title: Norovirus outbreak of probable waterborne transmission with high attack rate in a Guatemalan resort.
abstract: BACKGROUND
  In February 2009, a group of Guatemalan school children developed acute gastroenteritis (AGE) after participating in a school excursion.
  
  
  OBJECTIVE
  We conducted a retrospective cohort investigation to characterize the outbreak and guide control measures.
  
  
  METHODS
  A case was defined as an illness with onset of diarrhea or vomiting during February 25-March 5, 2009. Participants were interviewed using a standardized questionnaire, and stool specimens were collected. We inspected the excursion site and tested water samples for total coliforms and Escherichia coli.
  
  
  RESULTS
  We identified 119 excursion participants, of which 92 (77%) had been ill. Fifty-six (62%) patients sought care for their illness, and three (3%) were hospitalized. Eighteen (90%) of the 20 specimens from ill children tested positive for norovirus. Among these, 16 (89%) were of the genogroup I (GI.7) and two (11%) were genogroup II (GII.12 and GII.17). One (8%) of the 12 food handlers had norovirus (GI.7). Drinking water samples had 146 most probable numbers (MPN)/100ml of total coliforms and five MPN/100ml of E. coli.
  
  
  CONCLUSIONS
  We describe the first laboratory-confirmed norovirus outbreak in Guatemala. The high illness attack rate, detection of multiple norovirus strains in sick persons, and presence of fecal contamination of drinking water indicate likely waterborne transmission.
authors: US Centers for Disease Control and Prevention Regional Office for Central America and Panama, International Emerging Infections Program, Guatemala City, Guatemala. dwi4@cdc.gov
authors: Wences
authors: W
authors: Arvelo
authors: Silvia M
authors: SM
authors: Sosa
authors: Patricia
authors: P
authors: Juliao
authors: María R
authors: MR
authors: López
authors: Alejandra
authors: A
authors: Estevéz
authors: Beatriz
authors: B
authors: López
authors: María E
authors: ME
authors: Morales-Betoulle
authors: Miguel
authors: M
authors: González
authors: Nicole A
authors: NA
authors: Gregoricus
authors: Aron J
authors: AJ
authors: Hall
authors: Jan
authors: J
authors: Vinje
authors: Umesh
authors: U
authors: Parashar
authors: Kim A
authors: KA
authors: Lindblade
mesh_terms: D000328:Adult; D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000821:virology; D002648:Child; D004196:Disease Outbreaks; D060766:Drinking Water / Q000382:microbiology*; D005260:Female; D005511:Food Handling; D005759:Gastroenteritis / Q000453:epidemiology* / Q000821:virology; D006166:Guatemala / Q000453:epidemiology; D006294:Health Resorts; D006801:Humans; D008297:Male; D029322:Norovirus / Q000235:genetics / Q000302:isolation & purification*; D012189:Retrospective Studies
chemical_list: D060766:Drinking Water