우리나라에서 1991년 2002년 사이의 복어독 중독 발생상황에 대하여 신문에 보도된 내용을 검색하여 정리하고 특성을 분석하였다. 조사기간 중 우리나라에서는 총 32건의 복어독 중독사고가 발생하여, 111명이 중독되었고 그 중 30명이 사망하여 27.0%의 치사율을 나타내었으며, 연도에 따라 중독건수, 환자수 및 사망자수의 변동이 심하였다. 사망자는 29세 이상의 남성이 대부분을 차지하였다. 식중독 발생건별 환자수를 보면 4인 이하의 소규모 중독사건이 전체 발생건수의 75.0%인 24건을 차지하였고, 식중독 통계 집계기준인 5인 이상의 집단 식중독은 8건에 지나지 않았다. 우리나라에서 복어독 중독 발생건수의 59.4%(19/32)가 11월부터 익년 1월사이에 발생하였고, 이시기의 환자수 및 사망자수 또한 각각 65.8%(73/111), 66.7%(20/30)로 나타나 복어중독은 겨울철에 집중되었다. 지역적으로는 발생 건수의 75.0%(24/32)가 부산, 경남, 전남, 제주 등 남해안 지역에서 집중적으로 발생하였다. 섭취장소별로는 총 32건 중 18건(56.3%)이 선박에서 발생하였고, 가정에서 8건(25.0%)의 발생하였으며, 음식점에서 발생한 것은 5건(15.6%)이었다. 복어독 중독의 가장 중요한 원인 음식물은 국(탕 포함)으로 발생건수의 68.8%(22/32), 환자수의 64.0%(71/111), 사망자의 66.7%(20/30)를 차지하였고, 그 외 찜, 회, 내장탕, 알 등도 원인이 된 경우가 있었다.

Despite to the reality that the outbreaks from food poisoning in Korea have been continuously increasing in the last two decades, it was very much neglected even in the public health field in Korea. Food poisoning outbreaks resulted in many cases not only in the damage of health but also in the death of many lives. However, this problem can be effectively solved by efforts through health education activities, but not solely by the legal measures. This study was carried out to provide information that can be used in planning health education programs and proposing new rules to prevent any possible outbreaks from food poisoning. The main problems contributing to food poisoning outbreaks in an institutional setting or school catering and at home were reviewed and analyzed through the epidemiological investigations and articles related to food poisoning in the last a decade (1991-2000). Accordingly, the data presented in this study are sufficient to show and prove the significant trends in food poisoning accidents in Korea. The major findings investigated in this study are as follows. The frequency of food poisoning accidents as well as the number of victims have continuously increased in Korea. The number of victims per food poisoning accident is also increased from 20 persons in 1990 to 69.8 persons in 2000. Therefore, we should realize that the group poisoning outbreaks occur more frequently and the size of group poisoning accidents is getting larger. Among four seasons, the food poisoning accidents occurred more frequently in the summer (May-September) until 1997. However, after 1997, the food poisoning accidents occurred evenly in three seasons except the winter. The most important bacteria that cause food poisoning in Korea were Salmonella spp., Vibrio spp. and Staphylococcus aureus. They occupied 85-90% of the rates of accidents and the number of victims. And, the major category of food causing outbreaks in Korea are meats, raw and undercooked sea foods and compound food as Kimbab and lunch box. Among meats, the most food poisoning accidents were caused by pork. The frequency of food poisoning accidents at individual households tends to decrease continuously. Whereas, the rates of accidents at the public restaurants and food service establishments are comparatively increasing. Therefore, we must improve the quality of the sanitation management in food service establishments through HACCP and post- administration of HACCP.

The main problems contributing to food poisoning outbreaks in institutional settings and a home were reviewed and analyzed through the epidemiological investigations of food poisoning. The major documented factors included improper holding temperatures, inadequate cooking, poor personal hygiene, cross-contamination and contaminated equipment, food from unsafe sources, failure to follow food hygiene policies, and lack of education, training, monitoring and supervision. Usually more than one factor contributed to the development of an outbreak. (1) Use of improper holding temperatures was the single most important factor contributing to food poisoning. They included improper cooling, allowing a laps of time (12 hours or more) between preparing food and eating it, improper hot holding, and inadequate or improper thawing. Food thermometers were not used in most of the instances. (2) In inadequate cooking, the core temperature of food during and after cooking had not been measured, and routine monitoring was limited to recording the temperature of plated meals. Compared with conventional methods of cooking, microwave ovens did not protect against food poisoning as effectively. Centralized food preparation potentially increased the risk of food poisoning outbreaks. (3) Poor personal hygiene both at the individual level (improper handwashing and lack of proper hygienic practices) and at the institutional level (poor general sanitization) increased the risk of transmission. Person to person transmission of enteric pathogens through direct contact and via fomites has been noted in several instances. (4) Obtaining food from unsafe sources was a risk factor in outbreaks of food poisoning. Food risks were high when food was grown or harvested from contaminated areas. Possibilities included contamination in the field, in transport, at the retail site, or at the time it was prepared for serving. (5) Cross-contamination and inadequate cleaning/handling of equipment became potential vehicles of food poisoning. Failure to separate cooked food from raw food was also a risk factor. (6) Failure to follow food hygiene policies also provided opportunities for outbreaks of food poisoning. It included improper hygienic practices during food preparation, neglect of personnel policies (involvement of symptomatic workers in food preparation), poor results on routine inspections, and disregarding the results and recommendations of an inspection. (7) Lack of formal and in-service education, training, monitoring, and supervision of food handlers or supervisors were critical and perhaps neglected elements in occurrences of food poisoning.

Retrospective study on the comparison of outbreaks of food poisoning for food hygiene in Korea and Japan. The average value of morbidity rate by year in Korea during the period of 1971 to 1992 was 2.9 per 100,000 population, and that of Japan was 29.1. The mean value of mortality rates in case of food poisoning by year in Korea was 2.33%, and that of Japan was 0.07%. When compared the rates of morbidity and mortality between Korea and Japan during the same period, the morbidity rates of Japan were much higher than those of Korea (p$lt;0.0l). However, mortality rate of patients in Korea were much higher then those of Japan (p$lt;0.01). Resulting from comparative observation of food poisoning by preparing facilities between Korea and Japan. The highest list the places where the outbreaks occurred was home-made foods accounted for 48.8% of the total cases in Korea and that of Japan was restaurants accounted for 33.0%. Causative foods in Korea, the most common incrimination vehicles were seafood, meat and animal products and grain and vegetables, including mushroom. However, in the case of the common incrimination vehicles Japan were unknown and other foods, seafood, vegetables and meat and animal products etc.. Food poisoning of pathogenic substance in Korea were 60.9% of bacterial food poisoning of the total cases showing that Vibrio species, Salmonella spp., Staphylococcus app., pathogenic E. coli, Clostridium app. and other app. were 33.3%, 26.2%, 16.3%, 5.3%, 0.4% and 18.5%, respectively. On the other hand, in Japan, major causes were Vibrio app. (45.7%), Staphylococcus app. (23.7%), Salmonella app. (16.8%), pathogenic E. coli (3.8%), Clostridium app. (0.2%) and other app. (9.6%).