Non-O157 장출혈성대장균 불현성 감염증 집단유행
An outbreak of inapparent non-O157 enterohemorrhagic escherichia coli infection
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목적 : 우리나라에서 장출혈성대장균에 의한 집단발병 사례는 아직 없었다. 이번 사례는 2004년 7월 광주광역시의 한 초등학교에서 발생한 집단유행으로 그 감염원과 감염경로를 찾고자 역학조사를 실시하였다.방법 : 학교 교직원과 학생 전체를 대상으로 면접 및 설문조사를 실시하여 증상유무와 섭취음식을 확인하였고, 변 검체를 수거하여 미생물 검사를 실시하였다. 학교의 보존식과 여러 환경가검물을 수거하여 검사하였고, 학교시설 및 식자재 납품업체에 대해서도 역학조사를 실시하였다. 모든 양성자는 5개 병원에 분리 격리하였고, 장출혈성대장균 독소검사에서 연속 두 번 음성이 나올 때까지 매일 검사를 실시하였으며, 그들의 가족에 대해서도 설문조사 및 미생물 검사를 실시하였다. 분리된 균주는 PFGE 검사를 실시하여 유전적 연관성을 알아보았다. 결과 : 총 1,643명 중 77명(4.7%)이 균 양성이었고, 대부분 무증상이었다. 분리된 균주는 모두 non-O157형 장출혈성대장균이었고, 이 중 O91형이 가장 많았으며(68명), PFGE검사에서도 유전적 일치성을 보여주었다. 학교 급식의 관련성을 알아본 결과 상대위험도가 13.29 (95% 신뢰구간 = 3.28<RR<53.91)로 이번 유행이 급식과 유의한 관련이 있음을 알 수 있었다.
Abstract
Background : No outbreak of Enterohemorrhagic Escherichia coli (EHEC) infection has occurred as a group in Korea. On July 2004, an outbreak of EHEC infection occurred in an elementary school in Gwangju metropolitan city. Epidemic investigation was undertaken to track the source of infection and the mode of transmission of EHEC. Methods : All students and staffs of the elementary school were interviewed and completed questionnaires. We surveyed their clinical symptoms and the foods that they ate. Microbiologic examinations were also carried out on the above school-related persons and many environmental specimens. We also investigated the facilities of the school, some suppliers of food materials, and other associated institutions. All the EHEC-positive persons were isolated in 5 hospitals and tested everyday for verotoxin until they turned out to be negative twice in succession, and their family were also interviewed and tested for EHEC. Pulsed-field gel electrophoresis (PFGE) was performed to find out the genetic relationship between isolates. Results : Of the 1,643 school-related persons, 77 persons (4.7%) were positive for EHEC. Most of them were asymptomatic. All the isolated strains were non-O157 EHEC. Serotype O91 was the most frequent serotype (68 isolates), and the isolates revealing O91 serotypes showed identical PFGE patterns. The school meal was significantly associated with this outbreak (relative risk=13.29, p=0.00). Conclusions : This is the first EHEC outbreak occurred as a group in Korea, All the isolated strains were non-O157 serotypes and the mode of transmission was most likely by school meal.(Korean J Med 70:495-504, 2006)
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