title: A one-year intensified study of outbreaks of gastroenteritis in The Netherlands.
abstract: In 2002, in The Netherlands a national study of gastroenteritis outbreaks was performed. Epidemiological information was collected by the Public Health Services (PHS) and the Food Inspection Services (FIS) using standardized questionnaires. Stool samples were collected for diagnostic testing. For foodborne outbreaks, food samples were taken. In total, 281 gastroenteritis outbreaks were included, mainly from nursing homes and homes for the elderly (57%), restaurants (11%), hospitals (9%) and day-care centres (7%). Direct person-to-person spread was the predominant transmission route in all settings (overall 78%), except for restaurant outbreaks where food was suspected in almost 90% (overall in 21% of outbreaks). The most common pathogen was norovirus (54%), followed by Salmonella spp. (4%), rotavirus group A (2%), Campylobacter spp. (1%) and only incidentally others. In conclusion, most outbreaks were reported from health and residential institutions, with norovirus as the dominant agent. Control should aim at reducing person-to-person spread. In foodborne outbreaks norovirus was common, due to contamination of food by food handlers. Salmonella, as the second foodborne pathogen, was mainly associated with raw shell eggs. These results stress the continuous need for food safety education, complementary to governmental regulation.
authors.affiliation: Centre for Infectious Disease Epidemiology, National Institute of Public Health and the Environment, Bilthoven, The Netherlands. y.van.duynhoven@rivm.nl
authors.forename: Y T H P
authors.initials: YT
authors.lastname: van Duynhoven
authors.forename: C M
authors.initials: CM
authors.lastname: de Jager
authors.forename: L M
authors.initials: LM
authors.lastname: Kortbeek
authors.forename: H
authors.initials: H
authors.lastname: Vennema
authors.forename: M P G
authors.initials: MP
authors.lastname: Koopmans
authors.forename: F
authors.initials: F
authors.lastname: van Leusden
authors.forename: W H M
authors.initials: WH
authors.lastname: van der Poel
authors.forename: M J M
authors.initials: MJ
authors.lastname: van den Broek
mesh_terms: D017250:Caliciviridae Infections / Q000453:epidemiology; D002169:Campylobacter Infections / Q000453:epidemiology; D004196:Disease Outbreaks; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000382:microbiology; D005759:Gastroenteritis / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D012307:Risk Factors; D012400:Rotavirus Infections / Q000453:epidemiology; D012478:Salmonella Food Poisoning / Q000453:epidemiology; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires