Febrile Illness with Skin Rashes

강진한 대한감염학회 2015 Infection and Chemotherapy Vol.47 No.3

Skin rashes that appear during febrile illnesses are in fact caused by various infectious diseases. Since infectious exanthematous diseases range from mild infections that disappear naturally to severe infectious diseases, focus on and basic knowledge of these diseases is very important. But, these include non-infectious diseases, so that comprehensive knowledge of these other diseases is required. Usually, early diagnostic testing for a febrile illness with a rash is inefficient. For clinical diagnosis of diseases accompanied by skin rash and fever, a complete history must be taken, including recent travel, contact with animals, medications, and exposure to forests and other natural environments. In addition, time of onset of symptoms and the characteristics of the rash itself (morphology, location, distribution) could be helpful in the clinical diagnosis. It is also critical to understand the patient’s history of specific underlying diseases. However, diagnostic basic tests could be helpful in diagnosis if they are repeated and the clinical course is monitored. Generally, skin rashes are nonspecific and self-limited. Therefore, it could be clinically meaningful as a characteristic diagnostic finding in a very small subset of specific diseases.

Effectiveness and safety of seasonal influenza vaccination in children with underlying respiratory diseases and allergy

강진한 대한소아청소년과학회 2014 Clinical and Experimental Pediatrics (CEP) Vol.57 No.4

Influenza causes acute respiratory infections and various complications. Children in the high-riskgroup have higher complication and hospitalization rates than high-risk elderly individuals. Influenzaprevention in children is important, as they can be a source infection spread in their communities. Influenza vaccination is strongly recommended for high-risk children with chronic underlying circulatoryand respiratory disease, immature infants, and children receiving long-term immunosuppressanttreatment or aspirin. However, vaccination rates in these children are low because of concernsregarding the exacerbation of underlying diseases and vaccine efficacy. To address these concerns,many clinical studies on children with underlying respiratory diseases have been conducted sincethe 1970s. Most of these reported no differences in immunogenicity or adverse reactions betweenhealthy children and those with underlying respiratory diseases and no adverse effects of the influenzavaccine on the disease course. Further to these studies, the inactivated split-virus influenza vaccine isrecommended for children with underlying respiratory disease, in many countries. However, the liveattenuatedinfluenza vaccine (LAIV) is not recommended for children younger than 5 years with asthmaor recurrent wheezing. Influenza vaccination is contraindicated in patients with severe allergies to egg,chicken, or feathers, because egg-cultivated influenza vaccines may contain ovalbumin. There hasbeen no recent report of serious adverse events after influenza vaccination in children with egg allergy. However, many experts recommend the trivalent influenza vaccine for patients with severe egg allergy,with close observation for 30 minutes after vaccination. LAIV is still not recommended for patients withasthma or egg allergy.

건강한 소아에서의 47계대 Oka주 수두약독화 생백신의 면역원성 및 안전성에 관한 연구

강진한,김종현,서병규,Kang, Jin Han,Kim, Jong Hyun,Suh, Byung Kyu 대한소아감염학회 1997 Pediatric Infection and Vaccine Vol.4 No.2

목 적 : 국내 건강한 소아에서의 47계대 배양된 Oka주 수두 약독화 생백신의 단기간내 체액성 면역원성과 안전성 평가를 위해 본 연구를 시행하였다. 대상 및 방법 : 1997년 4월부터 1997년 8월까지 5개월간 가톨릭대학부속 성모자애병원 육아상담실을 방문한 소아와, 서울, 인천, 수원 지역에 있는 4곳의 보육원에 수용되고 있는 원아들 중 과거력상 수두에 이환되지 않았고, 수두백신 접종력이 없으며 중한 기저질환이나 약제 및 백신에 알레르기가 없는 12개월에서 15세 사이 연령의 건강한 소아를 대상으로 하였다. 백신의 접종은 1,400 PFU 용량의 47 계대 Oka주 수두백신을 상완 삼각근에 1회 피하 주사하였다. 단기간(접종후 6주)의 체액성 면역원성을 평가하기 위해 모든 피접종아에서 접종전, 접종 6주 후에 채혈하여 FAMA 법과 효소 면역법으로 수두 대상포진 바이러스의 세포막 항체와 IgG를 측정 비교하였다. 그리고 안전성 평가를 위해 접종 30분내 즉각반응, 접종 3일내 국소 및 전신반응, 접종 6주후까지의 백신에 의한 전신성 부작용 발생을 관찰하였다. 결과 : 1) 총 99명의 소아에서 접종과 검사가 완료되었다{육아상담실; 33명, 보육원 66명). 이들 중 49명은 접종전 대상포진 바이러스 항체 검사상 음성이었고 50명은 양성으로 판명되었다. 이 두군의 연령 및 성별분포는 유사하였다. 2) FAMA 법으로 시행한 검사상 접종전 음성군에서 97.9%의 양전율을 보였고, 음성군 및 양성군 모두에서 의의있는 GMT 상승을 보였다. 3) 효소 면역법으로 시행한 결과에서는 접종전 음성군에서는 100%의 항체 양전율을 보였고, 그리고 양성군에서도 항체가는 접종후 유의하게 상승하였다. 4) 경한 주사부위의 발적, 동통, 부종, 경결 등의 국소반응과 보챔, 식욕부진 등의 전신반응이 있었으나 3일내에 소실되었고, 이후 6주간 백신에 의한 부작용은 전례에서 관찰되지 않았다. 결 론 : 이상의 결과로 볼 때에 47계대 배양된 Oka주 수두백신은 단기간내에 높은 체액성 면역원성이 유발되고 안전성이 있음을 알 수 있었다. 그러나 이 백신의 광범위한 사용을 위해서는 지속적으로 장기간의 체액성 및 세포 매개성 면역원성 검증과 야외임상 대조설험 등이 요구되어 진다. Purpose: We performed this study to find out short period humoral immunogenicity and safety of 47 passaged Oka strain live attenuated varicella vaccine(1,400PFU) in 12 months to 15 years aged healthy children. Methods: Ninety nine healthy chidren, who have no histories of varicella vaccination, recent chicken pox illness and contact, allergy to other vaccines and underlying severe diseases, were involved in this study from April 1997 to August 1997. 5ml blood were collected before vaccination and after vaccination from all vaccinees to measure varicella membrane antibody by FAMA, and varicella IgG antibody by EIA. And immediate reactions within 30 minutes after vaccination, local and systemic reactions within 3 days after vaccination and vaccine induced systemic illness during 6 weeks postvaccination period were observed in all vaccinees to identify side effects of study vaccine. Results: 1) 49 seronegative and 50 seropositive vaccinees were identified in both prevaccination serologic tests. 2) Serologic responses after vaccination measured by the FAMA in seronegative group showed that the mean GMT level revealed 64.0, and seroconversion rate was 97.9%. And serologic responses after vaccination measured by the FAMA in seropositive group showed that the mean GMT level(242.2) was markedly elevated comparing with the mean GMT level(9.2) of pre vaccination. 3) The results of EIA in seronegative group revealed that postvaccination mean GMT was 435.2(prevaccination GMT; 78.7), and 100% seroconversion rate. Also, the results of EIA in seropositve group showed that the mean GMT level(769.9) of postvaccination was almostly two fold hihger than the mean GMT level(419.7) of prevaccination. 4) Observed local reactions like injection sites redness, pain, hardness and itching sense were mild and disappeared within 3 days, also shorterm systemic reactions like irritability, lethargy, poor appetites and rash were not remarkable. And there were no remarkable side effects due to vaccine during study period in all vaccinees. Conclusion: We confirmed that 47 paasaged Oka strain live attenuated varicella vaccine has high shorterm humoral immunogenicity and safety. However, we need more detail and longterm humoral and cell mediated immunogenicity studies of this vaccine including clinical field trials.

국내의 건강한 소아 및 성인에서 Epstein-Barr 바이러스의 감염형 분류

강진한,허재균,김종현,이안희 대한소아청소년과학회 2000 Clinical and Experimental Pediatrics (CEP) Vol.43 No.5

Purpose : Recently, the list of Epsterin-Barr Virus(EBV)-associated diseases has been growing. It is now known that there are two types(type 1 & 2) of EBV, but it has yet to be fully investigated as to whether type B EBV differs in any way from type A virus in terms of geographical distribution or disease association. We performed this study to find out the prevalence of the two types of EBV in EBV seropositive healthy children and adults by using one step Polymerase chain reaction(PCR). Methods : Fifty-four viral capsid antigen(VCA) IgG positive healthy children(5 to 15 yrs of age) and 60 healthy adults(20 to 50 yrs of age) were involved in this study. DNA extracted from saliva samples of healthy study children and adults were subjected to amplification using the modified one step general PCR, which was developed by M. Kunimoto et al for detection of EBV types. And B95-82 cells(type 1) and Jijoye cells(type 2) were used as positive controls, and K-562 cells was used as a negative control. Results : EBV was detected in mouth washing saliva of 8(14.8%) of 54 healthy children. Five EBV detected cases contained type 1 and the remaining three cases contained type 2. EBV was detected in mouth washing saliva of 21(35%) of 60 healthy adults. Twenty EBV detected cases contained type 1 and the remaining one was type 2. In total, EBV was detected in the saliva samples of 29 cases(25.4%), and 25(86.2%) contained type 1. Conclusion : The results of our study indicate that type 1 is highly dominant in Korea, and EBV excretion is more frequent in EBV positive healthy adults compared to EBV positive healthy children in Korea. 목 적 : Epstein-Barr 바이러스는 전 세계적으로 확산되어 있는 대표적인 herpes DNA 바이러스로서 국내에서는 어린 영아 연령에서부터 초감염이 되기 시작하여 5세 이후에는 90% 이상에서 노출된 역학적 양상을 보이고, 다양한 임상적 문제를 일으키는 것으로 알려져 있다. 이러한 Epstein-Barr 바이러스는 잠복감염에 관련된 일부 유전인자들의 특성에 따라 감염형이 1형과 2형으로 분류되고 이들 감염형은 지역에 따라 차이가 있으며 이로 인하여 임상에도 다른 양상을 보일 수 있다 한다. 이에 저자들은 Epstein- Barr 바이러스에 노출되어 잠복되어 있는 상태의 건강한 사람에서도 이 바이러스가 타액을 통하여 배출될 수 있는 점을 감안하여 국내의 건강한 소아 및 성인을 대상으로 하여 Epstein-Barr 바이러스의 감염형 분포에 관한 연구를 시행하게 되었다.방 법 : 혈청학적 검사상 Epstein-Barr 바이러스에 노출된 것이 확인된 5세에서 15세 사이 연령의 건강한 소아 54명과 60명의 성인을 대상으로 하였다. 연구 대상자들에게 생리식염수로 구강 세척을 실시하여 회수한 후 이 세척액에서 DNA를 추출한 다음 EBV U2 region의 sense primer(2771 to 2789), anti-sense primer(3149 to 3130)를 이용한 중합효소연쇄반응법으로 1형 및 2형의 분류를 시도하였다. Epstein- Barr 바이러스 1형의 양성 대조는 B 95-82세포, 2형의 양성 대조는 Jijoye 세포, 음성 대조는 K-562 세포를 활용하였다.

14인의 역사학자가 보낸 답변들_강진아

강진아 역사비평사 2012 역사비평 Vol.- No.100

<신종우 : 항생제의 임상. 소아과 1958;1:100-4>를 읽고

강진한,Gang, Jin-Han 대한소아청소년과학회 2007 Clinical and Experimental Pediatrics (CEP) Vol.50 No.8

발열과 발진

강진한 대한소아청소년과학회 2007 Clinical and Experimental Pediatrics (CEP) Vol.50 No.2

Patients with febrile illness and skin rashes need full and immediate attention. In general, these diseases show mild manifestations and good prognosis. However, causalities of some diseases with fever and rash may be life threatening or trivial. So, the differential diagnosis for those patients is extensive. A through history, a careful physical examination and close observation of clinical progress are very helpful and essential to confirming the diagnosis. Histories of recent travel, drug or specific food ingestion, exposure to human or an animal source of infection may be useful to discover the cause. Although laboratory tests can be useful in making the diagnosis, laboratory results usually are not available immediately. Knowledge and experiences of such diseases may be helpful to reduce the differential diagnosis to a few major possibilities. Rashes can be categorized as petechial, maculopapular, vesicular, urticarial and erythematous. Potential causes include infectious pathogens such as virus, bacteria, rickettsiae, spirohetes, connective tissue diseases, allergic diseases and heamto-oncologic diseases. Because the severity of these diseases can vary mild to life threatening, physicians must perform prompt management decisions regarding empirical therapies. In this article, the differential etiological diagnosis of each type rash is reviewed and discussed, and with emphasis on intensive care of life threatening febrile diseases with rashes that are seen in our country.

새로운 DTaP 백신의 효과 및 부작용

강진한 대한소아감염학회 1999 Pediatric Infection and Vaccine Vol.6 No.1

DTaP 혼합백신의 개발 및 사용

강진한,Gang, Jin-Han 대한소아감염학회 2003 Pediatric Infection and Vaccine Vol.10 No.1

Safety and Immunogenicity of a New Trivalent Inactivated Split-virus Influenza Vaccine in Healthy Korean Children: A Randomized, Double-blinded, Active-controlled, Phase III Study

강진한,오지은,이지나,이수영,차성호,김동수,김현희,이정현,김진택,마상혁,홍영진,정희진,이환종 대한의학회 2011 Journal of Korean medical science Vol.26 No.11

We report results of a randomized, double-blinded, active-controlled, phase III study conducted to evaluate the immunogenicity and safety of a new trivalent inactivated splitvirus influenza vaccine (GC501) manufactured by the Green Cross Corporation in Korea. A total of 283 healthy children aged 6 months to < 18 yr were randomized to receive either GC501 or control. Of the GC501 recipients, seroconversion occurred in 48.5% for A/H1N1,67.7% for A/H3N2 and 52% for influenza B. The proportion of subjects who had postvaccination hemagglutination-inhibition titers of 1:40 or greater was 90.7% for A/H1N1,86.8% for A/H3N2 and 82.4% for influenza B in the GC501 recipients. No serious adverse events related to vaccination, or withdrawals because of adverse events were reported. The majority of solicited adverse events were mild in intensity. GC501 vaccine has good tolerability and favorable immunogenicity in children aged 6 months to < 18 yr. The addition of one more brand of influenza vaccine may allow for better global accessibility of vaccine for epidemics or future pandemics.