Kwon Jeong Ran, Jeon Byoung-Hak, Park Kyeongeun, Park Sookkyung, Kim Miyoung
Division of Control for Zoonotic and vector borne Diseases, Center of Infectious Diseases Control, KCDC Cho Eun Hee
Division of VPD control &NIP, Center of Infectious Diseases Control, KCDC Lee Hee-Il, Lee Sang-Eun
Division of Vectors and Parasitic Diseases, Center for Laboratory Control of Infectious Diseases, KCDC
This paper is a report on the current status of malaria and the results of the “Malaria Re-Elimination Five-Year Action Plan(2019-2023)” developed and implemented in 2019.
Of the 559 malaria confirmed cases reported in 2019, a total of 485(86.8%) were indigenous cases, 74(13.2%) were imported cases. which accounted for 93%(520) of all patients occurring between May and October, 2019. Among the indigenous cases, persumptive infected region were investigated from Gyeonggi province 314(64.7%), Incheon province 98(20.2%), Gangwon Province 25(5.2%) and 48(9.9%) was unknown.
226 persons(46.6%) was aged 20s to 30s; 389(80.2%) were male, 96(19.8%) were female. Of them, 364 cases(75.1%) were civilians and 70 cases(14.4%) were soldiers serving near the demilitarized zone(DMZ), others 51 cases(10.2%) were veterans.
The main goals in 2019 under the five-year plan to eliminate malaria were to add diagnostic criteria for rapid diagnosis of infectious diseases, strengthen patient management by changing the amount of therapeutic agents per weight, and monitor the media through the expansion of each vector control and surveillance and protozoal infection rate. In addition, to expand research and development, the goal was to strengthen control, develop a discrimination diagnosis method for patients with recurrence and long-term incubation period, and conduct research on drug treatment monitoring for patients with malaria. Furthermore, as a result of the project, education and R&D were expanded to strengthen the medical-military cooperation system.
Keywords: Malaria, Elimination, Indigenous case, Import case, Patient management, Vector control and surveillance
0 5 10 15 20 25 30 35 40 45
1 5 7 10 13 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 81 84 91
No. of malaria cases
Age
Figure 1. Distribution by age of malaria patients, 2019
Table 1. General characteristics of confirmed cases by case classification
Category Total Indigenous case Imported case
n % n % n %
Gender
Male 444 (79.4) 389 (80.2) 55 (74.3)
Female 115 (20.6) 96 (19.8) 19 (25.7)
Age (years)
< 20 31 (5.5) 28 (5.8) 3 (4.1)
20-29 169 (30.2) 155 (32.0) 14 (18.9)
30-39 92 (16.5) 71 (14.6) 21 (28.4)
40-49 97 (17.4) 82 (16.9) 15 (20.3)
50-59 84 (15.0) 69 (14.2) 15 (20.3)
60-69 52 (9.3) 46 (9.5) 6 (8.0)
≥ 70 34 (6.1) 34 (7.0) 0 (0.0)
At risk groups
Civilian 438 (78.4) 364 (75.1) 74 (100.0)
Veteran 51 (9.1) 51 (10.5) 0 (0.0)
Soldier 70 (12.5) 70 (14.4) 0 (0.0)
Total 559 (100.0) 485 (100.0) 74 (100.0)
1 25 107
542 445 638 699 673 515
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
No. of malaria cases
Year
Figure 2. Trend of number of notified malaria cases, 1993-2019
227
2013 2014 2015 2016 2017 2018 2019
No. of malaria cases
Year Civilian Soldier Veteran
Figure 3. Current status of occurrence distribution by year and occupational-related malaria (2013-2019)
1 0 2 3
Jan. Feb. Mar. Apr. May June July Aug. Sep. Oct. Nov. Dec.
No. of malaria cases
Month Civilian
Veteran
Sildier
Figure 4. Current status of occurrence distribution by monthly and occupational-related malaria, 2019
Table 2. Regional distribution of malaria patients, 2019
Category Total Indigenous Case Imported Case
n % n % n %
Seoul 100 (17.9) 72 (14.8) 28 (37.8)
Busan 14 (2.5) 10 (2.0) 4 (5.4)
Gyeonggi 294 (52.6) 270 (55.7) 24 (32.5)
Gangwon 15 (2.7) 15 (3.2) 0 (0.0)
Total 559 (100.0) 485 (100.0) 74 (100.0)
The northern part of Gyeonggi-do Incheon Metropolitan City The northern part of Gangwon-do Unknown
Residence Military Service Travelling Unknown 64.7%
20.2%
8.4%
9.9%
37.3%
22.7%
15.1%
24.9%
Figure 5. Distribution of the presumptive infected region area and presumptive risk factor of malaria in Korea
Table 3. Distribution of the presumptive infected region by protozoa of malaria patients from overseas, 2019
Category Total Indigenous cases Imported cases
n % n % n %
Plasmodium spp.
P. vivax 501 (89.6) 485 (100.0) 16 (21.6)
P. falciparum 57 (10.2) 0 (0.0) 57 (77.0)
P. malariae 0 (0.0) 0 (0.0) 0 (0.0)
P. ovale 1 (0.2) 0 (0.0) 1 (1.4)
P.knowlesi 0 (0.0) 0 (0.0) 0 (0.0)
Total 559 (100.0) 485 (100.0) 74 (100.0)
Table 4. Distribution of protozoa for cases of malaria patients from overseas, 2019
lasmodium spp. Total Africa Asia
n % n % n %
Total 74 (100.0) 59 (100.0) 15 (100.0)
P. vivax 57 (77.0) 57 (96.6) 0 (0.0)
P. falciparum 16 (21.6) 1 (1.7) 15 (100.0)
P. malariae 0 (0.0) 0 (0.0) 0 (0.0)
P. ovale 1 (1.4) 1 (1.7) 0 (0.0)
P.knowlesi 0 (0.0) 0 (0.0) 0 (0.0)
들어가는 말
우리나라는 경제협력기구(OECD) 국가 중 결핵발생률, 유병률, 사망률 1위로 국격 대비 결핵 수준이 높은 국가이다[1]. 결핵의 획기적인 감소를 위해서는 활동성 결핵의 적절한 관리뿐 아니라, 접촉자 중심의 활동성 결핵 조기 진단 및 잠복결핵 진단, 치료를 확대해야 한다. 2050년까지 전 세계적으로 결핵의 발생률을 인구 100만 명 당 1건 미만으로 낮추기 위해서는 매년 결핵의 발생률이 평균 20%씩 감소해야 하는데, 이를 위해서는 활동성 결핵 뿐 아니라 잠복결핵에 대한 치료를 병행해야만 한다[2].
이러한 배경에서 세계보건기구(WHO)에서는 소득수준이 높으면서, 결핵의 발생률이 인구 10만 명당 100건 이하인 국가에서 활동성 결핵으로 진행할 위험이 높은 잠복결핵 감염자에 대하여 치료를 적극 시행할 것을 권장하고 있다[3]. 적극적인 잠복결핵 치료를
통해 활동성 결핵 발병으로 진행할 가능성을 60~90% 정도로 낮출 수 있음은 1960년대 잠복결핵 치료가 도입된 이래 익히 효과가 입증되었으며[4], 현재까지 효과가 입증된 유일한 결핵 예방 방법이다. 앞서 언급한 WHO 진료 지침에서는 재소자, 의료기관 종사자, 결핵 발생률이 높은 국가 출신의 이민자, 마약 중독자 및 노숙인에 대해 치료를 고려할 것을 권장하였으나 아직까지 그 근거수준은 낮은 편이다. 우리나라에서는 2025년까지 결핵의 발생률을 획기적으로 감소시키기 위하여 WHO 지침에서 더 나아가, 2017년 결핵 안심국가 사업을 통하여 집단 시설 종사자 및 고등학교 1학년 학생, 병역 판정 대상자 등 120만 명에 대한 잠복결핵 검진 및 치료를 시행하였고, 2018년 집단시설 종사자에 대하여 이 사업을 지속 수행하였다[5]. 향후 국내 실정에 맞는 잠복결핵 정책을 수립하기 위해서는 위 사업에 참여한 수검자를 대상으로 잠복결핵 코호트를 구성하고 사업 결과에 대한 분석이 필요하다.
역학·관리보고서 4