title: Waterborne gastroenteritis outbreak at a scouting camp caused by two norovirus genogroups: GI and GII.
abstract: BACKGROUND
  A cross-border gastroenteritis outbreak at a scouting camp was associated with drinking water from a farmer's well.
  
  
  OBJECTIVE
  A retrospective cohort study was performed to identify size and source of the outbreak, as well as other characteristics.
  
  
  METHODS
  Epidemiological investigation included standardized questionnaires about sex, age, risk exposures, illness and family members. Stool and water (100mL) samples were analyzed for bacteria, viruses and parasites.
  
  
  RESULTS
  Questionnaires were returned by 84 scouts (response rate 82%), mean age of 13 years. The primary attack rate was 85% (diarrhoea and/or vomiting). Drinking water was the strongest independent risk factor showing a dose-response effect with 50%, 75%, 75%, 93% and 96% case prevalence for 0, 1, 2-3, 4-5 and >5 glasses consumed, respectively. Norovirus (GI.2 Southampton and GII.7 Leeds) was detected in 51 stool specimens (75%) from ill scouts. Water analysis showed fecal contamination, but no norovirus. The secondary attack rate was 20%.
  
  
  CONCLUSIONS
  This remarkable outbreak was caused by a point-source infection with two genogroups of noroviruses most likely transmitted by drinking water from a well. Finding a dose-response relationship was striking. Specific measures to reduce the risk of waterborne diseases, outbreak investigation and a good international public health network are important.
authors.affiliation: Department of Infectious Diseases, Public Health Service South Limburg, 6160 HA Geleen, The Netherlands. henriette.terwaarbeek@ggdzl.nl
authors.forename: Henriëtte L G
authors.initials: HL
authors.lastname: ter Waarbeek
authors.forename: Nicole H T M
authors.initials: NH
authors.lastname: Dukers-Muijrers
authors.forename: Harry
authors.initials: H
authors.lastname: Vennema
authors.forename: Christian J P A
authors.initials: CJ
authors.lastname: Hoebe
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D017250:Caliciviridae Infections / Q000453:epidemiology*; D002165:Camping; D002648:Child; D015331:Cohort Studies; D004196:Disease Outbreaks; D005243:Feces / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology*; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D029322:Norovirus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D012367:RNA, Viral / Q000235:genetics; D012189:Retrospective Studies; D014871:Water Microbiology; D055815:Young Adult
chemical_list: D012367:RNA, Viral