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http://creativecommons.org/licenses/by-nc-nd/2.0/kr/legalcodehttp://creativecommons.org/licenses/by-nc-nd/2.0/kr/

2014 10

2014 12

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: , H1N1, , ,

: 2011-22086

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. 1

1. 1

2. 4

. 6

1. 6

2. WHO (framework) 10

3. 13

. 17

1. 17

2. 17

2.1. 18

2.2. 19

2.3. 21

3. 21

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1. 23

1.1. 23

1.2. 26

- 6 -

1.3. 29

1.4. 31

1.5. 34

2. 37

2.1. 37

2.2. 39

2.3. 44

2.4. 49

3. 53

3.1. 53

3.2. 54

4. 57

. 64

1. 64

2. 72

77

84

1. 84

2. 91

Abstract 95

- 7 -

7

WHO 10

14

18

19

CDC 26

Victoria 32

, , , 34

37

39

, 40

41

42

43

, 44

45

46

48

50

51

52

53

54

, 55

- 8 -

56

- 9 -

[ 1] (framework) 12

[ 2] 22

[ 3] 24

- 1 -

.

1.

2009 2009 3

.

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(, 2010),

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(1624 5.3%)

(, 2009).

WHO(2005)

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(2010)

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(Centers for Disease Control & Prevention) Emergency Operation

Center ,

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II.

1. (Influenza A, H1N1)

2009 4 21 2

4 24

, (WHO)

.

WHO ,

, 2009 6 11

(, 2010; , 2009).

, HA(haemmaglutinin)

NA(neuraminidase) HA NA

(, 2009).

, ,

,

Influenza A(H1N1)( ) (

, 2010; , 2009; , 2012).

2009 4 27 , , ,

, 7 .

2009 9 20

191 300,000

3,917 , WHO 2010 4

17.853 .

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),

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(, 2010; ,

http://www.cdc.go.kr).

2009 4 28 ,

2009 5 2 2009 9 20 15,160

. 2009 8

(1,000 2.67) , 10

. 2010 4 252

, 75 , 356

(, 2010; , http://www.cdc.go.kr).

,

(, http://www.tepic.or.kr)

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10 1.36-1.53

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H1N1

(, 2009).

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70-80%

9.6~51% . (H1 H3)

(, 2009; , 2010).

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, 2009).

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2. WHO (framework)

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1

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(framework) .

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(Blue)

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(09.11.3)(0.9.12.11)(10.3.8)(10.3.31)

(2010),

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Q&A

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38

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1) (2010),

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2014 11 3 11 14, 1

(http://goo.gl/forms/NKCSgPxfG6),

(http://goo.gl/forms/ufCb7DyyY8).

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415, 304.

450 , 348

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SPSS ver.18.0

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95%

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95% .

3.

WHO(2009) (framework)

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- 37 -

(%)

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450 3 ,

447 . .

(57.7%), (24.6%), (15.7%),

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(15.4%), (11.4%) 30-36

(22.1%) , 15-20

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.

- 38 -

258 57.7 110 24.6

70 15.7 9 2.0

447 100.0

/ 418 93.5 29 6.5 447 100.0

23 5.1 12 2.7 20 4.5 39 8.7 9 2.0 51 11.4 2 .4

40 8.9 69 15.4

21 4.7 18 4.0 19 4.3 15 3.4 12 2.7 81 18.1 16 3.6

447 100.0

6 4 .96-12 49 11.012-18 47 10.518-24 83 18.624-30 69 15.430-36 99 22.136-42 45 10.142-48 34 7.6

48 17 3.8 447 100.0

10 76 17.010-15 103 23.015-20 142 31.820-25 65 14.5

25 61 13.6 447 100.0

30 6.7 282 63.1

135 30.2 447 100.0

- 39 -

30 9 2.030-40 124 27.740-50 236 52.850-60 77 17.2

60 1 .2 447 100.0

x

2(df)

21(4.7) 91(20.4) 126(28.2) 137(30.6) 72(16.1) 447(100.0) 11.228(12)

19(4.3) 103(23.0) 132(29.5) 139(31.1) 54(12.1) 447(100.0) 13.806(12)

20(4.5) 141(31.5) 181(40.5) 90(20.1) 15(3.4) 447(100.0) 6.131(12)

26(5.8) 172(38.5) 168(37.6) 69(15.4) 12(2.7) 447(100.0) 15.123(12)

2.2.

(1)

,

, , ,

,

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.

*p

- 40 -

x

2(df)

158(35.3) 191(42.7) 60(13.4) 26(5.8) 12(2.7) 447(100.0) 4.377(12)

.

(2)

435

(97.3%) ,

49(11.3%), 166

(38.2%), 132(30.0%), 69(15.9%),

19(4.4%) .

(36.9%), (18.6%), (16.1%),

(12.1%), (9.6%), (6.7%) .

, ,

,

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349(78.0%) .

,

.

355(79.4%) 302

(67.6%) .

,

- 41 -

(,)

144(32.2) 211(47.2) 65(14.5) 21(4.7) 6(1.3) 447(100.0) 6.886(12)

100(22.4) 202(45.2) 110(24.6) 30(6.7) 5(1.1) 447(100.0) 16.152(12)

x2(df)

( )

10 25(32.9) 51(67.1) 76(100.0)

11.768(4)*

10-15 42(40.8) 61(59.2) 103(100.0)

15-20 70(49.3) 72(50.7) 142(100.0)

20-25 35(53.8) 30(46.2) 65(100.0)

25 35(57.4) 26(42.6) 61(100.0)

*p

- 42 -

207(46.3) 240(53.7) 447(100.0)

x

2(df)

10 12(15.8) 33(43.4) 15(19.7) 15(19.7) 1(1.3) 76(100.0)

39.599(16)*

10-15

15(14.6) 46(44.7) 30(29.1) 9(8.7) 3(2.9) 103(100.0)

15-20

24(16.9) 71(50.0) 27(19.0) 15(10.6) 5(3.5) 142(100.0)

20-25

10(15.4) 42(64.6) 8(12.3) 5(7.7) 0(0.0) 65(100.0)

25 21(34.4) 32(52.5) 3(4.9) 5(8.2) 0(0.0) 61(100.0)

82(18.3) 224(50.1) 83(18.6) 49(11.0) 9(2.0) 447(100.0)

*p

- 43 -

x2(df)

43(9.6) 114(25.5) 147(32.9) 96(21.5) 47(10.5) 447(100.0) 13.115(12)

22(4.9) 71(15.9) 110(24.6) 150(33.6) 94(21.0) 447(100.0) 13.629(12)

36(8.1%) 141(31.5%) 127(28.4%) 95(21.3%) 48(10.7%) 447(100.0) 19.443(12)

58(13.0)) 182(40.7) 123(27.5) 56(12.5) 28(6.3) 447(100.0) 14.049(12)

242(44.1%), 191(42.7%).

5 ( =5, =4, =3, =2.

=1)

3.720.955,

4.010.785.

3.520.968

,

3.330.921. , , , ,

.

,

,

.

, , ,

, 32%

, 54.6%

. 32%, 18.8%

.

- 44 -

x

2(df)

15(3.0) 113(25.0) 198(44.0) 94(21.0) 27(6.0) 447(100.0) 10.821(12) 14(3.1) 106(23.7) 184(41.2) 113(25.3) 30(6.7) 447(100.0) 11.130(12)

*p

- 45 -

2.910.997,

(F=3.848, df=4, p

- 46 -

x

2(df)

101(22.6) 258(57.7) 80(17.9) 6(1.3) 2(0.4) 447(100.0) 17.252(12)

61(13.6) 212(47.4) 121(27.1) 49(11.0) 4(0.9) 447(100.0) 18.082(12)

120(26.8) 248(55.5) 59(13.2) 16(3.6) 4(0.9) 447(100.0) 10.593(12)

41(9.2) 142(31.8) 119(26.6) 82(18.3) 63(14.1) 447(100.0) 36.457(16)*

92(20.6) 221(49.4) 87(19.5) 35(7.8) 12(2.7) 447(100.0) 13.083(12)

62(13.9) 209(46.8) 101(22.6) 61(13.6) 14(3.1) 447(100.0) 9.020(12)

F(df)

*p

- 47 -

258 4.10 .672

4.285(3)*, (Scheffe )

110 3.87 .743 70 3.90 .725 9 3.67 .707

447 4.01 .707

258 3.72 .861

2.645(3)*,

(LSD)

110 3.46 .964 70 3.50 .830 9 3.67 .707

447 3.62 .885

258 4.05 .833

0.349(3)

110 4.04 .765 70 4.03 .680 9 3.78 .667

447 4.04 .790

258 3.10 1.218

0.938(3)

110 2.97 1.223 70 2.96 1.109 9 2.56 .882

447 3.04 1.197

258 3.83 .970

0.826(3)

110 3.70 .982 70 3.67 .829 9 3.78 .972

447 3.77 .952

258 3.53 1.033

0.221(3)

110 3.61 .959 70 3.51 .928 9 3.44 .882

447 3.55 .994*p

- 48 -

x2(df)

180(69.8) 78(30.2) 258(100.0)

2.189(3)

81(73.6) 29(26.4) 110(100.0) 46(65.7) 24(34.3) 70(100.0) 5(55.6) 4(44.4) 9(100.0)

312(69.8) 135(30.2) 44(100.0)7

/ 299(71.5) 119(28.5) 418(100.0)

9.173(1)* 13(44.8) 16(55.2) 29(100.0) 312(69.8) 135(30.2) 447(100.0)

6 4(100.0) 0(0.0) 4(100.0)

16.785(8)*

6-12 42(85.7) 7(14.3) 49(100.0)12-18 33(77.2) 14(29.8) 47(100.0)18-24 58(69.9) 25(30.1) 83(100.0)24-30 49(71.0) 20(29.0) 69(100.0)30-36 70(70.7) 29(29.3) 99(100.0)36-42 27(60.0) 18(40.0) 45(100.0)42-48 22(64.7) 12(35.3) 34(100.0)48 7(41.2) 10(58.8) 17(100.0) 312(69.8) 135(30.2) 447(100.0)

2009

, 5,6, 1 17

,

69.8% . ,

.

- 49 -

*p

- 50 -

x2(df)

20(4.5) 181(40.5) 164(36.7) 68(15.2) 14(3.1) 447(100.0)12.096

(12)

40(8.9) 231(51.7) 110(24.6) 57(12.8) 9(2.0) 447(100.0) 27.547(16)*

52(11.6) 222(49.7) 103(23.0) 59(13.2) 11(2.5) 447(100.0) 13.814(12)

4(0.9) 48(10.7) 127(28.4) 174(38.9) 94(21.0) 447(100.0) 28.611(16)*

13(2.9) 95(21.3) 138(30.9) 160(35.8) 41(9.2) 447(100.0) 13.835(12)

*p

- 51 -

F(df)

10 76 2.97 .848

5.238(4)*10 , 25

(Scheff )

10-15 103 3.29 .882

15-20 142 3.29 .888

20-25 65 3.25 .952

25 61 3.66 .728

447 3.28 .886

10 76 3.21 .899

4.729(4)*

10 , 20-25 10-15, 25 10 , 25

(Dunnett T3 )

10-15 103 3.47 .884

15-20 142 3.55 .957

20-25 65 3.68 .850

25 61 3.82 .695

447 3.53 .898

10 76 3.37 .950

2.179(4)

10-15 103 3.42 .924

15-20 142 3.61 1.031

20-25 65 3.66 .940

25 61 3.74 .705

447 3.55 .946

10 76 2.26 .854

2.971(4)

10-15 103 2.23 1.002

15-20 142 2.20 .986

20-25 65 2.43 .951

25 61 2.66 .834 447 2.32 .952

=3.28), (=3.53), (

=3.55) ,

(=2.32), (=2.73)

.

- 52 -

10 76 2.72 1.028

0.161(4)

10-15 103 2.73 .931

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- 53 -

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- 54 -

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- 55 -

x2(df) 83(25.7) 240(74.3) 323(100.0) 3.103(1)

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- 56 -

() 117(36.2) 206(63.8) 323(100.0) 25.969(3)* () 51(15.8) 272(84.2) 323(100.0) 9.097(3)* () 179(55.4) 144(44.6) 323(100.0) 0.010(1)

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127(39.3) 41(12.7) 13(4.0) 20(6.2) 64(19.8) 39(12.1) 79(24.5) 237(73.4) 21(6.5) 5(1.5) 323

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127(39.3) 41(12.7) 13(4.0) 20(6.2) 64(19.8) 39(12.1) 79(24.5) 237(73.4) 21(6.5) 5(1.5) 323

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Public Health, Vol. 43, No. 2, 105-108

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, (2009), ,

(1996), ,

Anthony Giddens , (2003). . :

Arno Karlen , (2011). . : ()

Hans Peter Peters , (2009).

. :

. http://www.tepic.or.kr

. http://www.cdc.go.kr

Bruna De Marchi, Jerome R.Ravertz(1999). Risk management and

governance:a post-normal science approach, Future 31. 743-757

CDC, Pandemic Flu Checklist: K-12 School Administrators

CDC, School District (K-12) Pandemic Influenza Planning Checklist

Colorado Department of Public Health and Environment(2009),

Pandemic Influenza action plan for schools.

Depatment for Education adn skills(2006), Planning for a human

influenza pandemic:summary guidance to schools. UK

Department of Education and Early Childhood Development(2013),

Human Influenza pandemic incident response plan, AU

Department of Heath and Ageing(2006), Interim Infection Control

Guidelines for Pandemic Influenza in Healthcare and

Community Settings, AU

Department of Heath and Ageing(2011), Review of Australia's Health

Sector Respnse to Pandemic(H1N1) 2009

Depratment of the Prime Minister and Cabinet(2009), National

Influenza Pandemic public communications guidelines, AU

- 83 -

Devon County Council(2009), Guicance for schools in dealing with an

influenza pandemic. UK

Emergency Plnning Team(2009), model influenza pandemic plan for

schools and settings, UK

New York State Department of Health(2007), Panddemic flu action

kit for schools in New York State

PH-HPER-ID&BP 10200(2014), Impact of School Closures on an

Influenza Pandemic Scientific Evidence Base Review,

Department of Health UK

WHO(2005). Reducing transmission of pandemic (H1N1) 2009 in

school settings

WHO(2006). Risk reduction and preparedness

WHO(2013). Pandemic Influenza Risk Management WHO Interim

Guidance

- 84 -

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Abstract

School Responses to Pandemic

Influenza A(H1N1) and its

Improvements in Korea

Kim Jihak

Department of Public Health

The Graduate School of Public Health

Seoul National University

This study is focused on the fact that there is more and more risk

for the epidemic of new infectious diseases due to the frequent moves

of population, climatic change, or the emergence of mutant viruses

and more and more uncertainty about infectious diseases, and if

members in a society recognize the crisis differently, it would be

hard to exhibit effectiveness properly only with existing policies or

coping strategies. In this context, this study aims to analyze

guidelines to cope with infectious disease at school in both Korea and

major countries to explore implications from them, consider problems

by analyzing the actual situation of schools coping with infectious

disease at the epidemic of H1N1, and also find out political

implications to improve the system.

- 96 -

To attain the goal, the researcher analyzed comparatively the

coping guidelines in Korea and major countries including the US,

England, and Australia from the aspects of decision-making, work

continuance, blocking the routes of infection, information sharing

communication, and surveillance suggested by WHO (2009). After

that, the author reorganized the detailed contents found from the

coping guidelines and divided them into organizational and political

aspects and then applied them as the items of a questionnaire to

conduct a survey to health teachers and students. 447 health teachers

with over 5 years of teaching career and experience in coping with

H1N1 were selected. Self-administered questionnaire sheets were

distributed to them to examine organizational aspects including

networks, operation in organizations, members preparation, and

equipment and facilities, political aspects such as guidelines practical

applicability and effectiveness, and also directions about how to

evaluate the coping with H1N1 and improve the system. 323 students

who were attending elementary, middle, or high schools in 2009 were

selected, and self-administered questionnaire sheets were distributed

to them to investigate the measurement of temperature, suspension of

school attendance, and health improving behavior. As an analysis

method, for health teachers, the chi-square test and one-way

ANOVA were conducted with their significant level as 95%. For

students, the chi-square test was performed with its significant level

as 95%. The findings of this study are as written below:

According to the results of analyzing comparatively the coping

guidelines in Korea and major countries including the US, England,

and Australia, in Korea, the Office of Emergency Management was

made to be organized with the duties and participants designated but

without mentioning the consultative decision-making body in which

- 97 -

all concerned should participate from the aspects of decision-making.

From the aspects of work continuance, measures for the absence of

class were suggested concretely, but there was lack of plans for the

morbidity of the teaching staff. From the aspects of blocking the

routes of infection, not only basic hygiene for individuals, health

education, facility sanitation, suspension of school attendance, and

preparation for equipment and facilities but also surveillance over

daily fever and students vaccination were suggested. From the

aspects of information sharingcommunication, necessity to cooperate

with parents, students, and related institutions was suggested, but

concrete strategies or guidelines failed to be established. From the

aspects of surveillance, major countries stopped counting those with

symptoms but figured out the status of schools closed whereas Korea

kept counting those with symptoms and made them to report it daily.

Based on the results of comparing the coping guidelines in Korea and

the US, England, and Australia, it was possible to draw following

implications: first, educational authorities in major countries suggested

general and detailed guidelines based on steps and situations so that

each unit school could cope with the new infectious disease actively

through their systems closely cooperating with related ministries even

before the epidemic of the infectious disease. Second, in the coping

with infectious disease at school, they emphasized communication

with and participation of students, parents, communities, and related

institutions. Third, the central government did not take the initiative

in controlling schools nationwide, but each regional unit did cope with

it autonomously according to the situation in it. Mainly, they figured

out the status of schools closed and autonomously had those with

symptoms get a treatment at hospitals or clinics coping with it

flexibly as in the coping with a flu.

- 98 -

According to the surveys to health teachers and students, the

author has found problems in schools coping with H1N1 as follows:

first, they failed in building up solid networks between schools,

education offices, offices for educational support, hospitals.clinics,

health centers, and parents. Second, most schools organized the

Office of Emergency Management, but it did not operate properly. It

was mostly operated by top-down execution, and there was lack of

planning for the support of alternative manpower such as health

teachers and teaching staff. Third, the recognition of health teachers,

school principals, and teaching staff on their roles and responsibility

was slightly above the average. This implies that although in the

coping with H1N1, school members preparation was found to be

rather excellent, if there was some error in the direction of coping in

the authorities, bureaucratic school organizations might have increased

the damage unexpectedly even while coping with it eagerly based on

the guidelines. Fourth, before the epidemic of H1N1, related equipment

and facilities were insufficient. Fifth, there were some problems with

regard to the timeliness as well as concreteness.clarity of

H1N1-coping guidelines. Sixth, health teachers recognition on health

improving behavior like hand washing, isolation after temperature

measurement, or effectiveness in suspension of school attendance

indicated difference from the actual behavior in some of the students.

Isolation policies based on temperature measurement or suspension of

school attendance may have been a means to spread H1N1 in the

communities partially. Seventh, even though schools are educational

institutions, they were weak about health education strategies for

H1N1 then, and because of that, it was limited to provide students

with enough information that was accurate and reliable. Eighth, it is

needed to conduct introspective evaluation on the whole school H1N1

- 99 -

vaccination afterwards, and for the prior vaccination of health

teachers, there was possibility of conflict among the teaching staff.

Health teachers recognition about evaluation on the coping with

H1N1 and how to improve schools H1N1-coping system is as

follows: first, health teachers recognize positively schools coping with

H1N1 in general, enhancement of coping capacity with the experience

of H1N1, and confidence about coping in the epidemic of the new

infectious disease afterwards. Second, health teachers deem they can

cope with the epidemic of infectious disease properly with the school

health system based on participation and agreement rather than the

top-down bureaucratic school health system. Third, if it is needed to

change to a participatoryconsultative school health system, they

think that it is needed to improve structural conditions beforehand

with two health teachers arranged for large class, the cooperation

system with related institutions, and the formation of a new division

in charge of school health at school.

This study gives implications that it is limited to cope with it

properly only with previous technicalbureaucratic approaches to

coping with infectious disease with high uncertainty like H1N1 and it

is needed to change to a school health system based on participation

and agreement.

Based on the findings above, this study suggests directions for

schools' coping with infectious disease and the improvement of the

school health system: first, it is needed to democratize the

decision-making structure and allows students, parents, and teaching

staff to participate, and when making schools' infectious

disease-coping guidelines, it is needed to make concrete coping

guidelines integrating blocking the routes of infection, work

continuance, and communicationinformation sharing and deliver

- 100 -

them in time. Second, it is needed to explore organizational and

political plans covering school health in general in order to transfer

from the technicalbureaucratic school health system to the

participatoryconsultative school health system. Third, it is necessary

to be freed from unilateral control by central government and

consider how to enhance each regional copings autonomy. This

author will make following suggestions to improve from the technical

bureaucratic school health system to the participatoryconsultative

school health system. First, it is needed to build a cooperation system

within the frame of the local autonomous education in order to

enhance cooperation among related institutions including health

centers and hospitalsclinics. Second, it is necessary to increase the

leading systems expertise by increasing health specialized jobs in the

Ministry of Education and education offices for which those having

experience in working at schools can work. Third, it is needed to

enhance the opportunities and structures so that teachers, students,

and parents can communicate with one another ordinarily. Fourth, it

is necessary to build up school health infrastructure by securing

manpower, operating the health curriculum, and obtaining equipment

and facilities for effective infectious disease coping at school. Fifth, it

is necessary to make plans to increase the school health capacity of

school principals, vice-principals, as well as teachers.

keyword : pandemic influenza A, H1N1, school health, infectious

disease, risk response

student number : 2011-22086

. 1. 2.

. 1. 2. WHO (framework) 3.

. 1. 2. 2.1. 2.2. 2.3.

3.

. 1. 1.1. 1.2. 1.3. 1.4. 1.5.

2. 2.1. 2.2. 2.3. 2.4.

3. 3.1. 3.2.

4.

. 1. 2.

1. 2.

Abstract