재출현 이후 국내 삼일열 말라리아 발생 현황

염준섭,박재원 대한감염학회 2008 감염과 화학요법 Vol.40 No.4

Vivax malaria re-emerged in the Republic of Korea (ROK) in 1993. Sixteen years have passed and epidemiological characteristics have changed since then. The annual incidence of this disease which had increased rapidly through 2000, started to decrease rapidly in 2001, reaching about 800 cases in 2004. But it started to change again in 2005 and since then, about 2000 cases are occurring annually. Not only the cases are increasing but also geographic distributions are expanding into cities and counties bordering Seoul. Based on these data, possibility of occurrence of local transmission is very high. Malaria situation in North Korea is not so different from the ROK. Although annual incidence of diseases are decreasing every year, incidences in areas near demilitarized zone which can affect the ROK are still serious. And now economical and cultural exchange between the ROK and Nouth Korea is increasing every year. This also means that risks of exposure to this disease among civilians are also increasing, Control strategies in the beginning of resurgence had been focused mainly on decreasing transmission and cases of malaria. Main parts of these strategies were vector control and chloroquine chemoprophylaxis among soldiers stationed in high-risk areas. But now, epidemiological characteristics have changed and our control strategies need adjustment considering these changes.

0.05% Chlorhexidine Gluconate 수용액의 세균오염

염준섭,임혜숙,박효순 대한병원감염관리학회 2003 의료관련감염관리 Vol.8 No.1

현역 군인 발생을 중심으로 본 2000년도 국내 삼일열 말라리아 발생 현황

박재원,김영아,염준섭,유정식,양병국,채종일 대한감염학회 2001 감염 Vol.33 No.4

Background : Since 1997, the annual case occurrence of vivax malaria in the Republic of Korea have exceeded 1,000 cases since 1997. The military is thought to be an important source of the current outbreak. We collected various informations about malaria cases (soldiers, veterans and civilians) which occurred in 2000, and analyzed the characteristics of the current outbreak. Methods : Informations about malaria cases of soldiers, veterans and civilians, including name, age, sex, day of onset, region, etc., were collected through the National Institute of Health. Results : Out of total 4,141 cases, 1,288 (31.1%) occurred in the military, 1,273 (30.7%) occurred among the veterans, and 1,580 (38.2%) occurred among civilians. The monthly case occurrence reached its peak in early August. Areas such as Cheolwon, Yeoncheon and Paju showed the highest prevalence. Conclusion : It is considered that the current malaria outbreak has escaped from the exponential growth phase, however, more attention should be paid to prevent further spreading of malaria infection. (Korean J Infect Dis 33:280∼284, 2001)

국내 말라리아 퇴치사업의 현황 분석과 개선 방안

박재원,홍지영,염준섭,조성래,오대규 대한감염학회 2009 감염과 화학요법 Vol.41 No.1

Background : Vivax malaria had spread rapidly in areas adjacent to the Demilitarized Zone to reach more than 4,000 cases in 2000 in the Republic of Korea (ROK). After year 2000, annual cases decreased rapidly to reach less than 1,000 cases in 2004. However, the number increased again since 2005. Epidemiological characteristics of vivax malaria in the ROK are different before and after 2000. This article was aimed to evaluate the current status of malaria elimination project in the ROK for providing suggestions for its improvement. Materials and Methods : We analyzed the total reported malaria cases during 2005 to 2007 and reviewed the record on the malaria eradication project performed by the authorizations including the Korea Center for Disease Control and Prevention. Results : During 2005 to 2007, 45% of all the vivax malaria occurred in patients living in the non-prevalent areas; the interval between first symptom onset and diagnosis was longer in the non-prevalent areas compared to that in the prevalent areas. Education and publicity on malaria has not been properly performed in the non-prevalent areas. The military didn't take part in the control of the malaria infected discharged soldiers, most of whom might have been infected with malaria during their military service. Conclusion : For the efficient control of malaria and thus improving the effectiveness of the elimination project education and publicity on malaria in the non-prevalent areas should be strengthened and cooperation between private and military sector regarding the ex-soldiers infected with malaria is essential, In addition, there should be bilateral communication among malaria-related teams within the Korea Centers for Disease Control and Prevention and also among all the malaria-related sectors. Furthermore a common database on malaria patients and vector mosquitoes should be formed to grant access to all the malaria-related sectors, Improvement on report and surveillance system is also necessary.

장티푸스 진단에 있어서 Vi-Indirect Fluorescent Antibody Test의 민감도 및 특이도

장경희,류동렬,박성하,박병규,이준구,염준섭,최영화,송영구,김현숙,정윤섭,김준명 대한감염학회 1998 감염 Vol.30 No.4

목 적 : 장티푸스는 체액의 세균배양검사에서 Salmonella typhi의 분리로 확진하지만 조기진단을 위해서는 혈청학적인 검사가 도움이 된다. 저자 등은 1989년 이후 장티푸스진단에 S. typhi의 Vi항원을 이용한 간접형광항체법 (Vi-indirect fluorescent antibody test : Vi-IFAT)을 도입하였다. 이에 지난 7년간의 검사결과를 토대로 Vi-IFAT의 민감도 및 특이도를 규명하고자 하였다. 방 법 : 1989년부터 1996년까지 연세대학교 의과대학 세브란스 병원에 발열을 주소로 내원하여 Vi-IFAT가 의뢰된 환자 중 발열의 원인이 확진된 744명의 환자를 대상으로 하였으며, Vi-IFAT에 있어서 양성반응은 1:64이상으로 하였다. 결 과 : 1) 세균배양검사에서 확진된 장티푸스 환자 178예 중 168예에서 양성반응을 보여 민감도는 94.4%이었다. 항체가는 1:64가 89예, 1:128이 36예, 1:256이 27예, 그리고 1:512가 16예이었다. 위음성이었던 10예의 항체가는 1:32가 7예, 1:16이하가 3예이었다. 2) 발열을 주소로 내원한 환자 중 장티푸스 이외의 다른 질환으로 확진된 566예 중 538예에서 음성반응을 보여 특이도는 95.1%이었다. 항체가는 1:32가 117예, 1:16이하가 421예이었다. 위양성이었던 28예의 항체가는 1:64가 23예, 1:128이 5예이었으며, 장티푸스 이외의 살모넬라증이 4예, 요로계감염이 10예, 소화기계감염이 6예, 호흡기 계감염이 5예, 악성 종양이 2예, 그리고 바이러스 감염이 1예이었다. 3) Vi-IFAT 양성인 196예 중에서 장티푸스는 168예로 양성예측율은 85.7%이었으며, Vi-IFAT 음성인 548예 중 장티푸스 이외의 발열질환은 538예로 음성예측율 98.2%이었다. 4) 배양검사와 Widal test 사이의 일치율 (Kappa value)는 0.28로 poor agreement를 보였으며 Vi-IFAT와 Widal test 사이의 Kappa value는 0.74로 good agreement를 보였다. 그러나 배양검사와 Vi-IFAT 사이의 Kappa value는 0.86으로 excellent agreement를 보여 일치율이 가장 높은 검사는 배양검사와 Vi-IFAT라 할 수 있겠다. 5) 장티푸스 환자에 있어서 Vi-IFAT의 양성율은 발열기간이 1중 미만인 환자에서는 68%, 1내지 2주인 환자에서는 89.5%, 2주이상인 환자에서는 100%이었다. 결 론 : Vi 항원을 이용한 간접형광항체법 (Vi-IFAT)은 장티푸스 진단에 높은 민감도 및 특이도를 가지며, 또한 조기진단에 있어서도 임상적으로 유용함을 확인할 수 있었다. Background : Typhoid fever is diagnosed by culture or serological study. The confirmative diagnosis of typhoid fever is made by culture of the causative organism usually from body fluids. Serological test is a supportive diagnositic tool, which is useful for early diagnosis. In Severance Hospital, Vi-indirect foluorescent antibidy test(Vi-IFAT) using the Vi-antigen of Salmonella typhi has been used in the diagnosis of typhoid fever since 1989. We investigated the test results from the past 7 years, in order to clarify the sensitivity and specificity of Vi-IFAT. Methods : A retrospective study was done on patients whose chief complaint was fever and who were tested using Vi-IFAT in the Severance Hospital from 1989 to 1996. The positive value for Vi-IFAT was defined as 1:64 or higher. Results : The sensitivity and specificity of Vi-IFAT for typhoid fever was 94.4% and 95.1%, respectively. The positive and negative predictive values were 85.7% and 98.2% respectively. Positive rates of Vi-IFAT after fever onset increased with time and 68% were positive before the first week. From the first to the second week, 89.5% were positive and after the second week, 100% were positive. Conclusion : Vi-IFAT is not only a valuable serologic test for the diagnosis of typhoid fever, but also useful in the early diagnosis of the disease.

2009년 인플루엔자 대유행 중 인플루엔자 진료소 방문자의 연령 분포 변화

김백남,곽이경,문치숙,김연숙,김의석,배인규,염준섭,이창섭,허지안 대한감염학회 2010 감염과 화학요법 Vol.42 No.2

The pandemic influenza (H1N1 2009) virus, after being introduced in Korea in April, 2009, spread rapidly nationwide in mid-2009. This study was conducted to characterize trend in age distribution of visitors to Flu-clinics during the pandemic. Demographic, clinical and laboratory data of visitors to flu clinic from Week 36 to 52 (August 30 to December 26) of 2009 were retrieved and collected from electronic databases at 9 hospitals. Visitors 0-6, 7-12, 13-18, 19-29, 30-64, and 65 years or more of age were classified into group I to VI, respectively. A total of 107,467 visitors were seen at Flu-clinics for a 17-week study period. Of those, 32,485 were laboratory-confirmed. Antivirals were prescribed for 62,533 visitors. Numbers of visits, prescriptions of antivirals, and laboratory-confirmed cases of the pandemic influenza (H1N1 2009) peaked at Week 44. A large number of visits by group II and III were followed by those of group I and V, especially around the peak. Numbers of visits by group VI were lowest in all hospitals. In some hospitals, higher number of visits lasted longer in children than in adults while vice versa in other hospitals depending on the location. In summary, the pandemic influenza (H1N1 2009) was presumed to peak in late October and involved majorly children and students in Korea. Unique age distribution of visitors to flu clinic was observed in some hospitals.

Evaluation of Anti-Malarial Effects of Mass Chemoprophylaxis in the Republic of Korea Army

Joon-Sup Yeom,유승호,Sejoong Oh,Dong-Hyun Choi,Kyoung-Jun Song,오영하,Jae-Hyun Lee,Young-A Kim,Sun-Young Ahn,Hwa-Young Yang,Je-Eun Cha,박재원 대한의학회 2005 Journal of Korean medical science Vol.20 No.5

의학강좌 : 개원의를 위한 모범처방 ; 삼일열 말라리아의 진단과 치료

염준섭 ( Joon Sup Yeom ) 대한내과학회 2009 대한내과학회지 Vol.77 No.1

말라리아

염준섭 ( Joon Sup Yeom ) 대한내과학회 2014 대한내과학회지 Vol.86 No.3

Vivax malaria has occurred every year since its re-emergence in 1993. The majority of malaria infections in the Republic of Korea occur among person living in the vivax malaria-risk area. In the early period, most of the cases were from soldiers stationed in the Demilitarized Zone. But since the year 2000, epidemiologic characteristics have changed. In 2013, 453 cases occurred which is the lowest number since 1996 and more than half of the annual cases are occurring from civilian. Although number of malaria infection occurring among persons who traveled to regions with ongoing malaria transmission is relatively small, imported malaria is the important health concern. Imported malaria infections, especially falciparum malaria can be fatal if not diagnosed and treated promptly with appropriate antimalarial drugs. Even though malaria chemoprophylaxis will prevent majority of malaria infection, majority of persons with imported malaria did not take chemoprophylaxis. For proper prescription of prophylactic antimalarial medications and treatment, clinicians should consider likely country of malaria acquisition and drug resistance situation of that country.

뎅기열

염준섭 ( Joon Sup Yeom ) 대한인수공통전염병학회 2014 창립총회 및 학술대회 초록집 Vol.2014 No.1