pissn X eissn PUBLIC HEALTH WEEKLY REPORT, PHWR Vol.11, No CONTENTS 년국내일본뇌염실험실검사현황 0949 감염병실험실검

pissn 25-811X eissn 2586-86 www.cdc.go.kr PUBLIC HEALTH WEEKLY REPORT, PHWR Vol.11, No.29 218 CONTENTS 944 213-217 년국내일본뇌염실험실검사현황 949 감염병실험실검사온라인의뢰시스템소개 953 통계단신 (QuickStats) 안전벨트착용률추이 955 주요감염병통계환자감시 : 전수감시, 표본감시 병원체감시 : 인플루엔자및호흡기바이러스 급성설사질환, 엔테로바이러스 매개체감시 : 말라리아매개모기, 일본뇌염매개모기

주간건강과질병 제 11 권제 29 호 연구단신, Brief report 1 213-217 년국내일본뇌염실험실검사현황 질병관리본부감염병분석센터바이러스분석과이은주, 이혁진, 최우영, 강춘 * 질병관리본부국립보건연구원감염병연구센터신종감염병 매개체연구과이주연 * 교신저자 : kangchun@korea.kr, 43-719-819 Laboratory-based diagnosis of Japanese encephalitis in the Republic of Korea from 213 to 217 Lee EunJu, Lee Hyeokjin, Choi Wooyoung, Kang Chun Division of Viral Diseases, Center for Laboratory Control of Infectious Diseases, KCDC Lee Joo-Yeon Division of Emerging Infectious Disease and Vector Research, Center for Infectious Diseases Research, KNIH, KCDC Japanese encephalitis virus (JEV), a mosquito-borne zoonotic pathogen, is one of the major causes of viral encephalitis. Since 21, the number of patients with Japanese encephalitis (JE) in the Republic of Korea has increased. This article showed the results of the laboratory-based diagnosis of JE from 213 to 217. Real-time reverse transcription-polymerase chain reaction, enzyme-linked immunosorbent assay, indirect immunofluorescence assay, and plaque reduction neutralization test were used to detect JEV in serum and/or cerebrospinal fluid (CSF) samples. Although most JE cases showed higher antibody titers in acute and convalescent serum samples, this study focused on investigating four unusual cases. Based on these results, if the initial sample from suspected JE patients was negative for JE IgM, the second and third samples from the same patient should be obtained to accurately diagnose of JEV infection. Keywords : Japanese encephalitis, Japanese encephalitis virus, Enzyme-linked immunosorbent assay, Immunofluorescence assay, Plaque reduction neutralization test 들어가는말 일본뇌염 (Japanese encephalitis, JE) 은일본뇌염바이러스 (Japanese encephalitis virus, JEV) 에의한인수공통감염병으로, 바이러스성뇌염증상을보이며대부분아시아지역에서발생한다 [1,2]. 일본뇌염바이러스는플라비바이러스과 (family Flaviviridae) 플라비바이러스속 (genus Flavivirus) 에속하는 RNA 바이러스이며주로집모기속 (Culex genus) 모기를매개로전파된다. 돼지나물새가일본뇌염바이러스의주요증폭숙주로알려져있으며매개체인모기가그피를흡혈하고다시우연숙주인사람의피를흡혈할때바이러스가인체에침입하여감염된다 [3]. 일본뇌염은모기의활동이왕성한여름부터가을 (8월 ~11월 ) 동안주로발생하며 [4], 대부분이무증상으로지나가고 25명중 1명정도에서증상이나타난다. 약 7~14일의잠복기를거쳐고열 (39~4 ), www.cdc.go.kr 944

주간건강과질병 제 11 권제 29 호 두통, 현기증, 구토, 복통, 지각이상등을보인다. 심하면마비및운동장애와같은신경증상이나타나고급성뇌염, 무균성수막염, 비특이적인열성질환등으로의식장애, 경련, 혼수등에이르러 3% 정도의사망률을보인다. 회복되어도 1/3 정도는신경계합병증이남을수있다 [5,6,7]. 우리나라에서는 1985년부터소아를대상으로국가예방접종사업에일본뇌염예방접종을도입하면서일본뇌염발생이감소하였으나, 21년부터국내일본뇌염환자가증가하기시작하였다 [8]. 이글에서는 213년부터 217년까지국내일본뇌염의심환자에대한실험실검사현황및특이사례 4건에대해기술하고자한다. IFA) 또는플라크감소중화시험법 (Plaque reduction neutralization test, PRNT) 으로항체가상승여부를확인한다 [9](Table 1). 국내일본뇌염진단기준은 217년법정감염병진단 신고기준 의 2군감염병 ( 예방접종대상질환 ) 에따라일본뇌염에합당한임상적특징을나타내면서, 검체 ( 혈청, 뇌척수액등 ) 에서바이러스분리또는회복기혈청의항체가가급성기에비하여 4배이상증가가확인되거나특이유전자가확인되었을경우일본뇌염확진환자로판정하고있다. 그리고예방접종에의한항체가증가또는교차반응으로인해다른플라비바이러스 ( 예, 웨스트나일열바이러스 ) 감염에의한항체가증가가있을수있으므로역학적배경과임상증상을반드시고려하여, 필요시교차반응을확인하는실험을수행한다 [1,11]. 몸말 1. 일본뇌염실험실검사방법 2. 일본뇌염실험실검사현황 일본뇌염실험실검사의뢰건수는 213 년 8 건, 214 년 1,8 건, 215 년 1,118 건 216 년 1,491 건, 217 년 1,154 건으로 216 년까지는매년 증가하였으며 217 년에다소감소하였다 (Figure 1). 일본뇌염실험실 국내일본뇌염의심환자에대한실험실검사를위하여유전자검출검사 (Real-time reverse transcription-polymerase chain reaction, rrt-pcr), 항체검출검사 (Enzyme-linked immunosorbent assay, ELISA), 배양검사를수행하고있다. 검체채취일이발병일로부터 5일이내인경우유전자검출검사와항체검출검사를동시에수행하고, 검체채취일이발병일로부터 5일이후인경우항체검출검사를수행한다. 급성기혈청의항체검출검사에서 IgM 양성결과가나오면추정진단으로, 회복기혈청을요청하여두검체간간접면역형광항체법 (Indirect immunofluorescence assay, 검사의뢰건수에는뇌염증상을보이는환자의배제진단이대부분을차지하고있으며, 이중실제일본뇌염의심환자로신고된건수는 213년 32건, 214년 39건, 215년 64건, 216년 118건, 217년 143건으로보고되었다. 그리고국내일본뇌염확진환자는 213년 14건, 214년 26건, 215년 4건, 216년 28건, 217년 9건으로 213년부터 217년까지총 117건으로써, 215년까지증가하다최근 2년간감소한결과를보였다 (Figure 1). 검체종류별 ( 혈청, 뇌척수액 ) 로연도별실험실검사의뢰건수및양성건수를살펴보면, 혈청의경우 213년에실험실검사의뢰 356건중 23건, Table 1. Laboratory testing for Japanese encephalitis Classification Method Notes Molecular detection Real-time RT-PCR - Virus isolation Cell culture - Serology Indirect Immunofluorescence assay IgM, IgG Enzyme-Linked Immunosorbent assay Plaque reduction neutralization test IgM, IgG Neutralizing Ab www.cdc.go.kr 945

주간건강과질병 제 11 권제 29 호 No. of tested cases (serum) No. of tested cases (CSF) No. of reported cases No. of JE cases 16 836 14 No. of patients 12 1 8 6 444 565 515 678 44 655 635 519 4 356 2 32 213 14 118 143 64 39 26 4 28 214 215 216 217 Year 9 Figure 1. Annual distribution of patients with Japanese encephalitis in the Republic of Korea, 213-217 *JE: Japanese encephalitis; CSF: cerebrospinal fluid 214년 515건중 65건, 215년 44건중 7건, 216년 655건중 53건, 217년 519건중 12건의양성건수가있었다. 뇌척수액의경우 213년에실험실검사의뢰 444건중 7건, 214년 565건중 21건, 215년 678건중 34건, 216년 836건중 26건, 217년 635건중 7건의양성건수가확인되었다. 상승하여일본뇌염으로확인되었다. 조사결과, 이환자는발병일 2주전에라오스해외여행력과국내일본뇌염바이러스매개모기의활동시기를감안할때, 라오스에서감염되어입국후발병한것으로추정되는해외유입의심사례로밝혀졌다. 둘째, 일본뇌염은바이러스가혈액내에서검출될수있는 기간이짧기때문에유전자검출사례가거의없는데, 215 년에 3. 일본뇌염특이사례 213년부터 217년까지일본뇌염실험실검사를통한여러사례들을살펴보면, 대부분은급성기와회복기혈청간의항체역가가상승한경우들이지만여기서는특이한사례 4가지를소개하고자한다. 첫째, 일본뇌염확진환자는대부분모기의활동시기와맞물려 8월부터 11월에대부분발생하는데 214년 1건은 5월에발생하였다. 1차혈청과 2차혈청및뇌척수액에서일본뇌염바이러스에대한 IgM 항체가검출되었고, 전체항체역가는 1:16에서 1:256이상으로 1건의유전자검출사례가있었다. 환자뇌척수액에서유전자검출을확인하였으며세포배양으로바이러스분리도성공하였다. 염기서열분석결과, 일본뇌염바이러스유전형 5형에속하는것을확인하였다. 일본뇌염바이러스는유전형이크게 5개로구분되는데 [12], 과거우리나라모기에서유전형 1형과 3형이유행하다 21년이후부터유전형 5형이확인되기시작하였다 [13,14]. 현재시판되는일본뇌염백신주는유전형 3형에속한다. 국내에서일본뇌염바이러스유전형 5형이사람에서검출된경우는이사례가첫번째로써시사하는바가크다. 향후일본뇌염바이러스유전형 3형및유전형 5형에대한특성분석및관련연구의필요성이제기된다. www.cdc.go.kr 946

주간건강과질병 제 11 권제 29 호 셋째, 217년도에일본뇌염과웨스트나일열에대한교차반응을플라크감소중화시험법 (PRNT) 으로감별진단한사례이다. 일본뇌염 1차혈청에대한일본뇌염중화항체가 1:84, 2차혈청의일본뇌염중화항체가 1:7,878, 3차혈청의일본뇌염중화항체가 1:8,737로 4배이상의높은항체가상승을보였다. 웨스트나일열의경우 1차혈청중화항체가 1:49, 2차혈청의중화항체가 1:619로항체가가상승하였지만, 3차혈청의중화항체가 1:685로항체가상승이 2차, 3차비교시거의없어, 일본뇌염양성으로판정하였다. 일본뇌염바이러스와웨스트나일열바이러스는플라비바이러스 기술이전되어전국에서실험실검사가이루어지고있으며, 필요시추가적인확인검사는질병관리본부바이러스분석과에서수행하고있다. 213년부터 217년까지일본뇌염사례들을보면위에서언급한특이한사례들도있지만, 대부분은급성기와회복기혈청간의항체역가가상승한경우들이다. 일본뇌염확인진단을위하여일본뇌염의심환자로부터조기에적절한검체를채취하는것이중요하며, 필요할경우추가검체가확보되어실험실검사가잘이루어지도록하여야한다. 중에서도같은혈청형에속해서로교차반응을보이며이런경우 gold standard 방법인플라크감소중화시험법 (PRNT) 으로감별진단하는것이꼭필요하다 [15,16]. 넷째, 대부분의사례들은 1차검체에서 IgM 양성이면 2차검체의항체가상승으로이어져일본뇌염으로확진되지만, 이와다른결과를보이는사례가있었다. 215년사례는 1차뇌척수액에서 IgM 양성이었지만, 1차혈청에서는 IgM 음성, 2차혈청에서는 IgM equivocal( 양성과음성의경계치값 ), 3차혈청에서는 IgM 음성이나왔다. 또한플라크감소중화시험법 (PRNT) 으로확인실험을진행한결과 1:1 미만의항체가를보여최종일본뇌염음성으로판정하였다. 맺는말 29년 WHO 서태평양지역일본뇌염실험실네트워크가결성되어, 일본뇌염실험실진단체계를표준화하고이를기반으로각국의일본뇌염발생상황을정확히파악하여위험요인을분석함으로써일본뇌염퇴치에노력하고있다. 우리나라는 WHO 서태평양지역표준실험실 (Regional reference laboratory, RRL) 로지정되어일본뇌염실험실진단체계의표준화와서태평양지역내다른국가의일본뇌염확인검사를수행하는등 WHO와협력하고있다. 218년 1월부터 17개전국시 도보건환경연구원으로일본뇌염의실험실검사법 ( 유전자검출검사및항체검출검사 ) 이 참고문헌 1. Zheng Y, Li M, Wang H, Liang. Japanese encephalitis and Japanese encephalitis virus in mainland China. Reviews in Medical Virology. 212 Sep;22(5):31-322. 2. Sohn YM. Japanese encephlaitis Immunization in south Korea: Past, Present, and Future. Emerg Infect Dis. 2;6(1):17-24. 3. Endy TP, Nisalak A. Japanese encephalitis virus: ecology and epidemiology. Curr Top Microbiol Immunol. 22;267:11-48. 4. 질병관리본부법정감염병진단검사통합지침 ( 제2판 ). 5. So Lee Park, Yan-Jang S. Huang, Amy C. Lyons, Victoria B. Ayers, Susan M. Hettenbach, D. Scott McVey, Kenneth R. Burton, Stephen Higgs, Dana L. Vanlandingham. North American domestic pigs are susceptible to experimental infection with Japanese encephalitis virus. Sci Rep. 218;8:7951. Published online 218 May 21. doi: 1.138/s41598-18-2628-8 6. Tobias E. Erlanger, Svenja Weiss, Jennifer Keiser, Jurg Utzinger, and Karin Wiedenmayer. Past, Present, and Future of Japanese encephalitis. Emerg Infect Dis. 29 Jan;15(1):17. doi: 1.321/eid151.8311 7. Campbell GL, Hills SL, Fischer M, Jacobson JA, Hoke CH, et al. Estimated global incidence of Japanese encephalitis: a systematic review. Bull World Health Organ. 211;89:766774, 774A-774E. doi: 1.2471/BLT.1.85233 8. 정채원, 양태언, 홍정익. 211-215년국내일본뇌염환자의역학적특성. 주간건강과질병. 216;9(12):211-216. 9. Ju YR and Jeong YE. Manual for laboratory diagnosis of flavivirus infection. Korea Centers for Disease Control and Prevention. 29. 1. 217 법정감염병의진단및신고기준 - 2군감염병 ( 예방접종대상질환 ). www.cdc.go.kr 947

주간건강과질병 제 11 권제 29 호 11. 법정감염병진단검사통합지침. 12. Solomon T, Ni H, Beasley DW, Ekkelenkamp M, Cardosa MJ, Barrett AD. Origin and evolution of Japanese encephalitis virus in southeast Asia. J Virol. 23 Mar;77(5):391-398. 13. Takhampunya R, Kim HC, Tippayachai B, Kengluecha A, Klein TA, Lee WJ, Grieco J, Evans BP. Emergence of Japanese encephalitis virus genotype V in the Republic of Korea. Virol J. 211 Sep 23;8:449. doi: 1.1186/1743-422X-8-449. 14. Kim H, Cha GW, Jeong YE, Lee WG, Chang KS, Roh JY, Yang SC, Park MY, Park C, Shin EH. Detection of Japanese encephalitis virus genotype V in Culex orientalis and Culex pipiens (Diptera: Culicidae) in Korea. PLoS One. 215 Feb 6;1(2):e116547. doi:1.1371/ journal.pone.116547. ecollection 215. 15. Hirota J, Nishi H, Matsuda H, Tsunemitsu H, Shimiz S. Crossreactivity of Japanese encephalitis virus-vaccinated horse sera in serodiagnosis of West Nile virus. J Vet Med Sci. 21Mar;72(3):369-72. Epub 29 Dec 8. 16. Yamshchikov G, Borisevich V, Kwok CW, Nistler R, Kohlmeier J, Seregin A, Chaporgina E, Benedict S, Yamshchikov V. The suitability of yellow fever and Japanese encephalitis vaccines for immunization against West Nile virus. Vaccine. 25 Sep 15;23(39):4785-92. www.cdc.go.kr 948

주간건강과질병 제 11 권제 29 호 연구단신, Brief report 2 감염병실험실검사온라인의뢰시스템소개 질병관리본부감염병분석센터감염병진단관리과오은비, 길병철, 최영실, 유천권 * * 교신저자 : ckyoo@korea.kr, 43-719-784 Online referral system for laboratory testing of infectious diseases Oh Eun-bi, Gill Byoung-chul, Choi Young-sill, Yoo Cheon-kwon Division of Laboratory Diagnosis Management, Center for Infectious Disease Control, KCDC The Korea Centers for Disease Control and Prevention and Public Health and Environment Research Institutes at city/ provincial level provide laboratory testing services to medical institutions for the identification of pathogens-causing infectious diseases. Off-line referral system for laboratory testing revealed the inconveniences that medical institutions referring their specimens were required to submit paper-based request forms. To improve this process, we newly established an on-line referral system in September 217. This article provides an overview of the entire process of the system. Keywords : Infectious diseases, Clinical laboratory service, On-line system, Korea Centers for Disease Control and Prevention 들어가는말 국내발생감염병의예방및관리는 감염병의예방및관리에 이글에서는온라인 ( 질병보건통합관리시스템 ) 을통하여 감염병의사환자검체를의뢰하는 감염병실험실검사온라인 의뢰시스템 ( 이하, 온라인의뢰시스템 ) 에대해서소개하고자한다. 관한법률 제 4 조 ( 국가및지방자치단체의책무 ) 에의하여국가 및지방자치단체의공동책무로규정하고있다 [1]. 감염병병원체확인기관중질병관리본부와 17개시 도보건환경연구원은감염병의심환자로부터채취된검체로검사하여최종원인병원체를확인하는민원업무를수행하고있다. 이러한 검체시험의뢰 민원 [ 민원처리기준표고시 ( 행정자치부고시제 217-8호, 217.2.28.)] 은오프라인방식과최근 (217년 9월 ) 에개발한온라인방식으로의뢰되고있다. 몸말 감염병실험실검사온라인의뢰시스템 서면으로검체시험의뢰서를작성하여검사를의뢰하는오프라인검사의뢰는감염병관리기관 ( 보건소 ) 에결과를추후 www.cdc.go.kr 949

주간건강과질병 제 11 권제 29 호 Medical Institution Infectious diseases of outbreak notification and test request Notification and test request Test results The competent of public health clinic - Approval of test request - Infectious diseases of test request - Notice of test results Test request Test results KCDC Public Health and Environment Research Institute Figure 1. Procedure of test request and notice of test result 통보해야하며, 감염병환자신고건과검사결과가한화면에통합 관리되지않는다는어려움이있었다. 또한, 우편으로발송되는 시험성적서로는신속하게환자의검사결과를확인할수없으며, 온라인의뢰시스템은질병보건통합관리시스템에로그인후, 권한 / 부가정보관리 페이지에서기관에해당되는권한을모두 승인받아야이용가능하다 (Table 1). 의뢰기관의검사의뢰내역을통합적으로확인할수없는점, 검사기관에서는검체를받기전까지의뢰기관의검체발송내용을 확인하지못한다는어려움이있었다. 이러한오프라인검사의뢰의 의료기관 : 환자감시 / 전수감시 User, 병원체확인 User( 의료기관 ) 보건소 : 전수감시 User, 병원체확인 User( 보건소 ) 단점을개선하기위해, 질병관리본부에서는 217 년 5 월부터 유관기관 ( 질병관리본부, 보건환경연구원, 보건소 ) 과여러차례의견수렴및시범운영을진행하면서, 온라인의뢰시스템을개발하였다. 온라인의뢰시스템은국내발생감염병및환자발생정보를관리하는감염병관리통합정보지원시스템의일부로 환자감시 와 병원체확인 메뉴를통해서시험의뢰가가능하게구현하였다. 의료기관권한은승인신청후, 익일자동으로승인을진행하고있다. 보건소권한은보건복지인력개발원 (www.kohi.or.kr) 에서 국가감염병감시사업안내 교육을수료하고 전수감시 User 권한을승인받으면, 이튿날이내 병원체확인 User ( 보건소 ) 권한을승인처리하고있다. 환자감시 메뉴는제 1 군 ~ 제 4 군감염병신고및검사의뢰에 사용되는메뉴이며, 병원체확인 메뉴는그외감염병을검사의뢰, 시험성적서발급및추가검사의뢰하는메뉴로활용된다. 개발된온라인의뢰시스템에서검사의뢰절차는의료기관이의심환자에대한정보를온라인시스템에입력하고채취된검체를검사기관 ( 질병관리본부, 보건환경연구원 ) 으로전달하면관할보건소는온라인으로의뢰된내용을확인후승인한다. 승인된검사의뢰는검사기관 ( 질병관리본부, 보건환경연구원 ) 에서접수확인후검사가진행되어진다. 이러한검사의뢰부터결과를입력하는전과정이실시간으로확인될수있도록개발하여, 기존오프라인검체시험의뢰서의단점을보완하였다 (Figure 1). 감염병실험실검사온라인의뢰권한신청및승인방법 감염병실험실검사온라인검사의뢰방법 각기관에서는검사의뢰를진행하기전에 병원체확인 - 운영관리 - 기관정보관리 메뉴에서기관의정보 ( 기관주소, 담당자, 전화번호, 팩스번호, 기관직인이미지 ) 를등록해야만온라인검사의뢰가가능하다. 감염병실험실검사온라인의뢰방법은 1 제1군 ~ 제4군감염병대상으로의사환자를신고하는감염병검사의뢰방법과, 2 병원체보유자신고감염병, 의사환자를신고하지않는감염병, 제5군감염병, 지정감염병, 비법정감염병을검사의뢰하는방법 2가지로구분된다 [2]. 1 제1군 ~4군감염병중의사환자를신고하는감염병은의사환자를신고하는 환자감시 메뉴에서검사의뢰가진행된다. www.cdc.go.kr 95

주간건강과질병 제 11 권제 29 호 Table 1. Name of authority, function and menu of the online referral system Object Name of authority Function Name of menu Medical institution Patient surveillance /complete surveillance user Notification of national notifiable infectious diseases (Group 1~4) Request of laboratory testing service of national notifiable infectious diseases (Group 1~4) Patient surveillance Pathogen confirm user (Medical institution) Request of laboratory testing service of infectious diseases (Group 5, designated, etc.) Pathogen confirm Public health clinic Complete surveillance user Approval of specimen referral (for laboratory testing service of national notifiable infectious diseases (Group 1~4) Request of laboratory testing service of national notifiable infectious diseases (Group 1~4) Reporting of the test result Patient surveillance Pathogen confirm user (Public health clinic) Approval of specimen referral (for laboratory testing service of infectious diseases (Group 5, designated and etc) Request of laboratory testing service of infectious diseases(group 5, designated, etc.) Reporting of the test result Pathogen confirm 검사의뢰상세방법은 환자감시 - 감염병웹신고( 병의원 ) - 신고내역관리 페이지에서감염병발생신고건중에검사의뢰환자의인적사항을확인후, 검사의뢰 버튼을누른다. 환자감시 메뉴에서수행하는검사의뢰는감염병발생신고정보중에환자및 ( 신고의료기관 ) 기관정보가자동으로검사의뢰정보입력창에반영되어, 담당의사정보, 검체운송기관정보, 검사의뢰정보만입력하면된다. 2 의사환자를신고하지않는감염병과기타감염병 * 은 병원체확인 메뉴에서검사의뢰가진행된다. 검사의뢰상세방법은 병원체확인 - 검사의뢰현황관리 - 검사의뢰접수현황관리 페이지에서 검사의뢰 버튼을클릭한후, 검체시험의뢰서 ( 질병관리본부시험의뢰규칙 별지제 7호서식 ) 정보를입력한다. 검사의뢰접수완료후, 감염병실험실검사가수행된다. 검사결과는검사가끝마치는대로통보되며모든검사가완료되지 않은경우, 시험성적서의하단에 해당기관에서의뢰한검사가진행중입니다. 라는문구가표시된다. 모든검사가완료되면검사결과와최종감염병실험실판정결과가시험성적서에표시되며, 검사결과통보의절차도검사의뢰절차와동일하게 검사기관- ( 의료기관소재지 ) 보건소 - 의료기관 으로진행된다. 통보되는감염병검사결과는의료기관ㆍ보건소ㆍ시도ㆍ질병관리본부에서감염병검사결과와감염병발생 ( 신고 ) 현황을한화면에서통합하여확인할수있게된다. 감염병실험실검사온라인의뢰시스템문서특성 온라인의뢰시스템에서생성되는검체시험의뢰서와시험성적서는질병관리본부시험의뢰규칙, 보건환경연구원운영조례별지서식문서이다. 특히검사결과통보에활용되는 * 기타감염병 : 제1군 ~ 제4군감염병에서의사환자를신고하지않는감염병 [ 말라리아, 후천성면역결핍증, C형간염, 반코마이신내성황색포도알균 (VRSA) 감염증, 카바페넴내성장내세균속균종 (CRE) 감염증, 진드기매개뇌염 ], 제5군감염병, 지정감염병, 비법정감염병, 병원체보유자신고대상감염병 [ 제1군감염병, 제3군감염병 ( 말라리아, C형간염, 반코마이신내성황색포도알균 (VRSA) 감염증, 카바페넴내성장내세균속균종 (CRE) 감염증 ), 제4군감염병 ( 중동호흡기증후군 (MERS), 지카바이러스감염증 )], 그리고추정환자에한해서만의사환자신고를받는감염병 (b형헤모필루스인플루엔자, 폐렴구균, 레지오넬라증 ) www.cdc.go.kr 951

주간건강과질병 제 11 권제 29 호 시험성적서저장물에는위변조를확인하는전자문서의생성시점 확인및진본확인 ( 위변조검증 ) 을위한국제표준기술인 타임스탬프를도입하였다. 또한출력한시험성적서에는진위 검사결과입력시스템도입, 감염병집단발생시스템, 국제대회 선수관리시스템등앞으로도국내발생감염병관리에효율적으로 대응및운영될수있도록시스템개선및운영에노력할것이다. 확인조치및출력매수제한조치, 위ㆍ변조방지조치를수행한 출력물위변조방지솔루션도입등 민원처리에관한법률시행령 3조 ( 전자문서의출력사용등 ) 에부합한공문서규격을적용하였다 [3]. 감염병실험실검사온라인의뢰시스템기타기능 추가적으로, 검사기관별감염병검사법수행가능여부, 감염병 참고문헌 1. 감염병의예방및관리에관한법률 제4조 ( 국가및지방자치단체의책무 ), 제11조 ( 의사등의신고 ). 2. 217 법정감염병진단신고기준. 3. 민원처리에관한법률시행령 제3조 ( 전자문서의출력사용등 ). 4. 온라인감염병검사의뢰방법안내서 ( 의료기관, 보건소 ). 검사가능한검체, 시험담당부서연락처, 검사내용및처리기간을확인할수있는안내페이지 병원체확인 - 민원사무명안내 가개발되어, 검사의뢰인의참고메뉴로활용하고있다. 각의뢰기관별감염병검사의뢰내역을조회하여관리할수있는엑셀다운로드기능과회복기결과로동일환자에대해서추가로검사의뢰할수있는 추가검사의뢰 기능도운영중에있다. 시스템의상세사용방법매뉴얼자료는질병보건통합관리시스템 -공지사항에 온라인검사의뢰방법안내 게시글로등록되어있다. 맺는말 이글에서는질병관리본부, 보건환경연구원 감염병실험실검사온라인의뢰시스템 에대해서검사의뢰방법및개발된기능을간략히소개하였다. 현재온라인의뢰시스템은운영도입기로많은의료기관과보건소에서시스템사용함에따라발생되는불편한점과오류에대해서의견을제출하고있다. 발생되는오류에대해서는즉각적인개선을위해노력하고있으며, 사업부서인감염병관리과와협의를통해사용자가보다편리하게이용할수있도록디자인을개선하고기능을고도화하고있다. 향후감염병실험실검사온라인의뢰시스템은보건소 www.cdc.go.kr 952

주간건강과질병 제 11 권제 29 호 통계단신, QuickStats 안전벨트착용률추이 Seat belt use among Korean adults aged 19 years and over, 28-217 [ 정의 ] 운전자석안전벨트착용률 : 자동차운전시안전벨트를항상착용하는사람의분율동승차량앞좌석안전벨트착용률 : 승용차나택시앞좌석에탈때안전벨트를항상착용하는사람의분율동승차량뒷좌석안전벨트착용률 : 승용차나택시뒷좌석에탈때안전벨트를항상착용하는사람의분율만 19세이상동승차량뒷좌석안전벨트착용률의중앙값은 214년 7.8% 에서 217년 13.7% 로 5.9%p 증가하는경향을보였으나, 217년기준 1명중약 8명인운전자석또는동승차량앞좌석안전벨트착용률에비해매우낮은수준임 ( 그림 A). * 주 ) 제시된통계치는 254개지역단위 ( 시 군 구 ) 로산출된연령표준화율의중앙값임. Median value for the proportion of rear seat passengers who wear seat belts increased by 5.9%p from 7.8% in 214 to 13.7% in 217, but is still very low compared to the values for drivers and front seat passengers. Nearly eight out of 1 drivers and/or front seat passengers wore seat belts in 217 (Figure A). 1 9 8 87.7 79.6 79.8 79.7 74. 74.6 76.7 79.8 84.1 85.7 Age-standardized rates (%) 7 6 5 4 3 74.8 73. 74.1 7.8 Drivers wearing seat belts Front seat passengers wearing seat belts 69.6 71.5 69.3 7.5 76.8 79.9 2 1 Rear seat passengers wearing seat belts 7.8 9.6 12.6 13.7 28 29 21 211 212 213 214 215 216 217 Survey year Figure A. Trends in proportions of seat belt use among Korean adults aged 19 years and over, 28-217 * Provided statistical value is the median calculated from 254 regional units (Si Gun Gu) Proportion of drivers wearing seat belts: proportion of drivers who always wear seat belts when driving, among all drivers aged 19 years and over Proportion of front seat passengers wearing seat belts: proportion of front seat passengers who always wear seat belts when riding cars or taxis, among all front seat passengers aged 19 years and over Proportion of rear seat passengers wearing seat belts: proportion of rear seat passengers who always wear seat belts when riding cars or taxis, among all rear seat passengers aged 19 years and over Age standardized rates (%): calculated using the direct standardization method, based on a 25 population projection Source: 28-217 Community Health Statistics At A Glance, Korea Community Health Survey, http://chs.cdc.go.kr/ Reported by: Division of Chronic Disease Control, Korea Centers for disease Control and Prevention www.cdc.go.kr 953

주간 건강과 질병 제11권 제29호 www.cdc.go.kr 954

주요감염병통계, Statistics of selected infectious diseases 1.1 환자감시 : 전수감시감염병주간발생현황 (28th Week) Table 1. Reported cases of national infectious diseases in Republic of Korea, ending July 14, 218 (28th Week)* Category Ⅰ Category Ⅱ Category Ⅲ Category Ⅳ Classification of disease 218 ly average www.cdc.go.kr 955 Total no. of cases by year 217 216 215 214 213 Cholera 2 5 4 3 Typhoid fever 14 189 3 128 121 121 251 156 Paratyphoid fever 7 3 1 73 56 44 37 54 Cuba(1) Imported cases of current : Country (no. of cases) Shigellosis 12 15 2 111 113 88 11 294 Philippines(5), Ghana(1) EHEC 13 7 4 138 14 71 111 61 Philippines(1) Viral hepatitis A 29 1,542 46 4,419 4,679 1,84 1,37 867 Pertussis 43 336 4 318 129 25 88 36 Tetanus 2 1 34 24 22 23 22 Measles 7 85 2 7 18 7 442 17 Mumps 55 11,851 422 16,924 17,57 23,448 25,286 17,24 Rubella 1 56 1 7 11 11 11 18 Viral hepatitis B (Acute) 14 222 6 391 359 155 173 117 Japanese encephalitis 9 28 4 26 14 Varicella 1,954 5,336 81 8,92 54,6 46,33 44,45 37,361 Haemophilus influenza type b 2 3 Streptococcus pneumoniae 12 444 4 523 441 228 36 - Malaria 41 314 32 515 673 699 638 445 Scarlet fever 329 11,491 185 22,838 11,911 7,2 5,89 3,678 Meningococcal meningitis 1 17 6 6 5 6 Legionellosis 7 156 2 198 128 45 3 21 Vibrio vulnificus sepsis 1 1 46 56 37 61 56 Murine typhus 7 18 18 15 9 19 Scrub typhus 85 1,19 21 1,528 11,15 9,513 8,13 1,365 Leptospirosis 7 36 1 13 117 14 58 5 Brucellosis 2 34 6 4 5 8 16 Unknown(1) Rabies HFRS 21 184 6 531 575 384 344 527 Syphilis 28 1,28 27 2,148 1,569 1,6 1,15 799 CJD/vCJD 4 38 1 36 42 33 65 34 Tuberculosis 619 15,355 666 28,161 3,892 32,181 34,869 36,89 HIV/AIDS 17 475 26 1,9 1,62 1,18 1,81 1,13 Viral hepatitis C 246 6,161-6,396 - - - - Russia(1) VRSA - - - - - CRE 26 5,798-5,716 - - - - Dengue fever 9 13 6 171 313 255 165 252 Philippines(3), Laos(2), Malaysia(1), Maldives(1), Vietnam(1), Thailand(1) Q fever 31 214 1 96 81 27 8 11 Thailand(1) West Nile fever Lyme Borreliosis 7 58 31 27 9 13 11 Philippines(1) Melioidosis 2 4 4 2 2 Chikungunya fever 1 1 5 1 2 1 2 Philippines(1) SFTS 14 91 4 272 165 79 55 36 MERS - 185 - - Zika virus infection 2 2-11 16 - - - Thailand(2) 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 July 14, 218 (28th Week)* Diseases of Category Ⅰ Unit: No. of cases Reporting area Cholera Typhoid fever Paratyphoid fever Shigellosis 218 218 218 218 Overall 2 14 189 97 7 3 26 12 15 52 Seoul 2 35 18 1 8 5 1 29 9 Busan 2 1 22 6 2 3 1 12 3 Daegu 5 4 1 1 15 1 Incheon 1 11 5 1 2 1 12 9 Gwangju 2 7 4 1 2 1 3 1 Daejeon 4 5 1 2 1 Ulsan 5 1 Sejong 2 1 Gyonggi 3 4 16 3 9 5 3 22 14 Gangwon 9 1 1 1 1 4 Chungbuk 7 2 1 1 1 1 Chungnam 1 7 6 1 3 16 2 Jeonbuk 1 3 1 2 1 2 Jeonnam 2 7 5 1 4 1 5 3 Gyeongbuk 9 4 1 1 2 1 Gyeongnam 1 13 18 1 1 1 6 4 Jeju 3 2 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 956

Table 2. (Continued) Reported cases of infectious diseases by geography, s ending July 14, 218 (28th 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 13 7 48 29 1,542 1,656 43 336 61 2 9 Seoul 2 12 6 6 39 323 1 41 12 3 1 Busan 1 5 2 1 35 91 6 22 4 1 1 Daegu 1 7 6 45 35 1 8 1 2 Incheon 1 5 4 3 18 141 1 27 4 2 Gwangju 6 9 2 53 12 4 Daejeon 2 2 8 69 7 Ulsan 1 4 2 13 19 3 14 1 1 Sejong 1 8 1 7 Gyonggi 1 7 7 7 473 491 5 63 11 2 1 Gangwon 2 4 2 1 37 36 3 1 1 Chungbuk 2 2 54 46 2 17 Chungnam 2 3 1 1 14 98 1 7 2 1 Jeonbuk 1 4 1 74 8 1 Jeonnam 3 3 23 68 1 4 4 2 Gyeongbuk 1 3 1 3 47 35 18 8 3 1 Gyeongnam 2 1 1 41 58 22 71 7 1 2 Jeju 1 4 2 7 11 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 957

Table 2. (Continued) Reported cases of infectious diseases by geography, ending July 14, 218 (28th Week)* Diseases of Category Ⅱ Unit: No. of cases Reporting area Measles Mumps Rubella 218 218 218 Viral hepatitis B (Acute) 218 Overall 7 85 18 55 11,851 1,298 1 56 9 14 222 127 Seoul 2 17 23 62 1,48 1,1 1 2 5 39 21 Busan 1 4 35 72 734 3 1 11 1 Daegu 1 2 19 485 325 2 1 8 4 Incheon 5 11 3 616 456 12 9 Gwangju 1 21 346 729 2 5 2 Daejeon 4 3 2 425 391 4 9 3 Ulsan 1 17 379 32 1 5 4 Sejong 4 76 26 Gyonggi 3 35 29 121 3,27 2,282 16 4 2 62 29 Gangwon 1 1 2 388 386 4 7 4 Chungbuk 4 2 14 342 181 2 7 4 Chungnam 2 2 28 511 389 4 1 7 Jeonbuk 1 1 1 28 49 884 1 8 1 Jeonnam 3 8 22 443 536 3 2 9 6 Gyeongbuk 3 5 2 622 47 1 4 1 11 6 Gyeongnam 1 6 15 37 1,67 1,36 2 2 17 7 Jeju 2 7 191 152 1 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 958

Table 2. (Continued) Reported cases of infectious diseases by geography, ending July 14, 218 (28th 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 1,954 5,336 27,367 41 314 264 329 11,491 5,885 Seoul 27 5,34 2,763 5 38 34 3 1,728 688 Busan 173 2,87 1,842 1 5 3 18 1,31 414 Daegu 11 2,717 1,538 1 7 3 7 343 263 Incheon 61 2,79 1,597 6 43 39 7 531 267 Gwangju 75 1,7 793 4 1 32 468 259 Daejeon 19 1,341 743 2 1 9 359 27 Ulsan 62 1,754 872 1 2 14 665 221 Sejong 55 775 143 1 1 68 24 Gyonggi 569 14,89 7,78 24 186 152 117 3,62 1,767 Gangwon 4 1,456 1,78 1 7 11 6 186 91 Chungbuk 56 2,18 552 1 3 5 225 13 Chungnam 59 1,63 1,139 3 2 14 395 277 Jeonbuk 93 2,237 1,221 3 2 21 589 181 Jeonnam 51 1,755 1,211 2 4 2 14 444 214 Gyeongbuk 82 2,319 1,247 1 4 13 54 369 Gyeongnam 187 4,33 2,162 1 6 3 19 799 464 Jeju 55 2,16 686 3 1 2 94 76 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 959

Table 2. (Continued) Reported cases of infectious diseases by geography, ending July 14, 218 (28th 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 5 7 156 36 1 3 7 7 Seoul 1 2 2 39 11 1 2 Busan 1 13 2 1 Daegu 7 1 Incheon 3 1 12 3 1 1 Gwangju 1 Daejeon 3 Ulsan 3 1 Sejong Gyonggi 2 2 3 33 7 1 2 1 Gangwon 1 7 2 Chungbuk 9 1 Chungnam 1 3 1 1 Jeonbuk 1 1 Jeonnam 1 1 1 1 Gyeongbuk 2 2 Gyeongnam 3 4 2 1 3 Jeju 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 96

Table 2. (Continued) Reported cases of infectious diseases by geography, ending July 14, 218 (28th 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 85 1,19 397 7 36 14 2 34 4 21 184 131 Seoul 5 46 19 2 1 2 1 1 6 Busan 8 34 18 1 1 2 6 2 Daegu 1 12 6 1 2 2 1 2 1 Incheon 1 22 9 3 5 2 2 Gwangju 3 28 9 1 1 2 3 2 Daejeon 2 15 14 1 2 3 Ulsan 1 17 8 1 1 1 2 1 Sejong 1 3 2 1 1 Gyonggi 6 79 5 2 6 3 3 5 7 35 42 Gangwon 1 17 15 1 1 2 7 11 Chungbuk 1 38 5 2 3 8 1 13 7 Chungnam 9 138 31 2 9 1 3 5 3 29 11 Jeonbuk 9 117 37 1 1 4 18 9 Jeonnam 23 34 79 5 2 1 2 1 22 15 Gyeongbuk 5 68 29 2 6 1 1 1 23 12 Gyeongnam 9 163 62 1 1 2 1 1 9 6 Jeju 8 4 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 961

Table 2. (Continued) Reported cases of infectious diseases by geography, ending July 14, 218 (28th 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 28 1,28 62 4 38 26 619 15,355 17,848 9 13 93 Seoul 8 281 123 3 13 6 15 2,712 3,444 5 4 31 Busan 1 12 33 6 2 5 1,29 1,322 1 4 Daegu 55 29 3 2 24 713 896 1 4 4 Incheon 15 6 1 1 41 792 93 5 4 Gwangju 2 54 18 1 24 392 445 1 1 Daejeon 1 38 16 1 15 344 414 4 Ulsan 15 1 16 33 385 1 1 Sejong 8 2 1 62 46 Gyonggi 1 35 167 1 8 5 117 3,31 3,714 2 29 25 Gangwon 2 26 18 1 37 655 746 1 1 Chungbuk 2 33 13 1 14 527 536 1 1 Chungnam 1 43 21 2 28 747 784 1 2 Jeonbuk 29 13 1 1 21 69 671 2 3 Jeonnam 18 18 1 35 825 887 1 3 2 Gyeongbuk 51 24 3 2 44 1,67 1,257 3 3 Gyeongnam 1 41 37 2 1 43 1,3 1,169 1 5 Jeju 31 18 4 211 22 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 962

Table 2. (Continued) Reported cases of infectious diseases by geography, ending July 14, 218 (28th 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 31 214 19 7 58 4 14 91 26 2 2 - Seoul 4 44 2 2 24 2 3 1 1 1 - Busan 3 7 2 1 3 - Daegu 3 13 1 1 1 - Incheon 1 7 1 7 - Gwangju 5 1 - Daejeon 5 1 - Ulsan 3 1 - Sejong 1 1 - Gyonggi 7 4 3 7 1 1 5 - Gangwon 2 3 1 1 3 15 3 - Chungbuk 3 27 4 1 1 2 - Chungnam 3 15 3 1 6 2 1 3 - Jeonbuk 2 1 1 1 8 1 - Jeonnam 1 11 1 2 7 2 - Gyeongbuk 1 1 1 1 3 1 11 4 - Gyeongnam 1 18 2 3 4 15 3 1 1 - Jeju 1 3 1 6 4 - 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 963

1.2 환자감시 : 표본감시감염병주간발생현황 (28th ) 1. Influenza, Republic of Korea, s ending July 14, 218 (28th ) 218 년도제 28 주인플루엔자표본감시 ( 전국 2 개표본감시기관 ) 결과, 의사환자분율은외래환자 1, 명당 4.2 명으로지난주 (4.5 명 ) 대비감소 217-218 절기유행기준은 6.6 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 34 217-218 216-217 215-216 214-215 213-214 Figure 1. Weekly proportion of influenza-like illness per 1, outpatients, 213-214 to 217-218 flu seasons 2. Hand, Foot and Mouth Disease(HFMD), Republic of Korea, s ending July 14, 218 (28th ) 218 년도제 28 주차수족구병표본감시 ( 전국 95 개의료기관 ) 결과, 의사환자분율은외래환자 1, 명당 27.5 명으로전주 (24.9 명 ) 대비증가 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 964

3. Ophthalmologic infectious disease, Republic of Korea, s ending July 14, 218 (28th ) 218 년도제 28 주차유행성각결막염표본감시 ( 전국 92 개의료기관 ) 결과, 외래환자 1, 명당분율은 22.3 명으로전주 21.8 명대비증가 동기간급성출혈성결막염의환자분율은 1. 명으로전주.4 명대비증가 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 965

4. Sexually Transmitted Diseases, Republic of Korea, s ending July 14, 218 (28th ) 218 년도제 28 주성매개감염병표본감시기관 ( 전국보건소및의료기관 592 개참여 ) 에서신고기관당성기단순포진 2.8 건, 첨규콘딜롬 2.2 건, 클라미디아감염증 1.8 건, 임질 1.4 건발생을신고함. 제 28 주차신고의료기관수 : 임질 14 개, 클라미디아 51 개, 성기단순포진 38 개, 첨규콘딜롬 31 개 Unit: No. of cases/sentinels Gonorrhea Chlamydia Genital herpes Condyloma acuminata 218 218 218 218 1.4 5.4 6.9 1.8 18.8 16.1 2.8 24.9 18.3 2.2 14.8 11.1 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 (28th ) Waterborne and foodborne disease outbreaks, Republic of Korea, s ending July 14, 218 (28th ) 218 년도제 28 주에집단발생이 13 건이발생하였으며누적발생건수는 321 건 ( 사례수 5,218 명 ) 이발생함. 35 3 25 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 966

2.1 병원체감시 : 인플루엔자및호흡기바이러스주간감시현황 (28th ) 1. Influenza viruses, Republic of Korea, s ending July 14, 218 (28th ) 218 년도제 28 주에전국 52 개감시사업참여의료기관에서의뢰된호흡기검체 191 건중양성없음. 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, 216-217 to 217-218 flu season 2. Respiratory viruses, Republic of Korea, s ending July 14, 218 (28th ) 218 년도제 28 주호흡기검체 (191 건 ) 에대한유전자검사결과 48.2% 의호흡기바이러스가검출되었음 ( 최근 4 주평균 189 개의호흡기검체에대한유전자검사결과를나타내고있음 ) 주별통계는잠정통계이므로변동가능 218 () Weekly total Detection rate (%) No. of samples Detection rate (%) HAdV HPIV HRSV IFV HCoV HRV HBoV HMPV 25 191 66.5 9.9 18.8.5 1.6. 24.6 7.9 3.1 26 2 56.5 4.5 15.5.5.. 25. 7.5 3.5 27 174 58.6 5.2 12.6 1.1.6.6 2.1 13.2 5.2 28 191 48.2 5.2 13.1...5 18.8 6.8 3.7 756 57.4 6.2 15.1.5.5.3 22.2 8.7 3.8 217 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 June. 17. 218. July. 14. 218, (Average No. of detected cases is 189 in last 4 s) 217 : the rate of detected cases between January 1. 217. - December 3. 217. 자세히보기 : 질병관리본부 알림 주간질병감시정보 www.cdc.go.kr 967

2.2 병원체감시 : 급성설사질환실험실표본주간감시현황 (27th ) Acute gastroenteritis-causing viruses and bacteria, Republic of Korea, s ending July 7, 218 (27th ) 218년도제27주실험실표본감시 (17 개시 도보건환경연구원및 7개의료기관 ) 급성설사질환유발바이러스검출건수는 8건 (17.4%), 세균검출건수는 39건 (18.3%) 이었음. Acute gastroenteritis-causing viruses Week No. of sample No. of detection (Detection rate, %) Group A Rotavirus Norovirus Enteric Adenovirus Astrovirus Total 218 24 76 4 (5.3) 4 (5.3) 7 (9.2) 3 (3.9) 18 (23.7) 25 97 7 (7.2) 11 (11.3) 3 (3.1) 2 (2.1) 23 (23.7) 26 71 2 (2.8) 1 (14.1) 4 (5.6) (.) 16 (22.5) 27 46 (.) 4 (8.7) 4 (8.7) (.) 8 (17.4) 1,886 29 (11.1) 28 (14.8) 61 (3.2) 3 (1.6) 58 (3.8) * 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 24 188 4 (2.1) 12 (6.4) () () () 2 (1.1) 1 (.5) 3 (1.6) 4 (2.1) 26 (13.8) 25 182 16 (8.8) 15 (8.2) () () () 3 (1.6) 3 (1.6) 7 (3.8) 4 (2.2) 48 (26.4) 26 21 8 (4.) 13 (6.5) () () () 3 (1.5) 1 (.5) 11 (5.5) 4 (2.) 4 (19.9) 27 213 8 (3.8) 12 (5.6) () 1 (.5) () 5 (2.3) 3 (1.4) 2 (.9) 8 (3.8) 39 (18.3) 4,94 116 (2.4) 144 (2.9) 2 (.4) 3 (.6) () 33 (.7) 58 (1.2) 81 (1.7) 77 (1.6) 515 (1.5) * 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 968

2.3 병원체감시 : 엔테로바이러스실험실주간감시현황 (27th ) Enterovirus, Republic of Korea, s ending July 7, 218 (27th ) 218년도제27주실험실표본감시 (1개시 도보건환경연구원, 전국 53개참여병원 ) 결과, 엔테로바이러스검출률 48.4%(46 건양성 /95 검체 ), 218년누적양성률 21.9%(188 건양성 /857 검체 ) 임. - 무균성수막염 9건 (218 년누적 43건 ), 수족구병및포진성구협염 28건 (218 년누적 14 건 ), 합병증동반수족구 1건 (218 년누적 1건 ), 기타 8건 (218 년누적 4건 ) 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 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 969

3.1 매개체감시 / 말라리아매개모기주간감시현황 (27th ) Vector surveillance: Malaria vector mosquitoes, Republic of Korea, ending July 7, 218 (27th ) 218 년도제 27 주말라리아매개모기주간발생현황 (3 개시 도, 총 2 개채집지점 ) - 전체모기 : 평균 12 개체로평년 24 개체대비 12 개체 (5.%) 감소및전년 14 개체대비 2 개체 (14.3%) 감소 - 말라리아매개모기 : 평균 5 개체로평년 8 개체대비 3 개체 (37.5%) 감소및전년 4 개체대비 1 개체 (25.%) 증가 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 12 218 Malaria Vector Mosquitoes 1 5 Figure 1. Weekly incidences of malaria vector mosquitoes in 218 3.2 매개체감시 / 일본뇌염매개모기주간감시현황 (27th ) Vector surveillance: Japanese encephalitis vector mosquitoes, Republic of Korea, ending July 7, 218 (27th ) 218 년 27 주일본뇌염매개모기주간발생현황 : 1 개시 도보건환경연구원 ( 총 1 개지점 ) - 전체모기 : 평균 2,44 개체로평년 1,67 개체대비 797 개체 (49.6%) 증가및전년 1,429 개체대비 975 개체 (68.2%) 증가 - 일본뇌염매개모기 (Japanese encephalitis vector, JEV) : 평균 5 개체로평년 3 개체대비 25 개체 (83.3%) 감소및전년 6 개체대비 55 개체 (91.7%) 감소 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 218 JEV Vector Mosquitoes 3 1 2 3 4 5 Figure 11. Weekly incidences of Japanese encephalitis vector mosquitoes in 218 www.cdc.go.kr 97 자세히보기 : 질병관리본부 민원 / 정부 3. 사전정보공개

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 7 월 19 일 발행인 : 정은경 편집인 : 박도준 편집위원 : 최영실, 김기순, 최병선, 조신형, 조성범, 김봉조, 구수경, 김용우, 이동한, 조은희, 이은규, 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 972