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증례 : 감염 ; 황열 백신 접종 후 발생한 간염 1예
최은성 ( Eun Sung Choi ),배귀현 ( Kwi Hyun Bae ),정영의 ( Young Eui Jeong ),주영란 ( Young Ran Ju ),김현아 ( Hyun Ah Kim ),류성열 ( Seong Yeol Ryu ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S
23세 남자 환자가 황열 백신 접종 7일 후 고열, 근육통, 오심 주소로 내원하여 anti-YFV Ig M 양성 소견으로 황열 백신 접종 후 발생한 내장향성 질환(고열과 간염)으로 진단받고 입원 24일 후 증상 호전보여 퇴원하였다. 황열(yellow fever)은 세계 여러 지역에서 계속해서 발생하여 유병률과 사망률이 높은 질환으로 주로 아프리카나 중남미의 열대우림 지역에서 유행하며 10-20%에서 신부전, 간부전, 현저한 서맥을 동반한 고열이 나타나는 전형적인 황열 증상을 나타낸다. 예방을 위해서는 황열 백신의 접종이 가장 중요하며, 부작용은 비교적 적은 것으로 알려져 있으나 드물지만 중증의 합병증이 외국문헌에는 보고되고 있으나 아직까지 국내에는 YEL-AND 1예 외 보고된 바는 없다. 이에 저자는 국내에서 처음으로 황열 백신 접종 후 내장향성 질환(고열과 간염)이 발생한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. This report describes a case of yellow fever vaccine-associated viscerotropic disease (YEL-AVD) that occurred after vaccination in a 23-year-old male. Seven days after vaccination, our patient presented with fever, myalgia, and nausea. The IgM enzyme-linked immunosorbent assay (ELISA) for yellow fever virus was positive. After a 24 day hospitalization, he recovered and was discharged. Yellow fever is a viral hemorrhagic febrile illness caused by a flavivirus and transmitted by mosquitoes. The clinical presentation ranges from a mild febrile illness to a serious infection, leading to hepatic and renal failure, myocardial injury, hemorrhage, and shock, with a case fatality rate of 20-30%. Because yellow fever is a potentially fatal disease, vaccination is encouraged for people traveling to high-risk areas. Although considered a safe vaccine, severe adverse reactions have been reported. In 2001, rare, but severe, acute viscerotropic disease following vaccination was first described. We report the case of a 23-year-old male with fever and hepatitis following vaccination with 17D yellow fever vaccine. (Korean J Med 2011;80:S301-S304)
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이중복(Joong-Bok Lee),이훈재(Hun-Jae Lee),현방훈(Bang-Hun Hyun),방지환(Ji-Hwan Bang),남경옥(Kyung-Ok Nam),정영의(Young-Eui Jeong),신영학(Young-Hack Shin) 한국역학회 2005 Epidemiology and Health Vol.27 No.1
Rabies is a uniformly fatal encephalitis and cannot be treated, therefore efforts must be focused on preventing the disease. The incidence of rabies in humans and animals has decreased with the introduction of rabies vaccination for animals since the early 1950s in Korea. There was no rabies occurrence either in human or animal for 8 years from 1985 to 1992. However, a case of animal rabies recurred in 1993. Since then, rabies endemic areas were expanded into 17 counties near the demilitarized zone, and 6 human cases were reported from the endemic areas of animal rabies. According to epidemic studies, wild raccoon dogs were suspected to be the transmission source of rabies in dogs, domestic animals, and other wild animals, which resulted in human rabies. Rabies prevention strategies were aimed at the animals capable of transmitting rabies or vaccination for the high risk group and postexposure prophylaxis for the bitten patients. Unfortunately, these activities were not conducted appropriately and substantially. All rabies victims were either not treated or did not receive timely and appropriate postexposure treatment. Prevention of rabies can only be achieved by securing political and financial support for an effective rabies program. Key activities for rabies prevention should include changing current public perception regarding rabies, strengthening surveillance for the exposed person to suspected rabid animals, and laboratory-based rabies surveillance.
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