pissn 25-811X eissn 2586-86 www.cdc.go.kr PUBLIC HEALTH WEEKLY REPORT, PHWR Vol.11, No.42, 218 CONTENTS 141 217 년만 1-3 세어린이정기예방접종의완전접종률현황 1417 218 년참진드기전국분포조사현황 1422 통계단신 (QuickStats) 과체중및비만인구국제비교 OECD 가입국가중심, 216 1424 주요감염병통계환자감시 : 전수감시, 표본감시 병원체감시 : 인플루엔자및호흡기바이러스 급성설사질환, 엔테로바이러스 매개체감시 : 말라리아매개모기, 일본뇌염매개모기 쯔쯔가무시증매개털진드기
주간건강과질병 제 11 권제 42 호 연구논문, Research article 217 년만 1-3 세어린이정기예방접종의완전접종률현황 질병관리본부감염병관리센터예방접종관리과박광숙, 이재영, 최연화, 공인식 * * 교신저자 : insik.kong@korea.kr, 43-719-681 National Vaccination Coverage Among Children Aged 1-3 Years in the Republic of Korea, 217 Park Kwangsuk, Lee Jaeyoung, Choi Yeonhwa, Kong Insik Division of VPD Control & NIP, Center for Infectious Disease Control, KCDC Background: The most effective way to prevent communicable vaccine-preventable diseases (VPD) is to achieve and maintain vaccination coverage level above the threshold of disease transmission prevention. In the Republic of Korea, the government established a strategy for achieving more than 95% of immunization coverage through routine vaccinations and/or supplemental immunization activities. The national level of vaccination coverage is a critical performance process indicator of the National Immunization Program (NIP). The Korea Centers for Disease Control and Prevention (KCDC) publicly reported the national level of vaccination coverage since 215. Methods/results: This report details the vaccination coverage for the year 217, using 1.29 million data of children from the National Registration Information System. The calculations of vaccine coverages are modeled on birth cohorts at ages of 12 months (born in 216), 24 months (born in 215), and 36 months (born in 214). The complete vaccination coverage of subjects aged 12, 24, and 36 months in 217 were 96.6%, 94.1%, and 9.4%, respectively. According to the birth cohorts, the vaccination coverages of NIP were higher than 95%, except for Japanese encephalitis (92.9%). Conclusion: Vaccination coverage in the Republic of Korea was higher than that in many developed countries. Nonetheless, more investment and research are needed to identify vaccination hesitancy and refusal groups, as well as all VPD group. Keywords: Vaccination, Immunization, Coverage, Vaccination hesitancy 들어가는말 국가예방접종사업은개인의건강과생명을보호할뿐만아니라, 일정수준의접종률을달성할경우집단면역력형성 (herd immunity) 으로감염병전파를차단함으로써감염병유행을 예방한다. 예방접종은 $1 투자하면 $16 이득이생기는가장비용- 효과적인감염병예방관리전략이다 [1]. 우리나라의국가예방접종사업은 감염병의예방및관리에관한법률 제24조및제25조에의거하여예방접종대상감염병을예방하기위해 1954년전후부터실시하고있다. 1996년 www.cdc.go.kr 141
주간건강과질병 제 11 권제 42 호 이전까지는아동의보호자에게반드시예방접종을받도록하는책임을부여하였으나, 1999년규제정비계획에의해보호자의강제예방접종규정과벌금조항이폐지되었으며, 현재까지기초지자체장의책임하에국가예방접종을실시하고있다 [2]. 우리나라의국가예방접종사업은 22년까지예방접종률을감염병퇴치수준인 95% 이상으로높이기위해국가사업대상백신과접종대상자의확대, 민간의료기관접종에대한비용지원등양적 질적확대를통해국민의접종비용에대한부담을낮추고, 접종의편의성을향상시키고있다. 214년도부터는 12세이하어린이에대해국가예방접종을민간의료기관까지확대하여무료로실시하고있으며, 218년현재총 17종의백신접종에대해국가지원을하고있다. 또한, 미접종자관리, 예방접종기록의효율적관리를위한예방접종통합관리시스템의구축 운영, 실시간으로개인별접종정보및접종일정안내정보제공, 지연접종알림등을지속적으로실시하고있다 [3]. 우리나라의전국예방접종률현황통계는 213년통계청의국가승인통계 (11793 호 ) 로지정받았으며, 215년부터만3세어린이전수에대한접종률을산출하고있다. 전국예방접종률현황산출은최신의집단면역수준을확인하여, 예방접종대상감염병발생시신속한유행예방관리를위한대응전략마련을위해매우중요하다. 이글에서는국가예방접종사업의성과를파악할수있는중요한지표인우리나라의 217년만1~3세어린이예방접종률현황에대해자료의수집, 산출및분석방법과결과, 통계산출의발전방향에대해기술하고자한다. Integration System, 이하 전산시스템 이라함 ) 에전산등록한자료를이용하였다. 질병관리본부에서는전산등록된자료에대해지속적으로품질관리를실시하고있으며, 행정안전부의출생 사망정보및주소지정보와법무부의이중국적및출 입국정보를연계하였으며, 접종률분석을실시하여예방접종통계분야전문가회의를통해최종자문을받았다. 우리나라는 215년부터만3세어린이의전국예방접종률현황을전산시스템에등록된기록을분석해전수통계로매년산출하고있으며, 216년까지는만3세 1개년출생코호트 (213년생) 에과거 12개월, 24개월, 36개월시기의접종률을산출하였다. 217년부터는최근시점의접종률을산출하기위해연도말기준만1 3 세어린이로산출대상출생코호트를 3개년으로확대하고그에따라각출생코호트의연도말기준만1세, 2세, 3세각각의백신별접종률과해당연령시기의접종률을산출하는방식으로변경하였다. 산출방식의변경으로전년도 12개월과 24개월의접종률추이비교는곤란해졌으나, 최근시점의접종률을확인할수있게되었다는점에서큰의의가있다. 217년만1 3세어린이전국예방접종률은대한민국국적을보유하고국내에거주하는 217년말기준만1 3세아동인 214 216 년출생아를대상으로감염병의예방을위해 예방접종실시기준및방법 ( 보건복지부고시제216-8 호 ) 에따라권장하는예방접종횟수를모두완료한아동의비율로산출하였다 (Figure 1). 접종대상자인분모에서사망자와외국의영주권을취득하고영주목적으로외국에거주하는것으로확인된아동은제외하였다. 접종자인분자에대해서는질병관리본부의전산시스템에전산 몸말 1. 예방접종률자료의수집및산출방법 예방접종기록은보건소및의료기관에서예방접종을실시한후질병관리본부의예방접종통합관리시스템 (Immunization Registry 등록된기록만인정하였으며, 동일한예방접종을중복으로접종한경우는첫번째접종을인정하고, 그외의중복접종기록은제외하였으며, 예방접종실시기준보다이른접종을실시한경우에는접종력을인정하지않으므로제외하였다. 또한예방접종실시기준에서인정하지않는교차접종 1) 을한경우해당감염병의예방을위한접종을완료하기위해최종선택한백신의예방접종기록을인정하고, 그외교차접종의기록은제외하였다 (Figure 2)[4]. 1) 교차접종 : 동일한감염병을예방하기위해두개이상의백신을교차하여접종을실시한예방접종 ( 일본뇌염약독화생백신과불활성화백신간의교차접종 ) www.cdc.go.kr 1411
주간건강과질병 제 11 권제 42 호 Selection process of denominator Population data registered in the Ministry Yes Survival status No Excluding target Yes Check overseas resident with dual citizenship Yes No Denominator Figure 1. Flowchart of the selection process of denominator Selection process of numerator Immunization records registered in the Immunization Registry Integration System (IRIS) Yes Early-vaccination (Minimum age & immunization interval) No Yes Excluding early vaccination records Duplication Yes Excluding 2 nd duplicate vaccination records No Cross-vaccination Yes BCG & JE excludes later cross -vaccination records No Completion of vaccination by age N o Incomplete vaccination Yes Numerator Figure 2. Flowchart of the selection process of numerator www.cdc.go.kr 1412
주간건강과질병 제 11 권제 42 호 2. 예방접종률산출결과및해석 214 216 년출생아로서 217년 12월 31일기준행정안전부주민등록전산센터에주민등록된예방접종대상자는 129만명으로다음과같았다 (Table 1). 연령시기별예방접종률은생후 12개월까지접종완료를권장하는예방접종 (6종, 16회접종 ) 2) 을모두접종한아동은 96.6%, 생후 24개월까지권장되는예방접종 (8종, 21회접종 ) 3) 을모두접종한아동은 94.1%, 생후 36개월까지권장하는예방접종 (9종, 23 24회접종 ) 4) 을모두완료한아동은 9.4% 로각각나타났다 (Figure 3). 지역별완전접종률중 12개월까지 (6종, 16회접종 ) 권장하는예방접종을모두완료한아동은울산 98.1%, 전남 97.8%, 광주 97.7% 의순서로높았고, 24개월까지 (8종, 21회접종 ) 권장하는접종에대해서는울산과충남이 95.7%, 충북 95.3% 로높았으며, 36개월까지 (9종, 23 24회접종 ) 권장하는접종에대해서는울산 93.2%, 강원과충북이 92.1% 의순으로높았다 (Figure 4). 백신별로는생후 12개월, 24개월, 36개월까지각각권장하는예방접종의백신별예방접종률이 92.9% 98.2% 로일본뇌염을제외하고모든백신의예방접종률이 95.% 이상으로나타났다. 각연령별로는 BCG 백신접종이 98.% 이상으로가장높았다 (Table 2). 백일해 ) 백신과 Hib(b형헤모필루스인플루엔자 ) 백신, 생후 12 23개월에첫접종을하고 12개월후추가접종해가장늦은시기까지접종하는 JE( 일본뇌염 ) 백신의예방접종률이낮게나타났다. 일본뇌염백신은표준접종일정보다늦게접종하여아직다음접종시기가도래하지않은경우에도미접종자로분류되어다른백신보다낮은것으로보인다. 올해처음접종률을산출한 PCV( 폐렴구균 ) 백신의예방접종률은연령별로 96.8 97.4% 로다른백신과비슷한접종률을보였다. 지역별예방접종률차이는현재시점의주소지기준, 해외거주자등인구이동요인으로해석의한계는있으나지자체별로미접종자개별우편안내등접종독려방법의노력도차이가있는것으로보인다. 그러나 217년만3세아동의 36개월접종률은국가예방접종백신에 PCV가추가되어접종횟수가 4회증가하였음에도불구하고전년에비해 89.2% 에서 9.4% 로 1.2%p 증가되어 215년이후지속적으로증가하고있으며, 우리나라의백신별완전접종률은접종률현황을공개하고있는해외주요국가와비교한결과국가별로동일한접종기준이적용되고있는 DTaP, IPV, MMR, Var, Hib 등 5종백신의평균이한국 96.9% 로미국 87.8%, 호주 95.1%, 영국 94.% 등에비해평균약 2 9%p 가량높은것으로파악되어 (Figure 5)[5,6,7], 세계최고수준으로우리나라의어린이건강보호수준이높은것으로나타났다. 예방접종률은연령이높아질수록접종완료해야하는누적 접종횟수가많아져완전접종률이낮아졌으며, 백신별예방접종률은 만 3 세까지총 4 회로접종횟수가많은 DTaP( 디프테리아, 파상풍, Table 1. Subjects of birth cohorts used as denominator, 217 Unit: n, % Total number of children Male Female 12 months of age (born in 216) 24 months of age (born in 215) 36 months of age (born in 214) 49,17 29,58 199,662 442,257 226,726 215,531 438,726 224,81 213,925 2) 6 종백신 : BCG 1 회, HepB 3 회, DTaP 3 회, IPV 3 회, Hib 3 회, PCV 3 회를모두완료한아동 3) 8 종백신 : BCG 1 회, HepB 3 회, DTaP 4 회, IPV 3 회, Hib 4 회, PCV 4 회, MMR 1 회, Var 1 회를모두완료한아동 4) 9 종백신 : BCG 1 회, HepB 3 회, DTaP 4 회, IPV 3 회, Hib 4 회, PCV 4 회, MMR 1 회, Var 1 회및 JE 불활성화백신 3 회또는약독화생백신 2 회를모두완료한아동 www.cdc.go.kr 1413
주간건강과질병 제 11 권제 42 호 1 96.6% Vaccination coverages (%) 95 9 85 94.1% 9.4% 8 75 12 months(born in 216) 24 months(born in 215) 36 months(born in 214) (16 doses required) (21 doses required) (23-24 doses required) Figure 3. Completed vaccination coverages by 12 months, 24 months, and 36 months of age 12 months 24 months 36 months (16 (16 doses doses required) vaccine) (21 (21 doses doses required) vaccine) (23-24 (23~24 doses doses required) vaccine) 1 9 97.7 98.1 96.2 96.6 96.7 97. 97.4 97.6 96.7 97.3 97.6 97.3 97.8 97.3 97. 96.4 94.9 95.7 93.3 94.1 94.2 94.6 94.4 94.4 94.3 95.2 95.3 95.7 94. 94.7 94.9 93.2 94.5 92.3 92.7 9.9 91.6 91.2 9.8 92.1 92.1 91.8 89.8 9.2 9.8 9.3 89.1 89.7 88.9 89.6 89.2 Vaccination coverages (%) 8 7 6 5 Figure 4. Completed vaccination coverages by age cohort and region, 217 www.cdc.go.kr 1414
주간건강과질병 제 11 권제 42 호 Table 2. Completed vaccination coverage of selected vaccines by region, 217 Unit: n, % BCG HepB DTaP IPV Hib PCV MMR Var JE 12 months 24 months 36 months 12 months 24 months 36 months 12 months 24 months 36 months 12 months 24 months 36 months 12 24 36 months months months 12 24 36 months months months 24 36 months months 24 36 months months 36 months Total 98.2 98.1 98. 97.8 97.8 97.6 97.7 96.2 96.6 97.6 97.7 97.7 97.7 95.9 95.7 97.4 96.9 96.8 97.6 97.7 97.5 97.6 92.9 Seoul 96.8 96.7 96.4 96.3 96.3 95.9 96.5 94.9 95. 96.4 96.4 96.2 96.4 94.5 94.2 96.2 95.5 95.3 96.4 96.5 96.2 96.3 92. Busan 98. 97.9 97.8 97.4 97.3 97.2 97.4 95.4 96.1 97.3 97.2 97.2 97.4 95.2 95.3 97.1 96.2 96.2 97.2 97.3 97. 97.1 91.9 Daegu 98.3 98.3 98. 98. 98.1 97.9 97.9 96.5 96.7 97.8 97.9 97.9 97.7 95.7 95.6 97.5 97.1 96.9 97.9 98. 97.8 97.7 92.7 Incheon 98.2 98.2 98. 97.9 98. 97.7 97.9 96.7 96.8 97.8 98. 97.9 97.8 95.9 95.7 97.6 97.2 96.8 97.9 97.9 97.7 97.8 93.6 Gwangju 99.1 98.9 98.9 98.6 98.6 98.5 98.4 96.9 97.1 98.4 98.5 98.5 98.3 96.2 95.7 98.1 97.7 97.3 98.5 98.4 98.3 98.2 91.3 Daejeon 98.6 98.6 98.6 97.9 98.2 98.1 97.9 96.4 97.1 97.8 98.1 98.2 97.9 96.3 96.4 97.7 97.3 97.4 98. 98.2 97.7 97.8 93.7 Ulsan 99. 99. 99. 98.8 98.8 98.8 98.7 97.3 98.1 98.7 98.8 98.8 98.8 96.9 97.3 98.6 98.1 98.3 98.6 98.9 98.4 98.7 94.9 Sejong 99. 98.6 98.9 98.5 98.4 98.3 98.4 96.5 97.5 98.2 98.3 98.6 98.4 96.3 96.5 98.1 97.2 97.6 98.1 98.8 98. 98.6 93.8 Gyeonggi 98.2 98. 97.9 97.9 97.7 97.6 97.8 96.4 96.7 97.7 97.7 97.7 97.7 95.9 95.6 97.5 97. 96.9 97.7 97.9 97.6 97.6 93.4 Gangwon 98.8 98.5 98.6 98.5 98.1 98.2 98.5 96.7 97.4 98.5 98.1 98.2 98.4 96.6 96.6 98.1 97.4 97.6 97.9 98.2 97.8 97.9 94. Chungbuk 98.7 98.8 98.6 98.2 98.4 98.2 98.1 96.9 97.5 98. 98.3 98.4 98.1 96.8 96.7 97.9 97.6 97.6 98.4 98.4 98.3 98.2 94.2 Chungnam 98.9 98.9 98.7 98.5 98.7 98.2 98.4 97.3 97.5 98.3 98.6 98.3 98.5 97.1 96.6 98.2 97.9 97.5 98.6 98.4 98.5 98.3 94.2 Jeonbuk 98.7 98.4 98.4 98.3 98.2 98. 98.1 96.3 96.9 98.1 98.1 98.1 98.1 96.8 96.8 97.8 97.5 97.3 97.1 97.1 97.5 97.4 92.8 Jeonnam 99.1 98.9 98.9 98.9 98.5 98.4 98.6 96.7 97.2 98.6 98.5 98.4 98.6 96.5 96.1 98.3 97.5 97.4 98.4 98.4 98.3 98.2 91.9 Gyeongbuk 98.7 98.5 98.5 98.3 98.3 98.2 98.2 96.9 97.1 98.1 98.2 98.2 98.2 96.5 96.2 97.9 97.4 97.5 98.1 98.3 97.9 98.1 93.1 Gyeongnam 98.7 98.8 98.8 98.2 98.4 98.4 98. 96.5 97.1 97.9 98.2 98.4 97.9 96.7 96.8 97.6 97.4 97.6 97.5 97.7 97.6 97.9 92.6 Jeju 98.3 98.1 98.3 97.7 97.8 97.9 97.6 95.4 96.3 97.5 97.6 97.8 97.6 95.2 95. 97.1 96.4 96.6 97.5 97.7 97. 97.4 92.2 *Abbreviation: BCG, Bacille Calmette-Gúerin; HepB, Hepatitis B; DTaP, Diphtheria-Tetanus-acellular-Pertussis; IPV, Inactivated Polio Vaccine; Hib, Haemophilus influenza type b; PCV, Pneumococcal Conjugate Vaccine; Var, Varicella; MMR, Measles-Mumps-Rubella; JE, Japanese Encephalitis Vaccination coverages (%) 1 95 9 85 8 96.4 83.4 97.5 97.6 97.4 96.4 96.3 95. 95. 95.3 91.9 91.1 Korea America Australia U.K. U.S.A 92.8 9.6 92.7 92.1 95.5 81.8 94.8 95. 75 7 DTaP IPV MMR Var Hib Figure 5. Completed vaccination coverages by country www.cdc.go.kr 1415
주간건강과질병 제 11 권제 42 호 맺는말 전국예방접종률현황은주민등록상주소지를기준으로집계함에따라인구이동등으로접종당시지역또는현재거주하고있는지역사회의예방접종률과다소차이가있을수있다. 국외거주하거나장기출국이확인된아동에대해서는예방접종대상자에서제외하고있으나, 일부확인되지않은아동을포함하고있어, 이들아동의비율이높은지역의경우실제 국가예방접종사업의성과를지속적으로분석하고, 저소득층, 다문화가족등취약계층의접종현황과백신거부, 지연자등미접종사유조사등을통한현황조사와그에따른관리체계를수립할필요가있다. 또한, 장기적으로만4 6 세와만11 12 세추가접종에대한접종률분석등분석연령을지속적으로확대하고, 미접종자의사회경제적특성등심층분석을통해미접종자의접종률제고를위한노력이필요하며, 연구자원으로써예방접종빅데이터를활용할수있는체계를마련할필요가있다. 지역사회의접종률보다낮게산출되었을가능성이있다. 또한, 수두 예방접종률은수두감염자의경우면역력획득으로예방접종제외대상이나, 감염및면역획득여부확인의한계로수두감염자를예방접종대상자에포함하여집계하였으며, 예방접종완료자에서제외하지않아실제수두예방접종률보다낮게산출되었을가능성이있다. 결핵예방접종률은결핵을예방하는 BCG 경피용백신이국가예방접종으로도입되지않은백신이나, 질병관리본부전산시스템에등록된 BCG 경피용예방접종기록을예방접종률산출에포함하였으며, 일부예방접종기록이전산등록누락되었을수있어실제결핵예방접종률보다낮게산출되었을가능성이있다. 예방접종률은국가예방접종사업의성과를파악할수있는중요한지표로서, 접종률결과에따라사업의문제점을발견하여대응방안을마련할수있는유용한지표이다. 이에각나라들은예방접종률의측정방법을개발하고, 그측정주기나자료원등과같은사항들에대하여많은연구와노력을경주하고있다. 217년만1 3세어린이의전국예방접종률현황통계는 참고문헌 1. Ozawa S. Clark S. et al. Return On Investment From Childhood Immunization In Low- And Middle-Income Countries, 211-2. Health Aff. 216;35(2):199-27. 2. 보건복지부. 212 경제발전경험모듈화사업 : 어린이예방접종사업. 213. 3. 질병관리본부. 217년취학아동예방접종확인사업추진결과. 주간건강과질병. 218;11(17);533-537. 4. 질병관리본부. 217 전국예방접종률현황. 217. 5. Hill HA, Elam-Evans LD, et al. Vaccination Coverage Among Children Aged 19-35 Months-United States, 216. Morb Mortal Wkly Rep. 217;66:1171-1177. 6. Alexandra H, Brynley H. et al. NSW Annual Immunisation Coverage Report, 216. 7. National Statistics. Childhood Vaccination Coverage Statistics, England, 216-217, 217. 8. Choe YJ, Park K et al. School entry vaccination requirement program: Experience from the Republic of Korea. Vaccine. 218;36(37)5497-5499. 214 216년에출생한 129만명을대상으로질병관리본부의전산시스템에등록된접종기록을분석해산출하여, 가장최신의연령별접종률산출을통해집단면역수준을확인한통계라는점과, 여러분야에서예방접종빅데이터를활용할수있는정확한통계자료를제공하였다는것에큰의의가있다. 우리나라어린이의높은예방접종률은단체생활에의한유행을막을수있는수준의높은집단면역보호체계를갖췄다는것을의미한다. 이러한높은접종률유지를위해서는향후매년전수등록자료를이용해접종률을분석함으로써우리나라 www.cdc.go.kr 1416
주간건강과질병 제 11 권제 42 호 연구단신, Brief report 218 년참진드기전국분포조사현황 질병관리본부감염병분석센터매개체분석과노병언, 이욱교, 이희일, 조신형 * * 교신저자 : cho4u@korea.kr, 43-719-852 Geographical distribution of ticks in the Republic of Korea in 218 Noh Byung-Eon, Lee Wook-Gyo, Lee Hee il, Cho Shin-Hyeong Division of Vectors and Parasitic Diseases, Center for Laboratory Control of Infectious Diseases, KCDC Tick-borne diseases are caused by various pathogens, such as severe fever with thrombocytopenia syndrome (SFTS) virus, tick-borne encephalitis (TBE) virus, arthropod-associated bacteria (e.g., Borrelia, Richettsia), and protozoan parasites (e.g., Babesia). Reported cases of diseases caused by these pathogens have been steadily on the increase in the Republic of Korea in recent year. The present study was conducted to monitor the distribution of ticks, which are the main vectors transmitting these pathogens. A flagging method was used in four different types of environments, including graveyards, mountain roads, copses, and grasslands, in 46 regions of the Republic of Korea. In total, 45,974 ticks belonging to five species and three genera were collected through this survey. Haemaphysalis longicornis was the predominant species at all collection sites, reaching abundances of 44,161 (96.1%) of the ticks found. The second most common species was H. flava (1,427 ticks; 3.1% of the total), followed by Ixodes nipponensis (31 ticks;.7%), H. japonica (66 ticks;.1%), and Amblyomma testudinarium (1 ticks; <.1%). The flag index (F.I.) was the highest in Gyeonggi-do (77.8), and the lowest in Seoul (.1). The majority of ticks were collected in grassland environments (13,75 ticks; 28.4% of the total), followed by copses (12,377 ticks; 26.9%), mountain roads (1,641 ticks; 23.1%), and graveyards (9,881 ticks; 21.5%). The continuous surveillance of tick-borne diseases vectors is becoming increasingly important to geopathology in the Republic of Korea. Thus, efforts to expand the number and scale of collection sites and periods surveyed and monitored for ticks are necessary to protect public health. Keywords: Tick-borne diseases, Severe fever with thrombocytopenia syndrome (SFTS) virus, Geographical distribution 들어가는말 진드기는분류상거미강 (Class: Arachnida) 에속하며, 다리가 4쌍이고날개가없는것이특징인절지동물이다. 세계적으로약 5,종이상의진드기가보고되었고, 참진드기과 (Family: Ixodidae) 의진드기는약 7종이기록되어있으며, 국내에서는 5속 27종이보고되었다 [1]. 참진드기는바이러스, 세균, 리케치아및기생충등다양한병원체를전파하는감염병매개체로잘알려져있다. 국내에서식하고있는참진드기가매개하는질병은진드기매개티프스 (tick- www.cdc.go.kr 1417
주간건강과질병 제 11 권제 42 호 I. nipponensis.7% A. testudinarium <.1% H. flava 3.1% H. japonica.1% H. longicornis 96.1% Figure 1. Species ratio of collected ticks in 46 areas Table 1. Flag Index* of collected ticks from 46 area using flagging methods in seven metropolitan cities and nine provinces during May and June in 218 Area Genus Species Amblyomma Haemaphysalis Ixodes testudinarium flava japonica longicornis nipponensis Total Seoul....1..1 Busan... 66.5. 66.5 Daegu..5. 25.7.1 26.3 Incheon..6. 42.4.1 43.1 Gwangju... 26.4. 26.4 Daejeon... 5.9. 5.9 Ulsan... 61.8 4.9 66.7 Gyeonggi-do..7. 77.1 <.1 77.8 Gangwon-do. 1.6.3 46.2.3 48.5 Chungcheongbuk-do..7. 19.7 <.1 2.4 Chungcheongnam-do. 3.4. 36..5 39.9 Jeollabuk-do <.1.6. 35.5.2 36.3 Jeollanam-do <.1 1.2. 3.4.1 31.7 Gyeongsangbuk-do. 2.7. 41.3.4 44.4 Gyeongsangnam-do <.1 1.4. 44.5. 45.9 Jeju-do. 1.5. 31.2. 32.7 Total <.1 1.3.1 4..3 41.6 *Flag Index: total number of ticks/number of flagging www.cdc.go.kr 1418
주간건강과질병 제 11 권제 42 호 (A) Total ticks (B) H. longicornis (C) H. flava (D) I. nipponensis (E) A. testudinarium (F) H. japonica Figure 2. Geographical distribution map of total and five dominant species of ticks in 218 borne typhus), 진드기매개뇌염 (tick-borne encephalitis), 아나플라즈마증 (anaplasmosis), 에르리히증 (Ehrlichiosis), 야토병 (tularemia), 바베스열원충증 (babesiosis), 타일레리아증 (theileriasis) 등이있다 [2,3,4]. 국내에서식하는참진드기에서는작은소피참진드기 (Haemaphysalis longicornis), 개피참진드기 (H. flava), 일본참진드기 (Ixodes nipponensis) 가주요종으로확인되었으며, 이들종에서리케치아, 진드기매개뇌염바이러스, 중증열성혈소판감소증후군 (Severe Fever with Thrombocytopenia Syndrome, SFTS) 바이러스유전자검출이보고되었다 [4,5]. 213년국내에서중증열성혈소판감소증후군 (SFTS) 환자가처음으로보고된후동년 36건, 14년 55건, 15년 79건, 16년 165건, 17년 272건으로매년증가되는추세에있다 [6]. 또한참진드기에의한라임병 (Lyme disease) 도 212년첫환자발생이후계속증가하고있다. 참진드기는모기, 이, 벼룩등다른위생곤충에비해생활사가길고매년다른발생양상을보이기때문에장기적조사를통하여생태학적자료수집이필요하다. 따라서질병관리본부매개체분석과에서는매개체전파질환의효율적인예방및관리를위해참진드기의발생밀도및분포, 병원체감염률에대한기초자료를확보하고자 권역별기후변화매개체감시거점센터 를대상으로지속적인조사감시체계를구축하여 www.cdc.go.kr 1419
주간건강과질병 제 11 권제 42 호 Table 2. Total number of ticks and species ratio from four environments site Genus Species Grassland 2 (2.) Copse 2 (2.) Mountain road 5 (5.) Grave 1 (1.) Total (%) Amblyomma Haemaphysalis Ixodes testudinarium flava japonica longicornis nipponensis 1 (1.) 25 (14.4) 476 (33.4) 491 (34.4) 255 (17.9) 1,427 (1.) 2 (3.) 5 (7.6) (.) 59 (89.4) 66 (1.) 12,828 (29.) 11,833 (26.8) 1,89 (22.8) 9,411 (21.3) 44,161 (1.) 38 (12.3) 61 (19.7) 56 (18.1) 155 (5.) 31 (1.) Total (%) 13,75 (28.4) 12,377 (26.9) 1,641 (23.1) 9,881 (21.5) 45,974 (1.) 운영하고있다. 이글에서는 218 년거점센터에서수행한참진드기 전국분포현황을분석하여참진드기매개질환의예방및관리를 위한기초자료를제공하고자한다. 전국분포조사를수행한결과 3 속 5 종, 45,974 개체의 참진드기를채집하였으며, 채집된참진드기의종별분포로는 작은소피참진드기 44,161 개체 (96.1%), 개피참진드기 1,427 개체 (3.1%), 일본참진드기 31 개체 (.7%) 사슴피참진드기 (H. japonica) 몸말 1) 지역별분포 기후변화대응감염병매개체조사감시사업의일환으로참진드기의전국분포를조사하기위해 3년주기로조사를실시하고있다. 올해 (218) 는 16개의거점센터에서전국참진드기분포조사를실시하였으며, 조사지역은총 46개지역으로서울특별시와광역시 6개지역 ( 부산, 대전, 대구, 광주, 울산, 인천 ), 강원 8개지역 ( 삼척, 66개체 (.1%), 뭉뚝참진드기 (Amblyomma testudinarium) 1개체 (<.1%) 순이었으며, 작은소피참진드기가국내우점종임을확인하였다 (Figure 1). Flag Index(F.I; No. of tick/no. of flagging) 가가장높게나타난지역은경기도지역 (F.I. 77.8) 이었으며, 가장낮은지역은서울특별시 (F.I..1) 였다 (Table 1). 뭉뚝참진드기의경우에는경남, 전남, 전북지역에서만채집되었으며, 사슴피참진드기는강원도에서만채집되었다. 채집된진드기는종별로도지역적인차이를보였으며, 지역마다개체수의차이도보였다 (Figure 2). 2) 환경별분포 속초, 영월, 인제, 철원, 춘천, 평창, 횡성 ), 경기 4 개지역 ( 여주, 포천, 화성, 광주 ), 경남 4개지역 ( 거제, 밀양, 진주, 함양 ), 경북 6개지역 ( 문경, 상주, 안동, 영덕, 울진, 포항 ), 전남 5개지역 ( 곡성, 광양, 보성, 영암, 완도 ), 전북 4개지역 ( 고창, 군산, 임실, 진안 ), 충북 2개지역 ( 보은, 음성 ), 충남 4개지역 ( 당진, 보령, 천안, 홍성 ), 제주 2개지역 ( 제주, 서귀포 ) 에서채집을실시하였다. 조사는 5월과 6월에월 1회로지역별로 4개의환경 ( 잡목림, 초지, 무덤, 산길 ) 을선정하여 flagging method( 채집용천 : 1 m 1 m) 를이용하여채집환경당 2회 (2 m2 ) 를실시하였다. 서식환경별조사는초지 (grassland), 잡목림 (copse), 산길 (mountain road), 무덤 (grave) 으로구분하여참진드기채집개체수를비교한결과, 초지에서 13,75개체로가장많은개체가채집되었고, 다음이잡목림 (12,377개체), 산길 (1,641 개체 ) 그리고무덤 (9,881개체) 순으로나타났다 (Table 2). 작은소피참진드기는초지 (29.%), 잡목림 (26.8%), 산길 (22.8%), 무덤 (21.3%) 순으로높은비율을차지하였다. 개피참진드기는산길 (34.4%), 잡목림 (33.4%) 에서높은개체수가채집되었고, 사슴피참진드기 (89.4%) 와 www.cdc.go.kr 142
주간건강과질병 제 11 권제 42 호 일본참진드기 (5.%) 는대부분무덤에서채집되었으며, 뭉뚝참진드기는산길 (5.%) 에서가장많이채집되었다 (Table 2). 맺는말 국내에서참진드기로인해발생되는중증열성혈소판감소증후군 (SFTS) 은 213년에첫환자가발생한이후매년환자발생및사망자수가지속적으로증가추세에있고, 또한최근참진드기매개질환인라임병, 아나플라즈마증등의환자도발생하고있다. of human babesiosis in Korea: detection and characterization of a novel type of babesia sp. (KO1) similar to ovine babesia. J Clin Microbiol. 27;45(6):284-287. 3. Kim KH, Yi J, Kim G. Severe fever with thrombocytopenia syndrome. Emerg Infect Dis. 213;19(11):1892-1894. 4. Moon SJ, Gwack J, Hwang KJ, Kwon DK, Kim SY, Noh YT, et al. (213) Autochthonous Lyme Borreliosis in Humans and Ticks in Korea. Osong PHRP. 213;4(1):52-56. 5. Kim CH-M, Yi Y-H, Yu D-H, Lee M-J, Cho M-R, Atul R. et al. Tick-Borne Rickettsial Pathogens in Ticks and Small Mammals in Korea. Appl Environ Microbiol. 26;72(9):5766-5776. 6. Korea Centers for Disease Control and Prevention (KCDC). Disease Web Statistics System. Cheongju-si, Republic of Korea. 향후기후 환경변화에의해감염병매개체의서식 분포가확대될수있음에따라매개체전파질환의대유행가능성에대한대비가필요하다. 따라서현재중증열성혈소판감소증후군위주의참진드기감시체계에서라임병, 아나플라즈마증등도포함된감시체계확대 구축이필요할것으로판단된다. 이번참진드기전국분포조사를통해, 중증열성혈소판감소증후군의주요매개종으로알려진작은소피참진드기는이번조사에서전국적으로넓은분포범위와높은발생밀도를나타냈으며, 개피참진드기와일본참진드기도채집된개체수는적으나전국적으로분포하는것으로확인하였다. 특히작은소피참진드기는서식환경별분포에서도다양한환경에서높은발생밀도를보이고있어야외활동이잦은시기에참진드기에노출을줄여물리지않기위한보다적극적인홍보를통한예방 관리의강화가필요한것으로판단된다. 또한중증열성혈소판감소증후군을비롯한여러참진드기매개질환에대한방제및예방 관리전략등을수립하는기초자료로활용하기위해서는감시기간확대등지속적인조사 감시가필요할것으로사료된다. 참고문헌 1. 신이현. 중증열성혈소판감소증후군매개참진드기의종류와인체교상 사례, 주간건강과질병. 214;7(16):342-345. 2. Kim JY, Cho SH, Joo HN, Tsuji M, Cho SR, Park IJ, et al. First case www.cdc.go.kr 1421
주간건강과질병 제 11 권제 42 호 통계단신, QuickStats 과체중및비만인구국제비교 OECD 가입국가중심, 216 Comparison of overweight or obese population among OECD countries in 216 (or nearest available year) 216 년기준 OECD 과체중및비만인구비율을비교한결과, 우리나라는 34.5% 로 OECD 평균 58.1% 에비해매우낮은수준임. 국가별로는일본이 25.4% 로가장낮고, 다음으로우리나라 (34.5%), 프랑스 (49.%) 순이었으며, 가장높은국가순으로는칠레 (74.2%) 와 멕시코 (72.5%), 미국 (71.%) 으로국민 1 명중 7 명이과체중이거나비만인것으로나타남 ( 그림 A). According to percentages of overweight or obese population compared among OECD countries, in 216, Korea had secondlowest value of 34.5% following Japan with the lowest value of 25.4%, while France had the third-lowest value of 49.%. Chile had the highest value of 74.2%, followed by Mexico (72.5%) and United States (71.%) where 7 out of 1 people were either overweight or obese (Figure A). Percentage (%) 8 7 6 5 4 3 25.4 34.5 49. 5.9 51. 51.3 54.6 58.1 58.1 61. 61.4 62.3 63.4 64.1 64.4 66.8 67.6 71. 72.5 74.2 2 1 Figure A. Comparison of overweight or obese population among OECD countries in 216 (or nearest available year) * Overweight or obese population is the sum of the population with a BMI over 25 kg/m 2 (BMI 25 kg/m 2 ) OECD (19): Average of 19 member countries that have statistics of the year 216 (or nearest available year) Statistics of the year 215 have been used for France, Israel, Island, Canada, Portugal, while that of the year 214 have been used for Belgium, Estonia, Luxembourg, Hungary, Australia. Source: OECD Health Statistics 218 (OECD indicators) Reported by: Division of Chronic Disease Control, Korea Centers for Disease Control and Prevention www.cdc.go.kr 1422
주간건강과질병 제 11 권제 42 호 www.cdc.go.kr 1423
주요감염병통계, Statistics of selected infectious diseases 1.1 환자감시 : 전수감시감염병주간발생현황 (41st Week) Table 1. Reported cases of national infectious diseases in Republic of Korea, ending October 13, 218 (41st Week)* Category Ⅰ Category Ⅱ Category Ⅲ Category Ⅳ Classification of disease 218 ly average www.cdc.go.kr 1424 Total no. of cases by year 217 216 215 214 213 Cholera 2 5 4 3 Typhoid fever 4 221 1 128 121 121 251 156 Paratyphoid fever 8 54 1 73 56 44 37 54 Imported cases of current : Country (no. of cases) Shigellosis 7 24 2 111 113 88 11 294 Hong Kong(1) EHEC 2 126 2 138 14 71 111 61 Viral hepatitis A 42 2,4 4 4,419 4,679 1,84 1,37 867 Pertussis 33 759 4 318 129 25 88 36 Tetanus 26 34 24 22 23 22 Measles 4 33 1 7 18 7 442 17 Mumps 31 15,825 42 16,924 17,57 23,448 25,286 17,24 Rubella 3 15 1 7 11 11 11 18 Viral hepatitis B (Acute) 6 321 4 391 359 155 173 117 Japanese encephalitis 14 2 9 28 4 26 14 Varicella 1,88 67,526 692 8,92 54,6 46,33 44,45 37,361 Haemophilus influenza 2 3 type b Streptococcus pneumoniae 6 519 4 523 441 228 36 - Malaria 14 561 13 515 673 699 638 445 Malaysia(1), Thailand(1) Scarlet fever 174 13,749 159 22,838 11,911 7,2 5,89 3,678 Meningococcal meningitis 1 13 17 6 6 5 6 Legionellosis 9 236 2 198 128 45 3 21 Vibrio vulnificus sepsis 2 45 4 46 56 37 61 56 Murine typhus 1 12 1 18 18 15 9 19 Scrub typhus 222 1,834 43 1,528 11,15 9,513 8,13 1,365 Leptospirosis 11 11 4 13 117 14 58 5 Brucellosis 1 75 6 4 5 8 16 Rabies HFRS 2 323 16 531 575 384 344 527 Syphilis 27 1,86 28 2,148 1,569 1,6 1,15 799 CJD/vCJD 6 67 1 36 42 33 65 34 Tuberculosis 56 21,419 582 28,161 3,892 32,181 34,869 36,89 HIV/AIDS 2 728 18 1,9 1,62 1,18 1,81 1,13 Viral hepatitis C 164 8,694-6,396 - - - - VRSA - - - - - CRE 212 9,268-5,716 - - - - Dengue fever 9 156 5 171 313 255 165 252 Indonesia(2), Philippines(2), Nepal(1), Myanmar(1), Vietnam(1), India(1), Thailand(1) Q fever 26 317 1 96 81 27 8 11 West Nile fever Lyme Borreliosis 8 88 31 27 9 13 11 Melioidosis 1 2 4 4 2 2 Chikungunya fever 2 14 5 1 2 1 2 Thailand(1), Philippines(1) SFTS 18 229 9 272 165 79 55 36 MERS 1-185 - - Zika virus infection 13-11 16 - - - Unit: No. of cases 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) 719-7112
Table 2. Reported cases of infectious diseases by geography, ending October 13, 218 (41st Week)* Diseases of Category Ⅰ Unit: No. of cases Reporting area Cholera Typhoid fever Paratyphoid fever Shigellosis 218 218 218 218 Overall 2 1 4 221 131 8 54 44 7 24 85 Seoul 39 24 1 13 9 2 47 2 Busan 2 1 28 8 5 5 1 15 4 Daegu 5 5 1 5 2 1 22 2 Incheon 1 7 1 4 16 11 Gwangju 1 7 6 1 2 5 1 Daejeon 4 6 2 2 2 Ulsan 6 1 1 2 Sejong 2 1 Gyonggi 52 24 2 12 7 1 27 21 Gangwon 11 1 1 7 1 6 1 Chungbuk 8 3 1 2 3 2 Chungnam 7 7 1 1 1 19 3 Jeonbuk 4 3 1 1 2 1 3 Jeonnam 2 9 8 3 2 1 7 4 Gyeongbuk 1 5 2 1 1 21 2 Gyeongnam 1 16 21 1 1 2 9 8 Jeju 3 2 1 1 1 1 Cum: Cumulative counts from 1st to current in a year * The reported data for year 218 are provisional but the data from 213 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. www.cdc.go.kr 1425
Table 2. (Continued) Reported cases of infectious diseases by geography, s ending October 13, 218 (41st Week)* Unit: No. of cases Diseases of Category Ⅰ Diseases of Category Ⅱ Reporting area Enterohemorrhagic Escherichia coli 218 Viral hepatitis A Pertussis Tetanus 218 218 218 Overall 2 126 85 42 2,4 2,159 33 759 113 26 2 Seoul 23 11 8 47 419 63 22 2 2 Busan 1 7 4 5 12 6 98 7 3 2 Daegu 1 8 56 46 3 29 1 3 Incheon 11 7 2 143 188 4 7 2 1 Gwangju 12 14 3 26 67 3 33 6 Daejeon 3 1 3 16 92 13 1 Ulsan 7 6 1 18 22 25 2 Sejong 1 2 18 11 1 12 Gyonggi 1 11 14 1 586 661 6 19 23 2 2 Gangwon 5 2 1 49 51 4 1 2 Chungbuk 3 2 2 73 67 24 1 1 Chungnam 5 2 4 177 127 1 15 6 1 1 Jeonbuk 2 1 135 11 12 2 3 1 Jeonnam 6 5 2 27 77 4 18 5 5 3 Gyeongbuk 1 2 1 62 48 38 9 4 2 Gyeongnam 6 2 3 62 67 9 224 17 1 3 Jeju 5 3 9 13 2 3 Cum: Cumulative counts from 1st to current in a year * The reported data for year 218 are provisional but the data from 213 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. www.cdc.go.kr 1426
Table 2. (Continued) Reported cases of infectious diseases by geography, s ending October 13, 218 (41st Week)* Diseases of Category Ⅱ Unit: No. of cases Reporting area Measles Mumps Rubella 218 218 218 Viral hepatitis B (Acute) 218 Overall 4 33 12 31 15,825 14,847 3 15 19 6 321 181 Seoul 2 8 24 44 1,97 1,437 2 3 1 6 31 Busan 2 4 2 931 1,78 2 1 18 13 Daegu 1 2 2 12 662 471 1 1 14 5 Incheon 1 12 14 86 628 1 15 12 Gwangju 1 11 466 1,14 1 1 9 4 Daejeon 2 3 7 532 526 1 1 14 6 Ulsan 1 16 53 466 1 8 5 Sejong 1 11 37 Gyonggi 1 9 34 74 4,477 3,263 1 5 5 2 86 43 Gangwon 1 2 13 516 546 1 6 Chungbuk 1 2 3 42 259 1 1 1 6 Chungnam 2 3 15 67 556 1 1 13 9 Jeonbuk 2 1 11 678 1,267 2 1 11 14 Jeonnam 1 9 17 614 725 1 1 13 8 Gyeongbuk 2 5 16 833 673 1 2 15 8 Gyeongnam 17 24 1,385 1,551 1 23 1 Jeju 3 261 26 2 1 Cum: Cumulative counts from 1st to current in a year * The reported data for year 218 are provisional but the data from 213 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. www.cdc.go.kr 1427
Table 2. (Continued) Reported cases of infectious diseases by geography, s ending October 13, 218 (41st Week)* Unit: No. of cases Diseases of Category Ⅱ Diseases of Category Ⅲ Reporting area Japanese encephalitis Varicella Malaria Scarlet fever 218 218 218 218 Overall 14 13 1,88 67,526 34,567 14 561 561 174 13,749 7,565 Seoul 5 4 158 7,431 3,64 3 82 73 19 2,49 872 Busan 41 3,795 2,246 7 8 8 1,141 533 Daegu 1 1 41 3,491 1,966 12 7 5 396 338 Incheon 1 46 2,886 2,61 3 79 92 8 634 347 Gwangju 2 41 2,46 1,26 5 4 18 64 342 Daejeon 1 14 1,64 976 3 4 7 456 271 Ulsan 24 2,1 1,157 1 4 4 5 748 282 Sejong 19 1,79 177 1 1 2 88 31 Gyonggi 1 3 316 19,57 9,66 6 316 38 51 3,757 2,254 Gangwon 26 1,848 1,354 1 12 19 233 113 Chungbuk 2 1 34 2,611 687 3 6 4 272 136 Chungnam 3 2,16 1,444 8 7 7 487 363 Jeonbuk 41 2,914 1,545 5 5 8 668 236 Jeonnam 1 1 47 2,42 1,56 6 4 1 532 28 Gyeongbuk 1 1 79 3,263 1,576 3 9 13 62 466 Gyeongnam 1 14 5,839 2,686 12 7 8 931 66 Jeju 27 2,64 842 3 3 1 115 95 Cum: Cumulative counts from 1st to current in a year * The reported data for year 218 are provisional but the data from 213 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. www.cdc.go.kr 1428
Table 2. (Continued) Reported cases of infectious diseases by geography, s ending October 13, 218 (41st Week)* Diseases of Category Ⅲ Unit: No. of cases Reporting area Meningococcal meningitis Legionellosis Vibrio vulnificus sepsis Murine typhus 218 218 218 218 Overall 1 13 6 9 236 62 2 45 46 1 12 9 Seoul 1 3 2 3 58 18 7 5 1 2 Busan 1 1 1 2 3 6 4 1 Daegu 1 1 2 1 1 Incheon 3 1 19 5 5 3 1 2 1 Gwangju 1 1 1 Daejeon 3 1 1 Ulsan 3 2 2 1 Sejong Gyonggi 1 2 47 12 1 7 9 4 2 Gangwon 13 4 Chungbuk 11 3 1 Chungnam 1 7 2 6 2 1 Jeonbuk 2 1 1 1 2 Jeonnam 1 4 1 4 7 1 Gyeongbuk 1 1 25 3 1 2 Gyeongnam 3 1 9 3 7 5 4 Jeju 1 4 2 1 Cum: Cumulative counts from 1st to current in a year * The reported data for year 218 are provisional but the data from 213 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. www.cdc.go.kr 1429
Table 2. (Continued) Reported cases of infectious diseases by geography, s ending October 13, 218 (41st Week)* Diseases of Category Ⅲ Unit: No. of cases Reporting area Scrub typhus Leptospirosis Brucellosis 218 218 218 Hemorrhagic fever with renal syndrome 218 Overall 222 1,834 1,22 11 11 45 1 75 5 2 323 223 Seoul 6 62 41 8 2 1 1 16 1 Busan 8 56 42 2 2 1 2 2 13 5 Daegu 2 19 16 1 1 5 1 1 4 1 Incheon 7 35 15 2 1 11 1 6 3 Gwangju 13 49 32 2 1 1 5 3 Daejeon 15 44 34 3 4 1 3 1 6 4 Ulsan 11 38 39 1 1 1 2 2 Sejong 1 9 5 1 1 1 1 Gyonggi 12 127 114 6 16 9 2 12 3 47 62 Gangwon 2 35 31 8 3 1 3 11 16 Chungbuk 5 51 24 7 1 2 9 1 19 13 Chungnam 29 223 89 2 17 5 1 8 2 51 24 Jeonbuk 26 214 13 2 3 1 1 4 18 Jeonnam 31 445 25 13 7 6 44 32 Gyeongbuk 17 12 58 11 4 1 1 36 18 Gyeongnam 37 293 167 7 5 1 9 1 21 1 Jeju 14 7 1 1 1 Cum: Cumulative counts from 1st to current in a year * The reported data for year 218 are provisional but the data from 213 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. www.cdc.go.kr 143
Table 2. (Continued) Reported cases of infectious diseases by geography, s ending October 13, 218 (41st Week)* Unit: No. of cases Diseases of Category Ⅲ Diseases of Category Ⅳ Reporting area Syphilis CJD/vCJD Tuberculosis Dengue fever 218 218 218 218 Overall 27 1,86 976 6 67 39 56 21,419 25,718 9 156 189 Seoul 7 383 196 1 17 9 16 3,815 4,956 2 52 61 Busan 2 146 55 6 3 3 1,425 1,885 1 11 12 Daegu 1 77 45 3 3 29 99 1,286 8 8 Incheon 1 154 91 1 4 1 25 1,125 1,338 1 8 9 Gwangju 73 28 1 1 1 546 627 1 2 Daejeon 51 27 1 1 1 479 599 1 1 7 Ulsan 17 15 2 1 48 539 3 2 Sejong 9 3 2 81 68 1 Gyonggi 6 488 263 2 17 7 19 4,592 5,395 4 46 49 Gangwon 36 26 2 29 935 1,64 3 3 Chungbuk 3 58 22 1 13 79 762 2 2 Chungnam 2 64 34 1 3 26 1,35 1,141 4 5 Jeonbuk 2 43 21 3 1 12 817 956 5 4 Jeonnam 1 28 28 1 1 28 1,143 1,268 3 4 Gyeongbuk 77 4 1 6 4 28 1,499 1,844 3 8 Gyeongnam 2 65 56 1 4 2 36 1,442 1,694 5 1 Jeju 37 26 1 3 36 295 1 2 Cum: Cumulative counts from 1st to current in a year * The reported data for year 218 are provisional but the data from 213 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. www.cdc.go.kr 1431
Table 2. (Continued) Reported cases of infectious diseases by geography, s ending October 13, 218 (41st Week)* Diseases of Category Ⅳ Unit: No. of cases Reporting area Q fever Lyme Borreliosis SFTS Zika virus infection 218 218 218 3-year 218 3-year Overall 26 317 32 8 88 12 18 229 12 13 - Seoul 4 55 2 3 39 5 1 12 5 5 - Busan 1 11 1 5 1 4 1 1 - Daegu 9 1 1 1 1 4 - Incheon 1 18 1 1 1 2 2 - Gwangju 1 15 1 - Daejeon 2 12 1 1 4 2 2 - Ulsan 1 8 1 1 5 1 - Sejong 1 1 - Gyonggi 6 5 3 2 8 2 5 42 17 1 - Gangwon 4 3 3 31 13 1 - Chungbuk 3 32 1 2 12 5 - Chungnam 3 27 4 3 1 19 9 - Jeonbuk 1 12 1 2 1 12 2 2 - Jeonnam 1 26 2 2 1 15 7 - Gyeongbuk 13 2 2 1 1 32 17 - Gyeongnam 1 23 3 2 7 1 28 8 1 - Jeju 1 2 2 13 9 - Cum: Cumulative counts from 1st to current in a year * The reported data for year 218 are provisional but the data from 213 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. www.cdc.go.kr 1432
1.2 환자감시 : 표본감시감염병주간발생현황 (41st ) 1. Influenza, Republic of Korea, s ending October 13, 218 (41st ) 218 년도제 41 주인플루엔자표본감시 ( 전국 2 개표본감시기관 ) 결과, 의사환자분율은외래환자 1, 명당 3.7 명으로지난주 (3.5 명 ) 대비증가 218-219 절기유행기준은 6.3 명 (/1,) 1 9 8 7 ILI per 1, 6 5 4 3 2 1 36 38 4 42 44 46 48 5 52 2 4 6 8 1 12 14 16 18 2 22 24 26 28 3 32 34 218-219 217-218 216-217 215-216 214-215 Figure 1. Weekly proportion of influenza-like illness per 1, outpatients, 214-215 to 218-219 flu seasons 2. Hand, Foot and Mouth Disease(HFMD), Republic of Korea, s ending October 13, 218 (41st ) 218 년도제 41 주수족구병표본감시 ( 전국 95 개의료기관 ) 결과, 의사환자분율은외래환자 1, 명당 4. 명으로전주 (4.5 명 ) 대비감소 수족구병은 29 년 6 월법정감염병으로지정되어표본감시체계로운영 No. of outpatients / 1, 55. 5. 45. 4. 35. 3. 25. 2. 15. 1. 5. 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 218 217 216 215 214 213 Figure 2. Weekly proportion of hand, foot and mouth disease per 1, outpatients, 213-218 www.cdc.go.kr 1433
3. Ophthalmologic infectious disease, Republic of Korea, s ending October 13, 218 (41st ) 218 년도제 41 주차유행성각결막염표본감시 ( 전국 92 개의료기관 ) 결과, 외래환자 1, 명당분율은 33.7 명으로전주 37. 명대비감소 동기간급성출혈성결막염의환자분율은.9 명으로전주.9 명대비동일 6 5 No. of outpatients / 1, 4 3 2 1 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 218 217 216 215 214 Figure 3. Weekly proportion of epidemic keratoconjunctivitis per 1, outpatients 5 4 No. of outpatients / 1, 3 2 1 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 218 217 216 215 214 Figure 4. Weekly proportion of acute hemorrhagic conjunctivitis per 1, outpatients www.cdc.go.kr 1434
4. Sexually Transmitted Diseases, Republic of Korea, s ending October 13, 218 (41st ) 218 년도제 41 주성매개감염병표본감시기관 ( 전국보건소및의료기관 592 개참여 ) 에서신고기관당첨규콘딜롬 2.4 건, 성기단순포진 2.2 건, 클라미디아감염증 2.1 건, 임질 1.4 건발생을신고함. 제 41 주차신고의료기관수 : 임질 2 개, 클라미디아 53 개, 성기단순포진 37 개, 첨규콘딜롬 19 개 Unit: No. of cases/sentinels Gonorrhea Chlamydia Genital herpes Condyloma acuminata 218 218 218 218 1.4 7. 9.3 2.1 26.1 21.8 2.2 34.6 24.5 2.4 19.3 15. 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)719-7118, 7132 자세히보기 : 질병관리본부 정책 / 사업 감염병감시 표본감시주간소식지 1.3 수인성및식품매개감염병집단발생주간현황 (41st ) Waterborne and foodborne disease outbreaks, Republic of Korea, s ending October 13, 218 (41st ) 218 년도제 41 주에집단발생이 2 건 ( 사례수 221 명 ) 발생하였으며누적발생건수는 614 건 ( 사례수 13,25 명 ) 발생함. 9 7 5 3 No. of outbreaks 2 15 1 5 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 218 217 Average no. of cases in last 5 years(212-216) Figure 5. Number of waterborne and foodborne disease outbreaks reported by, 217-218 www.cdc.go.kr 1435
2.1 병원체감시 : 인플루엔자및호흡기바이러스주간감시현황 (41st ) 1. Influenza viruses, Republic of Korea, s ending October 13, 218 (41st ) 218 년도제 41 주에전국 52 개감시사업참여의료기관에서의뢰된호흡기검체 144 건중양성 1 건 (A/H1N1pdm9 1 건 ). No. of positives 2 18 16 14 12 1 8 6 4 2 36 37 38 39 4 41 42 43 44 45 46 47 48 49 5 51 52 1 2 3 4 5 6 7 8 9 1 11 12 13 14 15 16 17 18 19 2 21 22 23 24 25 26 27 28 29 3 31 32 33 34 35 A(H3N2) A(not subtyped) A(H1N1)pdm9 B Percent positive 11. 1. 9. 8. 7. 6. 5. 4. 3. 2. 1. Percent positives (%) Figure 6. Number of specimens positive for influenza by subtype, 218-219 flu season 2. Respiratory viruses, Republic of Korea, s ending October 13, 218 (41st ) 218 년도제 41 주호흡기검체 (144 건 ) 에대한유전자검사결과 43.8% 의호흡기바이러스가검출되었음. ( 최근 4 주평균 149 개의호흡기검체에대한유전자검사결과를나타내고있음 ) 주별통계는잠정통계이므로변동가능 218 () Weekly total Detection rate (%) No. of samples Detection rate (%) HAdV HPIV HRSV IFV HCoV HRV HBoV HMPV 38 214 51.4 11.2 2.8.9 1.4 2.8 31.3.5.5 39 23 39.1 8.7... 4.4 26.1.. 4 214 43. 11.7 5.6 1.9. 1.4 22..5. 41 144 43.8 12.5 4.2 2.8.7 4.2 18.8.7. 595 44.3 11. 3.1 1.4.5 3.2 24.5.4.1 217 11,915 56.6 3.7 6.3 4.6 1.9 4.4 19.4 2. 5.3 - 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 September 16, 218 October 13, 218. (Average No. of detected cases is 149 last 4 s) 217 : the rate of detected cases between January 1. 217. - December 3. 217. 자세히보기 : 질병관리본부 알림 주간질병감시정보 www.cdc.go.kr 1436
2.2 병원체감시 : 급성설사질환실험실표본주간감시현황 (4th ) Acute gastroenteritis-causing viruses and bacteria, Republic of Korea, s ending October 6, 218 (4th ) 218년도제4주실험실표본감시 (17 개시 도보건환경연구원및 7개의료기관 ) 급성설사질환유발바이러스검출건수는 4건 (12.5%), 세균검출건수는 39건 (21.5%) 이었음. Acute gastroenteritis-causing viruses Week No. of sample No. of detection (Detection rate, %) Group A Rotavirus Norovirus Enteric Adenovirus Astrovirus Total 218 37 65 (.) 3 (4.6) 2 (3.1) 5 (7.7) 1 (15.4) 38 56 1 (1.8) 4 (7.1) 5 (8.9) 2 (3.6) 12 (21.4) 39 34 (.) 3 (8.8) 1 (2.9) 3 (8.8) 7 (2.6) 4 32 (.) 1 (3.1) 1 (3.1) 2 (6.3) 4 (12.5) 2,82 225 (8.) 316 (11.3) 11 (3.9) 7 (2.5) 721 (25.7) * 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. 218 37 187 17 (9.1) 22 (11.8) () () () 2 (1.1) 1 (.5) 2 (1.1) 3 (1.6) 48 (25.7) 38 136 7 (5.1) 11 (8.1) 1 (.7) () () 1 (.7) () 5 (3.7) 1 (.7) 26 (19.1) 39 16 () 1 (6.3) () () () () () 1 (6.3) 2 (12.5) 4 (25.) 4 181 14 (7.7) 14 (7.7) () 3 (1.7) () () 2 (1.1) 4 (2.2) 2 (1.1) 39 (21.5) 7,161 238 (3.3) 359 (5.) 4 (.1) 11 (.2) () 75 (1.) 8 (1.1) 136 (1.9) 133 (1.9) 1,39 (14.5) * Bacterial Pathogens ; Salmonella spp., E. coli (EHEC, ETEC, EPEC, EIEC), Shigella spp., Vibrio parahaemolyticus, Vibrio cholerae, Campylobacter spp., Clostridium perfringens, Staphylococcus aureus, Bacillus cereus, Listeria monocytogenes, Yersinia enterocolitica. * Hospital participating in laboratory surveillance in 218 (7 hospitals) 자세히보기 : 질병관리본부 알림 주간질병감시정보 www.cdc.go.kr 1437
2.3 병원체감시 : 엔테로바이러스실험실주간감시현황 (4th ) Enterovirus, Republic of Korea, s ending October 6, 218 (4th ) 218년도제4주실험실표본감시 (1개시 도보건환경연구원, 전국 56개참여병원 ) 결과, 엔테로바이러스검출률 19.2%(1 건양성 /52 검체 ), 218년누적양성률 34.1%(641 건양성 /1,879 검체 ) 임. - 무균성수막염 6건 (218 년누적 188 건 ), 수족구병및포진성구협염 2건 (218 년누적 269 건 ), 합병증동반수족구 건 (218 년누적 24건 ), 기타 2건 (218 년누적 16 건 ) 임. Aseptic meningitis 8 No. of cases 6 4 2 1 5 9 13 17 21 25 29 33 37 41 45 49 53 218 Enterovirus detection cases 217 Enterovirus detection cases Figure 7. Detection cases of enterovirus in aseptic meningitis patients from 217 to 218 HFMD and Herpangina 5 4 35 3 No. of cases 25 2 15 1 5 1 5 9 13 17 21 25 29 33 37 41 45 49 53 218 Enterovirus detection cases 217 Enterovirus detection cases Figure 8. Detection cases of enterovirus in HFMD and herpangina patients from 217 to 218 HFMD with Complications No. of cases 1 9 8 7 6 5 4 3 2 1 1 5 9 13 17 21 25 29 33 37 41 45 49 53 218 Enterovirus detection cases 217 Enterovirus detection cases Figure 9. Detection cases of enterovirus in HFMD with complications patients from 217 to 218 www.cdc.go.kr 1438
3.1 매개체감시 / 말라리아매개모기주간감시현황 (4th ) Vector surveillance: Malaria vector mosquitoes, Republic of Korea, ending October 6, 218 (4th ) 218 년도제 4 주말라리아매개모기주간발생현황 (3 개시 도, 총 2 개채집지점 ) - 전체모기 : 평균 2 개체로평년 8 개체대비 6 개체 (75.%) 감소및전년 5 개체대비 3 개체 (6.%) 감소 - 말라리아매개모기 : 평균 1 개체미만으로평년 2 개체대비 2 개체 (1.%) 감소및전년 1 개체미만대비동일 모기수산출법 : 1 주일간유문등에채집된모기의평균수 ( 개체수 / 트랩 / 일 ) 7 6 No. of mosquitoes 5 4 3 2 1 Week 14 15 16 17 18 19 2 21 22 23 24 25 26 27 28 29 3 31 32 33 34 35 36 37 38 39 4 41 42 43 44 213-217 Total Mosquitoes(Average) 1 1 1 2 5 8 11 11 1 11 16 24 3 33 36 54 47 44 41 44 39 29 19 15 8 4 4 3 3 213-217 Malaria Vector Mosquitoes(Average) 1 1 2 5 8 12 12 13 21 16 17 19 23 22 16 9 6 2 1 217 Total Mosquitoes 1 1 1 1 3 4 8 8 7 8 13 14 14 19 16 17 15 15 14 22 29 2 1 8 6 5 2 3 3 4 217 Malaria Vector Mosquitoes 1 2 5 4 12 8 8 5 6 7 11 1 4 2 2 1 218 Total Mosquitoes 1 1 1 1 2 15 6 6 8 4 5 7 12 13 15 16 21 34 48 63 43 27 19 11 4 2 218 Malaria Vector Mosquitoes 1 5 3 5 9 7 18 33 45 3 16 11 2 1 Figure 1. Weekly incidences of malaria vector mosquitoes in 218 3.2 매개체감시 / 일본뇌염매개모기주간감시현황 (4th ) Vector surveillance: Japanese encephalitis vector mosquitoes, Republic of Korea, ending October 6, 218 (4th ) 218 년제 4 주일본뇌염매개모기주간발생현황 : 1 개시 도보건환경연구원 ( 총 1 개지점 ) - 전체모기 : 평균 16 개체로평년 176 개체대비 7 개체 (39.8%) 감소및전년 73 개체대비 33 개체 (45.2%) 증가 - 일본뇌염매개모기 (Japanese encephalitis vector, JEV) : 평균 12 개체로평년 41 개체대비 29 개체 (7.7%) 감소및전년 21 개체대비 9 개체 (42.9%) 감소 모기수산출법 : 주 2 회유문등에채집된모기의평균수 ( 개체수 / 트랩 / 일 ) No. of mosquitoes 3, 2, 1,8 1,6 1,4 1,2 1, 8 6 4 2 Week 14 15 16 17 18 19 2 21 22 23 24 25 26 27 28 29 3 31 32 33 34 35 36 37 38 39 4 41 42 43 44 213-217 Total Mosquitoes (Average) 2 2 3 3 12 19 145 146 261 45 68 91 13291671392 137 98 85 923 774 858 76 761 75 476 273 176 12 3 28 11 213-217 JEV Vector Mosquitoes (Average) 1 1 1 4 6 3 45 44 69 121 99 137 192 117 133 158 164 65 41 2 4 2 1 217 Total Mosquitoes 2 4 3 4 14 3 3 93 264 53 493 115 1128 1429 993 892 593 538 763 544 62 776 851 656 444 312 73 126 13 11 4 217 JEV Vector Mosquitoes 1 1 1 1 1 1 4 8 6 28 64 75 84 65 112 171 193 112 183 139 58 21 36 1 1 218 Total Mosquitoes 11 2 2 19 152 113 298 365 474 1135 427 1456 1933244 971 1964 13 1366 1386 1564 1166 68 649 728 74 22 16 218 JEV Vector Mosquitoes 3 1 2 3 4 5 8 25 21 32 45 57 97 12 114 6 72 27 12 Figure 11. Weekly incidences of Japanese encephalitis vector mosquitoes in 218 www.cdc.go.kr 1439 자세히보기 : 질병관리본부 민원 / 정부 3. 사전정보공개
3.3 매개체감시 : 쯔쯔가무시증매개털진드기누적감시현황 (41st ) Vector surveillance : Scrub typhus vector chigger mites, Republic of Korea, ending October 9, 218 (41st ) 218 년제 41 주쯔쯔가무시증매개털진드기주간발생현황 : 11 개시 도 ( 총 16 개지점 ) - 쯔쯔가무시증매개털진드기 : 털진드기지수가.5 로평년 (`13~`17) 동기간 (.3) 대비 66.7% 증가및전년 (217) 동기간 (.2) 대비 15.% 증가 *T.I.: Trap index (No. of chigger/trap) 털진드기산출법 : 1 주일간트랩에채집된털진드기의평균수 ( 개체수 / 트랩 / 주 ) 4. 3.5 No. of chigger mites/trap 3. 2.5 2. 1.5 1..5 Week 37 38 39 4 41 42 43 44 45 46 47 48 Avg.('13~'17)....1.3 1.2 1.9 2.5 3. 2.4 2.6 1.8 217.....2.4 1.1 1.8 2.4 2.3 1.2 1. 218..1..2.5 Week Figure 12. Weekly incidence of scrub typhus vector chiggers in 218 자세히보기 : 질병관리본부 민원 / 정부 3. 사전정보공개 www.cdc.go.kr 144
주요통계이해하기 < 통계표 1> 은지난 5년간발생한법정감염병과 218 년해당주발생현황을비교한표로, 금주환자수 ( ) 는 218 년해당주의신고건수를나타내며, 218 년누계환자수 ( 218) 는 218년 1주부터해당주까지의누계건수, 그리고 5년주평균환자수 ( ly average) 는지난 5년 (213-217 년 ) 해당주의신고건수와이전 2주, 이후 2주의신고건수 ( 총 25주 ) 평균으로계산된다. 그러므로금주환자수 ( ) 와 5년주평균환자수 ( ly average) 의신고건수를비교하면해당주단위시점과예년의신고수준을비교해볼수있다. 연도별환자수 (Total no. of cases by year) 는지난 5년간해당감염병현황을나타내는확정통계이며연도별현황을비교해볼수있다. 예 ) 218 년 12 주의 5 년주평균환자수 ( ly average) 는 213 년부터 217 년의 1 주부터 14 주까지의신고건수를 총 25 주로나눈값으로구해진다. * 5 년주평균환자수 ( ly average)=(x1 + X2 + + X25)/25 1주 11주 12주 13주 14주 218년 해당주 217년 X1 X2 X3 X4 X5 216년 X6 X7 X8 X9 X1 215년 X11 X12 X13 X14 X15 214년 X16 X17 X18 X19 X2 213년 X21 X22 X23 X24 X25 < 통계표 2> 는 17 개시 도별로구분한법정감염병보고현황을보여주고있으며, 각감염병별로최근 5년누계평균환자수 (Cum, average) 와 218년누계환자수 (Cum, 218) 를비교해보면최근까지의누적신고건수에대한이전 5년동안해당주까지의평균신고건수와비교가가능하다. 최근 5년누계평균환자수 (Cum, average) 는지난 5년 (213-217 년 ) 동안의동기간신고누계평균으로계산된다. 기타표본감시감염병에대한신고현황그림과통계는최근발생양상을신속하게파악하는데도움이된다.
발간등록번호 11-1351159-2-3 주간건강과질병, PHWR 은질병관리본부에서시행되는조사사업을통해생성된감시 및연구자료를기반으로근거중심의건강및질병관련정보를제공하고자최선을다할 것이며, 제공되는정보는질병관리본부의특정의사와는무관함을알립니다. 본간행물에서제공되는감염병통계는 감염병의예방및관리에관한법률 에의거, 국가감염병감시체계를통해신고된자료를기반으로집계된것으로집계된당해년도자료는의사환자단계에서신고된것이며확진결과시혹은다른병으로확인될경우수정될수있는잠정통계임을알립니다. 주간건강과질병, PHWR 은질병관리본부홈페이지를통해주간단위로게시되고있으며, 정기적구독을원하시는분은 kcdc215@korea.kr로신청가능합니다. 이메일을통해보내지는본간행물의정기적구독요청시구독자의성명, 연락처, 직업및이메일주소가요구됨을알려드립니다. 주간건강과질병 발간관련문의 : kcdc215@korea.kr/ 43-249-328/33 창 발 간 : 28 년 4 월 4 일 행 : 218 년 1 월 18 일 발행인 : 정은경 편집인 : 박도준 편집위원 : 최영실, 김기순, 조신형, 조성범, 김봉조, 구수경, 김용우, 조은희, 이은규, 윤여란, 신영림, 김청식, 전경아, 권효진 편 집 : 질병관리본부유전체센터의과학지식관리과 충북청주시흥덕구오송읍오송생명2로 187 오송보건의료행정타운 ( 우 )28159 Tel. (43) 249-328/33 Fax. (43) 249-334 www.cdc.go.kr 1442