Reemerging infectious diseases are infections that had decreased in incidence in the global population and were brought under control through effective health care policy such as vaccination, but more recently, began to resurge as a health problem due to many reasons. Measles, rubella, mumps and per...
Reemerging infectious diseases are infections that had decreased in incidence in the global population and were brought under control through effective health care policy such as vaccination, but more recently, began to resurge as a health problem due to many reasons. Measles, rubella, mumps and pertussis are the examples. Immunization with MMR (measles, mumps, rubella) and pertussis vaccine has contributed to marked decrease in measles, mumps, rubella and pertussis incidence worldwide. In Korea, measles and rubella almost disappeared after the introduction of 2 doses of MMR immunization schedule. Recently, these infections have been reemerging in many countries with low vaccination rates and can be introduced again in Korea. However mumps and pertussis outbreaks are reported among fully vaccinated populations. Declining vaccine effectiveness, an increased awareness and surveillance of the disease or improved laboratory diagnostic tools had been suggested as possible causes. For the clinicians, it is difficult to diagnose these reemerging infectious diseases partly because of few experience of typical cases of measles and rubella or partly because of modification of clinical symptoms and signs of infectious diseases in immunized population. In this article, the diagnosis of measles, mumps, rubella and pertussis will be reviewed in the aspects of clinical characteristics, serologic methods, virus isolation, and polymerase chain reaction.
Reemerging infectious diseases are infections that had decreased in incidence in the global population and were brought under control through effective health care policy such as vaccination, but more recently, began to resurge as a health problem due to many reasons. Measles, rubella, mumps and pertussis are the examples. Immunization with MMR (measles, mumps, rubella) and pertussis vaccine has contributed to marked decrease in measles, mumps, rubella and pertussis incidence worldwide. In Korea, measles and rubella almost disappeared after the introduction of 2 doses of MMR immunization schedule. Recently, these infections have been reemerging in many countries with low vaccination rates and can be introduced again in Korea. However mumps and pertussis outbreaks are reported among fully vaccinated populations. Declining vaccine effectiveness, an increased awareness and surveillance of the disease or improved laboratory diagnostic tools had been suggested as possible causes. For the clinicians, it is difficult to diagnose these reemerging infectious diseases partly because of few experience of typical cases of measles and rubella or partly because of modification of clinical symptoms and signs of infectious diseases in immunized population. In this article, the diagnosis of measles, mumps, rubella and pertussis will be reviewed in the aspects of clinical characteristics, serologic methods, virus isolation, and polymerase chain reaction.
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문제 정의
이제 다른 나라나 지역의 감염병의 유행은 더 이상 남의 일이 아니어서 이와 같은 감염병이 국내에 다시 도입되거나 유행할 수 있는 기회가 증가하고 있다. 백신 접종으로 더 이상 전형적인 홍역이나 풍진이 발생하지 않는 우리나라에서 수련 과정 중 이 질환들을 경험하지 못한 신세대 의사 들은 “열이 나고 기침을 하는데 피부에 발진도 있어요” 라고 병원에 오는 아이들을 진료하게 될 경우 홍역이나 풍진을 쉽게 진단할 수 있을까? “귀 밑이 부었어요”라고 하며 환자가 온다면 볼 거리라고 무조건 진단할 수 있을까? “기침을 너무 심하게 해서 기침하다가 토하고 약을 먹어도 낫지를 않아요”라는 환자를 만나면 백일해를 의심하여 감별 진단에 넣고 의심할 수 있을까? 본 글에서는 우리가 다시 만나게 될수 있는 이들 홍역, 볼거리, 풍진, 및 백일해 들의 진단을 위해 꼭 알아두어야 할 임상 증상과 검사 등에 대해 다루고자 한다.
성능/효과
코나 인두에서 풍진 바이러스를 배양하여 분리하면 진단에 도움이 되나, 최근에는 주로 중합 효소 연쇄반응법(polymerase chain reaction, PCR) 등을 이용하여 바이러스를 검출한다. 또한 효소면역법(enzyme immunoassay), 라텍스 응집법(latex agglutination), 혈구응집법(hemagglutination) 등 혈청학적 검사로 진단할수 있어 급성기와 회복기 혈청을 검사하여 풍진 IgG 항체가가 4배 이상 증가하였거나 또는 IgM 항체가 한 번 검출될 경우에는 최근의 감염으로 확인할 수 있다. 그러나 IgM 항체 검사는 민감도가 75-95%, 특이도가 85-100%로 그 범위가 다양하므로 해석에 주의를 해야 한다.
질의응답
핵심어
질문
논문에서 추출한 답변
풍진이란?
풍진은 미열과 홍반 구진, 림프절 비대를 특징으로 하는 급성 감염 질환으로, 특히 임신 초기에 감염될 경우 수막염, 폐렴, 간염, 자반병 및 빈혈 등의 다양한 임상 소견을 보이고, 지능 장애를 유발하는 선천 풍진 증후군을 지닌 신생아를 출산할 수 있다. 풍진 바이러스는 Togavirus 과 Rubivirus 속에 속하는 RNA 바이러스이다19-21) .
홍역의 특징은?
홍역은 전염력이 매우 높은 급성 감염병으로, 고열, 콧물, 결막염, 홍반 반구진의 융합 발진 및 질병 특유의 점막진을 특징으로 하는 질환이다. 한 번 걸린 후 회복되면 평생 면역을 얻게 되어 다시 걸리지 않는다.
홍역의 원인 바이러스는 무엇인가?
한 번 걸린 후 회복되면 평생 면역을 얻게 되어 다시 걸리지 않는다. 원인 바이러스는 RNA 바이러스로 Paramyxoviridae과 Morbillivirus 속에 속한다. 혈청형은 한 가지만 있다.
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