2009년 경주시 일개 고등학교에서 집단 발생한 노로바이러스 역학조사
Epidemiological Investigation on an Outbreak of Norovirus Infection at a High School in Gyeongju City, 2009
1
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
2009년 경상북도 경주시 G 고등학교에서 노로바이러스가 유행하였고, 이에 대한 원인과 전파양식 등을 규명하고 예방 및 관리대책을 마련하기 위해 역학조사를 시행하였다. G 고등학교 학생 520명과 조리종사자 8명을 대상으로 설문조사를 시행하였으며, 이 중 설사 증상이 심한 학생21명과 조리종사자 8명을 대상으로 경상북도 보건환경연구원에서 세균 10종 및 바이러스 5종에관한 검사를 시행하였다. 일별로 가장 많이 발생한2월 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, 2월3일의 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 콩나물초무침은끓는 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 있지만설문조사와 환경조사를 통해 2월 3일의 급식소정수기물과 저녁의 콩나물초무침이 오염되었으며, 급식소 상수도관과 하수도관이 동일한 공간에 위치하고 수위에 따라 고인 물에 의해 급식소상수도관이 오염되었다고 추정하였다.
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 GⅡwas 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.
참고문헌 (25)
- Adler JL, "Winter vomiting disease", J Infect Dis, 119(6), pp.668~673 (1969)
- Kapikian AZ, "Visualization by immune electron microscopy of a 27-nm particle associated with acute infectious nonbacterial gastroenteritis", J Virol, 10(5), pp.1075~1081 (1972)
- Lopman B, "The evolution of norovirus, the gastric flu", PLoS Med, 5(2), pp.e42~ (2008)
- Scipioni A, "Animal noroviruses", Vet J, 178(1), pp.32~45 (2008)
- Parashar U, "Norwalk-like viruses : public health consequences and outbreak management", MMWR Recomm Rep, 50(RR-9), pp.1~17 (2001)
- Wallace RB, "Public health and preventive medicine" (2008), McGraw-Hill
- Teunis PF, "Norwalk virus: how infectious is it?", J Med Virol, 80(8), pp.1468~1476 (2008)
- Lopman BA, "Viral gastroenteritis outbreak in Europe, 1995-2000", Emerg Infect Dis, 9(1), pp.90~96 (2003)
- Lee N, "Norovirus and foodborne disease", Safe food, 2(1), pp.22~29 (2007)
- Korea Centers for Disease Control and Prevention, "Water & foodborne diseases outbreaks in Korea, 2008", PHWR, 2(35), pp.54~590 (2009)
- Vivancos R, "Food-related norovirus outbreak among people attending two barbeques: epidemiological, virological, and environmental investigation", Int J Infect Dis, 13(5), pp.629~635 (2009)
- Appleton H, "A possible virus aetiology in outbreaks of food-poisoning from cockles", Lancet, 1(8015), pp.780~781 (1977)
- Cannon RO, "A multistate outbreak of norwalk virus gastroenteritis associated with consumption of commercial ice", J Infect Dis, 164(5), pp.860~863 (1991)
- Cheng PK, "Norovirus contamination found in oysters worldwide", J Med Virol, 76(4), pp.593~597 (2005)
- Seymour IJ, "Appleton H. Foodborne viruses and fresh produce", J Appl Microbiol, 91(5), pp.759~773 (2001)
- Murphy AM, "An Australia-wide outbreak of gastroenteritis from oysters caused by norwalk virus", Med J Aust, 2(7), pp.329~333 (1979)
- ter Waarbeek HL, "Waterborne gastroenteritis outbreak at a scouting camp caused by two norovirus genogroups: GI and GII", J Clin Virol, 47(3), pp.268~272 (2010)
- Yoder J, "Surveillance for waterborne disease and outbreaks associated with drinking water and water not intended for drinking -- United States, 2005 - 2006", MMWR Surveill Summ, 57(9), pp.39~62 (2008)
- Kim SH, "Outbreaks of gastroenteritis that occurred during school excursions in Korea were associated with several waterborne strains of norovirus", J Clin Microbiol, 43(9), pp.4836~7839 (2005)
- Parshionikar SU, "Waterborne outbreak of gastroenteritis associated with a norovirus", Appl Environ Microbiol, 69(9), pp.5263~5268 (2003)
- Jung C, "Analysis of transmission mode of confirmed shigellosis in Gyeongju, Korea", Korean J Epidemiol, 26(1), pp.1~16 (1998)
- 임현술, "2004년 영천시 D 초등학교에서 집단 발생한 살모넬라증", 예방의학회지, 38(4), pp.457~464 (2005), 대한예방의학회
- Fretz R, "An outbreak of norovirus gastroenteritis in an Austrian hospital, winter 2006-2007", Wien Klin Wochenschr, 121(3), pp.137~143 (2009)
- Iijima Y, "Multiple outbreaks of gastroenteritis due to a single strain of genotype GII", 4 norovirus in Kobe, Japan, 2006: risk factors for norovirus spread in health care settings, 2008, pp.61(5), 419~422
- Said MA, "Healthcare epidemiology: gastrointestinal flu: norovirus in health care and long-term care facilities", Clin Infect Dis, 47(9), pp.1202~1208 (2008)