일부 농촌지역 초.중학생의 B형 간염 바이러스 감염 발생률에 대한 조사 연구

최보율,Choi, Bo-Youl 대한예방의학회 1986 Journal of Preventive Medicine and Public Health Vol.19 No.2

Infection by hepatitis B virus is one of the major health problems of this nation. HBsAg positive rates of general population and school children were known to be as about 8 percent and 3.9 to 5.9 percent respectively. To study the incidence rate of hepatitis B infection in school children of rural area, author had examined 475 school children of relatively isolated agricultural area for baseline prevalence of hepatitis B virus serologic markers and followed up 415 school children during 10 months to determined the frequency of serologic conversion. The major results are summarized as followings: 1) Among the 278 susceptible children who were followed up, 26 had seroconversion for HBsAg or Anti-HBs. Therefore, the cumulative incidence rate during 10 months is estimated 9.4%. 2) The incidence rate of hepatitis B infection tends to increase with age (6-9yrs: 3.2%, 10-14yrs: 9.5%, 15-17yrs: 18.9%), and the incidence rate in male (13.0%) was higher than in female (5.7%). 3) The incidence rates of hepatitis B virus infection were not different statistically among three economic classes (The rates of lower, middle and higher class were 11.8%, 7.1% and 10.5%.). 4) The incidence rates of hepatitis B virus infection were not different statistically between visitors and non-visitors of clinic or hospital, dental clinic, persons received IV and not received IV, and persons with familial history and without familial history of liver diseases. Therefore all of these factors were not identified as risk factor of hepatitis B virus infection. And the transmissibility within the class of school was not recognized, too. 5) Among the 25 children who were HBsAg positive when enrolled, 15 (60%) were still HBsAg positive, who were identified as chronic carrier 15 of 415 school children were chronic carriers, then chronic carrier rate was estimated 3.6%, and there was no difference between sexes. 6) Of 38 children who had been Anti-HBs positive when enrolled, 5 (13.2%) lost Anti-HBs. Therefore, the loss rate of Anti-HBs per year is estimated to be 15.8%.

감염병의 새로운 등장

최보율(Bo Youl Choi) 한국역학회 2008 Epidemiology and Health Vol.30 No.2

The term and concept of emerging infectious diseases (EID) has been burgeoned out in the early 1990s and EID were expected as the most important public health problems of all of countries and global community as a whole. EID have been confirmed as the most important health and security problems when the global community has been experienced a lot of outbreaks of EID including avian influenza in Hong Kong (1997), Nipah encephalitis in Malaysia and Singapore (1999), and anthrax bioterrorism in U.S.A. (2001), and SARS outbreaks in global community (2003). Pandemic influenza could be a big disaster in global community in the near future in the situation of the occurrence of H5N1 avian influenza and it’s human cases in southeastern Asian countries. This paper described the EIDs in terms of two epidemiologic transition theories, and described the important EID in global community since 1970s and reviewed the remarkable emerging and re-emerging infectious diseases in Korea since 1990. Seven factors contributing to EID and the convergence model for EID were introduced. In conclusion, the preparedness and response plan of public health authority the role of epidemiologist was suggested. Especially the cooperative activities between epidemiologists and other field or sector’s professionals were emphasized to find out the etiology or risk factors of EID and preparedness and response plan.

우리나라 HIV/AIDS와 결핵 관리 정책에 대한 고찰

최보율(Bo Youl ChoI) 한국역학회 2006 Epidemiology and Health Vol.28 No.1

  Since the early 1990s, Korea has made efforts to strengthen its National Communicable Disease Control System. In 2005, the Korea government developed various goals for communicable diseases control as a part of Health Plan 2010. The goals include 40 objectives, for the achievement of which a variety of programs and research subjects have been developed. These efforts will contribute to raising the preparedness for and response to the global threat of emerging and reemerging infectious diseases. The author reviewed the status, management goals and future tasks of HIV/AIDS and tuberculosis in Korea. HIV/AIDS is an emerging infectious disease, and tuberculosis is an endemic disease in Korea. These two diseases are included in the UN Millennium Development Goal 6.   The number of HIV/AIDS cases reported in Korea at the end of December 2005 was 3,829, of which 721 have died. The reported HIV prevalence rate among adults aged in 15-49 years is below 0.1%, and the infection level is categorized as "very low". However, the number of newly infected cases has been rising rapidly. The goal of HIV/AIDS control in Health Plan 2010 is to reduce the increasing rate of HIV/AIDS to 35% in 2010. Compared with the global Millennium Development Goal, which is to halt and reverse the spread of HIV/AIDS by 2015, we should set up long-tenn, high level goals, in addition to a comprehensive national plan for the prevention and control of HIV/AIDS.   Korea first implemented a Nationwide Tuberculosis Control Program in the 1960s. By 2005, the prevalence of radiologically active tuberculosis had fallen to 0.35% which is one-fifteenth of the level of 1965. Nevertheless, the current prevalence of and death rate from tuberculosis continue to be much higher than those of advanced nations. Given this such a level of infection, the goals of tuberculosis control need to be specified, and an enhanced tuberculosis control program needs to be implemented to reduce the incidence of tuberculosis and associated death rates.

새로 등장하는 전염병과 국가간 전염병의 전파

최보율(Bo Youl Choi),이수진(Soo-jin Lee) 한국항공우주의학협회 2001 항공우주의학회지 Vol.11 No.2

풍진 예방접종사업의 비용-편익분석

신영전,최보율,박항배,문옥륜,윤배중,Shin, Young-Jeon,Choi, Bo-Youl,Park, Hung-Bae,Moon, Ok-Ryun,Yoon, Bae-Joong 대한예방의학회 1994 Journal of Preventive Medicine and Public Health Vol.27 No.2

Rubella is a viral disease with mild constitutional symptoms and generalized rashes. In childhood, it is an inconsequential illness, but when it occurs during early pregnant period, there are significant risks of heart defects, cataract, mental retardation to the fetus. The series of congenital defects induced by rubella is called 'congenital rubella syndrome'. Many research have been performed to find out more effective prevention program on rubella. The objectives of this study are, first, to calculate the incidence rate of acute rubella infection and congenital rubella syndrome in Korea, second, to evaluate economic efficiency of several rubella vaccination policies and to offer data for the most reasonable decision on vaccination policy. Study populations are 663,312 children of one year-old in 1992. The author has performed cost-benefit analyses according to the three vaccination policies-U.S.A.'s. U.K.'s and Sweden's. In this Study, the author got the incidence rate of acute rubella infection using the catalytic model. In the meantime, the author used 50 per 100,000 live births as the incidence rate of congenital rubella syndrome. The discount rate used in this study was 5 percent per annum. The sensitivity analyses were done with different discount rates (4%, 7%) and different incidence rate of congenital rubella syndrome (10,100 per 100,000 live births) : The study results are as follows: 1. Without vaccination, lifetime expenditures per patient for acute rubella infeciton amount to 14,822 won and the total expenditures to about 3.1 billion won. Meanwhile, lifetime expenditures per patient for congenital rubella syndrome amount to about 91 million won and the total expenditures to about 16.3 billion won without vaccination. 2. The cost of vaccination for a child of one year old was 2,322 won and the total cost for the one year old children was about 1.5 billion won (American style). The cost for vaccination of female children at fifteen was about 339 million won (Birtish style). And the cost of vaccination at one for both sex and female children at fifteen was about 1.9 billion won (Swedish style). 3. The benefit to cost ratios of vaccination of female children at fifteen that is the british mode of rubella vaccination, was 60.0 at the level of 80% population coverage and 48.6 at 100% coverage. It shows much higher benefit to cost ratio than those of the other two vaccination policies. 4. Both net benefits of vaccination at one (American style) and that of vaccinations at one and fifteen (Swedish style) range from about 17.0 billion to 17.8 billion won, those were larger than that of vaccinations of female children at fifteen (Birtish style, about 16.0 billion). 5. In marginal cost-benefit analysis of only additional program of revaccination, the benefit to cost ratios were 3.6 (80% coverage rate) or 0.6 (100% coverage rate). It implies that additional program was less efficient or inefficient. 6. In sensitivity analysis with different discount rates(4% or 7%) and different incidence rates of congenital rubella syndrome (10 or 100 per 100,000 live births), the benefit to cost ratios has fluctuated in wide range. However, all the ratios of vaccination of female children at fifteen were higher than those of the others. Even under the most conservative assumption, the benefit to cost ratios of all the rubella vaccination policies were higher than 3.3. In conclusion, all the rubella vaccination policies found to be cost-effective and particularly the vaccination of female children at fifteen was strongly recommended.

경기도 지역 임신부를 대상으로 한 풍진 항체 양성률에 대한 혈청 역학적 연구

기모란,최보율,신영전,박항배,윤배중,한중석,Ki, Mo-Ran,Choi, Bo-Youl,Shin, Young-Jeon,Park, Hung-Bae,Youn, Bae-Joong,Hahn, Joong-Surk 대한예방의학회 1997 Journal of Preventive Medicine and Public Health Vol.30 No.2

The vaccinations of susceptible children and postpubertal females are the major means to prevent congenital rubella syndrome(CRS). Another means for reducing the CRS is therapeutic abortion or fetal monitoring for women who are infected in the first four months of pregnancy. We could not estimate the incidence of CRS in Korea, because there was no surveillance system for rubella and CRS. Nationwide vaccination program for 15months infant had been started early 1980s. So, most women at childbearing age during study period were not received rubella vaccination. We set forth CRS management system for pregnant women in two rural county of Kyonggi province, Korea. In this system, the presence of rubella IgG and IgM antibodies for early pregnant women were examined with MEIA(Microparticle Enzyme Immunoassay) method by IMx automated analyzer $Abbott^(R)$. The infected pregnant women followed up in order to confirm their childrens CRS. This study was carried out from Mu. 1993 to Jun. 1994, and pregnant women examined were 874 persons. The results were summarized as follows. The overall positive .ate of rubella IgG antibody was 94.5%(826/874). The positive rate was significantly increase as the age increased, and reached 100% in pregnant women who were over 35 years old. This results suggest that a meaningful number of women are infected during childbearing years. The geometric mean titer of IgG of sero-positive subjects was significantly declined as the age increased. On the question about history of URI symptoms and rash in pregnancy, 20.7% of respondents checked on URI symptoms with .ash, 13.5% only URI symptoms without .ash, and 65.8% no symptoms. However there was no demonstrable association between the rubella like infection history in pregnancy and the rubella IgG and IgM antibody status. Rubella infection .ate in pregnant women was 0.9%(95% CI 0.4-1.8%). Two of these 8 infected pregnancies were terminated by therapeutic abortion. One of them was not followed. Five babies had no gross anomalies at birth. In Dec. 1996, three of five babies were normal appeared infants. Two of them were not followed. Throughout this study results, we confirmed the need of CRS management system for pregnant women, in Korea.

서울 S지역에서 발생한 영아 메트헤모글로빈혈증 1례의 원인구명을 위한 역학조사

김영열,최보율,박항배,김민영,여인학,Kim, Young-Yeul,Choi, Bo-Youl,Park, Hang-Bae,Kim, Min-Young,Yeo, In-Hak 대한예방의학회 1993 Journal of Preventive Medicine and Public Health Vol.26 No.2

Epidemiologic investigation was conducted on January, 1993 in Seoul to identify the cause of an infant methemoglobinemia. Field investigation of the area of outbreak, survey of household and family members, analysis of ground water, and blood tests of involved family members were performed. Following results were obtained On analyzing the quality of the ground water on patient's household high levels of nitrate was found indicating contamination of water as the cause of a methemoglobinemia outbreak. On analysing the quality of the ground waters on seven other places within the neighborhood five were contaminated by nitrate in concentration that exceeded the permissible limit implying presence nearby source of contamination. Sources of contamination were thought to be originating from human waste in conventional bathroom facilities, chicken manure used in nearby orchards and plant fields or fertilizers. But the results of water analysis with presence of bacteria or E.coli, concentration of potassium, phosphate and the past history of diarrhea among family members, chicken manure suggested the most possible source of contamination. To evaluate the health status of members in the neighborhood past history was reviewed revealing no prior existence of patient with cyanosis and 65 people in the neighborhood had normal levels of methemoglobin concentration in their blood. Conclusively, the ground water on patient's household was contaminated with nitrate and despite provision of adequate water supply, family members of the patient along with their distrust in the water supply system had used ground water as their source of drinking water resulting of methemoglobinemia. Many suburban area of Seoul and country side thought to be having similar problems concerning contaminated ground water supply and dormant outbreak of patients as a result of the drinking of the contaminated water. Epidemiologic investigation and water analysis of ground waters are advised.

비만 지표와 심혈관계질환 위험인자간의 상관성 및 복부비만지표의 유용성

하헌영,최보율,박항배,Ha, Hun-Young,Choi, Bo-Youl,Park, Hung-Bae 대한예방의학회 1997 예방의학회지 Vol.30 No.2

It is a well known fact that obesity is an important cause of cardiovascular disease, emphasized by many studies. Recently, cardiovascular diseaase has been found to correlate not only to the extent of obesity, but also the fat distribution of the individual; especially, focusing on obesity of the abdomen. Unfortunately, the proposed indices for abdominal obesity are numerous, and the results vary according to the index chosen. Three-hundred and twelve bus drivers in November, 1995, were chosen as subjects of this study. The author chose to measure serum lipid levels, fasting blood sugar levels and blood pressure, that are thought to be important risk factors of cardiovascular diseases. Obesity indices were calculated using anthropometric measurements. We were able to evaluate the significance of obesity indices by examining correlations between these indices and the risk factors of cardiovascular disease. The results obtained were as follows: 1. The abdominal obesity indices and risk factors of cardiovascular disease, the levels of total cholesterol in the serum, fasting blood sugar levels, and diastolic blood pressure, increased significantly according to age. 2. There was a significant difference in the abdominal obesity indices according to drinking and smoking habits controlled for age. Among the risk factors of cardiovascular disease, triglyceride and diastolic pressures had significant differences according to the presence or absence of a drinking history controlled for age. 3. Although all obesity indices showed significant correlations, the weakest correlation was between BMI and abdominal diameter index and the strongest correlation was between sagittal diameter and sagittal diameter matched for height. 4. There was a negative correlation between HDL-cholesterol and obesity indices. The weakest correlation was between fasting blood sugar levels and both SD and SDH showed correlations with the risk factors. 5. There was a significant correlation between SD and total cholesterol in the serum and fasting blood sugars controlled for age, drinking, and BMI. 6. After categorizing the subjects into 2 separate age groups at the 40 year mark, in the less than 40 you old age group, controlled for drinking and BMI, the results of comparitive studies have shown correlations between total cholesterol serum levels and waist-hip ratio, conicity-index, and SD. There were correlations between fasting blood sugar levels and SD, ADI, and SDH. There were no correlations between obesity indices and both total cholesterol serum levels and fasting blood sugar levels in the greater than 40 year old age group. There were significant correlations between abdominal obesity indices and total serum cholesterol or fasting blood sugar levels in the less than 40 year old age group, but no correlations in the age group over 40. These correlated factors between abdominal obesity and cardiovascular disease are assumed to exist in Korea as well. Furthermore, in this study a high correlation was found between SD, SDH and the risk factors of cardiovascular disease. Even when controlled for age, drinking, smoking, and BMI, the correlations between risk factors of cardiovascular disease and these indices exist. Therefore, the obesity indices, SD and SDH may prove to be important prognostic indicators or risk factors of cardiovascular disease.

한 농촌지역 주민에서 성, 연령 및 Helicobacter pylori 감염 여부에 따른 위축성 위염과 장상피화생 유병률

김현자,최보율,변태준,은창수,송규상,김용성,한동수,Kim, Hyun-Ja,Choi, Bo-Youl,Byun, Tae-Joon,Eun, Chang-Soo,Song, Kyu-Sang,Kim, Yong-Sung,Han, Dong-Soo 대한예방의학회 2008 예방의학회지 Vol.41 No.6

Objectives ; The objective of this study was to evaluate the prevalence of atrophic gastritis and intestinal metaplasia according to gender, age and Helicobacter pylori infection in a rural population in Korea. Methods: Between April 2003 and January 2007, 713 subjects (298 men and 415 women, age range: 18-85) among the 2,161 adults who participated in a population-based survey received gastrointestinal endoscopy. All the subjects provided informed consent. Multiple biopsy specimens were evaluated for the presence of atrophic gastritis and intestinal metaplasia. The presence of Helicobacter Pylori was determined using CLO and histology testing. Results ; The age-adjusted prevalence of atrophic gastritis was 42.7% for men and 38.1% for women and the prevalence of intestinal metaplasia was 42.5% for men and 32.7% for women. The prevalence of atrophic gastritis and intestinal metaplasia increased significantly with age for both men and women (p for trend<0.001). The age-adjusted prevalence of Helicobacter pylori was similar for men (59.0%) and women (56.7%). The subjects with Helicobacter pylori infection showed a significantly higher prevalence of intestinal metaplasia (44.3%) compared with that (26.8%) of the noninfected subjects (p<0.001). However, the prevalence of atrophic gastritis was not statistically different between the Helicobacter pylori-infected subjects and the noninfected individuals. Conclusions : Our findings suggest that the prevalence of atrophic gastritis and intestinal metaplasia is higher for a Korean rural population than that for a Western population; this may be related to the high incidence of gastric cancer in Koreans. Especially, the prevalence of intestinal metaplasia was high for the subjects with Helicobacter pylori infection. The multistep process of gastric carcinogenesis and the various factors contributing to each step of this process need to be determined by conducting future follow-up studies.

전염병 감시 체계 소개 및 평가

박옥,최보율,Park, Ok,Choi, Bo-Youl 대한예방의학회 2007 예방의학회지 Vol.40 No.4

Effective communicable disease surveillance systems are the basis of the national disease prevention and control. Following the increase in emerging and re-emerging infectious diseases since late 1990s, the Korean government has strived to enhance surveillance and response system. Since 2000, sentinel surveillance, such as influenza sentinel surveillance, pediatric sentinel surveillance, school-based sentinel surveillance and ophthalmological sentinel surveillance, was introduced to improve the surveillance activities. Electronic reporting system was developed in 2000, enabling the establishment of national database of reported cases. Disweb, a portal for sharing communicable disease information with the public and health care workers, was developed. In general, the survey results on usefulness and attributes of the system, such as simplicity, flexibility, acceptability, sensitivity, timeliness, and representa-tiveness, received relatively high recognition. Compared to the number of paid cases of national health insurance, reported cases by national notifiable disease surveillance system, and various sentinel surveillance system, the result of the correlation analysis was high. According to the research project conducted by KCDC, the reporting rate of physicians in 2004 has also greatly improved, compared with that in 1990s. However, continuous efforts are needed to further improve the communicable disease surveillance system. Awareness of physicians on communicable disease surveillance system must be improved by conducting education and information campaigns on a continuous basis. We should also devise means for efficient use of various administrative data including cause of death statistics and health insurance. In addition, efficiency of the system must be improved by linking data from various surveillance system.