title: A large multi-pathogen waterborne community outbreak linked to faecal contamination of a groundwater system, France, 2000.
abstract: A large waterborne outbreak of infection that occurred during August 2000 in a local community in France was investigated initially via a rapid survey of visits to local physicians. A retrospective cohort study was then conducted on a random cluster sample of residents. Of 709 residents interviewed, 202 (28.5%) were definite cases (at least three liquid stools/day or vomiting) and 62 (8.7%) were probable cases (less than three liquid stools/day or abdominal pain). Those who had drunk tap water had a three-fold increased risk for illness (95% CI 2.4-4.0). The risk increased with the amount of water consumed (chi-square trend: p < 0.0001). Bacteriological analyses of stools were performed for 35 patients and virological analyses for 24 patients. Campylobacter coli, group A rotavirus and norovirus were detected in 31.5%, 71.0% and 21% of samples, respectively. An extensive environmental investigation concluded that a groundwater source to this community had probably been contaminated by agricultural run-off, and a failure in the chlorination system was identified. This is the first documented waterborne outbreak of infection involving human C. coli infections. A better understanding of the factors influencing campylobacter transmission between hosts is required.
authors.affiliation: Institut de Veille Sanitaire, Saint Maurice, France.
authors.forename: A
authors.initials: A
authors.lastname: Gallay
authors.forename: H
authors.initials: H
authors.lastname: De Valk
authors.forename: M
authors.initials: M
authors.lastname: Cournot
authors.forename: B
authors.initials: B
authors.lastname: Ladeuil
authors.forename: C
authors.initials: C
authors.lastname: Hemery
authors.forename: C
authors.initials: C
authors.lastname: Castor
authors.forename: F
authors.initials: F
authors.lastname: Bon
authors.forename: F
authors.initials: F
authors.lastname: Mégraud
authors.forename: P
authors.initials: P
authors.lastname: Le Cann
authors.forename: J C
authors.initials: JC
authors.lastname: Desenclos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017250:Caliciviridae Infections / Q000175:diagnosis / Q000453:epidemiology*; D002169:Campylobacter Infections / Q000175:diagnosis / Q000453:epidemiology*; D017000:Campylobacter coli / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004196:Disease Outbreaks; D005243:Feces / Q000382:microbiology / Q000821:virology; D005602:France / Q000453:epidemiology; D005759:Gastroenteritis / Q000453:epidemiology* / Q000382:microbiology / Q000821:virology; D006801:Humans; D008875:Middle Aged; D029322:Norovirus / Q000302:isolation & purification; D012189:Retrospective Studies; D012401:Rotavirus / Q000302:isolation & purification; D012400:Rotavirus Infections / Q000175:diagnosis / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014871:Water Microbiology; D014881:Water Supply