title: A large multi-pathogen gastroenteritis outbreak caused by drinking contaminated water from antique neighbourhood fountains, Erzurum city, Turkey, December 2012.
abstract: We investigated a gastroenteritis outbreak in Erzurum city, Turkey in December 2012 to identify its cause and mode of transmission. We defined a probable case as onset of diarrhoea (⩾3 episodes/day) or vomiting, plus fever or nausea or abdominal pain during 19-27 December, 2012 in an Erzurum city resident. In a case-control study we compared exposures of 95 randomly selected probable cases and 95 neighbourhood-matched controls. We conducted bacterial culture and real-time multiplex PCR for identification of pathogens. During the week before illness onset, 72% of cases and 15% of controls only drank water from antique neighbourhood fountains; conversely, 16% of cases and 65% of controls only drank bottled or tap water (adjusted odds ratio 20, 95% confidence interval 4·6-84, after controlling for age and sex using conditional logistic regression). Of eight stool specimens collected, two were positive for Shigella sonnei, one for astrovirus, one for astrovirus and norovirus, and one for astrovirus and rotavirus. Water samples from the fountains had elevated total coliform (38-300/100 ml) and Escherichia coli (22-198/100 ml) counts. In conclusion, drinking contaminated fountain water caused this multi-pathogen outbreak. Residents should stop drinking water from these fountains, and clean water from the water treatment plant should be connected to the fountains.
authors.affiliation: Early Warning and Response and Field Epidemiology Department,Public Health Institution of Turkey.
authors.forename: F
authors.initials: F
authors.lastname: Sezen
authors.affiliation: Erzurum Provincial Health Directorate,Public Health Institution of Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Aval
authors.affiliation: Erzurum Provincial Health Directorate,Public Health Institution of Turkey.
authors.forename: T
authors.initials: T
authors.lastname: Ağkurt
authors.affiliation: Environmental Health Department,Public Health Institution of Turkey.
authors.forename: Ş
authors.initials: Ş
authors.lastname: Yilmaz
authors.affiliation: Early Warning and Response and Field Epidemiology Department,Public Health Institution of Turkey.
authors.forename: F
authors.initials: F
authors.lastname: Temel
authors.affiliation: Microbiology Reference Laboratory,Public Health Institution of Turkey.
authors.forename: R
authors.initials: R
authors.lastname: Güleşen
authors.affiliation: Microbiology Reference Laboratory,Public Health Institution of Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Korukluoğlu
authors.affiliation: Early Warning and Response and Field Epidemiology Department,Public Health Institution of Turkey.
authors.forename: M B
authors.initials: MB
authors.lastname: Sucakli
authors.affiliation: Office of the Vice Presidency for Communicable Disease Control Programs,Public Health Institution of Turkey.
authors.forename: M A
authors.initials: MA
authors.lastname: Torunoğlu
authors.affiliation: WHO Country Office,Turkey.
authors.forename: B-P
authors.initials: BP
authors.lastname: Zhu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019350:Astroviridae Infections / Q000453:epidemiology / Q000209:etiology; D017250:Caliciviridae Infections / Q000453:epidemiology / Q000209:etiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology / Q000821:virology; D004196:Disease Outbreaks; D060766:Drinking Water / Q000382:microbiology* / Q000821:virology; D004405:Dysentery, Bacillary / Q000453:epidemiology / Q000209:etiology; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology / Q000821:virology; D006801:Humans; D008297:Male; D001257:Mamastrovirus; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction; D029322:Norovirus; D012111:Residence Characteristics; D012401:Rotavirus; D012400:Rotavirus Infections / Q000453:epidemiology / Q000209:etiology; D012764:Shigella sonnei; D014421:Turkey / Q000453:epidemiology; D014871:Water Microbiology; D055815:Young Adult
chemical_list: D060766:Drinking Water
keywords: waterborne infections