Journal of agricultural medicine and community health (농촌의학ㆍ지역보건)

Korean Society for Rural Medicine and Community Health (한국농촌의학지역보건학회)
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Epidemiological Investigation on an Outbreak of Norovirus Infection at a High School in Gyeongju City, 2009

2009년 경주시 일개 고등학교에서 집단 발생한 노로바이러스 역학조사*

  • Park, Ji-Hyuk (Department of Preventive Medicine, Dongguk University College of Medicine) ;
  • Yoo, Seok-Ju (Department of Preventive Medicine, Dongguk University College of Medicine) ;
  • Lee, Kwan (Department of Preventive Medicine, Dongguk University College of Medicine) ;
  • Lim, Hyun-Sul (Department of Preventive Medicine, Dongguk University College of Medicine)
  • 박지혁 (동국대학교 의과대학 예방의학교실) ;
  • 유석주 (동국대학교 의과대학 예방의학교실) ;
  • 이관 (동국대학교 의과대학 예방의학교실) ;
  • 임현술 (동국대학교 의과대학 예방의학교실)
  • Received : 2010.09.28
  • Accepted : 2010.12.01
  • Published : 2010.12.31
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Abstract

Objectives: An outbreak of norovirus occurred at a high school in Gyeongju city in 2009. An epidemiological investigation was carried out to examine the infection source and the transmission route of norovirus, and to prevent a recurrence. Methods: A questionnaire survey was conducted for 520 male students and 8 food handlers. Rectal swabs were examined in 21 symptomatic students and the 8 food handlers by Gyeongsangbukdo Government Public Institute of Health & Environment, and an environmental investigation was performed. A case-control study was used to evaluate the association between risk factors and disease. Results: The attack rate was 21.3% (111/520) between January 29 and February 10, and norovirus GII was isolated from 12 of 21 students. Food handlers had no symptoms and their stool samples were negative. The case-control study revealed that seasoned soy bean sprouts {odds ratio (OR): 2.542, 95% CI=1.315-4.915} and drinking water from the purifiers in the cafeteria (OR: 2.854, 95% CI=1.107-7.358) supplied on February 3 were significant risk factors for the outbreak. Water pipes and waste pipes were located in the same place where was filled with some water and trace of high water level was detected. Conclusions: The major risk factors for this norovirus outbreak were presumed to be the contaminated seasoned soy bean sprouts and drinking water from the purifiers in the cafeteria. More strict personal and environmental hygiene need to be enforced to prevent such outbreaks.

2009년 경상북도 경주시 G 고등학교에서 노로바이러스가 유행하였고, 이에 대한 원인과 전파 양식 등을 규명하고 예방 및 관리대책을 마련하기 위해 역학조사를 시행하였다. G 고등학교 학생 520명과 조리종사자 8명을 대상으로 설문조사를 시행하였으며, 이 중 설사 증상이 심한 학생 21명과 조리종사자 8명을 대상으로 경상북도 보건환경연구원에서 세균 10종 및 바이러스 5종에 관한 검사를 시행하였다. 일별로 가장 많이 발생한 2월 5일을 기준으로 전후 1일간인 2월 4일부터 6일까지의 환례와 유행 기간 중 어떠한 증상도 없는 학생을 대상으로 환자-대조군 연구를 시행하였다. G 고등학교 학생 520명 중 환례는 111명이었으며, 이번 유행에서 G 고등학교의 노로바이러스 발병률은 21.3%이었다. 위험요인 분석에서, 2월 3일의 급식소 정수기물(2.854, 95% CI=1.107-7.358)과 저녁의 콩나물초무침(2.542, 95% CI=1.315-4.915)이 유의하였다. 조리 과정에서 콩나물초무침은 끓는 물에 콩나물을 삶은 후 오염된 것으로 추정된 조리수에 헹구었으며 이후 가열하지 않았다. 환경 조사에서 급식소 상수도관과 하수도관이 시멘트로 된 밀폐된 동일한 공간에 위치하여 수위에 따라 고인 물에 의해 급식소 상수도관이 오염되었다고 추정하였다. 검사상의 한계가 있지만 설문조사와 환경조사를 통해 2월 3일의 급식소 정수기물과 저녁의 콩나물초무침이 오염되었으며, 급식소 상수도관과 하수도관이 동일한 공간에 위치하고 수위에 따라 고인 물에 의해 급식소 상수도관이 오염되었다고 추정하였다.

Keywords

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