Enterotoxigenic Escherichia coli (ETEC) is now recognized as a common cause of foodborne outbreaks. This study aimed to describe the first ETEC O169 outbreak identified in Korea. In this outbreak, we identified 1642 cases from seven schools. Retrospective cohort studies were performed in two schools; and case-control studies were conducted in five schools. In two schools, radish kimchi was associated with illness; and in five other schools, radish or cabbage kimchi was found to have a higher risk among food items. Adjusted relative risk of kimchi was 5·87-7·21 in schools that underwent cohort studies; and adjusted odds ratio was 4·52-12·37 in schools that underwent case-control studies. ETEC O169 was isolated from 230 affected students, and was indistinguishable from the isolates detected from the kimchi product distributed by company X, a food company that produced and distributed kimchi to all seven schools. In this outbreak, we found that the risk of a kimchi-borne outbreak of ETEC O169 infection is present in Korea. We recommend continued monitoring regarding food safety in Korea, and strengthening surveillance regarding ETEC O169 infection through implementation of active laboratory surveillance to confirm its infection.

Background: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease. SFTS is caused by the SFTS virus, a novel phlebovirus, and is spread by ticks. Methods: A 50-year-old man was admitted to our hospital with the chief complaint of fever and was diagnosed with confirmed SFTS. An epidemiological investigation was conducted, and immunofluorescent antibody assays (IFAs) were performed to determine the role of the patient's three dogs in the transmission. PCR assays were performed using ticks that were collected with the dragging and flagging method from the patient's dogs and home. Results: PCR results were positive, and IFA confirmed an increased antibody titer. Although the reverse transcription PCR results of the three dogs were negative for SFTS virus, one dog had an elevated SFTS IFA immunoglobulin G (IgG) titer of 1:1,024. Moreover, a number of ticks were observed in the area surrounding the dog cages. Based on the findings of the patient interview, the patient was likely to have acquired SFTS by blood splash because he removed or burst ticks from the dogs with his bare hands. Although no tick bites were reported, tick transmission could not be ruled out. Studies have shown that only one in three individuals with a diagnosis of SFTS recalls a tick bite; thus, a definite exclusion of tick transmission in this case was not possible. Conclusions: The epidemiological findings of our case suggest a possible relationship between tick infestation in domestic dogs and SFTS virus transmission to humans. However, there is no direct evidence supporting this viral transmission route. Future studies are needed to further investigate a potential route of SFTS transmission by exposure to engorged tick blood or pet dogs.

There are well known infectious diarrheal disease including viral disease such as HuCVs (Human caliciviruses), rotaviruses, enteric adenoviruses and astroviruses. We performed surveillance of infectious diarrheal disease in this study for providing the information for regional prevalence of infectious diarrheal disease and establish basement of diagnostic scheme for these infectious diarrheal disease. For the study, 3,400 stool specimens collected from 10 hospitals in Gwangju from April 2000 to March 2002 were used in investigation for the detection of infectious diarrheal disease. For group A rotaviruses, enteric adenoviruses and astrovirus, we carried out antigen capturing ELISA and RT-PCR with specific primers reacting RNA dependent RNA polymerase gene of HuCVs is used for the detection of RNA of HuCVs. As a results, we detected viral antigen or genome from 537 out of 3,400 specimens (15.8%). 443 out of 537 (82.5%) were confirmed as rotaviruses antigen positively, and 14 (2.6%) and 3 (0.8%) samples were antigen positive to enteric adenoviruses and astroviruses, respectively. We detected HuCV genome from 73 (13.6%) samples by specific amplification. We found that predominantly causative virus is rotavirus in Gwangju but HuCVs take major portion of viral agents causing diarrhea considering the age and seasonal distribution of specimens. Prevalence of adenoviruses and astroviruses are very low compared with worldwide situation. While the infection of rotavirus is limited to young infant under 2 years old, infection of HuCV has wide age distribution. These results suggest that existence of various strains of HuCVs and low rate of cross-protection among distinct antigenic group make it difficult to form immunity in older age. This epidemiological information relating to various diarrheic viruses is first reported in Gwangju, therefore it could provide present prevalence of viral agents causing gastroenteritis and backgrounds to establishment of protection viral diarrhea and development.

Human enteroviruses (EVs) are associated with a broad spectrum of diseases. To understand EV epidemiology, we present longitudinal data reflecting changing EV prevalence patterns in South Korea. We collected 7160 specimens from patients with suspected EV infections in ten hospitals in Gwangju, Korea during 2011–2020. RNA extraction and real-time reverse transcription polymerase chain reaction using EV-specific probes and primers were performed. EV genotyping and phylogenetic analysis were performed; EVs were detected in 3076 samples (43.0%), and the annual EV detection rate varied. EV infection rates did not differ with sex, and children aged ≤ 4 years were the most prone to EV infection; this trend did not change over time. Overall, 35 different EV types belonging to four distinctive species and rhinoviruses were identified. Although serotype distribution changed annually, the most frequently observed EVs were EV-A71 (13.1% of the cases), CVA6 (8.3%), CVB5 (7.6%), CVA16 (7.6%), CVA10 (7.5%), E18 (7.5%), E30 (7.0%), and E11 (5.0%) during 2011–2020. The predominant EV genotypes by clinical manifestation were CVB5 for aseptic meningitis; EV-A71 for hand, foot, and mouth disease cases; and CVA10 for herpangina. These results will aid the development of vaccines against EV infection and allow comprehensive disease control.

To determine the distribution of rotavirus strain genotypes in Gwangju, Korea, we performed reverse-transcription polymerase chain reaction and nucleotide sequencing analysis using the 115 rotavirus EIA positive stool specimens collected from December 2006 through April 2007. The most predominant genotype was confirmed as G1P[8] (53.9%), followed by G3P[8] (29.6%), G4P[6] (8.7%), G2P[4] (4.3%) and G9P [8] (1.7%). A special attention is drawn to the unusual findings of the genotypes G11P[25] and G12P [9] during this study period. In order to investigate the phylogenetic relationships among the same or different genotypes, the nucleotide sequences of rotavirus circulating in Korea and the foreign countries were analyzed using MegAlign and Clustal X programme. The G11P [25] strain identified in this study showed the highest nucleic acid similarity with G11 /CUK1 /2006 /Korea (99.2%) and P[25] /Dhaka /2001 /BGD (98.7%). Meanwhile, the G12P[9] strain detected in this study shared 99.4~99.5% nucleotide homology with the reference strain G12P[9] /CP1030 /2004 /Japan. This incidence of new rotavirus genotypes in our area illustrates the large diversity of rotavirus strains found worldwide. Therefore, the epidemiological surveillance of rotavirus may need to be continued in a wide geographic area.