Consumption of raw shellfish has long been known to be associated with individual cases and sporadic outbreaks of enteric illness. However, during 1982, outbreaks of gastroenteritis associated with eating raw shellfish reached epidemic proportions in New York State. Between May 1 and December 31, there were 103 well-documented outbreaks in which 1017 persons became ill: 813 cases were related to eating clams, and 204 to eating oysters. The most common symptoms were diarrhea, nausea, abdominal cramps, and vomiting. Incubation periods were generally 24 to 48 hours long, and the duration of illness was 24 to 48 hours. Bacteriologic analyses of stool and shellfish specimens did not reveal a causative agent. Norwalk virus was implicated as the predominant etiologic agent by clinical features of the illness and by seroconversion and the formation of IgM antibody to Norwalk virus in paired serum samples from persons in five (71 percent) of seven outbreaks in which testing was done. In addition, Norwalk virus was identified by radioimmunoassay in clam and oyster specimens from two of the outbreaks. Determining the source of the shellfish was not always possible, but northeastern coastal waters were implicated. The magnitude, persistence, and widespread nature of these outbreaks raise further questions about the safety of consuming raw shellfish.

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A community waterborne nonbacterial gastroenteritis outbreak occurred in Eagle-Vail, Colorado in March 1981. Illness (defined as vomiting and/or diarrhea) was statistically associated with water consumption (X2 for linear trend = 7.07, p < .005). Five

We examined susceptibility to the murine rotavirus, epizootic diarrhea of infant mice virus (EDIM), in normal suckling and weaned mice and in suckling mice treated with glucocorticoids. Normal mice 1 to 40 days old were inoculated by gastrin intubation with high doses of EDIM and subsequently evaluated for rotavirus infection by solid-phase radioimmunoassay, by electron microscopy of intestinal tissue sections or by both. Radioimmunoassay and electron microscopy showed a concordance of 89.5% in the detection of rotavirus infection. After a period of low susceptibility to EDIM infection during the first 3 days after birth (23%), susceptibility was high for the next 11 days (95%), but decreased abruptly as mice approached weaning (41% on days 15 through 17). Mice 34 days or older did not develop EDIM infection after inoculation, but rotavirus antigen was detected in 12% of uninoculated mothers nursing inoculated litters. Administration of cortisone acetate to 8-day-old mice induced partial intestinal maturation prematurely. At 3 to 6 days after cortisone acetate treatment, susceptibility to EDIM infection decreased to 60% compared with 94% in age-matched controls. Our data suggest (i) that susceptibility of mice to EDIM infection is age dependent, decreasing in concert with intestinal maturation, and (ii) that glucocorticoids, which induce premature partial intestinal maturation, modulate susceptibility of mice to EDIM.

A solid-phase microtiter radioimmunoassay was established for the detection of Norwalk virus and its antibody, with clinical materials from human volunteers previously studied in Massachusetts as reagents. A study of 308 Massachusetts residents showed that serum antibody to Norwalk agent was rarely present during childhood but was detectable in approximately 50% of adults. All volunteers inoculated with Norwalk virus who developed illness seroconverted (10/10), whereas only one-third (5/15) of nonill volunteers seroconverted (P = 0.0009). The 10 nonill, nonseroconverting subjects had undetectable to low preexisting antibody levels. Paradoxically, 10/13 subjects with preexisting antibody became ill, whereas 17/25 lacking antibody did not (P = 0.009). All 3 subjects with preexisting anti-Norwalk radioimmunoassay blocking activity in duodenal intraluminal fluids became ill, whereas only 5/11 lacking such activity developed illness (P = 0.15). These data further support the unique concept that some individuals are susceptible to repeated infections with this agent, whereas others are incapable of developing infection.