Abstract
In Nokia city about 450,000 l of treated sewage water was for 2 days allowed to run into the drinking water supplies of the city due to a personal error of one employee. Within the next 5 weeks about 1,000 people sought care at the municipal health centre or regional hospital because of gastroenteritis. Here we report the results of viral analyses performed by gene amplification assays from the earliest water and sewage samples as well as from close to 300 patient samples. The contaminating treated sewage was shown to harbour several enteric viruses known to cause acute gastroenteritis. Likewise, the drinking water sample was positive for noro-, astro-, rota-, entero- and adenoviruses. Noroviruses were also found in 29.8% of stool samples from affected patients, while astro-, adeno-, rota- and enteroviruses were detected in 19.7, 18.2, 7.5 and 3.7% of the specimens, respectively.
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Atmar, R. L., Opekun, A. R., Gilger, M. A., Estes, M. K., Crawford, S. E., Neill, F. H., et al. (2008). Norwalk virus shedding after experimental human infection. Emerging Infectious Diseases, 14(10), 1553–1557.
Beller, M., Ellis, A., Lee, S. H., Drebot, M. A., Jenkerson, S. A., Funk, E., et al. (1997). Outbreak of viral gastroenteritis due to a contaminated well. International consequences. JAMA, 278, 563–568.
Blomqvist, S., Skyttä, A., Roivainen, M., & Hovi, T. (1999). Rapid detection of human rhinoviruses in nasopharyngeal aspirates by a microwell reverse transcription-PCR-hybridization assay. Journal of Clinical Microbiology, 37(9), 2813–2816.
Bosch, A., Guix, S., Sano, D., & Pintó, R. M. (2008). New tools for the study and direct surveillance of viral pathogens in water. Current Opinion in Biotechnology, 19, 295–301.
Costafreda, M. I., Bosch, A., & Pintó, R. M. (2006). Development, evaluation, and standardization of a real-time TaqMan reverse transcription-PCR assay for quantification of hepatitis A virus in clinical and shellfish samples. Applied Environmental Microbiology, 72, 3846–3855.
Dahling, D. R., & Safferman, R. S. (1979). Survival of enteric viruses under natural conditions in a subarctic river. Applied Environmental Microbiology, 38, 1103–1110.
Enriquez, C. (2002). Adenoviruses. In G. Bitton (Ed.), Encyclopedia of environmental microbiology (Vol. 1, pp. 92–100). USA: Wiley.
Gilgen, M. D. G., Lüthy, J., & Hübner, P. (1997). Three-step isolation method for sensitive detection of enterovirus, rotavirus, hepatitis A virus, and small round structured viruses in water samples. International Journal of Food Microbiology, 37, 189–199.
Gouvea, V., Glass, R. I., Woods, P., Taniguchi, K., Clark, H. F., Forrester, B., et al. (1990). Polymerase chain reaction amplification and typing of rotavirus nucleic acid from stool specimens. Journal of Clinical Microbiology, 28(2), 276–282.
Gutiérrez-Aguirre, I., Steyer, A., Boben, J., Gruden, K., Poljsak-Prijatelj, M., & Ravnikar, M. (2008). Sensitive detection of multiple rotavirus genotypes with a single RT-qPCR assay. Journal of Clinical Microbiology, 46(8), 2547–2554. (Epub 4 Jun 2008).
Harris, J. P., Edmunds, W. J., Pebody, R., Brown, D. W., & Lopman, B. A. (2008). Deaths from norovirus among the elderly, England and Wales. Emerging Infectious Diseases, 14(10), 1546–1552.
Hoebe, C. J., Vennema, H., de Roda Husman, A. M., & van Duynhoven, Y. T. (2004). Norovirus outbreak among primary schoolchildren who had played in a recreational water fountain. Journal of Infectious Diseases, 189(4), 699–705.
Iturriza-Gomara, M., Kang, G., & Gray, J. (2004). Rotavirus genotyping: Keeping up with an evolving population of human rotaviruses. Journal of Clinical Virology, 31, 259–265.
Jiang, X., Wang, J., Graham, D. Y., & Estes, M. (1992). Detection of Norwalk virus in stool by polymerase chain reaction. Journal of Clinical Virology, 30, 2529–2534.
Jothikumar, N., Cromeans, T. L., Hill, V. R., Lu, X., Sobsey, M. D., & Erdman, D. D. (2005). Quantitative real-time PCR assays for detection of human adenoviruses and identification of serotypes 40 and 41. Applied Environmental Microbiology, 71(6), 3131–3136.
Kageyama, T., Kojima, S., Shinohara, M., Uchida, K., Fukushi, S., Hoshino, F. B., et al. (2003). Broadly reactive and highly sensitive assay for Norwalk-like viruses based on real-time quantitative reverse transcription-PCR. Journal of Clinical Microbiology, 41(4), 1548–1557.
Kim, S. H., Cheon, D. S., Kim, J. H., Lee, D. H., Jheong, W. H., Heo, Y. J., et al. (2005). Outbreaks of gastroenteritis that occurred during school excursions in Korea were associated with several waterborne strains of norovirus. Journal of Clinical Microbiology, 43(9), 4836–4839.
Koopmans, M. (2008). Progress in understanding norovirus epidemiology. Current Opinion in Infectious Diseases, 21, 544–552.
Koopmans, M., von Bonsdorff, C. H., Vinje, J., de Medici, D., & Monroe, S. (2002). Foodborne viruses. FEMS Microbiology Reviews, 26, 187–205.
Le Cann, P., Ranarijaona, S., Monpoeho, S., Le Guyader, F., & Ferre, V. (2004). Quantification of human astroviruses in sewage using real-time RT-PCR. Research in Microbiology, 155, 11–15.
Leclerc, H., Schwartzbrod, L., & Dei-Cas, E. (2002). Microbial agents associated with waterborne disease. Critical Reviews in Microbiology, 28, 371–409.
Loisy, F., Atmar, R. L., Guillon, P., Le Cann, P., Pommepuy, M., & Le Guyader, F. S. (2005). Real-time RT-PCR for norovirus screening in shellfish. Journal of Virological Methods, 123, 1–7.
Lopman, B., Vennema, H., Kohli, E., Pothier, P., Sanchez, A., Negredo, A., et al. (2004). Increase in viral gastroenteritis outbreaks in Europe and epidemic spread of new norovirus variant. Lancet, 363(9410), 671–672.
Maunula, L. (2007). Waterborne norovirus outbreaks—a review. Future Virology, 2(1), 101–112.
Maunula, L., Miettinen, I. T., & von Bonsdorff, C. H. (2005). Norovirus outbreaks from drinking water. Emerging Infectious Disease, 11, 1716–1721.
Maunula, L., & von Bonsdorff, C. H. (2005). Norovirus genotypes causing gastroenteritis outbreaks in Finland 1998–2002. Journal of Clinical Virology, 34, 186–194.
Symes, S. J., Gunesekere, I. C., Marshall, J. A., & Wright, P. J. (2007). Norovirus mixed infection in an oyster-associated outbreak: An opportunity for recombination. Archives of Virology, 152(6), 1075–1086.
Van den Berg, H., Lodder, W., van der Poel, W., Vennema, H., & de Roda Husman, A. M. (2005). Genetic diversity of noroviruses in raw and treated sewage water. Research in Microbiology, 156, 532–540.
Vinje, J., Hamidjaja, R. A., & Sobsey, M. D. (2004). Development and application of a capsid VP1 (region D) based reverse transcription PCR assay for genotyping of genogroup I and II noroviruses. Journal of Virological Methods, 116, 109–117.
Werle, E., Schneider, C., Renner, M., Völker, M., & Fiehn, W. (1994). Convenient single-step, one tube purification of PCR products for direct sequencing. Nucleic Acids Research, 22(20), 4354–4355.
Wyn-Jones, A., & Sellwood, J. (2001). Enteric viruses in the aquatic environment. Journal of Applied Microbiology, 91, 945–962.
Acknowledgements
The study was supported by a grant from The Ministry of Social Affairs and Health of Finland. The local health authorities are acknowledged for participating actively on solving of the outbreak.
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An erratum to this article can be found at http://dx.doi.org/10.1007/s12560-009-9009-6
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Maunula, L., Klemola, P., Kauppinen, A. et al. Enteric Viruses in a Large Waterborne Outbreak of Acute Gastroenteritis in Finland. Food Environ Virol 1, 31–36 (2009). https://doi.org/10.1007/s12560-008-9004-3
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DOI: https://doi.org/10.1007/s12560-008-9004-3