2015 년 1-3 세어린이정기예방접종의완전접종률현황 질병관리본부감염병관리센터예방접종관리과박광숙, 이재영, 김선주, 김미영, 공인식 * * 교신저자 : insik.kong@korea.kr, 043-719-6810 National Childhood Vaccination Coverage of Children Aged 1-3 years in the Republic of Korea, 2015 Division of VPD control and NIP, Center for Infectious Disease Control, CDC Park Kwangsuk, Lee Jaeyoung, Kim Seonju, Kim Miyoung, Kong Insik The National Immunization Program (NIP) is the most cost-benefit effective policy of countermeasures against vaccine preventable diseases (VPD). The national level of vaccination coverage is the critical process indicator of NIP performances. In the Republic of Korea, the government has expanded the vaccination coverage by over 95% through reduction of vaccination barriers such as budgetary burden (out of pocket money) and physical accessibility. The Korea Centers for Disease Control and Prevention (CDC) publicly reported the national level of vaccination coverage for the first time in 2016. The vaccination coverage of children aged 12, 24 and 36 months in 2015 was 94.3%, 92.1% and 88.3%, respectively. This report will briefly describe methods of standardizing and collecting data, results of vaccination coverage rate, and suggestions on future directions for maximizing data utilizations from the National Registration Information System. 예방접종은해당감염병의발생및유행을예방하는가장비용-효과적인공중보건중재수단의하나이다. 우리나라는 감염병의예방및관리에관한법률 제 24조및제25조에의거하여예방접종대상감염병을예방하기위해 1954년부터국가예방접종사업을실시하고있으며, 2020년까지예방접종률을감염병퇴치수준인 95% 이상으로높이기위해무료화등의노력을하고있다. 예방접종률은국가예방접종사업의성과를파악할수있는 대응방안을마련할수있는유용한지표이다. 이에각나라들은예방접종률의측정방법을개발하고, 그측정주기나자료원등과같은사항들에대하여많은연구와노력을경주하고있다 [1]. 본글에서는국가승인통계로공식적으로처음산출된우리나라 2015년만3세어린이전수에대한전국예방접종률산출및분석방법과결과, 끝으로통계산출의발전방향에대해기술하고자한다. 중요한지표로서, 접종률결과에따라사업의문제점을발견하여 www.cdc.go.kr 560
예방접종률자료의수집및산출방법 예방접종기록은보건소및의료기관에서예방접종을실시후질병관리본부의예방접종통합관리시스템 (Immunization Registry Integration system) 에전산등록한자료를이용하였다. 질병관리본부에서는전산등록된자료에대해지속적으로품질관리를실시하고, 행정자치부의출생 사망정보및주소지정보와법무부의이중국적및출 입국정보를연계하였으며, 접종률분석을실시하여예방접종전문위원회산하세부분과위원회에서최종자문을받았다 (Figure1). 2015년만3세어린이전국예방접종률은대한민국국적을보유하고국내에거주하는 2015년말기준만3세아동인 2012년출생아를대상으로감염병의예방을위해 예방접종실시기준및방법 ( 보건복지부고시제2016-57호 ) 에따라권장하는예방접종횟수를모두완료한아동의비율로산출하였다. 접종대상자인분모에서사망자, 외국의영주권을 취득하고영주목적으로외국에거주하는것으로확인된아동은제외하였다. 접종자인분자에대해서는질병관리본부의예방접종통합관리시스템 (Immunization Registry Integration system) 에전산등록된기록만인정하였으며, 동일한예방접종을중복으로접종한경우는첫번째접종을인정하고, 그외의중복접종기록은제외하였으며, 예방접종실시기준보다이른접종을실시한경우의기록은제외하였다. 또한예방접종실시기준에서인정하지않는교차접종 1) 을실시한경우해당감염병의예방을위해접종을완료하기위해최종선택한백신의예방접종기록을인정하고, 그외교차접종의기록은제외하였다 [2]. 예방접종률산출결과및해석 2016년 7월 22일기준행정자치부주민등록전산센터에주민등록된 2012년출생아는 487,693 명이며, 성별로는남자 250,338 명, 여자 237,355 명으로 0.95의성비를보였다. Figure 1. Flow of vaccination coverage data collection and analysis 1 ) 교차접종 : 일본뇌염약독화생백신과불활성화백신간의교차접종 www.cdc.go.kr 561
2012년출생아의연령시기별예방접종률은생후 12개월까지권장되는 4종백신 2) 에대해 10회모두접종한완전접종률이 94.3%, 생후 24개월까지권장되는 6종백신 3) 에대해 13회모두접종한완전접종률은 92.1%, 생후 36개월까지권장되는 7종백신 4) 에대해 15 16 회모두접종한완전접종률은 88.3% 로각각나타났다 (Figure 2). 지역별완전접종률은 12개월까지권장하는접종에대해서는울산 97.2%, 강원 97.1%, 전남 97.0% 의순서로높았고, 서울 91.8%, 경기 93.3%, 전북 94.0% 의순으로낮았다. 24개월까지권장하는접종에대해서는울산 95.3%, 강원 95.1%, 충북 94.6% 로높았고, 서울 89.9%, 경기 91.3%, 전북 91.7% 의순으로낮았다. 36개월까지권장하는접종에대해서는강원 92.0%, 대전 91.6%, 울산 91.2% 의순으로높았고, 서울 86.8%, 부산 87.1%, 광주 87.3% 의순으로낮았다 (Figure3). 백신별완전접종률은 MMR이 97.7% 로가장높고, IPV 97.4%, Figure 2. Completed vaccination coverage by 12 months and 24 months and 36 months of age (Unit: %) 100 90 96.4 97.2 95.4 96.9 95.8 97.1 96.5 95.8 97.0 93.3 94.0 95.7 95.3 95.6 94.6 95.3 91.8 93.2 93.7 95.1 94.6 93.7 91.8 93.3 93.2 92.2 91.3 91.7 92.2 92.5 91.6 91.2 [ 값 ].0 89.9 89.8 91.1 90.5 89.1 89.6 [ 값 ].0 88.4 86.8 87.1 87.3 87.8 87.7 87.6 88.5 80 70 60 50 12 months (10 doses vaccine) 24 months (13 doses vaccine) 36 months (16 doses vaccine) Figure 3. Completed vaccination coverage by ages, by region, 2015 2) 4 종백신 : BCG( 결핵 ), HepB(B 형간염 ), DTaP( 디프테리아, 파상풍, 백일해 ), IPV( 소아마비 ) 3) 6 종백신 : 4 종백신 + MMR( 홍역, 풍진, 유행성이하선염 ), Var( 수두 ) 4) 7 종백신 : 6 종백신 + JE( 일본뇌염 ) www.cdc.go.kr 562
Var는 97.3%, BCG 96.7%, HepB 96.3%, DTaP 95.6%, JE 92.5% 순으로나타났다 (Table 1). 지역에따른백신별완전접종률은 BCG는전남 98.7%, 울산 98.6%, 광주 98.5% 의순으로높았고, 서울 94.9%, 경기 95.9%, 부산 96.6% 의순으로낮았다. HepB 3회접종은울산 98.2%, 강원 97.8%, 충북 97.7% 의순으로높았고, 서울 94.2%, 경기 95.9%, 부산과전북의 96.0% 순으로낮았다. DTaP 4회접종은울산 97.1%, 세종과강원이 96.9% 의순으로높았으며, 서울 %, 부산 95.0%, 제주 95.5% 의순으로낮았다, IPV 3회접종은울산과세종이 98.5%, 강원과대전이 98.3% 의순으로높았으며, 서울 95.6%, 부산 96.8%, 경기 97.3% 의순으로낮았다. MMR 접종은세종 98.9%, 울산 98.7%, 광주 98.6% 의순으로높았으며, 서울 96.3%, 부산 97.3%, 경기와경남 97.7% 의순으로낮았다. 수두접종은세종 98.5%, 울산 98.4%, 광주 98.1% 의순으로높았으며, 서울 96.0%, 부산 96.9% 의순으로낮았다. 일본뇌염은강원 94.2%, 충남 %, 대전 94.0% 의순으로높았으며, 광주 90.4%, 부산 91.1% 의순으로낮았다 (Table 2). 예방접종률은연령이높아질수록접종횟수가많아져 Table 1. Completed vaccination coverage by selected vaccines, by region, 2015 (Unit : %) 구분 BCG 3HepB* 4DTaP 3IPV MMR Var 3(2)JE Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total 96.7 96.8 96.6 96.3 96.3 96.2 95.6 95.7 95.6 97.4 97.4 97.3 97.7 97.7 97.7 97.3 97.3 97.3 92.5 92.5 92.6 Seoul 94.9 94.9 94.9 94.2 94.3 94.0 95.6 95.7 95.5 96.3 96.3 96.2 96.0 96.0 95.9 91.8 91.8 91.8 Busan 96.6 96.7 96.6 96.0 96.0 96.0 95.0 95.0 95.0 96.8 96.8 96.9 97.3 97.3 97.3 96.9 96.9 97.0 91.1 90.8 91.5 Daegu 97.3 97.6 96.9 97.2 97.3 97.1 96.0 96.3 95.8 97.8 97.9 97.6 98.1 98.3 97.8 97.7 97.8 97.5 91.8 92.1 91.6 Incheon 96.7 97.1 96.3 96.2 96.5 95.9 96.1 96.2 96.0 97.6 97.7 97.4 98.0 98.1 97.9 97.7 97.8 97.5 93.7 93.7 93.7 Gwangju 98.5 98.5 98.6 97.4 97.4 97.4 95.6 95.5 95.7 98.3 98.4 98.3 98.6 98.6 98.6 98.1 98.0 98.2 90.4 90.1 90.7 Daejeon 98.4 98.5 98.2 97.6 97.7 97.6 96.5 96.7 96.2 98.3 98.4 98.1 98.3 98.4 98.1 97.8 98.0 97.5 94.0 94.2 93.8 Ulsan 98.6 98.6 98.7 98.2 98.3 98.1 97.1 97.4 96.8 98.5 98.6 98.4 98.7 98.8 98.6 98.4 98.5 98.3 93.5 93.6 93.3 Sejong 98.1 98.2 98.0 97.4 97.1 97.7 96.9 96.8 97.1 98.5 98.4 98.5 98.9 98.9 99.0 98.5 98.3 98.8 93.8 93.4 94.2 Gyeonggi 95.9 96.1 95.8 95.9 95.9 95.8 95.7 95.8 95.6 97.3 97.3 97.2 97.7 97.7 97.7 97.3 97.3 97.3 92.8 92.9 92.7 Gangwon 98.4 98.5 98.3 97.8 97.8 97.8 96.9 96.8 96.9 98.3 98.2 98.4 98.4 98.3 98.4 97.9 97.9 97.8 94.2 94.2 94.2 Chungbuk 98.2 98.0 98.3 97.7 97.5 97.9 96.7 96.7 96.7 98.3 98.3 98.3 98.4 98.4 98.4 98.0 98.0 98.0 93.9 93.8 94.0 Chungnam 97.9 97.9 97.9 97.0 97.1 96.9 96.6 96.6 96.6 98.2 98.2 98.3 98.4 98.4 98.5 97.9 97.8 98.0 94.2 94.0 Jeonbuk 97.0 97.0 97.1 96.0 96.1 95.8 96.0 95.9 96.1 97.9 97.7 98.0 98.3 98.2 98.4 97.8 97.6 98.0 92.7 92.5 93.0 Jeonnam 98.7 98.8 98.5 97.7 97.6 97.7 95.9 96.0 95.9 98.2 98.4 98.1 98.3 98.4 98.3 97.8 97.8 97.8 92.2 92.0 92.4 Gyeongbuk 97.6 97.7 97.4 97.4 97.4 97.3 95.9 95.7 96.1 97.9 97.9 97.8 98.2 98.1 98.2 97.8 97.7 97.8 92.4 92.4 92.5 Gyeongnam 97.3 97.4 97.2 97.3 97.5 97.2 96.1 96.1 96.1 98.1 98.1 98.0 97.7 97.7 97.6 97.7 97.8 97.6 91.9 91.9 92.0 Jeju 97.6 97.6 97.6 97.1 97.3 96.8 95.5 95.8 95.3 97.6 97.7 97.5 97.9 97.9 97.9 97.0 96.9 97.3 92.3 92.2 92.5 * 3HepB: 3 doses of hepatitis B vaccine 4DTaP: 4 doses of DTaP-containing vaccine 3IPV: 3 doses of IPV vaccine 3(2)JE: 3 doses of JE(inactivated) vaccine or 2 doses of JE(live attenuated) vaccine Abbreviation: BCG=Bacille Calmette-Gúerin, HepB=Hepatitis B, DTaP=Diphtheria-Tetanus-acellular-Pertussis, IPV=Inactivated Polio Vaccine, Var=Varicella, MMR=Measles-Mumps-Rubella, JE=Japanese encephalitis www.cdc.go.kr 563
(Unit: %) 100 95 96.2 92.6 95.6 97.3 96.1 96.1 94.8 94.7 93.7 97.7 97.3 93.9 92.8 91.9 91.8 90 85 84.6 84.8 80 75 HepB DTaP IPV MMR Var Korea America Australia England Figure 4. Completed vaccination coverage by country 예방접종률이낮아졌으며, 백신별예방접종률은만 3세까지총 4회로접종횟수가많은 DTaP 백신과생후 12 23 개월에첫접종을하고, 12개월후추가접종해늦은시기까지접종하는 JE 백신의예방접종률이낮게나타났다. 지역별예방접종률차이는현재시점의주소지기준, 해외거주자등인구이동요인으로해석의한계는있으나지자체별로미접종자개별우편안내등접종독려방법의노력도차이가있는것으로보인다. 그러나우리나라의백신별완전접종률은접종률현황을공개하고있는해외주요국가와비교한결과국가별로동일한접종기준이적용되고있는 B형간염, DTaP, IPV, MMR, 수두등 5종백신에대해미국, 호주, 영국등과비교해평균적으로약 2 6%p 가량높은것으로파악돼 (Figure 4)[3,4,5], 선진국수준이상의예방접종률을달성하였고, 어린이건강보호수준이높은것으로나타났다. 예방접종률산출의한계 전국예방접종률현황은주민등록상주소지를기준으로 집계함에따라실제지역사회에거주하는아동의예방접종률과다소차이가있을수있으며, 국외접종등예방접종을완료하였으나예방접종의기록이전산등록되지않은경우예방접종기록이누락될수있어실제예방접종률보다낮게산출되었을가능성이있다. 또한, 수두예방접종률은수두감염자의경우면역력획득으로예방접종제외대상이나, 2015년예방접종률통계에는수두감염자를예방접종대상자로포함하여집계하였으며, 예방접종완료자에서제외하지않아실제수두예방접종률보다낮게산출되었을가능성이있다. 결핵예방접종률은결핵을예방하는 BCG 경피용백신이국가예방접종으로도입되지않은백신이나, 질병관리본부예방접종통합관리시스템에전산등록된 BCG 경피용예방접종기록을예방접종률산출에포함하였으며, 일부예방접종기록이전산등록누락되었을수있어실제결핵예방접종률보다낮게산출되었을가능성이있다. 일본뇌염예방접종률은일본뇌염약독화생백신이 2014년국가예방접종으로도입 (2014.2.10.) 됨에따라, 국가예방접종으로 www.cdc.go.kr 564
도입되기이전의일본뇌염약독화생백신의예방접종기록이일부 전산누락되었을수있어실제일본뇌염예방접종률보다낮게 산출되었을가능성이있다. 예방접종률통계발전방향 2015년만3세어린이의전국예방접종률현황통계는 2012년에출생한전국 48만명전원을대상으로질병관리본부의예방접종통합관리시스템에전산등록된접종기록을분석해산출한첫전수조사통계라는데큰의의가있으며, 향후매년전수등록자료를이용해접종률을분석함으로써우리나라국가예방접종사업의성과를지속적으로분석하고, 예방접종미접종자에대한원인을밝혀미접종자특성별관리전략을수립할필요가있다. 또한, 향후만4 6 세추가접종에대한접종률분석등분석연령을확대할필요가있으며, 미접종자의학부모교육수준, 소득재산수준등사회경제적특성등심층분석을통해미접종자의접종률제고를위한노력이필요하고, 연구자원으로서예방접종빅데이터를활용할수있는방안을마련할필요가있다. 참고문헌 1. 질병관리본부. 2012 경제발전경험모듈화사업 : 어린이예방접종사업. 충남대학교. 2013. 2. 질병관리본부. 2015 전국예방접종률조사. 2016. 3. Hill HA, Elam-Evans LD, et al. Vaccination Coverage Among Children Aged 19-35 Months-United States, 2015. MMWR Morb Mortal Wkly Rep 2016;65:1065-71. 4. Hull BP, Dey A, et al. Immunisation Coverage Annual Report, 2013. Commun Dis Intell 2016;40:E146-69. 5. HSCIC. NHS immunisation Statistics 2014-2015. 2015. www.cdc.go.kr 565