title: Multiprefectural spread of gastroenteritis outbreaks attributable to a single genogroup II norovirus strain from a tourist restaurant in Nagasaki, Japan.
abstract: A series of gastroenteritis outbreaks caused by noroviruses (NVs) among tourist groups from several prefectures was associated with eating a lunch prepared by a restaurant in Nagasaki City, Japan, on 18 and 19 November 2003. A retrospective cohort study was performed to estimate the magnitude of the outbreak and identify the source of infection. Epidemiological information was obtained through the local public health centers in the areas where the illness occurred. Stool and vomit specimens and food and environmental samples were analyzed by reverse transcription-PCR with genogroup-specific primers. Positive samples were sequenced and analyzed phylogenetically. Of 1,492 tourists who ate a lunch prepared by the restaurant during the 2-day period, 660 (44.2%) developed illness, with an average incubation time of 31.2 h. Whereas NVs were not detected in any food samples, identical sequences most closely related to the Mexico genotype of genogroup II NV were found in specimens from case patients, restaurant staff, and the kitchen table. Food handlers were concluded to be the source of the outbreak as a result of the contamination of several meals. The series of outbreaks described here exemplifies the role of tourism as a contemporary way to distribute a single infectious agent to multiple and geographically remote areas.
authors.affiliation: Department of Laboratory Medicine, Nagasaki University School of Medicine and Dentistry, Nagasaki 852-8501, Japan. hirakata@net.nagasaki-u.ac.jp
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Hirakata
authors.forename: Kokichi
authors.initials: K
authors.lastname: Arisawa
authors.forename: Osamu
authors.initials: O
authors.lastname: Nishio
authors.forename: Osamu
authors.initials: O
authors.lastname: Nakagomi
mesh_terms: D000293:Adolescent; D000328:Adult; D001483:Base Sequence; D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D015331:Cohort Studies; D004196:Disease Outbreaks; D005516:Food Microbiology; D005759:Gastroenteritis / Q000453:epidemiology* / Q000209:etiology; D005838:Genotype; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008969:Molecular Sequence Data; D029322:Norovirus / Q000145:classification* / Q000235:genetics; D010802:Phylogeny; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction