국내외 노로바이러스 집단발생 기여요인에 대한 체계적 문헌고찰
A Systematic Review of Factors Contributing to Norovirus Outbreaks in Korea and Worldwide
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= Abstract = Objectives: This study systematically reviewed norovirus outbreak investigations reported domestically and internationally (2013-2024) to describe epidemiological characteristics and identify key contributing factors by transmission route to inform future prevention and control strategies. Methods: A descriptive systematic review was conducted using PubMed, KoreaMed, and the Korea Disease Control and Prevention Agency (KDCA) Outbreak Investigation Reports. Fifty-five outbreak reports were included (35 publications and 20 domestic reports). Epidemiological characteristics such as outbreak setting, size, genotype, transmission route, and incubation period were extracted. Contributing factors were categorized according to transmission route and a weighted scoring system was applied for multiple contributing factors. Results: Across the 55 outbreaks, winter predominance and genotype GII were consistently observed. International outbreaks were frequently associated with foodborne transmission, whereas domestic outbreaks were linked to waterborne and person-to-person spread. Notably, person-to-person transmission increased after 2016 in both domestic (0.0% to 46.7%) and international (30.8% to 44.4%) data. Major contributing factors included contaminated or symptomatic/asymptomatic food handlers and improper food handling (foodborne); inadequate water treatment and groundwater contamination (waterborne); and insufficient isolation, improper cleaning of vomitus or feces, and close contact (person-to-person). Conclusion: This review highlights the growing importance of person-to-person transmission and persistent vulnerabilities across food, water, and environmental pathways. Policy responses are needed, including strengthening hygiene practices among food handlers, enhancing water-quality monitoring, ensuring appropriate isolation and disinfection procedures, and integrating climate-related risk assessments. Analyzing contributing factors by transmission route provides valuable evidence for developing future prevention policies and infection control strategies to mitigate the burden of norovirus outbreaks.
Abstract
= Abstract = Objectives: This study systematically reviewed norovirus outbreak investigations reported domestically and internationally (2013-2024) to describe epidemiological characteristics and identify key contributing factors by transmission route to inform future prevention and control strategies. Methods: A descriptive systematic review was conducted using PubMed, KoreaMed, and the Korea Disease Control and Prevention Agency (KDCA) Outbreak Investigation Reports. Fifty-five outbreak reports were included (35 publications and 20 domestic reports). Epidemiological characteristics such as outbreak setting, size, genotype, transmission route, and incubation period were extracted. Contributing factors were categorized according to transmission route and a weighted scoring system was applied for multiple contributing factors. Results: Across the 55 outbreaks, winter predominance and genotype GII were consistently observed. International outbreaks were frequently associated with foodborne transmission, whereas domestic outbreaks were linked to waterborne and person-to-person spread. Notably, person-to-person transmission increased after 2016 in both domestic (0.0% to 46.7%) and international (30.8% to 44.4%) data. Major contributing factors included contaminated or symptomatic/asymptomatic food handlers and improper food handling (foodborne); inadequate water treatment and groundwater contamination (waterborne); and insufficient isolation, improper cleaning of vomitus or feces, and close contact (person-to-person). Conclusion: This review highlights the growing importance of person-to-person transmission and persistent vulnerabilities across food, water, and environmental pathways. Policy responses are needed, including strengthening hygiene practices among food handlers, enhancing water-quality monitoring, ensuring appropriate isolation and disinfection procedures, and integrating climate-related risk assessments. Analyzing contributing factors by transmission route provides valuable evidence for developing future prevention policies and infection control strategies to mitigate the burden of norovirus outbreaks.