국내소아무균성뇌막염의전국적발생양상 정해관박수경기모란이관 B3 3 [14], 1995 B3 7 [13,15], 1996 B1[13], A24 9[16], 1997 B5 Echo 30[17,18], [19] [1-4]. . - [10].

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1 원저 국내소아무균성뇌막염의전국적발생양상 정해관박수경기모란이관 성균관대학교의과대학사회의학교실을지대학교의과대학예방의학교실 서울대학교의과대학예방의학교실동국대학교의과대학예방의학교실 [1-4] 서론 1994 B3 3 [14] 199 B3 7 [13] 199 B1[13] A24 9[1] B Echo 3[1718] 1998 [19] enterovirus adenovirus arbovirus mumps herpes virus [-] (enterovirus) 8% [7-9] 8 (herpangina) [-11] 1991 B[12] 1993 B3 7 [13] - [] [172] [17] 4 [21] 22

2 1 1 [22] 연구대상및방법 (ICD-) A87 (Viral meningitis) A878 (Other specified viral meningitis) A879 (Viral meningitis NOS) (3%) 83% 777% [22] 결과 1 발생환자 % (Table 1) 41% 23

3 (Table 2) 4% 424% 24% 89% 94% 2 전국발생률 Table 1 Number of admitted and out patient pediatric aseptic meningitis cases by year Year Admission Outpatient Total Total 12 (313%) 1431 (87%) Table 2 Number of pediatric aseptic meningitis cases by year and type of institution 293 (%) General hospital Hospital Clinic Total Total 9419 (41%) 142 (7%) 241 (479%) Table 3 Incidence of pediatric aseptic meningitis by gender and year Male Female Total 293 (%) No Incidence* No Incidence* No Incidence * Adjusted incidence Total (17%) (383%) (%) * //yr Adjusted for the population in the year 24

4 Incidence (/) Age Year 199 Fig 1 Incidence of pediatric aseptic meningitis by age and year Incidence is highest between age three to seven peaks at five However yearly pattern shows slight difference by year to year (Table 3) 3-7 (Fig 1) (Fig 2) ) Fig 2 National incidence of pediatric aseptic meningitis by year and month

5 7 ) Fig 3 National incidence of pediatric aseptic meningitis by year and month ~ 3 11 ~ 3 3/ (Fig 3) 199 Table 4 Incidence of pediatric aseptic meningitis by region and year (/) Region Total Seoul Busan Daegu Incheon Gwangju Daejeon Ulsan Gyeonggi Gangwon Chungbuk Chungnam Jeonbuk Jeonnam Gyeongbuk Gyeongnam Jeju

6 (Table 4) 고찰 (Fig ) [23] Incidence (/) Fig 4 Geographic distribution of pediatric aseptic meningitis by year

7 [24] [] [] -8 ' ) 제주 전남 광주 부산 울산 경남 전북 대구 경북 충남 대전 충북 경기 인천 서울 강원 ' ) 제주전남광주부산울산경남전북대구경북충남대전충북경기인천서울강원 ' ) 제주 전남광주부산 울산경남전북 대구경북충남 대전충북경기 인천서울강원 ' ) 제주전남광주 부산울산경남 전북대구경북 충남대전충북 경기인천서울 강원 ' ) 제주전남 광주부산울산 경남전북대구 경북충남대전 충북경기인천 서울강원 ' ) 제주 전남 광주 부산 울산 경남 전북 대구 경북 충남 대전 충북 경기 인천 서울 강원 Fig Geographic distribution of incidence of pediatric aseptic meningitis by week of the year This graphs show that from south to north pattern of the progression of the outbreak of the disease is not evident Disease clustering is more evident in localized area in each region 28

8 - (1-3 ) Week 2 2 제주광경주전남북지역경 북대전경 기서 울 Week Percentile 제주광 경주남전북경북대전경기서지역울 Week 2 2 Percentile 제주광경주 남전북경북대전경기서지역울 Week 2 2 제주광경주전남북지역경 북대전경 기서 울 Week 2 9 Percentile 2 제주광주경남전 북경북대전경기서울지역 Week Percentile 제주광 경주전남북경북대전경기서지역울 Fig Distribution of onset of pediatric aseptic meningitis cases in a year by region Each grid in Y-axis means percentile of the whole patients in each year Color stripes in each graph denotes the week of the year Regions are placed by the level of latitude increasing from left to right These graphs show that progression of pediatric aseptic meningitis is not dependent on the latitude without any evidence of from south to north progression of the disease It suggests that transmission of the disease is dependent on the factors other than temperature 29

9 (RT-PCR) 1 [] [] [2] [] %(184 ) 4%(8 ) ±% [22] /mcl 4-8% mg/dl 4% [] 2

10 참고문헌 1 Enterovirus 1998;41: Enterovirus 1999;:1-3 3 Bottner A Daneschnejad S Handrick W Schuster V Liebert UG Kiess W A season of aseptic meningitis in Germany: epidemiologic clinical and diagnostic aspects Pediatr Infect Dis J 22;21: Strikas RA Anderson LJ Parker RA Temporal and geographic patterns of isolates of nonpolio enterovirus in the United States J Infet Dis 198;3:34-1 Centers for Disease Prevention and Control Summary of notifiable disease United States 1994 MMWR 199;43(3):1-8 Centers for Disease Prevention and Control Outbreak of aseptic meningitis associated with multiple enterovirus serotypes Romania 1999 MMWR ; 49(29): Chonmaitree T Menegus MA Powell KR The clinical relevance of 'CSF viral culture' A two-year experience with aseptic meningitis in Rochester NY JAMA 1982;247: Ratzan KR Viral meningitis Med Clin North Am 198;9: Connolly KJ Hammer SM The acute aseptic meningitis syndrome Infect Dis Clin North Am 199;4:99-22 Morens DM Pallansch MA Moore M Polioviruses and other enteroviruses In: Belshe RB editor Textbook of human virology 2nd ed St Louis: Mosby Yearbook; 1991 p Morens DM Pallansch MA Epidemiology In: Rotbart HA editor Human enterovirus infections 1st ed Washington DC: ASM Press; 199 p ;3: ;: ;: ;28: Chung JA Kim YJ Choi HJ Chung WK An epidemic of aseptic meningitis in summer 199 and global analysis and comparison of it with 1993 J Korean Pediatr Soc ;4: Coxsackie B Echo 3 ;8: ;31:42-19 : ;31: :4: ;39: ;3(4): Gerba CP Rose JB Haas CN Sensitive populations: who is at the greatest risk? Int J Food Microbiol 199;3: Centers for Disease Prevention and Control Outbreak of aseptic meningitis - Whiteside County Illinois 199 MMWR ;4(): Green MS The male predominance in the incidence of infectious diseases in children: a postulated explanation for disparities in the literature Int J Epidemiol 1992;21:381-21

11 Six year national trend of childhood aseptic meningitis incidence in Korea Hae-Kwan Cheong 1) Sue Kyung Park 2) Moran Ki 3) Kwan Lee 4) Background and objectives: Aseptic meningitis is a disease of children with seasonal outbreak in summer In spite of high morbidity it is not notifiable without reported nationwide morbidity The authors estimated incidence of aseptic meningitis and its descriptive characteristics and time- and space-clustering pattern Subjects and methods: Cases of aseptic meningitis were extracted from National Health Insurance payment request data of National Health Insurance Corporation from January 199 to December 21 Cases were classified by region institution and hospitalization Standardized incidence was calculated and compared by the region month of the year whether there is any clustering Results: Nationwide incidence of aseptic meningitis among children under years old over the six year period was 348 per per year Incidence was higher in female (28/) compared to male (42/) Age-specific incidence was highest in years old Annual incidence was highest in (844/) and lowest in (79 /) with outbreak every 3 or 4 years Outbreak was mostly confined in summer months between May and September However seasonal pattern was variable by year Southern provinces and metropolitan areas had higher incidences and pattern was more prominent in the years with higher outbreak Time-dependent pattern of the disease from south to north was not prominent Discussions and conclusions: We have calculated the nationwide incidence of the aseptic meningitis over six year period In terms of aseptic meningitis using National Health Insurance data for the estimation of the incidence is a plausible method for the surveillance of the disease : Aseptic meningitis Enterovirus Descriptive epidemiology Clustering 22

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