Respiratory Syncytial Virus 유행 시기에 따른Palivizumab 예방요법시기의 적정성 평가: 22년간단일기관 연구
Evaluation of Timeliness of Palivizumab Immunoprophylaxis Based on the Epidemic Period of Respiratory Syncytial Virus: 22 Year Experience in a Single Center
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목적: 본 연구는 respiratory syncytial virus (RSV) 유행 시기에 따른 palivizumab 투여 시기의 적절성을 분석함으로써 palivizumab 예방요법을 시작하는 시기의 적절성을 평가하고자 하였다. 방법: 1991년 1월부터 2012년 7월까지 서울대학교 어린이병원에서 호흡기 증상이 있는 소아의 호흡기 검체를 채취하여 RSV 항원 검사, 배양 검사 및 중합효소 연쇄 반응 검사를 시행하였으며 그 결과를분석하였다. RSV 양성건수와 RSV 검출률을 2주 단위로 조사하였으며 중합효소 연쇄 반응 검사가 도입되기 전, 1991년 1월부터 2007년 10월까지는 RSV 항원 및 배양 검사로 바이러스를 검출하였고 이후에는 중합효소 연쇄 반응 검사 방법으로 검출하였다. RSV 유행 시기의 시작은 2주 동안 4건 이상의 검체에서 양성을 보이면서 RSV의 검출률이 10% 이상을 동시에 만족하는 시기로 정의하였다. 또한2007년 1월부터 2014년 3월까지 2세 미만의 RSV 감염 고위험군을 대상으로 palivizumab의 예방요법 시작시기를 분석하였다. 결과: 22년간 RSV 검출률은 2,013/21,698 (9.69%)였으며 RSV 평균 유행기간은 10월 2-3주에서 2 월 1-2주로 확인되었다. 가장 빨리 유행이 시작되었던 시기는 7월 셋째 주(2001년)이었고 가장 늦게유행 시기가 끝났던 시기는 5월 셋째 주(1990년)였다. 가장 많이 palivizumab을 시작한 시기는 10월셋째 주(18.7%)였으며, 9월 15일 이전에 palivizumab 예방요법을 시작하는 비율이 2007년 3.8%에서2013년에는 14%로 증가하였다. 결론: RSV 유행 시기에는 해마다 차이가 있으며, palivizumab의 비용효과성을 증대시키기 위해 매해RSV 유행이 시작하는 시점에 따라 palivizumab 투여 시작 시기와 투여 기간을 조절해야 할 것으로 사료된다.
Abstract
Purpose: This study aimed to analyze the epidemic period of RSV infection and evaluate the appropriate time of palivizumab immunoprophylaxis. Methods: From January 1991 to July 2012, nasopharyngeal (NP) aspirates were obtained from patients who visited Seoul National University Children’s Hospital for respiratory symptoms. NP samples were used to detect respiratory viruses. Among them, we analyzed the positive number and detection rate of RSV infection in two-week interval. The beginning of RSV season was defined when RSV positive number was more than 4 and RSV detection rate was over 10%. From January 2007 to March 2014, we analyzed the starting time of palivizumab immunoprophylaxis for the infants at high risk. Results: The RSV detection rate was 2,013/21,698 (9.69%) over 22 years. The median RSV season was from 2nd-3rd week of October to 1st- 2nd week of February. The earliest starting week was the 3rd week of July in year 2001, and the latest end week was the 3rd week of May in year 1990. Palivizumab immunoprophylaxis was initiated most frequently at the 3rd week of October (18.7%). However, the percentage of starting palivizumab on the 1st week of September has increased from 3.8% in the year 2007 to 14.1% in 2013. Conclusions: The year to year variability of RSV season exists. The starting time of palivizumab immunoprophylaxis should be adjusted based on the season of RSV epidemic.
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