title: Investigation and control of a Norovirus outbreak of probable waterborne transmission through a municipal groundwater system.
abstract: During March 2011 an outbreak of gastroenteritis occurred in Santo Stefano di Quisquina, Agrigento, Sicily, Italy. Within two weeks 156 cases were identified among the 4,965 people living in the municipality. An epidemiological investigation was conducted to characterize the outbreak and target the control measures. A case was defined as a person developing diarrhea or vomiting during February 27-March 13, 2011. Stool specimens were collected from 12 cases. Norovirus (NoV) genotype GII.4 variant New Orleans 2009 was identified in stool samples from 11 of 12 cases tested (91.7%). Epidemiological investigations suggested a possible association with municipal drinking water consumption. Water samples from the public water system were tested for NoV and a variety of genotypes were detected during the first 3 months of surveillance, including GII.4 strains belonging to different variants from that involved in the gastroenteritis outbreak. Contamination of the well and springs supplying the public water network was eventually thought to be the source of the NoV contamination.
authors.affiliation: Dipartimento di Scienze per la Promozione della Salute e Materno Infantile 'G. D'Alessandro', Università di Palermo (DSHP-MCC, Department of Sciences for Health Promotion and Mother-Child Care, University of Palermo), Palermo, Italy E-mail: giovanni.giammanco@unipa.it.
authors.forename: Giovanni M
authors.initials: GM
authors.lastname: Giammanco
authors.affiliation: Department of Veterinary Public Health & Food Safety, Istituto Superiore di Sanità (ISS, National Institute of Health), Rome, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Di Bartolo
authors.affiliation: Istituto Zooprofilattico Sperimentale della Sicilia (IZS, Experimental Zooprophylactic Institute of Sicily), Palermo, Italy.
authors.forename: Giuseppa
authors.initials: G
authors.lastname: Purpari
authors.affiliation: Dipartimento di Scienze per la Promozione della Salute e Materno Infantile 'G. D'Alessandro', Università di Palermo (DSHP-MCC, Department of Sciences for Health Promotion and Mother-Child Care, University of Palermo), Palermo, Italy E-mail: giovanni.giammanco@unipa.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Costantino
authors.affiliation: Dipartimento di Scienze per la Promozione della Salute e Materno Infantile 'G. D'Alessandro', Università di Palermo (DSHP-MCC, Department of Sciences for Health Promotion and Mother-Child Care, University of Palermo), Palermo, Italy E-mail: giovanni.giammanco@unipa.it.
authors.forename: Valentina
authors.initials: V
authors.lastname: Rotolo
authors.affiliation: Azienda Sanitaria Provinciale di Agrigento, Dipartimento di Prevenzione (ASP, Local Health Authority of Agrigento, Department of Prevention), Agrigento, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Spoto
authors.affiliation: Azienda Sanitaria Provinciale di Agrigento, Dipartimento di Prevenzione (ASP, Local Health Authority of Agrigento, Department of Prevention), Agrigento, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Geraci
authors.affiliation: Azienda Sanitaria Provinciale di Agrigento, Dipartimento di Prevenzione (ASP, Local Health Authority of Agrigento, Department of Prevention), Agrigento, Italy.
authors.forename: Girolama
authors.initials: G
authors.lastname: Bosco
authors.affiliation: Azienda Sanitaria Provinciale di Agrigento, Dipartimento di Prevenzione (ASP, Local Health Authority of Agrigento, Department of Prevention), Agrigento, Italy.
authors.forename: Agata
authors.initials: A
authors.lastname: Petralia
authors.affiliation: Istituto Zooprofilattico Sperimentale della Sicilia (IZS, Experimental Zooprophylactic Institute of Sicily), Palermo, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Guercio
authors.affiliation: Istituto Zooprofilattico Sperimentale della Sicilia (IZS, Experimental Zooprophylactic Institute of Sicily), Palermo, Italy.
authors.forename: Giusi
authors.initials: G
authors.lastname: Macaluso
authors.affiliation: Dipartimento di Scienze per la Promozione della Salute e Materno Infantile 'G. D'Alessandro', Università di Palermo (DSHP-MCC, Department of Sciences for Health Promotion and Mother-Child Care, University of Palermo), Palermo, Italy E-mail: giovanni.giammanco@unipa.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Calamusa
authors.affiliation: Dipartimento di Scienze per la Promozione della Salute e Materno Infantile 'G. D'Alessandro', Università di Palermo (DSHP-MCC, Department of Sciences for Health Promotion and Mother-Child Care, University of Palermo), Palermo, Italy E-mail: giovanni.giammanco@unipa.it.
authors.forename: Simona
authors.initials: S
authors.lastname: De Grazia
authors.affiliation: Department of Veterinary Public Health & Food Safety, Istituto Superiore di Sanità (ISS, National Institute of Health), Rome, Italy.
authors.forename: Franco M
authors.initials: FM
authors.lastname: Ruggeri
authors.affiliation: Dipartimento di Scienze per la Promozione della Salute e Materno Infantile 'G. D'Alessandro', Università di Palermo (DSHP-MCC, Department of Sciences for Health Promotion and Mother-Child Care, University of Palermo), Palermo, Italy E-mail: giovanni.giammanco@unipa.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Vitale
authors.affiliation: Dipartimento di Scienze per la Promozione della Salute e Materno Infantile 'G. D'Alessandro', Università di Palermo (DSHP-MCC, Department of Sciences for Health Promotion and Mother-Child Care, University of Palermo), Palermo, Italy E-mail: giovanni.giammanco@unipa.it.
authors.forename: Carmelo M
authors.initials: CM
authors.lastname: Maida
authors.affiliation: Dipartimento di Scienze per la Promozione della Salute e Materno Infantile 'G. D'Alessandro', Università di Palermo (DSHP-MCC, Department of Sciences for Health Promotion and Mother-Child Care, University of Palermo), Palermo, Italy E-mail: giovanni.giammanco@unipa.it.
authors.forename: Caterina
authors.initials: C
authors.lastname: Mammina
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000517:prevention & control* / Q000821:virology; D004196:Disease Outbreaks; D060766:Drinking Water / Q000821:virology*; D005243:Feces / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000517:prevention & control* / Q000821:virology; D006801:Humans; D007841:Latex Fixation Tests; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D029322:Norovirus / Q000302:isolation & purification*; D060888:Real-Time Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D012802:Sicily / Q000453:epidemiology; D055815:Young Adult
chemical_list: D060766:Drinking Water