인의건강한삶을위협하는낙상 급증하는노인낙상 낙상환자중노인의비중이점차증가 216년 26년 31.2% 42.2% 출처 : 질병관리본부, 응급실손상환자심층조사손상유형및원인통계, 218 년 낙상및추락환자중 65 세이상노인분율 노인 4 명중 1 명이낙상사고경험, 노인낙상환자 4 명중 1 명사망 25% 25% 연간낙상사고경험노인비율 25% 뇌손상, 골절등심각한손상연간 12, 명 낙상사고로인한노인사망 25% 출처 : 질병관리본부, 응급실손상환자심층조사손상유형및원인통계, 218 년 65 세이상노인의낙상사고현황 노인낙상사망증가, 삶의질저하 노인에서낙상손상의발생및사망위험도가가장높아 장애 질병을가지고생활하는기간 5 위 단위 (%) 세이상 6-69세 5-59세 위 하부요통 2위 당뇨병 세 3-39세 위두통 세 1-19세 -9세 위 우울증 5위 낙상및추락 응급실내원낙상환자연령별분율 출처 : 질병관리본부응급실손상환자심층조사손상유형및원인통계 218 연령별응급실내원낙상환자중사망자분율 우리나라전체질병중장애생활연수순위 출처 : Global burden of disease, South Korea profile, 217 년 275

12 주간건강과질병 제 12 권제 1 호 노인낙상, 사고예방이최선 노인낙상의위험요인 생활습관요인 음주 신체체력요인 근력및근지구력저하, 평형성저하 동반질환 부정맥, 기립성저혈압, 파킨슨병, 시력저하 환경요인 미끄러운바닥, 실내턱, 조명, 눈길, 빙판길 노인낙상 복용약물 수면제, 정신안정제, 항우울제, 이뇨제등 출처 : 질병관리본부, 손상예방과건강한안전사회, 218 년 4 호, p.17 의료비증가와노후를망가뜨리는낙상 65 세이상노인낙상후머리와골반을가장많이다쳐 머리손상골반손상상지손상 단위 (%) 실외낙상실내낙상 응급실내원 65 세이상노인낙상환자주요손상부위및응급실진료결과 출처 : Kim SH. Risk factors for severe injury following indoor and outdoor falls in geriatric patients. Arch Gerontol Geriatr. 216 ;62: 사회적의료비용 1조 1,억원 / 연 출처 : 노인실태조사 ( 통계청 214), 낙상예방세미나입법기획처 (215) 발제 : 김선휴 ( 울산대병원응급의학과교수 ) / 감수 : 지역사회건강과질병편집위원회 276

13 주간건강과질병 제 12 권제 1 호 [ 미세먼지안내문 ] 미세먼지대비민감계층건강보호수칙 미세먼지가증가하면이렇게하세요! 호흡기질환자 천식환자 심혈관질환자 호흡기질환자는미세먼지에노출되지않는것이중요합니다. 실외활동을줄이고, 창문을닫고주로실내에서지내세요. 공기청정기가도움이될수있습니다. 외출시에는천식증상완화제를항상가지고다니세요. 어린이는학교보건실에도맡겨두세요. 식약처인증보건용마스크가도움을줄수있습니다. 의사와상의한후착용해보세요. 부득이외출을해야할경우 COPD 환자는구제약물을반드시소지하고필요할경우사용하세요. 미세먼지가높은날이지나도그영향은수일까지지속되므로, 평소에하던천식유지치료를더욱더철저하게해주세요. 기존질환을적극적으로관리하는것이중요합니다. 기존의호흡기질환치료제를성실히복용하세요. 미세먼지가발생후 6주까지도영향이지속될수있으므로꾸준히관리해야합니다. 부득이외출을해야할경우의사와상의한후얼굴에맞는보건용마스크를착용하세요. 실외활동을자제하고, 창문을닫고주로실내에서지내세요. 공기청정기가도움이될수있습니다. 심장및뇌혈관질환자는장시간의힘든육체활동을줄여주세요. 호흡곤란, 가래, 기침등호흡기증상이악화되는경우에는바로병원으로가세요. 비염등동반질환이있는경우미세먼지의영향이더클수있으니천식이악화되었을때의행동요령을숙지하시고필요시의사와상담하세요. 물을적당히마시는것은몸밖으로노폐물을내보내는효과가있어도움이됩니다. 부적절한마스크착용이위험할수있습니다. 반드시의사와상의한후착용하세요. 착용후두통, 호흡곤란, 어지러움이있으면바로벗으세요. 기침, 호흡곤란, 쌕쌕거림등의천식증상과최대호기유속을측정해천식수첩에기록하세요. 심혈관질환자는미세먼지에노출되지않는것이중요합니다. 실외활동을줄이고, 창문을닫고주로실내에서지내세요. 공기청정기가도움이될수있습니다

14 주간건강과질병 제 12 권제 1 호 [ 미세먼지안내문 ] 올바른마스크착용법 278

15 주간건강과질병 제 12 권제 1 호 279

16 주요감염병통계, Statistics of selected infectious diseases 1.1 환자감시 : 전수감시감염병주간발생현황 (9 주차 ) Table 1. Reported cases of national infectious diseases in Republic of Korea, ending March 2, 219 (9th Week)* Category Ⅰ Category Ⅱ Category Ⅲ Category Ⅳ Classification of disease 219 ly average 28 Total no. of cases by year Cholera Unit: No. of cases Imported cases of current : Country (no. of cases) Typhoid fever Laos(2), Philippines(2) Paratyphoid fever Vietnam(1) Shigellosis EHEC Viral hepatitis A 179 1,5 63 2,451 4,419 4,679 1,84 1,37 Uzbekistan(1) Pertussis Tetanus Measles Philippines(2), Malaysia(1), Cambodia(1) Mumps 237 2, ,251 16,924 17,57 23,448 25,286 Rubella Viral hepatitis B (Acute) Japanese encephalitis Varicella 1,159 16, ,47 8,92 54,6 46,33 44,45 Haemophilus influenza 2 3 type b Streptococcus pneumoniae Malaria Uganda(1) Scarlet fever 149 1, ,781 22,838 11,911 7,2 5,89 Meningococcal meningitis Legionellosis Vibrio vulnificus sepsis Murine typhus Scrub typhus ,752 1,528 11,15 9,513 8,13 Leptospirosis Brucellosis Rabies HFRS Syphilis ,27 2,148 1,569 1,6 1,15 CJD/vCJD Tuberculosis 461 4, ,553 28,161 3,892 32,181 34,869 HIV/AIDS ,9 1,62 1,18 1,81 Viral hepatitis C 164 1,66-11,23 6, Russia(1) VRSA CRE 175 2,172-11,923 5, Dengue fever Vietnam(4), Thailand(3), Philippines(3) Q fever West Nile fever Lyme Borreliosis Melioidosis Chikungunya fever Vietnam(2), Thailand(1) SFTS MERS Zika virus infection Malaysia(2), Philippines(1) Abbreviation: EHEC= Enterohemorrhagic Escherichia coli, HFRS= Hemorrhagic fever with renal syndrome, CJD/vCJD= Creutzfeldt-Jacob Disease / variant Creutzfeldt-Jacob Disease, VRSA= Vancomycin-resistant Staphylococcus aureus, CRE= Carbapenem-resistant Enterobacteriaceae, SFTS= Severe fever with thrombocytopenia syndrome, MERS-CoV= Middle East Respiratory Syndrome Coronavirus. Cum: Cumulative counts from 1st to current in a year. * The reported data for year 217, 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, 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)

17 Table 2. Reported cases of infectious diseases by geography, ending March 2, 219 (9th Week)* Diseases of Category Ⅰ Unit: No. of cases Reporting area Cholera Typhoid fever Paratyphoid fever Shigellosis Overall Seoul Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi Gangwon Chungbuk Chungnam Jeonbuk 1 1 Jeonnam Gyeongbuk Gyeongnam Jeju 1 Cum: Cumulative counts from 1st to current in a year * The reported data for year 218, 219 are provisional but the data from 214 to 217 are finalized data. According to surveillance data, the reported cases may include all of the cases such as confirmed, suspected, and asymptomatic carrier in the group. average is mean value calculated by cumulative counts from 1st to current for 5 preceding years

18 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending March 2, 219 (9th Week)* Unit: No. of cases Diseases of Category Ⅰ Diseases of Category Ⅱ Reporting area Enterohemorrhagic Escherichia coli Viral hepatitis A Pertussis Tetanus Overall , Seoul Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year 218, 219 are provisional but the data from 214 to 217 are finalized data. According to surveillance data, the reported cases may include all of the cases such as confirmed, suspected, and asymptomatic carrier in the group. average is mean value calculated by cumulative counts from 1st to current for 5 preceding years

19 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending March 2, 219 (9th Week)* Diseases of Category Ⅱ Unit: No. of cases Reporting area Measles Mumps Rubella Viral hepatitis B (Acute) Overall ,226 2, Seoul Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year 218, 219 are provisional but the data from 214 to 217 are finalized data. According to surveillance data, the reported cases may include all of the cases such as confirmed, suspected, and asymptomatic carrier in the group. average is mean value calculated by cumulative counts from 1st to current for 5 preceding years

20 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending March 2, 219 (9th Week)* Unit: No. of cases Diseases of Category Ⅱ Diseases of Category Ⅲ Reporting area Japanese encephalitis Varicella Malaria Scarlet fever Overall 1,159 16,257 1, ,47 2,3 Seoul 154 1,753 1, Busan Daegu Incheon Gwangju Daejeon Ulsan Sejong Gyonggi 182 4,211 2, Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam 161 1, Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year 218, 219 are provisional but the data from 214 to 217 are finalized data. According to surveillance data, the reported cases may include all of the cases such as confirmed, suspected, and asymptomatic carrier in the group. average is mean value calculated by cumulative counts from 1st to current for 5 preceding years

21 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending March 2, 219 (9th Week)* Diseases of Category Ⅲ Unit: No. of cases Reporting area Meningococcal meningitis Legionellosis Vibrio vulnificus sepsis Murine typhus Overall Seoul Busan 3 2 Daegu 3 1 Incheon Gwangju Daejeon Ulsan 1 1 Sejong Gyonggi Gangwon Chungbuk 2 1 Chungnam Jeonbuk Jeonnam 2 Gyeongbuk Gyeongnam Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year 218, 219 are provisional but the data from 214 to 217 are finalized data. According to surveillance data, the reported cases may include all of the cases such as confirmed, suspected, and asymptomatic carrier in the group. average is mean value calculated by cumulative counts from 1st to current for 5 preceding years

22 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending March 2, 219 (9th Week)* Diseases of Category Ⅲ Unit: No. of cases Reporting area Scrub typhus Leptospirosis Brucellosis Hemorrhagic fever with renal syndrome 219 Overall Seoul Busan Daegu 1 Incheon Gwangju Daejeon Ulsan Sejong 1 Gyonggi Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju Cum: Cumulative counts from 1st to current in a year * The reported data for year 218, 219 are provisional but the data from 214 to 217 are finalized data. According to surveillance data, the reported cases may include all of the cases such as confirmed, suspected, and asymptomatic carrier in the group. average is mean value calculated by cumulative counts from 1st to current for 5 preceding years

23 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending March 2, 219 (9th Week)* Unit: No. of cases Diseases of Category Ⅲ Diseases of Category Ⅳ Reporting area Syphilis CJD/vCJD Tuberculosis Dengue fever Overall ,495 4, 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 218, 219 are provisional but the data from 214 to 217 are finalized data. According to surveillance data, the reported cases may include all of the cases such as confirmed, suspected, and asymptomatic carrier in the group. average is mean value calculated by cumulative counts from 1st to current for 5 preceding years

24 Table 2. (Continued) Reported cases of infectious diseases by geography, s ending March 2, 219 (9th Week)* Diseases of Category Ⅳ Unit: No. of cases Reporting area Q fever Lyme Borreliosis SFTS Zika virus infection Overall Seoul Busan Daegu Incheon Gwangju Daejeon Ulsan 7 - Sejong - Gyonggi Gangwon 1 - Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju - Cum: Cumulative counts from 1st to current in a year * The reported data for year 218, 219 are provisional but the data from 214 to 217 are finalized data. According to surveillance data, the reported cases may include all of the cases such as confirmed, suspected, and asymptomatic carrier in the group. average is mean value calculated by cumulative counts from 1st to current for 5 preceding years

25 1.2 환자감시 : 표본감시감염병주간발생현황 (9 주차 ) 1. Influenza, Republic of Korea, s ending March 2, 219 (9th ) 219 년도제 9 주인플루엔자표본감시 ( 전국 2 개표본감시기관 ) 결과, 의사환자분율은외래환자 1, 명당 8.3 명으로지난주 (8.6 명 ) 대비감소 절기유행기준은 6.3 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 March 2, 219 (9th ) 219 년도제 9 주차수족구병표본감시 ( 전국 95 개의료기관 ) 결과, 의사환자분율은외래환자 1, 명당 1.2 명으로전주 (1.1 명 ) 대비증가 수족구병은 29 년 6 월법정감염병으로지정되어표본감시체계로운영 No. of outpatients / 1, Figure 2. Weekly proportion of hand, foot and mouth disease per 1, outpatients,

26 3. Ophthalmologic infectious disease, Republic of Korea, s ending March 2, 219 (9th ) 219 년도제 9 주차유행성각결막염표본감시 ( 전국 92 개의료기관 ) 결과, 외래환자 1, 명당분율은 14.8 명으로전주 13.3 명대비증가 동기간급성출혈성결막염의환자분율은.6 명으로전주와동일 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 29

27 4. Sexually Transmitted Diseases, Republic of Korea, s ending March 2, 219 (9th ) 219 년도제 9 주성매개감염병표본감시기관 ( 전국보건소및의료기관 59 개참여 ) 에서신고기관당성기단순포진 2.7 건, 클라미디아감염증 2.2 건, 첨규콘딜롬 2.1 건, 임질 1.5 건발생을신고함. 제 9 주차신고의료기관수 : 임질 19 개, 클라미디아 43 개, 성기단순포진 4 개, 첨규콘딜롬 24 개 Unit: No. of cases/sentinels Gonorrhea Chlamydia Genital herpes Condyloma acuminata Cum: Cumulative counts from 1st to current in a year According to surveillance data, the reported cases may include all of the cases such as confirmed, suspected, and asymptomatic carrier in the group. average is mean value calculated by cumulative counts from 1st to current for 5 preceding years. 문의 : (43) , 수인성및식품매개감염병집단발생주간현황 (9 주차 ) Waterborne and foodborne disease outbreaks, Republic of Korea, s ending March 2, 219 (9th ) 219 년도제 9 주에집단발생이 8 건 ( 사례수 54 명 ) 이발생하였으며누적발생건수는 78 건 ( 사례수 771 명 ) 이발생함 No. of outbreaks Average no. of cases in last 5 years( ) Figure 5. Number of waterborne and foodborne disease outbreaks reported by,

28 2.1 병원체감시 : 인플루엔자및호흡기바이러스주간감시현황 (9 주차 ) 1. Influenza viruses, Republic of Korea, s ending March 2, 219 (9th ) 219 년도제 9 주에전국 52 개감시사업참여의료기관에서의뢰된호흡기검체 22 건중양성 17 건 (A/H1N1pdm9 4 건, A/H3N2 13 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, flu season 2. Respiratory viruses, Republic of Korea, s ending March 2, 219 (9th ) 219 년도제 9 주호흡기검체 (22 건 ) 에대한유전자검사결과 42.3% 의호흡기바이러스가검출되었음. ( 최근 4 주평균 174 개의호흡기검체에대한유전자검사결과를나타내고있음 ) 주별통계는잠정통계이므로변동가능 219 () Weekly total Detection rate (%) No. of samples Detection rate (%) HAdV HPIV HRSV IFV HCoV HRV HBoV HMPV , HAdV : human Adenovirus, HPIV : human Parainfluenza virus, HRSV : human Respiratory syncytial virus, IFV : Influenza virus, HCoV : human Coronavirus, HRV : human Rhinovirus, HBoV : human Bocavirus, HMPV : human Metapneumovirus the rate of detected cases between February 3, 219 March 2, 219 (Average No. of detected cases is 174 last 4 s) 218 : the rate of detected cases between January 1, December 29, 218 자세히보기 : 질병관리본부 질병 건강 주간질병감시정보 292

29 2.2 병원체감시 : 급성설사질환실험실표본주간감시현황 (8 주차 ) Acute gastroenteritis-causing viruses and bacteria, Republic of Korea, s ending February 23, 219 (8th ) 219년도제8주실험실표본감시 (17 개시ㆍ도보건환경연구원및 7개의료기관 ) 급성설사질환유발바이러스검출건수는 17건 (41.5%), 세균검출건수는 8건 (6.1%) 이었음. Acute gastroenteritis-causing viruses Week No. of sample No. of detection (Detection rate, %) Norovirus Group A Rotavirus Enteric Adenovirus Astrovirus Sapovirus Total (4.6) 4 (5.8) (.) 1 (1.4) (.) 33 (47.8) (28.) 8 (16.) 1 (2.) 1 (2.) (.) 24 (48.) (33.3) 4 (5.8) (.) (.) (.) 27 (39.1) (19.5) 6 (14.6) (.) 3 (7.3) (.) 17 (41.5) ** (35.6) 34 (7.7) 1 (.2) 9 (2.) 1 (.2) 23 (45.7) * 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 (1.8) 2 (1.2) () () () 1 (.6) 2 (1.2) 3 (1.8) 2 ( (7.7) (3.5) 1 (.7) () () () 3 (2.1) 2 (1.4) 3 (2.1) () 15 (1.5) (1.8) 2 (1.8) () () () 2 (1.8) 3 (2.8) 1 (.9) 1 (.9) 11 (1.1) (.8) () () () () () 2 (1.5) 2 (1.5) 3 (2.3) 8 (6.1) 1, (1.4) 17 (1.4) () () () 9 (.7) 29 (2.4) 23 (1.9) 1 (.8) 16 (8.6) * Bacterial Pathogens ; Salmonella spp., E. coli (EHEC, ETEC, EPEC, EIEC), Shigella spp., Vibrio parahaemolyticus, Vibrio cholerae, Campylobacter spp., Clostridium perfringens, Staphylococcus aureus, Bacillus cereus, Listeria monocytogenes, Yersinia enterocolitica. * Hospital participating in laboratory surveillance in 218 (7 hospitals) 자세히보기 : 질병관리본부 질병 건강 주간질병감시정보 293

30 2.3 병원체감시 : 엔테로바이러스실험실주간감시현황 (8 주차 ) Enterovirus, Republic of Korea, s ending February 23, 219 (8th ) 219년도제8주실험실표본감시 (14 개시ㆍ도보건환경연구원, 전국 57개참여병원 ) 결과, 엔테로바이러스검출률 37.5%(3 건양성 /8 검체 ), 219년누적양성률 8.1%(1 건양성 /123 검체 ) 임. - 무균성수막염 1건 (219 년누적 4건 ), 수족구병및포진성구협염 2건 (219 년누적 5건 ), 합병증동반수족구 건 (219 년누적 건 ), 기타 건 (219 년누적 1건 ) 임. Aseptic meningitis 8 No. of cases Enterovirus detection cases 218 Enterovirus detection cases Figure 7. Detection cases of enterovirus in aseptic meningitis patients from 218 to 219 HFMD and Herpangina No. of cases Enterovirus detection cases 218 Enterovirus detection cases Figure 8. Detection cases of enterovirus in HFMD and herpangina patients from 218 to 219 HFMD with Complications No. of cases Enterovirus detection cases 218 Enterovirus detection cases Figure 9. Detection cases of enterovirus in HFMD with complications patients from 218 to

31 주요통계이해하기 < 통계표 1> 은지난 5년간발생한법정감염병과 218 년해당주발생현황을비교한표로, 금주환자수 ( ) 는 218 년해당주의신고건수를나타내며, 218 년누계환자수 ( 218) 는 218년 1주부터해당주까지의누계건수, 그리고 5년주평균환자수 ( ly average) 는지난 5년 ( 년 ) 해당주의신고건수와이전 2주, 이후 2주의신고건수 ( 총 25주 ) 평균으로계산된다. 그러므로금주환자수 ( ) 와 5년주평균환자수 ( ly average) 의신고건수를비교하면해당주단위시점과예년의신고수준을비교해볼수있다. 연도별환자수 (Total no. of cases by year) 는지난 5년간해당감염병현황을나타내는확정통계이며연도별현황을비교해볼수있다. 예 ) 218 년 12 주의 5년주평균환자수 ( ly average) 는 213 년부터 217 년의 1 주부터 14 주까지의신고건수를 총 25주로나눈값으로구해진다. * 5년주평균환자수 ( ly average)=(x1 + X2 + + X25)/25 1주 11주 12주 13주 14주 218년 해당주 217년 X1 X2 X3 X4 X5 216년 X6 X7 X8 X9 X1 215년 X11 X12 X13 X14 X15 214년 X16 X17 X18 X19 X2 213년 X21 X22 X23 X24 X25 < 통계표 2> 는 17 개시 도별로구분한법정감염병보고현황을보여주고있으며, 각감염병별로최근 5년누계평균환자수 (Cum, average) 와 218년누계환자수 (Cum, 218) 를비교해보면최근까지의누적신고건수에대한이전 5년동안해당주까지의평균신고건수와비교가가능하다. 최근 5년누계평균환자수 (Cum, average) 는지난 5년 ( 년 ) 동안의동기간신고누계평균으로계산된다. 기타표본감시감염병에대한신고현황그림과통계는최근발생양상을신속하게파악하는데도움이된다.

32 발간등록번호 주간건강과질병, PHWR 은질병관리본부에서시행되는조사사업을통해생성된감시및연구자료를기반으로근거중심의건강및질병관련정보를제공하고자최선을다할것이며, 제공되는정보는질병관리본부의특정의사와는무관함을알립니다. 본간행물에서제공되는감염병통계는 감염병의예방및관리에관한법률 에의거, 국가감염병감시체계를통해신고된자료를기반으로집계된것으로집계된당해년도자료는의사환자단계에서신고된것이며확진결과시혹은다른병으로확인될경우수정될수있는잠정통계임을알립니다. 주간건강과질병, PHWR 은질병관리본부홈페이지를통해주간단위로게시되고있으며, 정기적구독을원하시는분은 이메일을통해보내지는본간행물의정기적구독요청시구독자의성명, 연락처, 직업및이메일주소가요구됨을알려드립니다. 주간건강과질병 발간관련문의 : kcdc215@korea.kr/ /33 창 발 간 : 28 년 4 월 4 일 행 : 219 년 3 월 7 일 발행인 : 정은경 편집인 : 지영미 편집위원 : 최영실, 김기순, 조신형, 조성범, 김봉조, 구수경, 김용우, 조은희, 이은규, 윤여란, 신영림, 김청식, 권효진 편 집 : 질병관리본부유전체센터의과학지식관리과 충북청주시흥덕구오송읍오송생명 2 로 187 오송보건의료행정타운 ( 우 )28159 Tel. (43) /33 Fax. (43)