Pediatric Infection and Vaccine

  • 제22권2호
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  • Pages.63-68
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  • 2015
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  • 2384-1079(pISSN)
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  • 2384-1087(eISSN)
대한소아감염학회 (The Korean Society of Pediatric Infectious Diseases)
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2013년 경기 북부 한 병원에서 확인된 소규모 홍역 유행

A Small Outbreak of Measles in 2013: In a Single Hospital in Northern Gyeonggi-do

  • 김민재 (가톨릭대학교 의과대학 소아과학교실) ;
  • 김소현 (가톨릭대학교 의과대학 소아과학교실) ;
  • 김성언 (가톨릭대학교 의과대학 소아과학교실) ;
  • 장미진 (가톨릭대학교 의과대학 소아과학교실) ;
  • 이현승 (가톨릭대학교 의과대학 소아과학교실) ;
  • 김영훈 (가톨릭대학교 의과대학 소아과학교실) ;
  • 한지환 (가톨릭대학교 의과대학 소아과학교실) ;
  • 김진택 (가톨릭대학교 의과대학 소아과학교실) ;
  • 장필상 (가톨릭대학교 의과대학 소아과학교실)
  • Kim, Min Jae (Department of Pediatrics, The Catholic University of Korea College of Medicine) ;
  • Kim, So Hyun (Department of Pediatrics, The Catholic University of Korea College of Medicine) ;
  • Kim, Sung Un (Department of Pediatrics, The Catholic University of Korea College of Medicine) ;
  • Jang, Mi Jin (Department of Pediatrics, The Catholic University of Korea College of Medicine) ;
  • Lee, Hyun Seung (Department of Pediatrics, The Catholic University of Korea College of Medicine) ;
  • Kim, Young Hoon (Department of Pediatrics, The Catholic University of Korea College of Medicine) ;
  • Han, Ji Whan (Department of Pediatrics, The Catholic University of Korea College of Medicine) ;
  • Kim, Jin Tack (Department of Pediatrics, The Catholic University of Korea College of Medicine) ;
  • Jang, Pil Sang (Department of Pediatrics, The Catholic University of Korea College of Medicine)
  • 투고 : 2014.10.23
  • 심사 : 2014.10.30
  • 발행 : 2015.08.25
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초록

목적: 저자들은 2013년 경기 북부의 한 병원에서 경험한 소규모 홍역 유행의 양상을 알아보기 위해 본 연구를 시행하였다. 방법: 2013년 8월부터 10월까지 가톨릭대학교 의정부성모병원에서 홍역으로 확진된 환아 15명의 의무기록을 후향적으로 분석하였다. 결과: 홍역으로 진단된 환아는 모두 15명으로, 신생아 1명, 영아 11명, 유아 3명이었으며 역전사 중합 효소연쇄반응법(RT-PCR)과 혈청 내 홍역 IgM 검사로 확진하였다. 모든 환아는 Measles-Mumps-Rubella (MMR) 접종을 받지 않았다. 홍역으로 확진된 환아의 바이러스 유전형은 모두 B3이었다. 9명(60%)의 환아가 원내 감염에 의해 홍역에 걸렸다. 잠복기는 8-15일이었고 발열은 접촉 후 평균 10일째 발생하여 평균 8일 동안 39도 이상으로 지속되는 양상을 보였다. 발진은 접촉 후 평균 13일째 발생하였다. 40%의 환아가 호흡기 합병증을 보였고 53%의 환아가 설사를 동반하였다. 결론: 우리나라는 꾸준한 접종 사업을 통해 홍역 퇴치 수준에 이르게 되었지만 홍역 재유행, 특히 영아에 대한 위험성을 간과할 수 없게 되었다. 영유아에서 홍역이 의심될 때에는 가속접종, 면역글로불린 투여와 같은 처치를 적극적으로 시행하는 것이 필요하다. 향후 홍역 유행을 막기 위한 첫 번째 단계로, 신생아, 영아, 가임기 여성의 홍역 IgG 항체가 재조사가 필요할 것으로 사료된다.

Purpose: This study analyzed a small outbreak of measles at a single hospital located in northern Gyeonggi-do in 2013. Methods: We reviewed the medical records of measles patients at The Catholic University of Korea Uijeongbu St. Mary's Hospital from August to October, 2013. Results: Fifteen children were confirmed to have measles by RT-PCR and serum IgM test; 1 neonate, 11 infants, and 3 toddlers. None of the patients had received Measles-Mumps-Rubella vaccination. All patients showed B3 type in viral genotyping. Nine children (60%) had been exposed to measles during treatment for other diseases in the pediatric ward. Incubation period was between 8 and 15 days. Fever started at a median 10 days after exposure and persisted for a median of 8 days. Rash showed at a median 13 days after exposure. Respiratory complications were observed in 40% of patients. Diarrhea developed in 53% of patients. Conclusion: Although measles has been well-controlled due to the high rate of vaccination coverage, it is possible to have an outbreak at any given time, especially in infants. We must learn from this outbreak, and remain fully aware of the possibility of reemergence and provide proper management, including vaccination or immune globulin administration, to infants exposed to measles. Reevaluation of serum IgG titer of neonates, infants, and pregnant women may be the first step to prevent further outbreaks.

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참고문헌

  1. Park YJ, Eom HS, Kim ES, Choe YJ, Bae GR, Lee DH. Reemergence of measles in South Korea: implication for immunization and surveillance programs. Jpn J Infect Dis 2013;66:6-10. https://doi.org/10.7883/yoken.66.6
  2. Rappuoli R, Pizza M, Del Giudice G, De Gregorio E. Vaccines, new opportunities for a new society. Proc Natl Acad Sci USA 2014;111:12288-93. https://doi.org/10.1073/pnas.1402981111
  3. Rogalska J, Karasek E, Paradowska-Stankiewicz I. Measles in Poland in 2012. Przegi Epidemiol 2014;68:187-90.
  4. Caseris M, Houhou N, Lonquet P, Rioux C, Lepeule P, Rioux C, et al. French 2010-2011 measles outbreak in adults: report from a Parisian teaching hospital. Clin Microbiol Infect 2014;20:O242-4. https://doi.org/10.1111/1469-0691.12547
  5. Navarro E, Mochon MM, Galicia MD, Marin I, Laquna J. Study of a measles outbreak in Granada with preventive measures applied by the courts, Spain, 2010 to 2011. Euro Surveill 2013;18:pii=20612. https://doi.org/10.2807/1560-7917.ES2013.18.43.20612
  6. Gastanaduy PA, Redd SB, Fiebelkorn AP, Rota JS, Rota PA, Bellini WJ, et al. Measles-United States, January 1-May 23, 2014. MMWR Morb Mortal Wkly Rep 2014;63:496-9.
  7. Teleb N, Lebo E, Ahmed H, Hossam AR, El Sayed el T, Dabbagh A, et al. Progress toward measles elimination-Eastern Mediterranean Region, 2008-2012. MMWR Morb Mortal Wkly Rep 2014;63:511-5.
  8. Wallace AS, Masresha BG, Grant G, Goodson JL, Birhane H, Abraham M, et al. Evaluation of economic costs of a measles outbreak and outbreak response activities in Keffa Zone, Ethiopia. Vaccine 2014;32:4505-14. https://doi.org/10.1016/j.vaccine.2014.06.035
  9. Mitchell P, Turner N, Jennings L, Dong H. Previous vaccination modifies both the clinical disease and immunological features in children with measles. J Prim Health Care 2013;5:93-8.
  10. Griffine DE. Measles virus and the nervous system. Handb Clin Neurol 2014;123:577-90. https://doi.org/10.1016/B978-0-444-53488-0.00027-4
  11. Nadaoka Y, Hayata N, Suqishita Y, Kajiwara T, Watanabe Y, Yoshida M, et al. The 2011 measles outbreak in Tokyo. An analysis of surveillance data. Nihon Koshu Eisei Zasshi 2014;61:136-44.
  12. Maglione MA, Das L, Raaen L, Smith A, Chari R, Newberry S, et al. Safety of vaccines used for routine immunization of U.S. children: a systematic review. Pediatrics 2014;134:325-37. https://doi.org/10.1542/peds.2014-1079
  13. Defay F, De Serres G, Skowornski DM, Boulianne N, Ouakki M, Landy M, et al. Measles in children vaccinated with 2 doses of MMR. Pediatrics 2013;132:e1126-33. https://doi.org/10.1542/peds.2012-3975
  14. Jones P. Measles targets and herd immunity. Br J Gen Pract 2013;63:403-4.
  15. Giddings G, Sibbald B. Imported measles outbreaks prompt call for patents to vaccinate their children. CMAJ 2014;186:205-6. https://doi.org/10.1503/cmaj.109-4759
  16. Centers for Disease Control and Prevention (CDC). Two measles outbreaks after importation--Utah, March-June 2011. MMWR Morb Mortal Wkly Rep 2013;62:222-5.
  17. Rosen JB, Rota JS, Hickman CJ, Sowers SB, Mercarder S, Rota PA, et al. Outbreak of measles among persons with prior evidence of immunity, New York City, 2011. Clin Infect Dis 2014;58:1205-10. https://doi.org/10.1093/cid/ciu105
  18. Tapisiz A, Polat M, Kara SS, Tezer H, Simsek H, Aktas F. Prevention of measles spread on a paediatric ward. Epidemiol Infect 2014;30:1-5.
  19. Borras E1, Urbiztondo L, Costa J, Batalla J, Torner N, Plasencia A, et al. Measles antibodies and response to vaccination in children aged less than 14 months: implications for age of vaccination. Epidemiol Infect. 2012;140:1599-606. https://doi.org/10.1017/S0950268811002184
  20. Wang FJ, Sun XJ, Wang FL, Jiang LF, Xu EP, Guo JF. An outbreak of adult measles by nosocomial transmission in a high vaccination coverage community. Int J Infect Dis 2014;26:67-70. https://doi.org/10.1016/j.ijid.2014.05.006
  21. Low C, Thoon KC, Lin R, Chua A, Hishamudding P, Tay J, et al. Possible nosocomial transmission of measles in unvaccinated children in a Singapore public hospital. Western Pac Surveil Response J 2012;3:7-11. https://doi.org/10.5365/wpsar.2012.3.4.008
  22. Maltezou HC, Wicker S. Measles in health-care settings. Am J Infect Control 2013;41:661-3. https://doi.org/10.1016/j.ajic.2012.09.017