Jae Yoon Kim

Rabies Post-Exposure Prophylaxis of Overseas Travelers in the International Travel Clinic of the National Medical Center from 2006 to 2012, Korea

Background Rabies is an acute fatal viral disease generally transmitted from infected animals to humans through bites. It is distributed worldwide. The number of Korean people traveling to rabies-endemic countries and being bitten by infected animals has been increasing recently. Therefore, we investigated international travelers who received rabies post-exposure prophylaxis (PEP) at the National Medical Center (NMC) and compared the data with those of other clinics. Materials and Methods This study was a retrospective review of 106 patients who visited the International Travel Clinic of the NMC and received rabies PEP between July 2006 and December 2012. During that period, we used the Essen intramuscular regimen protocol. Complete rabies PEP was defined as 5 doses of rabies vaccination with or without rabies immunoglobulin (RIG) administration according to the World Health Organization guidelines. Results A total 106 cases documented within the period of 6 years were selected, including 10 children younger than 15 years and 96 older than 15 years. The mean age of the patients who received PEP was 33.4 years. Of the patients, 53 were male and another 53 were female. Most of the exposures occurred in Southeast Asia, predominantly from dog bites (71, 66.9%). The lower extremities were the most frequent site of exposure (37, 34.9%). All the patients began receiving rabies vaccination for prophylaxis after exposure, and 51 received rabies vaccination with RIG. Meanwhile, 74 cases (69.8%) initiated rabies vaccination overseas, but only 10 of them received RIG while overseas; the remaining 32 (30.2%) initiated rabies vaccination after returning to Korea. Within 7 days, all the children and 74 adults received their first rabies vaccination. Six adults initiated first rabies vaccination after 1 week. Eleven of the 106 patients stopped PEP before 5 doses, among whom 4 (1 child and 3 adults) discontinued vaccination after confirming that the biting animal remained healthy throughout 10 days of observation. None of the patients had been previously vaccinated against rabies. Conclusions Most of the overseas travelers who visited our clinic after being bitten by suspected rabid animals received appropriate rabies PEP. However, the interval between exposure and first rabies vaccination was often delayed. Tourists who plan to travel in rabies enzootic regions need to be aware that prompt initiation of PEP is important to reduce the risk for developing human rabies.

Adverse Events Following Yellow Fever Vaccination in Korean Children

목 적: 황열은 모기에 의해 전염되는 급성 바이러스 출혈열로 중부아프리카와 열대 남아메리카에서 주로 발생한다. 이 연구는 황열 백신을 접종한 소아 및 청소년 여행객에게 이상반응에 대한 임상적 고찰을 시행하여 백신의 안전성 및 이상반응에 대한 정보를 제공하고자 시행하였다. 방 법: 이 연구에서는 2007년 4월 1일-2008년 6월 30일까지 국립의료원 해외여행클리닉을 방문한 소아 및 청소년 125명을 대상으로 하였다. 황열백신 투여 이후 6회의 전화면담을 통해 백신투여와 이상반응과의 관련성에 대하여 평가하였다. 결 과: 황열백신을 투여한 11개월에서 19세 사이의 소아 및 청소년 125명 중 이상반응의 발생은 31명(24.8 %)이었다. 증상으로는 주사부위의 통증(8.8%)이 가장 많았고 뒤를 이어 부종(6.4%), 발적(5.6%), 발열(4.0%), 두통(4.0%)순서였다. 대부분의 이상반응은 백신 투여 후 7일 이내에 발생했으며 성별 및 연령과 이상반응간의 유의한 차이가 없었다. 증상을 호소한 모두 자연적으로 혹은 보존적인 치료에 증상이 호전되었다. 결 론: 이 연구에서 황열백신은 우리나라 소아나 청소년에게 심각한 이상반응 없이 널리 사용될 수 있음을 보여주었다. 그러나 심각한 부작용의 원인이나 위험요소에 대한 연구는 지속적으로 필요할 것이다. 【Purpose : Yellow fever, a mosquito-borne viral hemorrhagic fever, is one of the most lethal diseases. Recently there have been an increasing number of Korean children who have travelled to yellow fever endemic zones and were administered yellow fever vaccine (YFV). Therefore, we carried out this study to provide child travelers with safety information of YFV. Methods : This study was conducted at the International Clinic of National Medical Center in Seoul between April 2007 and June 2008 for the evaluation of adverse events of YFV. One hundred twenty-five children received YFV (17-DD) and were prospectively monitored for adverse events through telephone interviews on day 3, 6, 9, 16, 23 and 30 after vaccination. Results : Adverse events were observed in 31 (24.8%) of 125 child travelers who received the YFV. The mean age was 12.5

A Case of Pneumocystis carinii Pneumonia in an Infant with Failure to Thrive

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Clinical Features of Patients with Anaphylaxis at a Single Hospital

5.0 years. Sixty-six of the child travelers (52.8%) were males. The common adverse events were pain in 11 (8.8%), swelling in 8 (6.4%) and redness in 7 children (5.6%) at the injection site. The systemic adverse events included mild fever in 5 (4.0%), headache in 5 (4.0%), cough in 4 (3.2%), abdominal pain in 3 (2.4%), and vomiting in 2 children (1.6%). Most of the adverse events were detected within 7 days of administration and there were no differences in adverse events by gender or age. All travelers who had complained of symptoms improved spontaneously or following symptomatic treatment. Conclusion : This study showed that YFV is well-tolerated and there were no reports of severe adverse events. Studies are ongoing to clarify the cause and risk factors for rare adverse events.】

Five Year Experience of Preexposure and Postexposure Rabies Prophylaxis in Korean Children at the National Medical Center

책임저자 :김재윤, 국립의료원 소아과 Tel : 02)2260-7306, Fax : 02)2267-7301 E-mail : nmcmpkjy@uniltel.co.kr 고된 이후 유럽에서 2차대전 직후 많은 수의 집단 발생이 보고되었다. 미국에서는 1956년 처음 보고 된 후 7) 면역이 저하된 환아들에서의 산발적인 혹 은 집단적인 발생에 대한 보고가 있었고, 국내에서 도 1950년대 후반기에 고아원 등의 수용시설에서 집단적으로 발생된 것이 보고된 바 있다 2) . 최근에 는 악성 종양환자나 면역 억제 요법을 받는 환자의 생존율이 높아짐에 따라 주폐포자충 폐렴이 증가 추세에 있다. 이에 저자들은 상기 위험군에는 속하지 않으나 10여일 정도의 수유부진을 보이며 성장 장애를 나 타낸 영아에서 발현된 주폐포자충 폐렴 1례를 경험 하여 보고하고자 한다. 성장 장애를 보인 영아에서 발현된 주폐포자충 폐렴 1례