생후 6개월 미만의 영아에서 백일해에 대한 적극적인 감시활동: 2011-2013년 단일기관 연구
Active Surveillance of Pertussis in Infants Under 6 Months of Age: A Single Center Experience from 2011 to 2013
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목적: 본 연구에서는 6개월 미만의 영아를 대상으로 백일해의 기초적인 역학조사를 확인하고자 단일 기관에서실시하였다. 방법: 2011년 10월부터 2013년 4월까지 분당 차병원에 내원한 진찰 당시 호흡기계 증상을 보여서 입원한 생후 6개월 미만의 영아들을 대상으로 비인두 흡입물로 B. pertussis PCR 또는 배양검사를 시행하였다. 또한 respiratorysyncytial virus, adenovirus, metapneumovirus,rhinovirus, parainfluenza virus, influenza A,B virus 포함한 호흡기 바이러스들에 대한 multiplexRT-PCR 검사를 시행 후 분석하였다. 결과: 대상 환아 수는 총 79례였으며 환아 연령 중앙값은 2개월이었고 대부분 진단은 급성 세기관지염(60%)이거나 폐렴(28%)이었다. B. pertussis 이 확인된 경우는 13례(16%)였으며 환아 연령 중앙값은 2개월이었다. B. pertussis 이 확인된 13례 중 7례(53%)에서 respiratorysyncytial virus가, 1례(7%)에서 influenza Avirus가 확인되었다. B. pertussis 이 확인된 13증례 중DTaP 접종력 없는 증례는 6례(46%)이었고 DTaP 백신 1회 접종한 증례는 6례(46%)이었고 DTaP 백신 2회접종한 증례는 1례(8%)이었다. 결론: 호흡기계 증상들을 보이는 입원한 생후 6개월 미만의 영아의 원인 병원체 중 B. pertussis 이 16%를 차지하였다. 6개월 미만의 영아들에 대한 향후 전국적인 다 기관이 포함된 역학적 감시 활동이 필요할 것으로 사료된다.
Abstract
Purpose: The objective of this study was to assess and investigate the epidemiology of pertussis in infants under 6 monthsof age. Methods: A prospective study was conducted between October 1, 2011 and April 30, 2013 in CHA Bundang Medical Center,Seongnam, South Korea. Polymerase chain reaction (PCR) or culture was used to detect Bordetella pertussis in nasopharyngealaspirates from case patients who were hospitalized for acute lower respiratory tract infection (LRTI). In addition,multiplex real-time PCR assays were also performed to detect 6 etiologic viruses, including adenovirus, human metapeumovirus,influenza virus, parainfluenza virus, respiratory syncytial virus and rhinovirus. Results: Of the 79 enrolled case patients, whose median age was 2 months of age, the most common diagnoses uncoveredin this study were acute bronchiolitis (60%) and pneumonia (28%). B. pertussis infection was found in 13 cases (16%), inwhich 7 (53%) was coinfected with respiratory syncytial virus and 1 (7%) with influenza A virus. Of the 13 patients withB. pertussis infection, 6 (46%) were not vaccinated with the diphtheria, tetanus toxoid, and acellular pertussis vaccine,while 6 (46%) received 1 dose, and 1 (8%) received 2 doses. Conclusion: B. pertussis infection was present in 16% of under 6 month-old infants, who were hospitalized for acute LRTI. Therefore, a nationwide epidemiological surveillance of pertussis, including institutions that cater to infants under 6 monthsof age is necessary and needed.
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