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Original article Public Health, Environmental, and Occupational Health Significant reduction in norovirus outbreaks and secondary transmission of acute gastroenteritis in Seoul schools following the COVID-19 pandemic: a retrospective epidemiological study
Euncheol Son1,2,3,*orcid, Young-Hoon Kim2,4,*orcid
Journal of Yeungnam Medical Science 2025;42:65.
DOI: https://doi.org/10.12701/jyms.2025.42.65 [Epub ahead of print]
Published online: October 14, 2025

1Department of Physiology, University of Ulsan College of Medicine, Ulsan, Korea

2Bio-Medical Institute of Technology, University of Ulsan, Ulsan, Korea

3Infectious Disease Control Division, General of Health for All Bureau, Seoul Metropolitan Government, Seoul, Korea

4Department of Pharmacology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Corresponding author:  Euncheol Son,
Email: ecson24@naver.com
Young-Hoon Kim,
Email: kimyh@amc.seoul.kr
Received: 27 June 2025   • Revised: 26 September 2025   • Accepted: 4 October 2025
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Background
Unexpectedly, during the coronavirus disease 2019 (COVID-19) pandemic (2020–2022), it was reported that the number of acute gastroenteritis outbreaks (AGEOs) increased abruptly in childcare centers and kindergartens due to the increase in norovirus GII.4 transmission. However, changes in AGEOs in schools have not been reported during the same period. Therefore, this study aimed to compare the characteristics of AGEOs in schools before and after 2020.
Methods
We analyzed the results of AGEO epidemiological investigation reports in Seoul.
Results
The number of AGEO cases in schools decreased after 2020. Norovirus was identified as the causative pathogen in 10 of 11 cases in 2019, while only five cases were caused by norovirus among the 12 cases between 2020 and 2022. The average attack rate decreased from 10.2% in 2019 to 5.2% between 2020 and 2022. The average duration of patient occurrence also decreased from 7.5 days in 2019 to 4 days between 2020 and 2022. Secondary transmission occurred in all 2019 cases. However, secondary transmission was not observed in half of the cases between 2020 and 2022.
Conclusion
Norovirus outbreaks and secondary transmission in schools declined after the onset of the COVID-19 pandemic, probably because of infection control measures implemented to prevent COVID-19 transmission.

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