title: Multiple enteropathogenic viruses in a gastroenteritis outbreak in a military exercise of the Portuguese Army.
abstract: BACKGROUND
  Gastroenteritis is one of the most common infectious diseases in the military populations and can diminish operational effectiveness and impede force readiness.
  
  
  OBJECTIVE
  The present study investigates the cause and the source of an acute gastroenteritis outbreak that occurred during a military exercise of the Portuguese Army, in February 2013.
  
  
  METHODS
  A retrospective investigation was performed and stool samples, food items and water were screened for common foodborne bacteria and viruses, namely Norovirus GI, Norovirus GII, Astrovirus, Rotavirus, Adenovirus and Sapovirus.
  
  
  RESULTS
  From the total of 160 soldiers that participated in the military exercise 20 developed gastroenteritis (attack rate of 12.5%). Symptoms were predominantly vomiting (n=17, 85%) and diarrhoea (n=9, 45%). The first cases occurred 24-48h after drinking water from the creek, the plausible origin of the outbreak. The epidemic peak was registered 2 days after and the last cases 6 days after, upon returning to base. No pathogenic bacteria were found in stools however virological analysis revealed the presence of multiple enteropathogenic viruses, namely Norovirus GI (GI.3), Norovirus GII (GII.4 New Orleans 2009), Astrovirus and Sapovirus, as single or co-infections. Food and water samples were not tested for the presence of viruses due to exhaustion of samples on bacteriological analysis.
  
  
  CONCLUSIONS
  To the best of our knowledge this is the first report of a viral gastroenteritis outbreak among military personnel in the Portuguese Army.
authors.affiliation: Laboratório de Bromatologia e Defesa Biológica do Exército, Lisboa, Portugal. Electronic address: alopes.joao@gmail.com.
authors.forename: António
authors.initials: A
authors.lastname: Lopes-João
authors.affiliation: Laboratório de Biologia Molecular, Departamento de Doenças Infecciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal. Electronic address: ines.costa@insa.min-saude.pt.
authors.forename: Inês
authors.initials: I
authors.lastname: Costa
authors.affiliation: Escola Superior Agrária de Viseu, Instituto Politécnico de Viseu, Viseu, Portugal; CIBIO/UP, Centro de Investigação em Biodiversidade e Recursos Genéticos/Universidade do Porto, Campus Agrário de Vairão, Vairão, Portugal. Electronic address: jmesquita@esav.ipv.pt.
authors.forename: João R
authors.initials: JR
authors.lastname: Mesquita
authors.affiliation: Laboratório de Biologia Molecular, Departamento de Doenças Infecciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal; Laboratório Nacional de Referência para as Infeções Gastrointestinais, Departamento de Doenças Infecciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal. Electronic address: Monica.Oleastro@insa.min-saude.pt.
authors.forename: Mónica
authors.initials: M
authors.lastname: Oleastro
authors.affiliation: Laboratório de Bromatologia e Defesa Biológica do Exército, Lisboa, Portugal. Electronic address: cpenha@igc.gulbenkian.pt.
authors.forename: Carlos
authors.initials: C
authors.lastname: Penha-Gonçalves
authors.affiliation: CIBIO/UP, Centro de Investigação em Biodiversidade e Recursos Genéticos/Universidade do Porto, Campus Agrário de Vairão, Vairão, Portugal; Laboratório de Microbiologia, Departamento de Ciências Biológicas, Faculdade de Farmácia da Universidade do Porto, Porto, Portugal. Electronic address: saojose@ff.up.pt.
authors.forename: Maria S J
authors.initials: MS
authors.lastname: Nascimento
mesh_terms: D060085:Coinfection / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D004196:Disease Outbreaks; D005243:Feces / Q000821:virology; D005759:Gastroenteritis / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D006801:Humans; D008889:Military Personnel; D011174:Portugal / Q000453:epidemiology; D012189:Retrospective Studies; D014777:Virus Diseases / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D014780:Viruses / Q000145:classification / Q000302:isolation & purification*
keywords: Enteropathogenic viruses; Gastroenteritis; Military; Outbreak