# A large-scale norovirus outbreak associated with kimchi consumption across multiple schools in a Korean city in 2024

## TL;DR

A large norovirus outbreak in Korean schools was traced to contaminated kimchi, highlighting the need for better food safety practices.

## Contribution

This study identifies kimchi as the source of a large-scale norovirus outbreak and emphasizes asymptomatic food handlers as a risk.

## Key findings

- Norovirus GII.17 was detected in symptomatic individuals, asymptomatic food handlers, and cabbage kimchi products.
- Kimchi consumption was strongly associated with illness (relative risk of 3.85).
- High school status and kimchi consumption were significant risk factors in multivariate analysis.

## Abstract

Norovirus is a major global concern for foodborne outbreaks. We investigated a large-scale norovirus outbreak in a Korean city to identify the source of infection and implement control measures.

A retrospective cohort study was conducted. Data were collected from questionnaires and laboratory test results, along with an environmental investigation. Human and environmental samples were obtained.

The overall attack rate was 20.2%, with 862 cases among 4,276 individuals exposed across 24 affected schools. Norovirus GII.17 was detected in symptomatic individuals, asymptomatic food handlers, and cabbage kimchi products. Kimchi consumption was significantly associated with illness (relative risk, 3.85; 95% confidence interval [CI], 3.12 to 4.74) and was confirmed as the outbreak source. In multivariate logistic regression, both high school status (odds ratio [OR], 1.49; 95% CI, 1.11 to 2.00) and kimchi consumption (OR, 5.56; 95% CI, 4.24 to 7.30) emerged as significant risk factors.

Kimchi contamination likely occurred either through ingredients or food handlers during the manufacturing process. This study provides key insights for prevention and rapid response to norovirus outbreaks, emphasizing the vulnerability of school food services. We highlight the importance of stringent food safety practices and routine training for food handlers, particularly in manufacturing facilities, given the role of asymptomatic carriers.