title: A large waterborne gastroenteritis outbreak in central Greece, March 2012: challenges for the investigation and management.
abstract: In March 2012, there was an unusual increase of gastroenteritis cases in a district with 37,264 inhabitants in central Greece. It was estimated that more than 3600 people developed symptoms. A 1:1 case-control study showed that consumption of tap water was a risk factor for acquiring infection [odds ratio (OR) 2.18, 95% confidence interval (CI) 1.11-4.28]. Descriptive data, low gastroenteritis incidence in adjacent areas with different water supply systems, and water-quality data further supported the hypothesis of a waterborne outbreak. Thirty-eight stool samples were positive for rotavirus. Bacterial indicators of recent faecal contamination were detected in samples from the water source and ice cubes from a local production enterprise. Molecular epidemiology of rotavirus strains, apart from the common strain, G3[P8], identified the unusual G/P combination G2P[8]. Water sanitation measures contributed to the control of the outbreak. This outbreak demonstrated the need for the cooperation of laboratories with different expertise and the importance of early notification of waterborne gastroenteritis outbreaks.
authors: Hellenic Centre for Disease Control and Prevention, Epidemiological Surveillance and Intervention, Athens, Greece.
authors: K
authors: K
authors: Mellou
authors: A
authors: A
authors: Katsioulis
authors: M
authors: M
authors: Potamiti-Komi
authors: S
authors: S
authors: Pournaras
authors: M
authors: M
authors: Kyritsi
authors: A
authors: A
authors: Katsiaflaka
authors: A
authors: A
authors: Kallimani
authors: P
authors: P
authors: Kokkinos
authors: E
authors: E
authors: Petinaki
authors: T
authors: T
authors: Sideroglou
authors: T
authors: T
authors: Georgakopoulou
authors: A
authors: A
authors: Vantarakis
authors: C
authors: C
authors: Hadjichristodoulou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D060766:Drinking Water / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D005759:Gastroenteritis / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012401:Rotavirus / Q000235:genetics / Q000302:isolation & purification*; D012400:Rotavirus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D011795:Surveys and Questionnaires
chemical_list: D060766:Drinking Water
references: Clin Microbiol Infect. 2006 Jun;12(6):561-70
references: 16700706
references: J Appl Microbiol. 1998 Jul;85(1):187-91
references: 9721669
references: J Appl Microbiol. 2003;94 Suppl:37S-46S
references: 12675935
references: New Microbiol. 2011 Jan;34(1):17-24
references: 21344142
references: Am J Trop Med Hyg. 2005 Apr;72(4):488-94
references: 15827293
references: MMWR Surveill Summ. 2008 Sep 12;57(9):1-29
references: 18784642
references: Euro Surveill. 2008 Aug 21;13(34):
references: 18761889
references: J Med Virol. 2010 Jul;82(7):1277-81
references: 20513096
references: J Clin Microbiol. 1990 Feb;28(2):276-82
references: 2155916
references: Appl Environ Microbiol. 2002 Sep;68(9):4523-33
references: 12200309
references: J Water Health. 2006;4 Suppl 2:19-30
references: 16895084
references: Clin Infect Dis. 2007 Feb 15;44(4):506-12
references: 17243052
references: Rev Med Virol. 2005 Jan-Feb;15(1):29-56
references: 15484186
references: J Virol Methods. 2008 Nov;153(2):79-83
references: 18765255
references: Arch Virol. 2011 Aug;156(8):1397-413
references: 21597953
references: J Water Health. 2008 Dec;6(4):491-503
references: 18401114
references: Epidemiol Infect. 2013 Apr;141(4):671-86
references: 22877498
references: Appl Environ Microbiol. 2000 Aug;66(8):3241-8
references: 10919776
references: Water Sci Technol. 2004;50(1):57-61
references: 15318487
references: Water Res. 2011 Dec 15;45(20):6603-14
references: 22048017
references: J Clin Microbiol. 1992 Jun;30(6):1365-73
references: 1320625
references: Epidemiol Infect. 2010 Apr;138(4):491-500
references: 19751538
references: Appl Environ Microbiol. 2006 Mar;72(3):2218-20
references: 16517675
references: Crit Rev Microbiol. 2002;28(4):371-409
references: 12546197
references: Water Sci Technol. 2001;43(12):1-8
references: 11464736
references: Epidemiol Infect. 2010 Dec;138(12):1726-34
references: 20836911
references: Annu Rev Microbiol. 1995;49:461-87
references: 8561468
references: BMC Infect Dis. 2009 Apr 15;9:43
references: 19368717
references: J Expo Sci Environ Epidemiol. 2010 Jan;20(1):19-28
references: 18941478