전국 초·중·고등학교의 홍역 예방접종률 및 항체 양성률에 관한 연구 = Nationwide Study of the Vaccination Rate and Seroprevalence of Measles for Students in Korea

다국어 초록 (Multilingual Abstract)

BACKGROUNDS: In Korea, there was a nationwide epidemic of measles in 2000 and approximately 32,000 cases of measles were reported to the KNIH. We proposed a measles seroepidemiologic study to determine the most susceptible age groups for measles and then to implement a catch-up campaign for them.
METHODS: Approximately 23,000 students from all 16 provinces in Korea were sampled by a modified population based cluster random sampling method, in which the parents of the selected students provided informed consent. 18,139 students (boys 49.1 %, girls 50.9 %) were enrolled in this study. They were given a questionnaire for their vaccination histories and vaccination records, if they existed, and a serologic test on the measles-specific IgG by an enzyme linked immunosorbent assay.
RESULTS: The vaccination record-keeping rates were 33.1 % of elementary school subjects, 14.0 % of middle school students and the vaccination record-present rate was 14.7 % of elementary school subjects. The vaccination rates for the MMR at 12-15 months of age were 86.2 % of elementary school subjects, 80.2 % of middle school subjects. The rate for the MMR at 4-6 years age was 37.7% of elementary school subjects. The history of a past measles infection increased as the age of students increased.
Of the 18,139 students tested, 16,212 (89.4 %; 95% C.I.=88.9-89.8) were seropositive, and the seroprevalence was 85.4 % (95% C.I.=84.8-86.2) of elementary school subjects, 92.8% (95% C.I.=92.1-93.6) of middle school subjects, and 94.5 % (95% C.I.=93.8-95.2) of high school subjects for the measles IgG antibody. Of the 980 seronegative students, 952 (97.1 %) had been seroconverted after a revaccination with the MMR.
Despite the nationwide outbreak of measles, only 28 % (54 / 188) of schools and 31.5 % (4,414 / 14,032) of students were estimated to be exposed to measles.
In multiple logistic regression analysis, a secondary dose (odds ratio, 2.86; 95% C.I.=1.73-4.73), a primary dose (odds ratio, 2.56; 95% C.I.=1.16-5.65), the outbreak in the year 2000 (odds ratio, 1.94; 95% C.I.=1.27-2.96), and the grade in school (odds ratio, 1.69; 95% C.I.=1.04-2.76) were significant factors for the seropositivity. The single dose vaccination (odds ratio, 8.01; 95% C.I.=2.87-22.33), the two dose vaccination (odds ratio, 2.73; 95% C.I.=1.62-4.58), the outbreak in the year 2000 (odds ratio, 1.96; 95% C.I.=1.28-2.99), and the grade in school (odds ratio, 1.69; 95% C.I.=1.03-2.75) were significant predictors for the seropositivity as an alternative.
CONCLUSIONS: The coverage rate of the MMR was not high enough to be able to protect against an outbreak of measles, particularly the secondary dose. Therefore, the maintenance of a high coverage rate of a two dose vaccination would be the decisive factor to prevent an outbreak of measles in the future and to eliminate measles in Korea. Furthermore, nationwide catch-up campaign for measles in elementary and middle school students is necessary.

목차 (Table of Contents)

• 목차 = i
• I. 서론 = 1
• II. 대상 및 방법 = 6
• 1. 조사 대상자 표본 추출 = 6
• 1) 표본수 산정 = 6
• 2) 표본 추출방법 = 6
• 2. 조사 방법 = 11
• 1) 설문조사 = 11
• 2) 홍역 항체가 검사 = 12
• 3) 홍역 항체 음성자에 대한 MMR 접종 후 양전율 검사 = 13
• 3. 조사대상자 참여율 = 14
• 4. 조사 대상자 및 분석방법 = 15
• 5. 통계 분석 방법 = 18
• III. 결과 = 19
• 1. 대상자의 특성 = 19
• 1) 학년별 성별 분포 = 19
• 2) 시ㆍ도별 성별 분포 = 21
• 2. 예방접종기록 보유 현황 = 22
• 1) 학년별 예방접종기록 보유 현황 = 22
• 2) 시ㆍ도별 예방접종기록 보유 현황 = 24
• 3. 홍역 예방접종률 = 25
• 1) 학년별 홍역 예방접종률 = 25
• (1) 학년별 MMR 1차 접종률 = 25
• (2) 학년별 MMR 2차 접종률 = 26
• (3) 학년별 MMR 접종횟수 = 27
• 2) 시ㆍ도별 홍역 예방접종률 = 28
• 4. 홍역 이환력 = 29
• 1) 학년별 홍역 이환력 = 29
• 2) 학년군별 홍역 발생 연령 = 30
• 3) 시ㆍ도별 홍역 이환력 = 31
• 5. 홍역 항체 양성률 = 32
• 1) 학년별 홍역 항체 양성률 = 32
• 2) 시ㆍ도별 항체 양성률 = 34
• 6. 홍역 항체 음성자의 MMR 접종 후 항체 양전율 = 35
• 7. 항체 양성률 관련인자 분석 = 36
• 1) 백신접종별 홍역 항체 양성률 = 36
• 2) 접종횟수별 항체 양성률 = 37
• 3) 홍역 이환력별 항체 양성률 = 38
• 4) 2000년 홍역 유행에 의한 항체 양성률 = 39
• (1) 시ㆍ도별 유행학교의 분포 = 39
• (2) 학교별 유행학교 분포 = 40
• (3) 유행 여부별 예방접종률 = 40
• (4) 유행 여부별 항체 양성률 = 41
• 5) 다중 로지스틱 회귀분석 = 42
• IV. 고찰 = 44
• V. 결론 = 55
• 참고문헌 =57
• Abstract = 60
• 부록 1. 조사대상 보건소 = I
• 부록 2. 보건소별 조사대상 학교 및 학년 = II
• 부록 3. 설문지 = VII
• 부록 4. 개인별 검사결과 알림 양식 : 양성자 = XI
• 부록 5. 개인별 검사결과 알림 양식 : 음성자 = XII
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