서울특별시 감염병 관리체계

평상시 감염병 감시체계 운영 방식

◆ 서울시 방역대책반

										서울특별시 방역대책반
										시민건강국장
			공보관								담당관								연락관
			- 주민 홍보 - 의료기관 홍보								생활보건과장 (방역관)								-협업기관 공조체계
																				감염병관리지원단 위기분석,현장지원
감염병관리팀							감시‧조사팀						의료자원관리팀			진단검사팀								예방접종팀 (필요시)
환자 관리 지역별대응책 마련 환자상담 및 정보 제공 관련홍보							환자 발생 및 사망 감시 환자사례조사 및 조치 보건소사례조사 지도, 자문						진료병원 지정 격리병상 관리 항바이러스제 및 개인보호장비 관리			환자검사 및 진단 실험실 감시체계 운영								예방접종 계획 수립 예방접종 수행 예방접종기록 관리

◆ 서울시 역학조사반

▶ 조직구성 : 1개반 5개팀 20명 운영

- 총 20명(반장 : 생활보건과장, 반원 19명)

· 역학조사관 5명, 보건 5명, 간호 1명, 검사 1명

· 감염병관리지원단 7명(교수 2, 전임의 1, 간호 1, 보건 3)

▶ 임    무

- 관할 지역 역학조사 계획의 수립, 시행 및 평가

- 관할 지역 역학조사의 세부 실시 기준 및 방법의 개발

- 중앙역학조사반에 관할 지역 역학조사 결과 보고

- 감염병의 발생․유행 사례 및 예방접종 후 이상반응 사례수집, 분석 제공

- 자치구 역학조사반에 대한 기술지도 및 평가

※ 위기경보 : 질병관리본부(위기평가회의)에서 각 단계를 결정하여 발령

구분	판단기준	비고
관심 (Blue)	ㅇ 해외의 신종감염병 발생 및 유행 * 국제보건기구(WHO)의 국제공중보건위기상황(PHEIC) 선포 ㅇ 국내 원인불명·재출현 감염병 발생	징후활동감시 대비계획 점검
주의 (Yellow)	ㅇ 해외 신종감염병의 국내 유입 및 제한적 전파 ㅇ 국내 원인불명·재출현 감염병의 제한적 전파	협조체제 가동
경계 (Orange)	ㅇ 해외 신종감염병의 국내 유입후 추가전파에 따른 지역사회 전파 ㅇ 국내 원인불명·재출현 감염병 추가발생애 따른 지역사회 전파	대응체제 가동
심각 (Red)	ㅇ 해외 신종감염병의 전국적 확산 징후 ㅇ 국내 원인불명·재출현 감염병의 전국적 확산 징후	대응역량 총동원

위기시 감염병 대응체계 운영 방식

◆ 시민건강국 대응(1단계) - 주의단계(Yellow) 이상 발령시

□ 내용 : 방역대책반(5개팀 20명) → 방역대책본부(5개반 50명) 확대

□ 구성

- 본 부 장 : 시민건강국장 / 총괄반장 : 생활보건과장

- 반 구 성 : 총괄반, 현장조사반, 분석·평가반, 검체분석반, 환경검체반

- 반     원 : 49명(역학조사관5, 보건11, 간호3, 행정2, 감염병관리지원단7,

운전5, 검사(보건환경연구원)15 □ 시민건강국 인력 파견 근무

서울시 방역대책본부 (50명)
․본부장 : 시민건강국장 ․역 할 : 역학조사 기획‧실행, 분석 및 평가, 환경검체 등
총괄반 (7명)				현장조사반 (5개조, 20명)						분석·평가반 (7명)					검 체 분석반(8명)			환 경 검체반(7명)
생활보건과장 보건3·행정2 감염병관리지원단 1				역학조사관5 보건5·간호3,운전5, 감염병관리지원단2						보건3, 감염병관리지원단 4					보건환경 연구원			보건환경 연구원

◆ 서울시 대응(2단계) - 경계단계(Orange) 이상 발령시

□ 확대내용 : 방역대책본부(5개반 50명) → 지역재난안전대책본부(11개반)

□ 구성내용 : 본부장(서울특별시장 / 차장 : 행정1부시장)

					본부장			서울특별시 지역재난안전대책본부
					서울특별시장
					차 장
					행정1부시장
					통제관
					시민건강국장
공보관					상황총괄반					연락관
					생활보건과장 -생활보건과 -상황대응과
재난홍보반										대외협력반
-뉴미디어담당관 -언론담당관 -시민소통담당관							서울시 감염병 관리지원단			-교통정책과 -문화관광과 -체육정책과 -문화예술과 -민방위담당관 -안전총괄과
상황분석			현장대응				자원지원			대민지원
정보관리반			역학조사반				의료자원지원반			생활안정지원반
-생활보건과			-생활보건과 -보건환경연구원				-생활보건과 -보건의료정책과			-생활보건과 -어르신복지과 -희망복지지원과 -보건의료정책과
			이송지원반				행정지원· 자원봉사반
			-상황대응과				-생활보건과 -자치행정과
			병원대책반
			-생활보건과 -보건의료정책과 -자원순환과
			접촉자관리반
			-생활보건과 -인재개발원 -자원순환과 -생활환경과

국가지정입원치료병상(격리치료기관) 현황

○ 전  국 : 29개 병원 161개 격리병실(음압)

○ 서울시 : 5개병원 31개 격리병실(음압)

- 서울시 국가지정입원치료병상 현황

· 국립중앙의료원(7병실), 서울의료원(10병실), 서울대학교병원(7병실),

중앙대학교병원(4병실), 한일병원(3병실)

메르스 대응 절차도

○ 신고방법 : 증상발현으로 자진신고 또는 진단 병의원 신고

○ 절 차 도

유증상자 발생	⇒	역학 조사	⇒	의심환자 여부 판정	⇒	격리병상 배정	⇒	환자이송 및 접촉자 조사	⇒	격리병상에서 채취한 검체이송	⇒	검사수행 결과판정
		보건소 서울시		서울시 질병관리본부		서울시		보건소		전문업체		보환연

외국인 방문객의 감염병 관리수단

○ 해외 오염지역 입국자 추적조사

○ 메르스 등 신종감염병 의심환자 대응 24시간 비상대응 체계 유지

○ 입국자 증상 발생시 역학조사 및 격리입원 조치

○ 외국인대상 감염병 집중 홍보

- 내용 : 의심증상 발생시 의료기관 방문전 집에서 1339 신고

영어·아랍어·한국어로 제작, 주요 호텔 리플렛 배포(업주용/손님용)

○ 지원사항

- 격리치료시 치료비 국고 100% 지원

- 격리입원을 위한 통역, 할랄식사 지원

- 입원 시 필요한 수건·세면도구 등 일회용 위생용품 지원

- 제반비용(국내교통비, 항공비 등 포함) 추가 지원 가능

* 격리로 국내교통비 및 항공료·차액 등이 발생한 경우 질병관리본부에서 지원

Seoul Metropolitan Government Infectious Disease Management System

Regular infectious disease response system

◆ Seoul Metropolitan Government Disease Control Group

										Seoul Metropolitan Government Disease Control Group
										Director of Citizens’ Health Bureau
			Public Information Officer								Director								Liaison Officer
			- PR to citizens - PR to medical institutions								Director of Public Health & Hygiene Division (Epidemic Commander)								-Cooperation system with partner organizations
																			Seoul Center for Infectious Disease Control and Prevention Risk assessment and response support
Infectious Disease Control Team							Surveillance & Investigation Team						Medical Resources Management Team			Diagnosis & Examination Team							Vaccination Team (if necessary)
Patient management Establishment of countermeasures by district Patient counseling and information provision PR							surveillance for incidence and mortality Patient case investigation and response Guidance and consultation on public health center						Designation of hospitals Management of quarantine beds Management of antiviral drugs and PPEs			Patient examination and diagnosis Operation of laboratory surveillance system							Vaccination planning mass prophylaxis Management of vaccination records

◆ Seoul Metropolitan Government Epidemiologic Investigation Group

▶ Organization: 20 staff, 5 teams, 1 group

- Total of 20 staff (Head: Director of Public Health & Hygiene Division, 19 members)

· 5 Field epidemiologists, 5 health care aids, 1 nurse, 1 examiner

· 7 members from the Seoul Center for Infectious Disease Control and Prevention[SCDC] (2 professors, 1 research professor, 1 nurse, 3 MPHs)

▶ Duties

- Plan, conduct, and evaluate epidemiologic investigation in jurisdictional region

- Establish criteria for epidemiologic investigation and develop its methods

- Report results of epidemiologic investigations conducted in jurisdictions to the Central Epidemiologic Investigation Group

- Collect and analyze cases relating to the incidence and prevalence of infectious diseases and abnormal reactions after vaccination

- Provide technical guidance for and evaluate the Epidemiologic Investigation Groups of autonomous gu districts

※ Crisis Alert Level : Korea Centers for Disease Control and Prevention (Each level is determined & issued at the Crisis Assessment Conference)

Category	Standards of Assessment	Note
Watch (Blue)	ㅇ Outbreak & spread of overseas new infectious disease * World Health Organization (WHO)’s declaration of Public Health Emergency of International Concern (PHEIC) ㅇ Domestic source unknown / Recurrence of infectious disease	* Monitoring for signs of activity * Investigation of countermeasures
Caution (Yellow)	ㅇ Transmission of new infectious disease domestically & limited spread ㅇ Domestic source unknown / Limited spread of recurring of communicable disease	Initiation of cooperation system
Warning (Orange)	ㅇ Transmission of new infectious disease domestically / Widespread outbreak within local communities ㅇ Domestic source unknown / Recurrence of infectious followed by widespread outbreak within local communities	Initiation of infectious disease surveillance system
Severe (Red)	ㅇ Overseas new infectious disease shows signs of nationwide outbreak ㅇ Domestic source unknown / Recurrence of infectious disease shows signs of nationwide outbreak	Full initiation of infectious disease surveillance system

Emergency infectious disease response system

◆ Citizens Health Bureau’s responses (Stage 1) - (when crisis alert level is “Caution” or higher)

□ Description: Expanded Disease Control Group (5 teams, 20 members) to the Disease Control Headquarters (5 groups, 50 members)

□ Organization

- Head: Director of Citizens Health Bureau / Chief: Director of Public Health & Hygiene Division

- Groups: General Management Group, Field Investigation Group, Assessment & Evaluation Group, Clinical laboratory Group, and Environmental laboratory Group

- Number of members: 49 (5 field epidemiologists, 11 health care workers, 3 nurses, 2 administrative officers, 7 staff from the SCDC, 5 drivers, 15 laboratory services (Research Institute of Public Health & Environment)

□ Dispatched staff from Citizens Health Bureau

Seoul Metropolitan Government Disease Control Headquarters (50 members)
․Head: Director of Citizens’ Health Bureau ․Roles: Plan, conduct, analyze, and evaluate epidemiologic investigation and manage environmental samples, etc.
General Management Group (7 members)				Field Investigation Group (5 teams, 20 members)						Assessment & Evaluation Group (7 members)					Clinical laboratory (8 members)			Environmental laboratory (7 members)
Director of Public Health & Hygiene Division, 3 health care aids, 2 administrative officers, 1 SCDC staff				5 epidemiologic investigators, 5 health care aids, 3 nurses, 5 drivers, and 2 SCDC staff						3 health care aids and 4 SCDC staff					Research Institute of Public Health & Environment			Research Institute of Public Health & Environment

◆ Seoul Metropolitan Government responses (Stage 2) - (when crisis alert level is “Warning” or higher)

□ Description: Expanded the Disease Control Headquarters (5 groups, 50 members) to the Regional Disaster & Safety Countermeasures Headquarters (11 groups)

□ Organization: Head (Mayor of Seoul / Deputy Manager: Administrative Vice Mayor 1)

					Head						Seoul Disaster & Safety Countermeasures Headquarters
					Seoul City Mayor
					Deputy Manager
					Administrative Vice Mayor 1
					Controller
					Director of Citizens Health Bureau
Public Information Officer					General Situation Management Group								Liaison Officer
					Director of Public Health & Hygiene Division - Public Health & Hygiene Division - Situation Response Division
Disaster PR Group													Cooperation Group
- New Media Officer - Press Media Officer - Citizens Communication Officer									Seoul Center for Infectious Disease Control and Prevention				- Transport Policy Division - Culture Policy Division - Tourism Division - Sports Policy Division - Culture & Arts Division - Civil Defense Officer - General Safety Management Division
Situation Analysis			Onsite Response						Resources Support				Citizen Support
Information Management Group			Epidemiologic Investigation Group						Medical Resources Support Group				Life Stability Support Group
- Public Health & Hygiene Division			- Director of Public Health & Hygiene Division - Research Institute of Public Health & Environment						- Director of Public Health & Hygiene Division - Health & Medical Policy Division				- Director of Public Health & Hygiene Division - Seniors Welfare Division - Welfare Support Division - Health & Medical Policy Division
			Transport Support Group						Administrative Support & Volunteer Group
			- Situation Response Division						- Director of Public Health & Hygiene Division - Autonomous Administrative Division
			Hospital Countermeasures Group
			-Director of Public Health & Hygiene Division - Health & Medical Policy Division - Resources Circulation Division
			Contact Management Group
			- Director of Public Health & Hygiene Division - HR Development Center - Resources Circulation Division - Life Environment Division

State-designated hospitals (Hospitals for quarantine treatments)

○ Republic of Korea: 161 isolated wards of 29 hospitals (negative pressure)

○ Seoul Metropolitan City: 31 isolated wards of 5 hospitals (negative pressure)

- State-designated medical institutions in Seoul

· National Medical Center (7 wards), Seoul Medical Center (10 wards), Seoul National University Hospital (7 wards), Chung-Ang University Hospital (4 wards), Hanil General Hospital (3 wards)

MERS response procedure

○ Reporting: Patient or his/her hospital is to report when symptoms are detected.

○ Procedure

Person showing signs or symptoms	⇒	Epidemiologic investigation	⇒	Suspected MERS case determined	⇒	Quarantine sickbed assigned	⇒	Patient transfer and investigation of contact	⇒	Transfer of samples collected from quarantine	⇒	Test result determined
		Public Health Center in Seoul		Seoul Center for Disease Control and Prevention		Seoul Metropolitan Government		Public Health Center		Clinical specimen transport Agency		Research Institute of Public Health & Environment

Foreign visitors infectious disease management

○ Conduct tracing on people entering the country from high risk regions overseas

○ Operate 24-hour emergency response system in order to respond to patients with novel infectious diseases such as MERS

○ If a person entering the country shows any signs or symptoms, conduct epidemiologic investigation and hospitalize the patient in quarantine

○ Intensive PR to foreigners regarding infectious diseases

- Description: If any signs or symptoms are found, report to 1339 at home before visiting a medical institution.

Prepare leaflets in English, Arabic, and Korean and distribute to major hotels (for business owners / for guests)

○ Support

- The national government covers all medical expenses for quarantine treatments.

- Provision of interpretation service and Halal food during quarantine treatments

- Provision of necessary disposable personal hygiene items such as towels and toiletries during hospitalization

- Various additional expenses (including domestic transportation expenses, airfares, etc.) may be covered.

* If domestic transportation expenses, airfares, or other expenses occur due to quarantine treatment, the Korea Centers for Disease Control and Prevention will cover all expenses.