Epidemiology and Infection



Waterborne outbreak of gastroenteritis in a religious summer camp in Norway, 2002


K. NYGÅRD a1c1, L. VOLD a1a2, E. HALVORSEN a3, E. BRINGELAND a3, J. A. RØTTINGEN a1a4 and P. AAVITSLAND a1
a1 Department of Infectious Disease Epidemiology, Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
a2 European Programme for Intervention Epidemiology Training, Sweden
a3 Regional Food Control Authority of Midt-Rogaland, Norway
a4 Institute for Nutrition Research, University of Oslo, Norway

Article author query
nygard k   [PubMed][Google Scholar] 
vold l   [PubMed][Google Scholar] 
halvorsen e   [PubMed][Google Scholar] 
bringeland e   [PubMed][Google Scholar] 
rottingen j   [PubMed][Google Scholar] 
aavitsland p   [PubMed][Google Scholar] 

Abstract

In July 2002 an outbreak of acute gastroenteritis occurred in a camp facility in western Norway during a 10-day seminar, with around 300 guests staying overnight and several day-time visitors. Environmental and epidemiological investigations were conducted to identify and eliminate the source of the outbreak, prevent further transmission and describe the impact of the outbreak. Of 205 respondents, 134 reported illness (attack rate, 65%). Multivariate analysis showed drinking water and taking showers at the camp-site to be significant risk factors. Secondary person-to-person spread among visitors or outside of the camp was found. Norovirus was identified in 8 out of the 10 stool samples analysed. Indicators of faecal contamination were found in samples from the private untreated water supply, but norovirus could not be identified. This outbreak investigation illustrates the importance of norovirus as a cause of waterborne illness and the additional exacerbation through person-to-person transmission in closed settings. Since aerosol transmission through showering contributed to the spread, intensified hygienic procedures such as isolation of cases and boiling of water may not be sufficient to terminate outbreaks with norovirus.

(Accepted November 10 2003)


Correspondence:
c1 Karin Nygård, Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Pb 4404 Nydalen, 0403 Oslo, Norway.


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