title: Outbreak of acute gastroenteritis caused by contamination of drinking water in a factory, the Basque Country.
abstract: On 18 September 2013, the Gipuzkoa Epidemiology Unit was notified of an outbreak of acute gastroenteritis (AGE) among employees at a domestic appliance factory. The first signs of the outbreak had emerged at the end of June and at the time of the notification 30 workers were on sick leave for gastroenteritis. Some employees had had more than one episode and the main symptoms were diarrhoea and vomiting. An investigation began to identify the causative agent, assess exposure and determine the route of transmission. Data collected by a questionnaire identified 302 episodes of AGE among 238 people affected between June and September 2013. The source of water consumed was found to be a risk factor associated with the appearance of symptoms both in the crude and the adjusted analysis: odds ratio 1.8 (0.8-4.2) and 6.4 (4.2-9.8), respectively. Microbiological analysis of stool samples and of water confirmed the presence of norovirus and rotavirus. The environmental study detected a connection between an industrial use water system and drinking water at the factory. It was concluded that the outbreak was caused by mixed viral infections, due to contamination of drinking water.
authors.affiliation: Public Health Division of Gipuzkoa, Epidemiology Unit, Gipuzkoa, Basque Government, Spain; Instituto BIO-Donostia, San Sebastian, Gipuzkoa, Basque Government, Spain and CIBER Epidemiología y Salud Pública, CIBERESP, Spain E-mail: l-arriola@ej-gv.es.
authors.forename: J M
authors.initials: JM
authors.lastname: Altzibar
authors.affiliation: Public Health Laboratory of Gipuzkoa, Gipuzkoa, Basque Government, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Zigorraga
authors.affiliation: Public Health Laboratory of Gipuzkoa, Gipuzkoa, Basque Government, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Rodriguez
authors.affiliation: Public Health, Alto-Bajo Deba Health District, Gipuzkoa, Basque Government, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Leturia
authors.affiliation: Public Health, Alto-Bajo Deba Health District, Gipuzkoa, Basque Government, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Garmendia
authors.affiliation: Microbiology Department, Alto-Deba Hospital, Gipuzkoa, Basque Government, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Rodriguez
authors.affiliation: Microbiology Department, Hospital Universitario Donostia, San Sebastian, Gipuzkoa, Basque Government, Spain and Instituto BIO-Donostia, San Sebastian, Gipuzkoa, Basque Government, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Alkorta
authors.affiliation: Public Health Division of Gipuzkoa, Epidemiology Unit, Gipuzkoa, Basque Government, Spain; Instituto BIO-Donostia, San Sebastian, Gipuzkoa, Basque Government, Spain and CIBER Epidemiología y Salud Pública, CIBERESP, Spain E-mail: l-arriola@ej-gv.es.
authors.forename: L
authors.initials: L
authors.lastname: Arriola
mesh_terms: D000328:Adult; D000368:Aged; D001419:Bacteria / Q000235:genetics / Q000302:isolation & purification; D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000382:microbiology; D003458:Cryptosporidium / Q000235:genetics / Q000302:isolation & purification; D004269:DNA, Bacterial / Q000235:genetics; D016054:DNA, Protozoan / Q000235:genetics; D004279:DNA, Viral / Q000235:genetics; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D060766:Drinking Water / Q000382:microbiology*; D004747:Entamoeba / Q000235:genetics / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000382:microbiology; D005872:Giardia / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007221:Industry; D008297:Male; D008875:Middle Aged; D012400:Rotavirus Infections / Q000453:epidemiology* / Q000382:microbiology; D013030:Spain / Q000453:epidemiology; D014780:Viruses / Q000235:genetics / Q000302:isolation & purification; D014871:Water Microbiology; D014873:Water Pollutants / Q000302:isolation & purification; D017132:Workplace
chemical_list: D004269:DNA, Bacterial; D016054:DNA, Protozoan; D004279:DNA, Viral; D060766:Drinking Water; D014873:Water Pollutants