Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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The usefulness of skin test in evaluation of immunity to varicella

수두에 대한 면역력 평가에 있어서 피부 시험의 유용성

  • Kim, Ji-Young (Department of Pediatrics, College of Medicine, Hallym University) ;
  • Lee, Hye Jeen (Department of Pediatrics, College of Medicine, Hallym University) ;
  • Kim, Me Jin (Department of Pediatrics, College of Medicine, Hallym University) ;
  • Kim, Young Ho (Department of Pediatrics, College of Medicine, Hallym University) ;
  • Jung, Ji A (Department of Pediatrics, College of Medicine, Hallym University) ;
  • Yang, Seung (Department of Pediatrics, College of Medicine, Hallym University) ;
  • Hwang, Il Tae (Department of Pediatrics, College of Medicine, Hallym University) ;
  • Lee, Hae Ran (Department of Pediatrics, College of Medicine, Hallym University)
  • 김지영 (한림대학교 의과대학 소아과학교실) ;
  • 이혜진 (한림대학교 의과대학 소아과학교실) ;
  • 김미진 (한림대학교 의과대학 소아과학교실) ;
  • 김영호 (한림대학교 의과대학 소아과학교실) ;
  • 정지아 (한림대학교 의과대학 소아과학교실) ;
  • 양승 (한림대학교 의과대학 소아과학교실) ;
  • 황일태 (한림대학교 의과대학 소아과학교실) ;
  • 이혜란 (한림대학교 의과대학 소아과학교실)
  • Received : 2007.10.20
  • Accepted : 2007.12.12
  • Published : 2008.04.15
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Abstract

Purpose : The aim of this study is to assess the usefulness of skin test by an inactivated, 1/50 diluted solution of attenuated varicella vaccine in evaluating the immune status to varicella. Methods : Total 41 subjects (22 males, 19 females, aged 1-32 years) were enrolled from July to August, 2005. Past medical history including varicella infection, varicella vaccination were investigated through questionnaires. The skin test solution was prepared from solution of attenuated varicella vaccine(Oka strain) which was inactivated by exposure to room temperature for 10 days and diluted at 1/50 with normal saline. Skin test was done by injecting 0.1 mL of the solution intradermally into the volar surface of the right forearm and sterile normal saline was used as a control on the left forearm. Positive reaction was defined when the transverse diameter of the induration was 5 mm or more. Serum varicella zoster virus specific IgG antibody test by ELISA (enzyme-linked immunosorbent assay) was done. Results : In adults, the sensitivity of the varicella zoster virus skin test compared to ELISA was 94.7% and the positive predictive value was 100%. In children, both the positive predictive value and specificity were 100% but the sensitivity and the negative predictive value were 50% and 30.7% respectively. Children showed smaller skin test reactivity compared to adults. Conclusion : The varicella zoster virus skin test using inactivated, 1/50 diluted solution of attenuated varicella vaccine was proved as one of the useful tools for evaluating the immunity and susceptibility of the varicella zoster virus.

목 적 : 수두에 대한 개체 면역력을 평가하는데 있어서 약독화 수두백신을 불활성화 시킨 후 희석시켜 만든 용액을 이용한 피부시험이 유용한지를 알아보고자 하였다. 방 법 : 2005년도 7월에서 8월까지 한림대의료원 강동성심병원 의료진 19명과 입원한 소아 22명을 포함한 총 41명(남자 22명, 여자 19명, 만 1-32세)을 대상으로 하였다. 수두 감염의 과거력, 수두 예방접종 여부에 대한 사항은 설문지를 통해 이루어졌고 피부시험을 위한 용액은 Oka 균주의 약독화 수두백신을 상온에 10일간 방치하여 불활성화 시킨 후, 이를 다시 생리식염수로 50배 희석하여 사용하였다. 이 용액을 우측 상완 전박부에 피내 주사하였고 대조액으로 반대편 상완 전박부에 생리식염수액을 피내 주사하였다. 48시간 이후 경결의 직경 5 mm 이상일 때 양성으로 판독하였다. 또한 효소면역분석법을 이용하여 혈청 VZV 특이 IgG 항체가를 측정하여 피부시험 결과와 비교 분석하였다. 결 과 : 효소면역분석법을 이용한 항체 검사에 대한 성인에서의 수두 피부시험의 민감도는 94.7%이고 양성 예측도는 100%였다. 동일한 판정 기준을 소아에 적용하였을 때 양성 예측도와 특이도는 100%로 높았으나 민감도와 음성 예측도는 각각 50%, 30.7%로 낮았다. 소아에서의 VZV 피부반응도는 성인에 비해 낮았다. 결 론 : 약독화 수두백신을 불활성화, 희석시켜 만든 용액을 이용한 피부시험은 수두에 대한 면역력을 예측하는데 있어, 간편하고 안전한 저가의 유용한 검사이다. 그러나 피부시험에서 양성판정기준을 결정할 때 조사목적, 대상연령 등을 고려하여 신중히 판단하여야 할 것이며, 이에 대해서는 향후 더 많은 대상에서 추가 연구가 이루어져야 할 것으로 사료된다.

Keywords

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