A large waterborne gastroenteritis outbreak in central Greece, March 2012: challenges for the investigation and management

Abstract

In March 2012, there was an unusual increase of gastroenteritis cases in a district with 37,264 inhabitants in central Greece. It was estimated that more than 3600 people developed symptoms. A 1:1 case-control study showed that consumption of tap water was a risk factor for acquiring infection [odds ratio (OR) 2.18, 95% confidence interval (CI) 1.11-4.28]. Descriptive data, low gastroenteritis incidence in adjacent areas with different water supply systems, and water-quality data further supported the hypothesis of a waterborne outbreak. Thirty-eight stool samples were positive for rotavirus. Bacterial indicators of recent faecal contamination were detected in samples from the water source and ice cubes from a local production enterprise. Molecular epidemiology of rotavirus strains, apart from the common strain, G3[P8], identified the unusual G/P combination G2P[8]. Water sanitation measures contributed to the control of the outbreak. This outbreak demonstrated the need for the cooperation of laboratories with different expertise and the importance of early notification of waterborne gastroenteritis outbreaks.

Genetic Diversity of Rotavirus Strains Circulating in Environmental Water and Bivalve Shellfish in Thailand

“…Both water and oyster samples contaminated with rotavirus were collected mostly in the cool weather (winter season) of Thailand, corresponding to the period of a high prevalence of rotavirus in hospitalized patients [24]. The presence of rotavirus in water sources may cause the virus to spread and be a potential vehicle for virus transmission leading to rotavirus outbreaks [9,10,11]. In addition, bivalve shellfish, such as oysters and mussels, can accumulate rotavirus [15,17] and might be associated with a gastroenteritis outbreak [8].…”

“…The viruses are also transmitted via fecally contaminated food, water and environmental surfaces [3]. Water- and shellfish-borne outbreaks, caused by rotaviruses, have been reported, possibly associated with sewage contamination [8,9,10,11]. Surveillance studies monitoring rotaviruses confirm the circulation of rotaviruses in bivalve shellfish and aquatic environments [12,13,14,15,16] indicating the potential for rotavirus transmission to humans.…”

Rotavirus and Astrovirus

“…RVA and HAstV are transmitted by the fecal-oral route and quickly spread through person-to-person contact (Estes & Greenberg, 2013), airborne droplets and fomites (Estes & Greenberg, 2013). Transmission is also observed by ingestion of contaminated water and food and cases of RVA-and HAstV-associated waterborne disease have been reported (Gallay et al, 2006;Martinelli et al, 2007;Moreno et al, 2009;Koroglu et al, 2011, Villena et al, 2013Kittigul et al, 2014;Mellou et al, 2014;Quiroz-Santiago et al, 2014;El-Senousy et al, 2015).…”

“…Outbreaks associated with RVA, resulting from contamination of waters by sewage, have been reported in several countries such as Albania, Belgium, Canada, China, Finland, France, Greece, Italy, Russia, Sweden, Turkey, and United States of America (USA) (Lycke et al, 1978;Hopkins et al, 1984;Hung et al, 1984;Solodovnikov et al, 1989;Ansari et al, 1991;Kukkula et al, 1997;Borchardt et al, 2004;Divizia et al, 2004;Gallay et al, 2006;Martinelli et al, 2007;Rasanen et al, 2010;Koroglu et al, 2011;Mellou et al, 2014;Braeye et al, 2015). Data on the occurrence of RVA in environmental samples has been generated mostly by studies carried out in developing countries, where RVA still have significant morbidity when compared to developed ones.…”

Food Hygiene Surveillance in Italy: Is Food Ice a Public Health Risk?

“…and Salmonella spp. in Greece [8,9]; Salmonella Saintpaul in Australia [10]; multi-antibiotic-resistant strains such as Escherichia coli ESLB (extended-spectrum-beta-lactamase) in Vietnam; and some episodes of cholera related to Vibrio cholerae O1 Ogawa ctxA have been linked with ice melted in tea [11,12].…”