최종결과보고서 편집순서 겉표지 뒷면 측면 앞면 발간등록번호 학술연구용역과제 과 최종결과보고서 제 명 국문과제명 주의 주의내용기재 글 고딕체 질병관리본부 영문과제명 Study on improvement of national notifiable disease surveillance system 주관연구기관 동국대학교경주캠퍼스산학협력단질병관리본부
주의내용 주 의 이보고서는질병관리본부에서시행한학술연구용역과제의최종결과보고서입니 다 이보고서내용을발표할때에는반드시질병관리본부에서시행한학술연구용 역과제의연구결과임을밝혀야합니다 국가과학기술기밀유지에필요한내용은대외적으로발표또는공개하여서는아 니됩니다
학술연구용역과제최종결과보고서 과제번호 2013E2300300 과제명 주관연구기관 주관연구 감염병, 감시체계, 법정감염병, 국가감염병감시시스템, 건강보험자료 Study on improvement of national notifiable disease surveillance system 기관명소재지대표 123 성명소속및부서전공 책임자 부서명담당자발주부서 연구비 연구기간 총참여연구원 보안등급분류 수행년도년도학술연구용역과제에의하여수행중인학술연구용역과제의최종결과보고서를붙임과같이제출합니다. 붙임 1. 최종결과보고서제본 (20 부 ) 2. CD 2 매 질병관리본부장귀하 일반용지 재활용품 - 1 -
목 차 연구개발결과요약문 6 7 학술연구용역과제연구결과 1 8 1.1 8 1.2 9 2 10 2.1 10 2.2 23 3 28 3.1 28 3.2 29 3.3 29 3.4 31 4 32 4.1 32 4.2 34 4.3 63 4.4 69 4.5 78 5 104 6 107 7 107 8 107 9 108 10 110 11 113-2 -
표목차 1. 9 2. 21 3. 21 4. 22 5. 22 6. 25 7. 25 8. NNDSS 26 9. 30 10.,, 35 11. PHE Colindale 44 12. Notifiable disease 46 13. 47 14. Surveillance 50 15.,, 61 16. 2011 64 17. 65 18. 67 19. 69 20 1 70 21. 71 22. ( ) 72 23. KCD 83 24. I 85 25. II 86 26. Type I 87 27. Type I 88 28. Type II-1 90 29. Type II-2 92 30. Type III 93-3 -
31. Type IV I 95 32. Type IV II 95 33. 97 34. 99 35. 101 36. 102 37. () 103-4 -
그림목차 1. Framework for Evaluating Public Health Surveillance Systems for Early Detection of Outbreaks. 11 2.. 13 3.. 13 4.. 14 5. WHO 20 6.. 23 7.. 28 8.. 31 9.. 37 10. Public health agency I-1. 38 11. Public health agency I-2. 39 12. Public health agency.i-3. 40 13. NNDSS. 41 14.. 45 15. Laboratory reporting flow chart. 48 16. NHS Direct syndromic surveillance flow chart. 49 17.. 53 18.. 54 19.,,,. 63 20. (A00-B99) (1983-2012). 66 21. (1983-2012). 68 22.. 73 23.. 75 24.. 75 25.. 80 26. Type II. 91 27.. 92 28.. 102-5 -
연구결과점검보고서요약문,,, - 6 -
Summary Title of Project Study on improvement of national notifiable disease surveillance system Key Words Institute communicable disease, surveillance system, national notifiable disease surveillance system, health insurance data College of Medicine, Dongguk Project Leader Lee, Kwan University Project Period 2013. 10. 10-2014. 04. 09 Infectious disease surveillance is very important as a element in public health system in the prevention and control of infectious diseases. Results of infectious disease surveillance system in Korea have been influenced the reduction of the incidence of infectious disease and its related death. Whole occurrences of acute diseases as well as chronic infectious disease such as tuberculosis were greatly reduced compared to 50 years ago. However, for the data of infectious diseases surveillance system and the health insurance claim data are different, it has been raised issues continuously that the different statistical results of national institutions are provided. Though the two data cannot be compared absolutely and the purposes of collection are different, the health insurance claim data is useful for evaluating the overall trend of infectious disease, but there are errors that no cases in world and Korea are claimed. In this study, we studied the differences, the status, and the pros and cons of the two data, and reviewed the methods of utilization of health insurance claim data. Through comparison with health insurance claim data, we suggest strategies to use efficiently these data by classification of infectious disease in Korean infectious disease surveillance system. The first type (small pox, polio) is a case to be claimed the diseases of no cases in world and Korea. The minimal error checking when these cases are claimed is necessary, and when this data is provided to other institutions, it is needed to except these data such as that of oriental hospital with much errors through data review and providing system. The second type (Brucellosis, malaria) is a case of being managed well by government, and the trend is consistent with claims data. The third type (hepatitis A, typhoid fever) is a case of showing distinguishing clinical characteristics with similar trend annually. The fourth type (chicken pox, mumps) is a case of increasing reporting rate recent, it can be used as evaluation index to improve the reporting rate. As can be seen in the detailed analysis, the data that there is no cases in world, or no consistency of claim data must not be compared and presented. Above all, the coordination scheme between surveillance system data and health insurance claim data by their characteristics is needed. Through comparison with the infectious disease surveillance system of other countries, it is needed to consider the current status of infectious diseases that require changes or introduction newly in the surveillance system or appropriate reporting time by characteristics of diseases. And in case of small pox, it can be used as an indicator of improvement in the reporting rate, for the reporting rate is recently continuously increasing. The purpose of infectious disease surveillance system is to understand the scope of problems with infectious diseases, to observe the trend of the incidence of diseases, to identify the outbreak, and to find the new issues. It is required the efforts to develop the new standards of evaluation, to evaluate continuously, and to improve the surveillance system. - 7 -
목표 1. (surveillance system),, 1954, 2000.,,,,,,,,, - 8 -
2... 목표달성도및관련분야에대한기여도 1. < > < > < > - - - - -, - / -,, - - 9 -
2.1 1. Langmuir,,, " 1).,,,, (),,,,,, 2).,, (false alarm).,. 3) 1) LANGMUIR AD. The surveillance of communicable diseases of national importance. N Engl J Med 1963;268:182-92 2) Teutsch SM, Churchill RE. Principles and practice of public health surveillance. 2nd ed. Oxford, New York: Oxford University Press, 2000. 3) German RR, Lee LM, Horan JM, Milstein RL, Pertowski CA, Waller MN; Guidelines Working Group Centers for Disease Control and Prevention (CDC). Updated guidelines for evaluating public health surveillance systems: recommendations from the Guidelines Working Group. MMWR Recomm Rep 2001;50(RR-13):1-35 - 10 -
1. Framework for Evaluating Public Health Surveillance Systems for Early Detection of Outbreaks.,,, 4 4). 2. 5) (sensitivity), (timeliness), (predictive value), (representativeness), (data quality), (simplicity), (flexibility), (acceptability) Sensitivity:? Timeliness: data flow? Predictive value:? 4) Buehler JW, Hopkins RS, Overhage JM, Sosin DM, Tong V; CDC Working Group. Framework for evaluating public health surveillance systems for early detection of outbreaks: recommendations from the CDC Working Group. MMWR Recomm Rep 2004;53(RR-5):1-11 5) Rothman KJ, Greenland S, Lash TL, eds. Modern epidemiology, 3rd ed. Lippincott Williams & Wilkins, 2008. - 11 -
Representativeness: target population? Data quality:? Simplicity:? Flexibility:? Acceptability:? 3. 6) (1) System Description ( ) (purpose). -, -, - - - outbreak (small, large) ( ) (Stakeholders) - - : : : :,, : 6) Buehler JW, Hopkins RS, Overhage JM, Sosin DM, Tong V; CDC Working Group. Framework for evaluating public health surveillance systems for early detection of outbreaks: recommendations from the CDC Working Group. MMWR Recomm Rep 2004;53(RR-5):1-11 - 12 -
: (NGO) ( ) 1 2 그림 2. 전염병발생의조기진단을위한진행모델. 그림 3. 감시체계자료의진행모식도. - 13 -
3 :,, 4 5, (2) (Outbreak Detection) ( ) (Timeliness) (Timeliness) 그림 4. 감시시스템의시간적적절성. 1 (Onset of exposure) Exposure() point-source outbreak. outbreak 2 (Onset of symptoms).,,. 3 (Onset of behavior) - 14 -
(, )., ( ). 4 (Capture of data)., 5 (Completion of data processing). (, ).. 6 (Capture of data in surveillance system) (, ) 7 (Application of pattern recognition tools/algorithms) :,, 8 (Generation of automated alert) 9 (Initiation of public health investigation),.. - 15 -
. 10 (Initiation of public health intervention),. (, ) (, ) ( ) (Validity).,.,,,,,.. 1 : 2 :.. 3 :, 4 : (, ) 5 :, 6 :. 7,, :,, ( ),,., - 16 -
,,. 1 :,, 2 : --> (3) ( ) (Usefulness)....... ( ) (Flexibility)... - 17 -
( ) (Acceptability) (State).,,.,, ( ) (Portability).. ( ) (Stability).. ( ). * - - - - (,, ) * - - -. -? -, - 18 -
? -? -? -? (,,, ) -? -? (,,?) -? -? -? (4) - - - -, - 19 -
4. WHO 7) (1) (input), (process), (output), (outcome), (impact).,,,,.,,.,,, ().,,,.,,. (2) (),,,,. 5. WHO 7) WHO. Communicable disease surveillance and response systems. Guide to monitoring and evaluating. World Health Organization 2006. - 20 -
( ).,.. ( ),,,. 2. /,,,.,, ( ),,,, ( ) ( ).,,,,,, ( ). 3. ( ),, ( ),,,, (),,, ( ),, ( ),,, - 21 -
( ) ( ), /, /,, (, ),,. 4. /,,,,,,,,, (,, ), /, ( ) / /,, ( ) (quality),,,,,,,,,,.,,. 5.,,, (24), (week), (month) (,,,,, ) (,,,, ),,,,,,,,, - 22 -
2.2 1.,,,,,,,,,, 50 5% 6.. (2007) 8) - 51.7%, 66.4%, 96.9% -., SFTS -,,. 8) 박옥, 최보율. 전염병감시체계소개및평가. 예방의학회지 2007;40(4):259-264 - 23 -
(2003) 9) 95%,,,, 60-70%. 100% - 1,, 70% (1 77.1%, 2 60.9%, 3 84.6%, 4 65.1%) -, ( 0.93, 1.0, 0.87, 0.90, 0.91, 0.98, 0.93) - (2003),,.,, 9) 신의철. 전염병감시체계평가및발전방안연구. 2003-24 -
2. 10),,,,.,,,,,,,,,. 6., 7.,,,. 90 ( 18.1 ), NNDSS,,,, (),, 10) Miller M1, Roche P, Spencer J, Deeble M. Evaluation of Australia's National Notifiable Disease Surveillance System. Commun Dis Intell Q Rep 2004;28(3):311-323. - 25 -
CDC 11). CDC. CDC,,.,,,,,,.,,,.,,.,,,,. program office OSELS (Office of Surveillance, Epidemiology, and Laboratory Services), OID (Office of Infectious Diseases), CGH (Center for Global Health), OSELS,,. 8. NNDSS NNDSS CSTE CDC OSELS PHITPO PHSPO OID NCIRD NCEZID NCHHSTP CGH DPDM ONC CMS Nationally Notifiable Disease Surveillance System Council of State and Territorial Epidemiologists Centers for Disease Control and Prevention Office of Surveillance, Epidemiology, and Laboratory Services Public Health Informatics and Technology Program Office Public Health Surveillance Program Office Office of Infectious Diseases National Center for Immunization and Respiratory Diseases National Center for Emerging and Zoonotic Infectious Diseases National Center for HIV, HEP, STD, and TB Prevention Center for Global Health Division of Parasitic Diseases and Malaria Office of the National Coordinator for Health Information Technology Centers for Medicare and Medicaid Services 11) CDC. Evaluation of and Recommendations for the National Notifiable Disease Surveillance System Within the Federal Centers for Disease Control and Prevention. Available from: http://www.cdc.gov/osels/phsipo/dndhi/docs/pdf/nndss-evaluation-report-final.pdf - 26 -
.,,.,. OSELS,,, CDC,.,,,,. NETSS (National Electronic Telecommunications System for Surveillance), NEDSS(National Electronic Disease Surveillance System) Base System (NBS). Common Data Store (CDS). The PHIN Vocabulary Access and Distribution System (PHINVADS). - 27 -
7.. 3.1 - National Notifiable Diseases Surveillance System (NNDSS) - National epidemiological surveillance for infectious disease (NESID) - European Surveillance System (TESSy),, 3 (,,, ) - 28 -
3.2 Updated Guidelines for Evaluating Public Health Surveillance Systems : ( ), (,, ), (), [, - (sensitivity), (timeliness), (predictive value), (representativeness), (data quality), (simplicity), (flexibility), (acceptability)],, () ( ), 3.3 1. (46 ),,,, (,,,, - ) 2. /, 1,,, 1, 29, 10. - 29 -
( ) 1, 9. (),,,, (, ).. (,, (,,, ) ) ( ),. ( ), 3 ( ( : ) : ) 2, 3. (, -, - 30 -
), ( ) 3.4 - (MMWR, CDC protocol ) - (PubMED, EMBASE ) - (,,, ), -,,, : 8.. - 31 -
4.1 1. 1 (2013.10.07.) - (NNDSS), (NESID), (TESSy) - -,, - 2. 2 (2013.11.11.),, : (, ) 3. 3 (2013.12.20.) 54 ( ) 3(,, ) 4. 4 (2014.01.13.) - - trend - - - 32 -
-, 5. 5 (2014.02.10.) - ( I) - ( II-1) - ( II-2) - ( III) - ( IV) 2012-33 -
4.2 1.., 12).,,, 13).,,,. 12) Krause G, Ropers G, Stark K. Notifiable disease surveillance and practicing physicians. Emerging Infectious Diseases 2005;11(3):442-445 13) Azar FE, Masoori N, Meidani Z, Paul L. Proposal for a modernized Iranian notifiable infectious diseases surveillance system: comparison with USA and Australia. East Mediterr Health J 2010;16(7):771-777 - 34 -
10.,, / Centers for Disease Control and Prevention (Department of Health and Human Services) National Notifiable Diseases Surveillance System (NNDSS) Territorial health departments, State health departments, Centers for Disease Control and Prevention Physician offices, Hospitals, Health maintenance organizations, Blood transfusion centres, Blood banks, Health care organizations, Veterinarians, Health care practitioners, Laboratory departments, Schools, Prisons/reform schools, Dentist offices, Nursing care facilities, Medicolegal, Registration of vital statistics, Day-care clinics,, National Electronic Disease Surveillance System (NEDSS) Morbidity and Mortality Weekly Report (MMWR) (Ministry of Health, labour and Welfare) (National Institute of Infectious Disease, NIID) (Infectious Disease Surveillance Center, IDSC) National epidemiological surveillance for infectious disease (NESID) Local public health centers, Prefectural public health institutes, Prefectural IDSC, National IDSC Physician offices, Hospitals, Laboratory reports, Day-care clinics, Schools,,, (nationwi de electronic surveillance system) IDWR (Infectious Diseases Weekly Report), IASR (Infectious Agents Surveillance Report), SeroEpi (National Surveillance of Vaccine-preventable Diseases) Department of Health Public Health England (PHE) Centre for Infections(CfI) Notifications of infectious diseases(noids) sentinel reporting framework Local Authority, Local Health Protection Unit, CfI Notifiable diseases, Laboratory reports, Clinician reporting, NHS Direct,,, LabLink CoSurv LabBase Health Protection Report (HPR) - 35 -
2.. CDC National Notifiable Diseases Surveillance System (NNDSS). CDC Council of State and Territorial Epidemiologists (CSTE). NNDSS (state, territorial, tribal, local)..,,,. (, ).. CDC. states/partners. Morbidity and Mortality Weekly Report (MMWR)..,,... CDC.,. CDC,, /,,,.. 14). 14) Jajosky RA, Groseclose SL. Evaluation of reporting timeliness of public health surveillance systems for infectious diseases. BMC Public Health 2004;4:29-36 -
9.. Public health agency CDC 15).. Immediate, extremely urgent CDC Emergency Operations Center (EOC) 4. 15) Centers for Disease Control and Prevention. Protocol for Public Health Agencies to Notify CDC about the Occurrence of Nationally Notifiable Conditions, 2013. - 37 -
, CDC. Immediate, urgent 24 CDC EOC, (next regularly scheduled electronic transmission) CDC. (next reporting cycle). State/territory CDC. 10. Public health agency I-1. - 38 -
11. Public health agency I-2. - 39 -
12. Public health agency.i-3. NNDSS National Electronic Disease Surveillance System (NEDSS). NEDSS (information technology) state, local, territorial health department CDC. NEDSS. CDC. Public health disease reporting electronic laboratory reporting. - 40 -
. NNDSS 16). 13. NNDSS. NNDSS state/local health department, CDC, CSTE., state,,,. CDC state/local health department,, private provider health IT system. NEDSS. ( ) (capture) (public health record). (interoperable system). state local level. CDC 57 (reporting jurisdictions). state state level (report) state CDC (notification) (voluntary). 16) CDC. Evaluation of and Recommendations for the National Notifiable Disease Surveillance System Within the Federal Centers for Disease Control and Prevention. - 41 -
57. reportable disease notifiable disease. Reportable disease: (health provider),, reportable disease state territorial jurisdictions. (personal identifiers) state. state reportable disease. Reportable disease state. Notifiable disease: state territorial jurisdictions ( ) CDC, (voluntary). /,, (regular) (frequent) (timely). state. CSTE CDC state reportable disease. (1) NEDSS/NBS NEDSS. NNDSS NEDSS. State territories CDC, NEDSS. CDC data. NEDSS Base System (NBS) jurisdiction reportable disease data, CDC (CDC Public Health Information Network ) notifiable disease. (2) Electronic laboratory reporting (ELR) Electronic Laboratory Reporting (ELR) electronic health records (EHR) Laboratory Information Management System (LIMS) (,, ) state/local public health departments. ELR reportable condition state/local level. health department ELR. ELR (timeliness) (accuracy) - 42 -
. CDC (timeliness) (accuracy). (3) NETSS NEDSS CDC National Electronic Telecommunications System for Surveillance (NETSS). NEDSS. (4) CDC reporting system. NNDSS CDC data MMWR.,, HIV, varicella deaths, arboviral disease reporting system CDC. Sexually transmitted disease (STD) STD - reporting system, NETSS.. CDC's Morbidity and Mortality Weekly Report (MMWR). - 43 -
3.. 1889, 1917, 1940. 1984 () [the Public Health (Control of Disease) Act] 1988 ( ) [the Public Health (Control of Disease) Regulation]. 19 (the Public Health (Control of Disease) Act) 1875. 1889. 1891 1899. ( ),,. 1871 1919.. Heath Protection Agency( HPA) (Center for Infections; CfI) HPA Public Health England( PHE) PHE Colindale. Condinale PHE specialist microbiology services, reference microbiology services,. 11. PHE Colindale Expert advice and issue of vaccines and immunoglobulins Informing National Policy Microbiological Services Public Health Related Research Response, co-ordination and specialist support for outbreaks and incidents Specialist Microbiology Services. 17).,,, 17) Public Health England. Sources of surveillance data. Available from: http://www.hpa.org.uk/topics/infectiousdiseases/infectionsaz/surveillance/sourcesofsurveillancedata/ - 44 -
,,,,. 14.. data source Notifiable disease, laboratory reporting, clinical reporting. - 45 -
(1) Notifiable disease Notifiable disease. 12. Notifiable disease Acute encephalitis, Acute infectious hepatitis, Acute meningitis, Acute poliomyelitis, Anthrax, Botulism, Brucellosis, Cholera, Diphtheria, Enteric fever (typhoid or paratyphoid fever), Food poisoning, Haemolytic uraemic syndrome (HUS), Infectious bloody diarrhoea, Invasive group A streptococcal disease, Legionnaires Disease, Leprosy, Malaria, Measles, Meningococcal septicaemia, Mumps, Plague, Rabies, Rubella, SARS, Scarlet fever, Smallpox, Tetanus, Tuberculosis, Typhus, Viral haemorrhagic fever (VHF), Whooping cough, Yellow fever Notifiable disease Health Protection (Notification) Regulations 2010. (clinical suspicion of disease). 'all hazards' approach dataset HPA (, ). England Wales Local Authority Local Health Protection Unit (HPU) 'Proper Officer' suspected cases. (Registered Medical Practitioner, RMP) notifiable disease. 3 Proper Officer 24. Notifiable disease RMP,,,,, (,,,,, NHS,,,, ). HPU,,. Proper Officer 3, 24 HPA. HPA Health Protection Services (HPS) Information Management Department /. - 46 -
(2) Laboratory reporting Health Protection (Notification) Regulations 2010 (Causative agents notifiable). 2010 10 (laboratory confirmed disease), England 1 (primary diagnostic role) Public Health England (PHE). 13. Bacillus anthracis, Bacillus cereus (only if associated with food poisoning), Bordetella pertussis, Borrelia spp, Brucella spp, Burkholderia mallei, Burkholderia pseudomallei, Campylobacter spp, Chikungunya virus, Chlamydophila psittaci, Clostridium botulinum, Clostridium perfringens (only if associated with food poisoning), Clostridium tetani, Corynebacterium diphtheriae, Corynebacterium ulcerans, Coxiella burnetii, Crimean-Congo haemorrhagic fever virus, Cryptosporidium spp, Dengue virus, Ebola virus, Entamoeba histolytica, Francisella tularensis, Giardia lamblia, Guanarito virus, Haemophilus influenzae (invasive), Hanta virus, Hepatitis A/B/C/delta/E viruses, Influenza virus, Junin virus, Kyasanur Forest disease virus, Lassa virus, Legionella spp, Leptospira interrogans, Listeria monocytogenes, Machupo virus, Marburg virus, Measles virus, Mumps virus, Mycobacterium tuberculosis complex, Neisseria meningitidis, Omsk haemorrhagic fever virus, Plasmodium falciparum/vivax/ovale/malariae/ knowlesi, Polio virus (wild or vaccine types), Rabies virus (classical rabies and rabies-related lyssaviruses), Rickettsia spp, Rift Valley fever virus, Rubella virus, Sabia virus, Salmonella spp, SARS coronavirus, Shigella spp, Streptococcus pneumoniae (invasive), Streptococcus pyogenes (invasive), Varicella zoster virus, Variola virus, Verocytotoxigenic Escherichia coli (including E.coli O157), Vibrio cholerae, West Nile Virus, Yellow fever virus, Yersinia pestis (diagnostic laboratories).. LabLink+ laboratory information management system (LIMS) CfI. CoSurv notification. HPA., LIMS CoSurv electronic link LabLink+, pathology system CoSurv data. LabLink+ HPA - 47 -
antimicrobial susceptibility surveillance system (AmSurv). CoSurv LabBase OPIE principle (Organism-Patient-Illness-Episode). OPIEs record episode. (including two different sub-types of a single species) 2 OPIEs. (with recovery implied between those two episodes of infection) 2 OPIEs. 2, (Influenza A 6, Salmonella spp 13, Mycobacterium spp 26, Hepatitis B & C, HIV, HTLV Creutzfeld-Jakob agent ) 18). 15. Laboratory reporting flow chart. (3) NHS Direct 24,. NHS Direct,,,,,,. NHS 18) Health Protection Agency. Laboratory reporting to the Health Protection Agency: Guide for diagnostic laboratories. Available from: http://www.hpa.org.uk/webc/hpawebfile/hpaweb_c/1194947381307-48 -
Direct syndromic surveillance 19). 16. NHS Direct syndromic surveillance flow chart. 19) Smith GE, Cooper DL, Loveridge P, Chinemana F, Gerard E, Verlander N. A national syndromic surveillance system for England and Wales using calls to a telephone helpline. Euro Surveill. 2006;11(12):pii=667. Available from: http://www.eurosurveillance.org/viewarticle.aspx?articleid=667-49 -
. 20). 14. Surveillance Health Protection Report Week the weekly Health Protection Report (HPR) provides regular updates on many routine surveillance activities Bacteraemia Antimicrobial resistance COVER (Cover of Vaccination Evaluated Rapidly) Enhanced pneumococcal surveillance report European legionella travel alerts Eurosurveillance Monthly Annual Quarterly 6-monthly As required Weekly Reports in HPR Bacteraemia reports. Monitoring trends in hospital-acquired infections Monitoring trends in hospital acquired infection and identifying sites requiring further investigation Monitoring uptake of all routinely given paediatric vaccines Monitoring burden of disease, serotype distribution and antimicrobial resistance of invasive pneumococcal infections in order to inform national vaccination and local prescribing policies Early detection of outbreaks and travel associated clusters of infection in Europe Dissemination of public health outputs and bulletins on significant infectious disease incidents in Europe through open-access journal, supported by HPA advice and topic editors GRASP (Gonococcal Resistance to Antimicrobials Surveillance Programme) Annual Monitoring prevalence and trends of gonococcal antimicrobial resistance to aid development of rational prescribing policies Human disease chapters of DEFRA - UK Zoonoses Reports Influenza bulletin Annual weekly during influenza season Integration of human and veterinary surveillance information, where possible, to better inform prevention strategies. In support of the Food Standards Agency's disease reduction target Early detection of winter pressures on NHS from acute respiratory viral illness MMR (measles mumps and rubella) surveillance in HPR Immunisation reports Quarterly Monitoring impact of MMR programme on disease incidence MRSA (Methicillin-resistant 6-monthly Monitoring trends in hospital acquired infection 20) Public Health England. Surveillance outputs. Available from: http://www.hpa.org.uk/topics/infectiousdiseases/infectionsaz/surveillance/surveillanceoutputs/ - 50 -
Staphylococcus aureus) tables for all acute hospital trusts in England and Wales and identifying sites requiring further investigation. Part of the Department of Health, Health Care Associated Infection Action Plan National guidance on recognition of, and response to, deliberate release of infectious disease agents Notification of infectious disease (NOIDS) reports Prisons Reports from food database Local Authorities Coordinators of Regulatory Services/Health Protection Agency (LACORS/HPA) studies - As required Reports from private water supplies surveillance - 6 monthly Review of infectious intestinal disease outbreak investigations RCGP Research & Surveillance Centre and NHS Direct information on gastrointestinal disease HIV and STI reports Summary report on travel associated infections As required Weekly, quarterly, annual Quarterly 6-monthly As required 6-monthly 3 times per year Quarterly, annual Annual Monthly To maintain awareness and inform action required for response to episodes of deliberate release Dissemination of surveillance outputs on notifiable infectious diseases in England and Wales Provide information on communicable diseases affecting the prison population Provide information for risk based public health assessments and interventions Provide information for risk based public health assessments and interventions Provide information for risk based public health assessments and interventions To inform control and prevention of gastrointestinal infection Inform control and prevention of gastrointestinal infection Monitoring the effectiveness of the sexual health and HIV strategy Inform the public and professionals on a series of travel health and infection topics and significant developments. Assess the burden of infectious morbidity associated with travel and to identify priority diseases, destinations and demographic groups for intervention Survey of Prevalent Diagnosed HIV Infections (SOPHID) report Annual Monitoring the effectiveness of the sexual health and HIV strategy and allowing planning of HIV treatment cost allocations Unlinked anonymous reports on HIV prevalence Annual Monitoring the effectiveness of the sexual health and HIV strategy and implementation of antenatal HIV screening policies - 51 -
4.. 1999 4 (infectious disease control law),. national notifiable disease (national epidemiological surveillance for infectious disease, NESID). (National Institute of Infectious diseases, NIID) (Infectious Disease Surveillance Center, IDSC) 1997, (Division of Infectious Disease Epidemiology). IDSC 21). (Intelligence and Policy Planning Division): //., FETP-J(Field Epidemiology Training Program, Japan). (Surveillance and Information Division),., ( 都 ) ( 道 ) ( 府 ) ( 縣 ) (public health center). IDSC (http://idsc.nih.go.jp/index.html), (Infectious Disease Weekly Report), (Infectious Agents Surveillance Report)., CD-ROM.,,. (Immunization Program Division).,,. National Serum Bank. (Laboratory Diagnosis Division) NIID () 21) IDSC. Organization & Functions. Available from: http://idsc.nih.go.jp/about/idabs.html - 52 -
.. (Division of Bacteriological Laboratory Training).,. (Division of Virological Laboratory Training).,. 1 5. National IDSC / (local IDSC).. (flow) 22) 23). 17.. 22) Taniguchi K, Hashimoto S, Kawado M, Murakami Y, Izumida M, Ohta A, Tada Y, Shigematsu M, Yasui Y, Nagai M. Overview of infectious disease surveillance system in Japan, 1999-2005. J Epidemiol 2007;17:S3-13. 23) 자발적참여에의한전염병표본감시체계구축방안. 양기화, 김태학, 윤현병, 김영표, 이종선, 김은숙, 강보경. 대한의사협회연구보고서. - 53 -
18.. - 54 -
. Category Ⅰ Ⅳ V. Category Ⅰ Ⅳ. Category V 1 (local public health center) 7. V (sentinel reporting diseases),... category I-V category V (clinical), (laboratory), V... IDSC. category V, ( )., Public health center. (report). (target Infectious Diseases). notifiable diseases 6 ( ).,,, AIDS. dysentery dysentery Shigella dysentery entamoeba histolytica., sentinels,.. (hospital sentinel)..,, (vaccine preventable diseases) 7-55 -
.,,, (mandatory notifiable diseases), 1981., (mandatory system) (sentinel system). (case definition). (mandatory system) (clinical characteristics).,,... 1998 606 887 553... IDWR(Infectious Diseases Weekly Report).,. IASR(Infectious Agents Surveillance Report). SeroEpi (National Surveillance of Vaccine-preventable Diseases),. JANIS(Japan Nosocomial Infections Surveillance).,,,.. 1898 4 1. notifiable disease (Mandatory reporting). (disease notification),. 1990, (,, ).. risk communication.,., (surveillance) - 56 -
.. (reporting completeness) 9% 99%.., notifiable diseases..,,, ( ). (sentinel reporting framework), (mandatory system). (scarlet fever) A.,.,. (disease categorization)., (mandatory system for severe diseases) (sentinel system for milder diseases)., sentinels. capture rate (standard disease) Exanthema subitum. (re-designing) capture rate....,...,.,. (health impact). - 57 -
, (milder diseases) (surveillance performance). - (disease-specific analysis)., documented reporting.. 5.,.. NNDSS., NNDSS (consistency),.,.,,,,., NNDSS CDC., NNDSS ( NBS HL7 message NETSS ) NNDSS. CDC (critically important), ( : Foodnet data), CDC Public Health Surveillance Program Office SAS MMWR,. state CDC, (stand-alone). (state) notifiable disease,.,. World Health Organization (WHO) (international health regulations) (cholera, plague, yellow fever). state CDC. CDC state (suspect, probable, confirmed case) - 58 -
. (timeliness)..,,...... NHS direct (syndromic surveillance)..,.,,.. (disease categorization).. (mandatory system for severe diseases) (sentinel system for milder diseases).,., - (disease-specific analysis).,.,.,... - 59 -
6. (,, ).,. () (157), (32), (74, 58, 1 16). (notifiable),,,, (,,, ) (, )., 50.,.,, 4, 24, 1. 119(24). 7.,. 4 (,,,,, ) (4 ), 24,., (, B ) 7.,,, ( ), (B, A ) ( ).. - 60 -
,,. 15.,, / (Ministry of Health, labour and Welfare) (Nationa l Institute of Infectious Disease, NIID) (Infectious Disease Surveillance Center, IDSC) Centers for Disease Control and Prevention (Department of Health and Human Services) National Notifiable Diseases Surveillance System (NNDSS) Territorial health departments State health departments Centers for Disease Control and Prevention Physician offices Hospitals Health maintenance organizations Blood transfusion centres Blood banks Health care organizations Veterinarians Health care practitioners Laboratory departments Schools Prisons/reform schools Dentist offices Nursing care facilities Medicolegal Registration of vital statistics Day-care clinics, National Electronic Disease Surveillance System (NEDSS) ELR Morbidity and Mortality Weekly Report (MMWR) Reportable disease Notifiable disease National epidemiological surveillance for infectious disease (NESID) Local public health centers Prefectural public health institutes Prefectural IDSC National IDSC Physician offices Hospitals Laboratory reports Day-care clinics Schools,, (natio nwide electronic surveillance system) IDWR (Infectious Diseases Weekly Report), IASR (Infectious Agents Surveillance Report), SeroEpi (National Surveillance of Vaccine-preventable Diseases) Department of Health Public Health England (PHE) Centre for Infections(CfI) Notifications of infectious diseases(noids) sentinel reporting framework Local Authority Local Health Protection Unit CfI Notifiable diseases Laboratory reports Clinician reporting NHS Direct,, LabLink CoSurv LabBase Health Protection Report (HPR) - 61 -
Reportable: state Notifiable disease:. disease state. Nationally notifiable diseases state reportable disease intentional release 4 Immediate, extremely urgent Immediate, urgent: 24 Standard: reporting cycle Anthrax, Botulism, Plaque, Paralytic poliomyelitis, SARS-associated coronavirus, Smallpox, Tularemia, Viral hemorrhagic fever 4 Anthrax, Botulism, Plaque, Tularemia, Viral hemorrhagic fever Polio 24 Anthrax viral hemorrhagic fever, Brucellosis, Diphtheria, Novel influenza A, Measles, Rubella, Rabies, Yellow fever 24 Ⅰ-Ⅳ (clinical&laboratory case definition ) Ⅴ 7 (clinical clinical&laboratory case definition ) Influenza, pediatric disease, eye disease, sexually transmitted disease (milder diseases) target disease Avian influenza online system suspected case, 24 3 Acute encephalitis, Acute meningitis, Food poisoning Pneumonia: Self reported illness NHS Direct - 62 -
4.3 (,, ), 6-70, 30.,,, 4 50 19.,,,. 1.. (122 cities mortality reporting system, http://wonder.cdc.gov/mmwr/mmw rmort.asp), CDC 2-3 122.., CDC - 63 -
. NCHS (National Center for Health Statistics) 2-3.. National Vital Statistics System (NVSS),,.,. 6,. NCHS (National Center for Health Statistics). (http://www.cdc.gov/nchs/nvss/writing_cod_statements.ht m), NCHS. (ICD). 16. 2011 ICD ( ) Salmonella infections (A01 A02) 42 Shigellosis and amebiasis (A03,A06) 8 Certain other intestinal infections (A04,A07 A09) 10,972 Tuberculosis (A16 A19) 536 Respiratory tuberculosis (A16) 392 Other tuberculosis (A17 A19) 144 Whooping cough (A37) 8 Scarlet fever and erysipelas (A38, A46) 4 Meningococcal infection (A39) 85 Septicemia (A40 A41) 35,539 Syphilis (A50 A53) 45 Acute poliomyelitis (A80) - Arthropod-borne viral encephalitis (A83 A84,A85.2) 5 Measles (B05) 1 Viral hepatitis (B15 B19) 7,794 Human immunodeficiency virus (HIV) disease (B20 B24) 7,638 Malaria (B50 B54) 1 Other and unspecified infectious and parasitic diseases and their sequelae (A00,A05,A20 A36, A42 A44,A48 A49,A54 A79,A81 A82,A8 5.0 A85.1,A85.8,A86 B04,B06 B09,B25 B 49,B55 B99) 5,713-64 -
2.. 2010 1, 2010 2011 1 4. (2012 ).,,., (A75). 17. 1 2 3 2010 2011 2012 0 1 0 0 A 0 3 0 - - 2 1 4-0 1-7 0 5 7-2 0 4-340 () 2,466-2 0 - - 1 3 - - 26 38 - - 6 9 49-3 8 13-148 110 124-1 1 - - - 1 2-7 536 178 -., 1982 1980, - 65 -
9 ( 4 ). (KCD),. WHO (Underlying cause of death). 20. (A00-B99) (1983-2012). - 66 -
18. ( ) (236) 2000 2001 2002 2003 2004 2005 2006 2007 2008 2010 2011 2012 (A00-A09) 269 203 197 102 90 94 95 218 252 597 736 797 (A00) 1 0 0 0 0 0 0 0 0 0 0 0 (A01) 8 5 0 0 0 0 0 0 0 1 2 0 (A02, A05) 36 30 71 15 9 13 13 27 16 25 27 25 (Re. A00- A09) 224 168 126 87 81 81 82 191 236 571 707 772 (A15-A19) 3,411 3,218 3,350 3,329 2,940 2,893 2,726 2,376 2,323 2,365 2,364 2,466 (A27) 10 10 9 9 2 2 2 8 1 3 0 2 [ ] (A30) 18 40 18 3 2 1 1 2 1 3 1 1 (A33-A35) 11 15 13 5 5 9 10 4 5 5 6 4 (A36) 0 0 0 0 0 0 0 0 0 0 0 0 (A37) 0 0 0 0 0 0 0 0 0 0 0 0 (A38) 1 1 0 0 0 0 0 0 0 0 0 0 (A50-A64) 10 12 6 6 2 4 4 2 1 2 4 10 (A75) 38 52 30 35 52 54 37 56 58 33 41 49 (A83.0) 0 2 0 1 1 3 1 1 0 6 2 7 () (A98.5) 29 27 15 17 12 19 19 24 21 10 9 13 (B05) 14 16 1 0 0 0 0 1 2 0 1 0 (B15-B19) 383 464 650 823 790 841 905 1,024 1,012 1,111 1,095 890 (B20-B24) 28 38 64 62 72 69 77 105 99 122 124 124 (B26) 0 0 0 0 1 0 0 1 1 0 0 1 (B50-B54) 4 5 1 0 3 0 2 3 5 6 4 4 (Re.A00- B99) 252 308 302 300 263 385 387 438 466 558 544 598 (J09-J11) 171 134 82 24 10 5 0 7 5 95 71 99-67 -
. (A00-B99).,,,. 21. (1983-2012). - 68 -
4.4 WHO 24) (2006). 1. Data quality and completeness ( ) 1. 100%.,, 2013 75,790 7,522 10%., 2011~2013, (, ), ( ). 19. 2011 2012 2013 ( ) 826 542 445 ( ) 198 92 135 (%) 24.0 17.0 30.3, 1 2. Sensitivity ( )..,,,.,,. 2002, 4%. 24) WHO. Communicable disease surveillance and response systems. Guide to monitoring and evaluating. World Health Organization 2006. - 69 -
. 20 1 뒤쪽의작성방법및신고방법안내를읽고작성하여주시기바라며, [ ] 에는해당되는곳에 표를합니다. ( 앞쪽 ) 감염병 환자등 또는 사망자 성명 ( 만 19 세이하인경우보호자성명 ) 주민등록번호 전화번호 직업 성별 [ ] 남 [ ] 여 주소 우편번호 [ ] 거주지불명 [ ] 신원미상 감염병명 제1군제2군제3군제4군 [ ] 콜레라 [ ] 장티푸스 [ ] 파라티푸스 [ ] 세균성이질 [ ] 장출혈성대장균감염증 [ ]A 형간염 [ ] 디프테리아 [ ] 백일해 [ ] 파상풍 [ ] 홍역 [ ] 유행성이하선염 [ ] 풍진 [ ] 폴리오 [ ] 일본뇌염 [ ] 수두 [ ]B형간염 ([ ] 급성 [ ] 산모 [ ] 주산기 ) [ ]b형헤모필루스인플루엔자 [ ] 말라리아 [ ] 한센병 [ ] 성홍열 [ ] 수막구균성수막염 [ ] 레지오넬라증 [ ] 비브리오패혈증 [ ] 발진티푸스 [ ] 발진열 [ ] 쯔쯔가무시증 [ ] 렙토스피라증 [ ] 브루셀라증 [ ] 탄저 [ ] 공수병 [ ] 신증후군출혈열 [ ] 매독 ([ ]1기 [ ]2기 [ ] 선천성 ) [ ] 크로이츠펠트 -야콥병 (CJD) 및변종크로이츠펠트 -야콥병 (vcjd) [ ] 페스트 [ ] 황열 [ ] 뎅기열 [ ] 두창 [ ] 보툴리눔독소증 [ ] 중증급성호흡기증후군 [ ] 조류인플루엔자인체감염증 [ ] 신종인플루엔자 [ ] 야토병 [ ] 큐열 [ ] 웨스트나일열 [ ] 라임병 [ ] 진드기매개뇌염 [ ] 바이러스성출혈열 [ ] 유비저 [ ] 치쿤구니아열 [ ] 신종감염병증후군 ( 증상및징후 ) 발병일년월일진단일년월일 확진검사결과 환자등분류 추정감염경로 [ ] 양성 [ ] 음성 [ ] 검사진행중 [ ] 검사미실시 [ ] 환자 [ ] 의사환자 [ ] 병원체보유자입원여부 [ ] 외래 [ ] 입원 [ ] 기타 [ ] 집단감염환자와접촉 [ ] 개별감염환자와접촉 [ ] 불확실함 [ ] 접촉없었음 추정감염지역 [ ] 국내 [ ] 국외 ( 국명 : ) ( 체류기간 : ) 사망여부 [ ] 생존 [ ] 사망 - 사망원인 ( 원사인기준 ): 해당사항이있는경우기록 신고기관명 비고 ( 특이사항 ) 요양기관지정번호 진단 ( 한 ) 의사성명 ( 서명또는날인 ) 면허번호 신고기관장 210mm 297mm[ 일반용지 60g/ m2 ( 재활용품 )] - 70 -
3. Timeliness ( ).,, 1, 3(, ). 1. 2010 2001 66.4% 2010 79.4%, 2001 76.5% 2010 97.6%. 2013 2010.. 21. 1 2 3 2010 2013 0.9 86.5 0.7 88.7 1.4 81.8 0.6 88.9 0.9 88.6 0.4 95.2 0.6 85.7 0.5 90.3 2.3 63.0 0.9 88.6 4.3 78.6 0.6 95.7 0.8 93.9 1.3 87.7 2.1 79.3 0.7 91.2 1.9 76.7 0.7 87.5 1.1 84.6 1.0 71.4 1.3 83.9 0.6 91.8 2.8 66.5 1.2 85.2 5.5 62.3 1.2 85.3 3.1 50.0 1.0 83.3 2.1 70.0 1.5 72.2 2.2 72.6 1.1 86.2 2.4 75.9 1.8 78.9 3.0 55.4 0.6 91.5 3.4 51.5 0.8 90.0-71 -
1.7 80.6 0.4 95.2 3.3 53.1 0.9 87.8 4 3.6 68.0 1.1 83.7 2.3 61.5 1.1 76.5 [ 1] 2010 3 7 2013 ( 1 ), 2013 22. ( ) B (2013) - Hib - - 1:128 - -, (1:320 ), (IgG 1:256 ), - 1:200 - (, ) - 1:160 - (, ) - IgM 1:16 IgG 1:256 - (, ELISA ) * : - 72 -
22.. 4. Usefulness ( )., - 73 -
,.,,., WHO.,.,,. 5. Simplicity ( ) 2007, 51.7%, 66.4%, 96.9%. NIDS(National Infectious Disease Surveillance).,,.,.,..,. - 74 -
23.. 6. Flexibility ( ).. 24.. - 75 -
, (case definition).. 7. 1. 100%., (2013, 10%).,.,,,,..,, 1, 3(, ). 2010 2001 66.4% 2010 79.4%, 2001 76.5% 2010 97.6%. 2013 2010.,,.,,., WHO.. - 76 -
2007, 51.7%, 66.4%, 96.9%. NIDS(National Infectious Disease Surveillance).,,.,... - 77 -
4.5 1.. ( ) 55,.,., (EDI), 2006 99%. 1999 19.8%, 64.3%, 2005 93.9%, 99.3%, 2006 99.7%, 2007~2010 99.9%. 25).. WHO 1973 ICD-8 (KoreanStandardClassificationofDiseases, KCD)1. 1979 (ICD-O-1) ICD-9 KCD-2. 1995 ICD-O-2 ICD-10 KCD-3, 2002 ICD-10 KCD-4. 2008 WHO ICD-O-3 ICD-10 KCD-5, 2011 KCD-6. 26). KCD,, (99.9%, ) EDI. 27). 25) 한국보건의료원. 국내보건의료이차자료원활용. 2013 26) 통계청, 한국표준질병사인분류개정및분류세분화연구,2006. 27) 강민석, 기타및상세불명코드를이용한건강보험청구상병코드의질평가, 충북대학교대학원석사학위논문,2013. - 78 -
2. () (1992) 28) 10 15.8%, 6 11.6%, (1995) 29) 3 1 58.0%, (,2007) 69.7%( 75.9%, 55.8%). 신의철등 30) 은의료보험자료상병기호의정확도추정및관련특성분석-법정전염병을중심으로-에서의료보험자료상병기호의정확도는 10.1%, 95% 신뢰구간은 8.8-11.4% 였다. 423 (21.7%), 1,528 (78.3%). 1,528 1,097 (71.8%). 770 (50.4%). 333 (21.8 %), 146 (9.6%). (2000) 31) 83.0%, (2002) EDI 10,224 73.1%. 32) (kappa index) 0.70, 2. 0.4 0.7,,,,,,.,,,,, 0.3. 28) 문옥륜, 김창엽, 김명기. 동일질환에대한상병분류기호의의료기관별변이에관한연구. 보건행정학회지 1992;2:69-79 29) 이건세, 의무기록과의료보험청구명세서의진단코드일치에대한연구, 서울대학교대학원석사학위논문,1995. 30) 신의철, 박용문, 박용규, 김병성, 박기동, 맹광호. 의료보험자료상병기호의정확도추정및관련특성분석 - 법정전염병을중심으로. 예방의학회지 1998;31(3):471-180 31) 박종구, 김기순, 김춘배, 이태용, 이강숙, 이덕희, 이선희, 지선하, 서일, 고광욱, 류소연, 박기호, 박운제, 왕승준, 이화순, 채유미, 홍현숙, 서진숙. 의료보험청구자료중뇌혈관질환상병기호의정확도에관한연구. 예방의학회지 2000;33(1):76-82 32) 박재경, 허진희. 건강보험청구자료의코호트조사활용가능성연구. 주간건강과질병 2013;46(6):931-938 - 79 -
. (2002) 89.7%, 87.3% 33), 32.0~39.0% 34), 70.0% 35), (2003) 9,345 3 69.7%, 44.9%). 36) 3...,,, 3,. 25.. KCD-6. 22, 267, 2,093 12,603, (6,335). :,,, 33) 안진하, 진료비청구명세서의상병코드와의무기록코딩간의일치현황분석, 인제대학교보건대학원석사학위논문,2002. 34) 남영희. 동일환자의무기록과진료비명세서의상병명에관한실태조사연구. 중앙대학교사회개발대학원석사학위논문. 1997 35) 신종연. 동일환자의의무기록과진료비명세서에기록된상병분류기호의비교연구 -10 대입원다빈도상병을중심으로. 서울보건전문대학논문집 1996;16:121-136 36) 박병주. 건강보험질병코드의타당도제고방안 - 80 -
22. 3 : 4 : 3, 3. 5 :.. 13, 19, 4, 4. 6 :.. 19, S 5. - 81 -
.. ( ). - 82 -
4. (47 ). (1) 2007-2012 2013 6 (2) : KCD 23. KCD KCD A00 A010, Z220 1 A011-014 A03 A043 A B15 A36 A37 A33-35 B05 2 B26 B06, P350 A80 B () B16 A83 B01, P358 B50-53 A38 A390, G01 A481, A482 A4152 A750 3 A752 A753 A27 A23 A22 A82 A985 CJD CJD A81 4 A20-83 -
KCD A95 A90-91 A96-97, A981, A982, A983, A984, A988 B03 A051 (SARS) U049 J09 J09 A21 A78 A923 A692 A84 A241-4 A920 형간염 주산기 산모 결핵 한센병 인플루엔자 매독 후천성면역결핍증제외 : :, :, /,,,.,.. - 84 -
24. I - - Type I - 17 :,,,,,,,,, (SARS),,,,,,, - Type II-1-7 :, A, B,,,, - Spearman s Type II-2 - - 2 :, Type III - - 7 :,,,,,, Type IV - 13 :,,,,,,,,,,, CJD, - 85 -
(2012 ) 25. II Type IV II-1 1 (6 ) III III IV A II-1 I III IV IV 2 (10 ) III III I B () II-1 II-1 III II-2 III IV IV IV I IV 3 (14 ) IV II-1 II-2 I I IV - (CJD) - (vcjd) IV I I II-1 (,, ) I I I 4 (16 ) (SARS) I I IV I II-1 I IV - 86 -
Type I I I (1) Type I, 26. Type I 2007 2008 2009 2010 2011 2012 (SARS) 15 14 9 11 14 14 0 0 0 0 0 0 245 199 212 246 173 103 0 0 0 0 0 0 15 14 14 13 17 9 0 0 0 0 0 0 35 34 30 61 21 53 0 0 0 0 0 0 49 67 59 40 31 21 0 0 0 0 0 0 64 44 21 16 10 9 0 0 0 0 0 0 0 2 5 9 4 4 0 0 0 0 0 0 14 12 9 14 18 9 0 0 0 0 0 0 5 20 2 10 6 2 0 0 0 0 0 0 3 9 3 4 2 4 0 0 0 0 0 0 0 1 2 0 0 0 0 0 0 0 0 0 1 8 4 2 0 1 0 0 0 0 0 0 16 12 7 7 5 7 0 0 0 0 0 0 285 349 219 242 230 167 0 0 0 0 0 0 88 295 803,781 58,319 11,886 36,931 0 0 0 0 0 0 31 15 32 25 18 24 0 0 0 0 0 0 12 9 5 8 8 15 0 0 0 0 0 0-87 -
50,. Case 1 1, B03 L509. 27. Type I (A220) (A241 A244) (A988) SARS (U049) (A923) Case Case1 Case2 M1990,M0280 M9950 L239, K291 T814, L739 1 2( ) M220( ) R220(, ) L22( ) Case3 L239, K296 L22( ) Case4 L899 R220(, ) Case1 J22 L24( ) Case2 Q250, Q909 I10 Q244( ) Z988( Case1 M3213, N085 Z940, H3539 ) J988( Mycoplasma ) Case2 Case3 N10, N179 E079, E785 J0390, K210 E079, K592 K219, A099 A985, B3780 J988( ) Case1 I109, R0609 J111, R049 Case2 J449, I279 J180, J91 R42, J459 R074 J80( ) Case3 J690, J459 I500, Q999 Case1 G049, Hantaan V Hantaan V Leptospirosis Case2 H041, H400 Case3 - Case1 K201, K219 (A218 J304, J450 A211) Case2 J302, J40 J218( ) Case1 J449, I109 A059( - 88 -
(A051) (A369) (A750) (A20) (A829) (A849 A840) (A920) (A80) (A959) Case 1 2( ) H1600, K769 A047 ) Case1 L0290, L984 B369( ) Case2 H108, H162 H358, H360 H368( ) Case1 R509, E785 K759, R609 A753() Case2 R1049, A493 Case3 K219, K296 M79190 A753() Case1 - L20 Case2 L209, L739 L853, K769 L20 Case3 I208 I208( ) Case1 - ( ) Case2 L0311, K760 K829 F959, R509 F849() Case1 R933, A681 F681 Case2 K602, K590 I840 Case3 A753, G039 A753( ) G530 Case1 - Case1 Case2 Case3 G610, M6089 M6593, B084 M0117, T813 K219, M2417 B91, I10 M245, M624 Case1 L308 Case2 H659, J00 J459 H920( ) P920( ) G80() L959( ) J959() Case1 L509 L03() Case2 R509 J03( ) : : (,, 100, 2009 80., 2009. 6 Type I 17, 4-89 -
,, 17, Type I 17,. (2) Type II (II-1) (II-2) Type II-1 28. Type II-1 2007 2008 2009 2010 2011 2012 A 525 532 478 397 358 295 223 188 168 133 148 129 9,054 26,069 53,675 33,048 19,232 7,381 2,223 7,895 15,231 7,655 5,521 1,197 22 25 19 35 20 35 7 6 6 26 3 20 p 0.886 0.019 0.943 0.005 0.794 0.059 385 279 192 199 180 103 208 100 62 66 49 28 1.000 0.010 B 35,077 30,154 25,761 21,312 19,971 14,429 () 1,588 1,612 1,746 1,486 462 289 0.771 0.072 103 95 108 146 123 172 97 51 59 125 72 149 0.829 0.042 24 35 31 27 24 13 12 19 14 13 8 10 0.899 0.015-90 -
26. Type II. /,, - 91 -
Type II-1 8, Type II-2 29. Type II-2 2007 2008 2009 2010 2011 2012 p 2,440 1,374 1,358 1,662 921 650 2,227 1,052 1,345 1,772 826 542 0.943 0.005 128 65 33 42 20 17 1.000 0.010 101 58 24 31 19 17 Type II-2 2 27.. - 92 -
(3) Type III 7 Type III 30. Type III 2007 2008 2009 2010 2011 2012 207,402 201,155 182,312 155,816 184,923 115,640 20,284 22,849 25,197 24,400 36,249 27,763 9.8% 11.4% 13.8% 15.7% 19.6% 24.0% 21,780 21,441 26,994 25,177 24,625 23,391 4,557 4,542 6,399 6,094 6,137 7,492 20.9% 21.2% 23.7% 24.2% 24.9% 32.0% 1131 832 1022 921 414 490 14 9 66 27 97 230 1.2% 1.1% 6.5% 2.9% 23.4% 46.9% 10,833 1,800 8,290 5,969 12,677 10,826 146 151 127 106 406 968 1.3% 8.4% 1.5% 1.8% 3.2% 8.9% 283 280 263 176 269 117 45 44 36 55 56 58 15.9% 15.7% 13.7% 31.3% 20.8% 49.6% 2,258 3,060 1,573 1,704 1,099 686 131 209 180 228 171 90 5.8% 6.8% 11.4% 13.4% 15.6% 13.1% 1,429 1,233 1,211 917 977 791 35 30 36 43 53 28 2.4% 2.4% 3.0% 4.7% 5.4% 3.5%,,, 2007 2011, 2013-93 -
,,, Type III 7, (4) Type IV 13 3 ( ) ( ),,, 2010 KCD 5 A4152,,,.,,. - 94 -
31. Type IV I 2007 2008 2009 2010 2011 2012 30 70 59 49 24 73 51 65 36 42 53 43 65 35 61 87 29 54 23 41 73 92 67 55 68 37 41 58 62 56 71 58 36 32 34 38 26 13 19 21 24 30 28 25 ( ),,,,,, CJD,, 32. Type IV II 2007 2008 2009 2010 2011 2012 1,630 830 557 574 451 331 194 2 17 114 42 3 301 378 197 120 156 119 4 1 3 12 7 4 7,031 9,482 12,357 10,472 10,560 12,813 6,022 6,057 4,995 5,671 5,151 9,604 547 582 610 586 577 462 450 375 334 473 370 364 321 341 298 329 1,637 405 7 5 0 8 3 0 159 191 373 512 602 619 8 16 17 14 19 17 CJD 83 61 82 84 70 88 29 45 22 35 30 54 31 28 2 3-95 -
3.. (1),,,,,,,,, (SARS),,,,,,,, (),, 1, (2) (B,,, ). 2-3, B / (3) ( ) - 96 -
33. KCD Z23 Z23.0 Z23.1 - [TAB] Z23.2 [BCG] Z23.3 Z23.4 Z23.5 Z23.6 Z23.7 Z23.8 Z24 Z24.0 Z24.1 Z24.2 Z24.3 Z24.4 Z24.5 Z24.6 Z25 Z25.0 Z25.1 Z25.8 Z26 Z26.0 Z26.8 Z26.9 Z27 Z27.0 - Z27.1 - - [DTP] Z27.2 - - - Z27.3 - - Z27.4 - -[MMR] Z27.8 Z27.9 (4) (,, ) - 97 -
( ). ( ), (5),,,. I IV (B -2013,,,,,,, ). / 1 (, A,,,,,, ) (,,,,,, ) - 98 -
34. IV II-1 III 1 (6 ) III ( IV ) A II-1 I III IV IV 2 (10 ) III III I B () II-1 (but, ) II-1 III II-2 III IV ( IV ) ( IV ) I ( IV ) 3 (19 ) IV II-1 II-2 I I IV IV 4 (17 ) - (CJD) IV - (vcjd) I I II-1 (,, ) I I I (SARS) I - 99 -
I IV I II-1 I IV IV I I I - 100 -
4.,.. 35. / 20 1) 2007-2012, 2013 6 2) : KCD ( : B01.0~B01.9, P35.8) : :, :,. 6-7 - 10% 20% (1 ), 6 4,363 6( 6 ) 1 47.5%, 2 19.2%, 3 33.2%, 1 2011 (17.6%) - 101 -
2012 (25.3%), 36. 2007 11,067 1,641 15% 200,394 20,284 10% 2008 10,497 1,649 16% 197,038 22,849 12% 2009 10,160 1,767 17% 179,583 25,197 14% 2010 9,725 1,650 17% 153,679 24,400 16% 2011 9,914 2,089 21% 184,336 36,249 20% 2012 8,630 2,157 25% 116,183 27,763 24% 28.. - 102 -
37. () 1,762 357 20.3 ( ) 565 221 39.1 417 137 32.9 485 228 47.0 255 59 23.1 299 64 21.4 21 3 14.3 200 80 40.0 2,221 612 27.6 240 116 48.3 238 60 25.2 304 88 28.9 260 89 34.2 246 60 24.4 422 95 22.5 579 131 22.6 116 58 50.0-103 -
.. 50, 1952..,., /,. (,, ),. 1, 3. ( ),....,.,. (,, ).,.,. - 104 -
4 (,,,,, ) (4 ), 24,., (, B ) 7.,,, ( ), (B, A ) ( )..,,.,,,,,,,. 100%,...,,,. 2010 2001 66.4% 2010 79.4%, 2001 76.5% 2010 97.6%..,. 2007, 51.7%, 96.9%.,, - 105 -
..,., (, ).,., (, ). (A, ). (, )..,...,.,,,.. - 106 -
- 107 -
연구비사용내역 구분 비목 단위 원 당초계획변경금액사용금액잔액구성비비고 인건비소계 책임연구원 총 명 연구원 총 명 연구보조원 총 명 보조원 총명 경비소계 여 비 유 인 물 비 전 산 처 리 비 시약및연구용재료비 회 의 비 임 차 료 교 통 통 신 비 감가상각비 위탁정산수수료 일반관리비 이윤 계 - 108 -
연구분담표 () 30 18 18 18 15 15 15 15 () 15-109 -
,,,2013.,,,,,.. 1985:7(2):240-252.. 1987;9(2):157-060... 1997.. 2007,,.. 1992;2:69-79.. 2006;27(4):483-488... 2003,.. 2007;40(4):259-264,.. 2013;46(6):931-938,,,,,,,,,,,,,,,,,.. 2000;33(1):76-82,,,,,.. 1996;18(1):18-26,,,,,. -. 1998;31(3):471-180.. 2003. -10. 1996;16:121-136,,,2002... 1994;37(1):6-8,,,1995. - 110 -
.,,,,,,... 2007. 2008;1(2):21-25. [Handbook]. 2012.. 2005,,2006... 2013,,,.,. 1964;1(1):54-66,,,,.? 2008;30(2):230-238 Azar FE, Masoori N, Meidani Z, Paul L. Proposal for a modernized Iranian notifiable infectious diseases surveillance system: comparison with USA and Australia. East Mediterr Health J 2010;16(7):771-777 Buehler JW, Hopkins RS, Overhage JM, Sosin DM, Tong V; CDC Working Group. Framework for evaluating public health surveillance systems for early detection of outbreaks: recommendations from the CDC Working Group. MMWR Recomm Rep 2004;53(RR-5):1-11 CDC. Evaluation of and Recommendations for the National Notifiable Disease Surveillance System Within the Federal Centers for Disease Control and Prevention. Available from: http://www.cdc.gov/osels/phsipo/dndhi/docs/pdf/nndss-evaluation-report-final.pdf Centers for Disease Control and Prevention. Protocol for Public Health Agencies to Notify CDC about the Occurrence of Nationally Notifiable Conditions, 2013. German RR, Lee LM, Horan JM, Milstein RL, Pertowski CA, Waller MN; Guidelines Working Group Centers for Disease Control and Prevention (CDC). Updated guidelines for evaluating public health surveillance systems: recommendations from the Guidelines Working Group. MMWR Recomm Rep 2001;50(RR-13):1-35 Health Protection Agency. Laboratory reporting to the Health Protection Agency: Guide for diagnostic laboratories. Available from: http://www.hpa.org.uk/webc/hpawebfile/hpaweb_c/1194947381307 IDSC. Organization & Functions. Available from: http://idsc.nih.go.jp/about/idabs.html Jajosky RA, Groseclose SL. Evaluation of reporting timeliness of public health surveillance systems for infectious diseases. BMC Public Health 2004;4:29-111 -
Krause G, Ropers G, Stark K. Notifiable disease surveillance and practicing physicians. Emerging Infectious Diseases 2005;11(3):442-445 LANGMUIR AD. The surveillance of communicable diseases of national importance. N Engl J Med 1963;268:182-92 Miller M1, Roche P, Spencer J, Deeble M. Evaluation of Australia's National Notifiable Disease Surveillance System. Commun Dis Intell Q Rep 2004;28(3):311-323. Public Health England. Sources of surveillance data. Available from: http://www.hpa.org.uk/topics/infectiousdiseases/infectionsaz/surveillance/sourcesofsurveillanc edata/surveillance outputs. Public Health England. Available from: http://www.hpa.org.uk/topics/infectiousdiseases/infectionsaz/surveillance/surveillanceoutputs/ Rothman KJ, Greenland S, Lash TL. Modern Epidemiology, 3rd ed. Lippincott Williams and Wilkins. 2008 Smith GE, Cooper DL, Loveridge P, Chinemana F, Gerard E, Verlander N. A national syndromic surveillance system for England and Wales using calls to a telephone helpline. Euro Surveill. 2006;11(12):pii=667. Taniguchi K, Hashimoto S, Kawado M, Murakami Y, Izumida M, Ohta A, Tada Y, Shigematsu M, Yasui Y, Nagai M. Overview of infectious disease surveillance system in Japan, 1999-2005. J Epidemiol. 2007;17:S3-13. Teutsch SM, Churchill RE. Principles and practice of public health surveillance. 2nd ed. Oxford, New York: Oxford University Press, 2000 WHO. Communicable disease surveillance and response systems. Guide to monitoring and evaluating. World Health Organization 2006. - 112 -
1. 외국의법정감염병현황 - 감염병목록 2. (SAS Syntax) - 113 -
1. () (: ) United State Japan England-clinic England-Lab AIDS AIDS Amebiasis Amebiasis Entamoeba histolytica Anaplasma phagocytophilum Anthrax Anthrax Anthrax Bacillus anthracis Aseptic meningitis acute meningitis Bacillus cereus Asthma, work-related Burkholderia mallei Babesiosis Bacterial meningitis, other Botulism, foodborne Botulism, foodborne Botulism, foodborne Clostridium botulinum, Botulism, infant Clostridium perfringens Botulism, other (includes wound and unspecified) Brucellosis Brucellosis Brucellosis Brucella spp Cache Valley virus neuroinvasive disease Cache Valley virus non-neuroinvasive disease California serogroup virus neuroinvasive disease California serogroup virus non-neuroinvasive disease Campylobacteriosis Campylobacter spp Cancer Chikungunya virus Chancroid Chlamydophila psittaci Chlamydia trachomatis infection Chlamydia trachomatis genital infection Cholera Cholera Cholera Vibrio cholerae Coccidioidomycosis Coccidioidomycosis Cryptosporidiosis Cryptosporidium spp Cyclosporiasis Dengue fever Dengue fever Dengue virus Dengue hemorrhagic fever Dengue shock syndrome Diphtheria Diphtheria Diphtheria Corynebacterium diphtheriae Eastern equine encephalitis virus neuroinvasive disease Eastern equine encephalitis virus Corynebacterium ulcerans - 114 -