title: Outbreak of viral gastroenteritis due to a contaminated well. International consequences.
abstract: BACKGROUND
  Small round-structured viruses (SRSVs) are known to cause viral gastroenteritis, but until now have not been confirmed in the implicated vehicle in outbreaks.
  
  
  OBJECTIVE
  Investigation of a gastroenteritis outbreak.
  
  
  METHODS
  After applying epidemiologic methods to locate the outbreak source, we conducted environmental and laboratory investigations to elucidate the cause.
  
  
  METHODS
  Tourists traveling by bus through Alaska and the Yukon Territory of Canada.
  
  
  METHODS
  Staff of a restaurant at a business complex implicated as the outbreak source, convenience sample of persons on buses that had stopped there, and bus employees.
  
  
  METHODS
  Odds ratios (ORs) for illness associated with exposures. Water samples from the restaurant and stool specimens from tourists and restaurant staff were examined by nucleic acid amplification using reverse transcription polymerase chain reaction and sequencing of viral amplification products.
  
  
  RESULTS
  The itineraries of groups of tourists manifesting vomiting or diarrhea were traced back to a restaurant where buses had stopped 33 to 36 hours previously. Water consumption was associated with illness (OR, 5.3; 95% confidence interval [CI], 2.3-12.6). Eighteen of 26 employees of the business complex were ill; although not the index case, an employee ill shortly before the outbreak lived in a building connected to a septic pit, which was found to contaminate the well supplying the restaurant's water. Genotype 2/P2B SRSV was identified in stool specimens of 2 tourists and 1 restaurant employee. Stools and water samples yielded identical amplification product sequences.
  
  
  CONCLUSIONS
  The investigation documented SRSVs in a vehicle epidemiologically linked to a gastroenteritis outbreak. The findings demonstrate the power of molecular detection and identification and underscore the importance of fundamental public health practices such as restaurant inspection, assurance of a safe water supply, and disease surveillance.
authors.affiliation: Division of Public Health, Alaska Department of Health and Social Services, Anchorage 99524, USA. mikeb@health.state.ak.us
authors.forename: M
authors.initials: M
authors.lastname: Beller
authors.forename: A
authors.initials: A
authors.lastname: Ellis
authors.forename: S H
authors.initials: SH
authors.lastname: Lee
authors.forename: M A
authors.initials: MA
authors.lastname: Drebot
authors.forename: S A
authors.initials: SA
authors.lastname: Jenkerson
authors.forename: E
authors.initials: E
authors.lastname: Funk
authors.forename: M D
authors.initials: MD
authors.lastname: Sobsey
authors.forename: O D
authors.initials: OD
authors.lastname: Simmons
authors.forename: S S
authors.initials: SS
authors.lastname: Monroe
authors.forename: T
authors.initials: T
authors.lastname: Ando
authors.forename: J
authors.initials: J
authors.lastname: Noel
authors.forename: M
authors.initials: M
authors.lastname: Petric
authors.forename: J P
authors.initials: JP
authors.lastname: Middaugh
authors.forename: J S
authors.initials: JS
authors.lastname: Spika
mesh_terms: D001483:Base Sequence; D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000209:etiology; D002170:Canada / Q000453:epidemiology; D004196:Disease Outbreaks; D005759:Gastroenteritis / Q000453:epidemiology* / Q000209:etiology / Q000821:virology; D006801:Humans; D017720:Molecular Epidemiology; D009663:Norwalk virus / Q000235:genetics*; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000302:isolation & purification; D012194:RNA-Directed DNA Polymerase; D012147:Restaurants; D014195:Travel; D014481:United States / Q000453:epidemiology; D014871:Water Microbiology; D014881:Water Supply
chemical_list: D012367:RNA, Viral; D012194:RNA-Directed DNA Polymerase