title: Outbreak of norovirus illness associated with a swimming pool.
abstract: On 3 February 2004, the Vermont Department of Health received reports of acute gastroenteritis in persons who had recently visited a swimming facility. A retrospective cohort study was conducted among persons attending the facility between 30 January and 2 February. Fifty-three of 189 (28%) persons interviewed developed vomiting or diarrhoea within 72 h after visiting the facility. Five specimens tested positive for norovirus and three specimen sequences were identical. Entering the smaller of the two pools at the facility was significantly associated with illness (RR 5.67, 95% CI 1.5-22.0, P=0.012). The investigation identified several maintenance system failures: chlorine equipment failure, poorly trained operators, inadequate maintenance checks, failure to alert management, and insufficient record keeping. This study demonstrates the vulnerability of recreational water to norovirus contamination, even in the absence of any obvious vomiting or faecal accident. Our findings also suggest that norovirus is not as resistant to chlorine as previously reported in experimental studies. Appropriate regulations and enforcement, with adequate staff training, are necessary to ensure recreational water safety.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. lpp8@cdc.gov
authors.forename: L J
authors.initials: LJ
authors.lastname: Podewils
authors.forename: L
authors.initials: L
authors.lastname: Zanardi Blevins
authors.forename: M
authors.initials: M
authors.lastname: Hagenbuch
authors.forename: D
authors.initials: D
authors.lastname: Itani
authors.forename: A
authors.initials: A
authors.lastname: Burns
authors.forename: C
authors.initials: C
authors.lastname: Otto
authors.forename: L
authors.initials: L
authors.lastname: Blanton
authors.forename: S
authors.initials: S
authors.lastname: Adams
authors.forename: S S
authors.initials: SS
authors.lastname: Monroe
authors.forename: M J
authors.initials: MJ
authors.lastname: Beach
authors.forename: M
authors.initials: M
authors.lastname: Widdowson
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002713:Chlorine / Q000494:pharmacology; D015331:Cohort Studies; D004196:Disease Outbreaks; D004203:Disinfection; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D029322:Norovirus / Q000187:drug effects / Q000302:isolation & purification*; D012189:Retrospective Studies; D013551:Swimming Pools; D014871:Water Microbiology
chemical_list: D002713:Chlorine