A Waterborne Gastroenteritis Outbreak Caused by a GII Norovirus in a Holiday Camp in Catalonia (Spain), 2017

Abstract

On 2 February 2017, Epidemiological Surveillance Services were notified of an outbreak of acute gastroenteritis (AGE) among schoolchildren who had taken part of a school trip from 30 January to 3 February 2017 at a holiday camp in Catalonia. A retrospective cohort study was performed to identify the causative agent, estimate the magnitude of the outbreak and identify its source, as well as to determine the route of transmission. Data collected by standardised questionnaires identified 41 episodes of AGE among 174 individuals who attended the camp. Cases had mainly symptoms of abdominal pain (73.8%), nausea (64.3%), vomiting (54.8%), diarrhoea (45.2%) and headache (42.9%). Consumption of water was associated with gastroenteritis (crude RR: 1.72, 95%CI: 1.01–2.92; adjusted RR: 1.88, 95%CI 1.03–3.56). NoV GII was detected in faeces (5 out of 13) and water samples. Additionally, faecal indicator bacteria and protozoa were detected in water samples. The outbreak showed a high attack rate and was caused by a natural water fountain not properly treated and not monitored for safety quality. There could have been a discharge of wastewater at a point close to the fountain; however, the source of contamination of the water could not be identified. Health education may be useful to eliminate risks associated with the consumption of untreated water from natural fountains.

Outbreaks of Gastroenteritis Due to Norovirus in Schools and Summer Camps in Catalonia, 2017–2019

“…In our study, 52.63% of outbreaks occurred in the fall and winter months (October to March), similar to the 68% found by Steele et al in outbreaks in the US in 2009 ( 21 ). Ahmed et al in a meta-analysis of 293 studies found that 71% of outbreaks occurred in the cold months of the year (October to March in the Northern hemisphere and April to September in the Southern hemisphere) ( 14 ).…”

“…In our study only one outbreak was waterborne with an attack rate of 64.1% ( 21 ), clearly larger that the attack rate in all common source transmission outbreaks (33.42%) or in all studied outbreaks (25.7%). Waterborne outbreaks reported by other authors also show a large number of affected people ( 22 , 23 ).…”

Global public health implications of human exposure to viral contaminated water

“…Recently, Carol et al (2021) investigated the causative agent responsible for an outbreak of acute gastroenteritis (AGE) among 174 pupils that were involved in a school trip between 30 January and 3 February 2017 at a holiday camp in Catalonia. The authors discovered about 41 episodes of AGE with symptoms ranging from abdominal pain (73.8%), nausea (64.3%), vomiting (54.8%), diarrhea (45.2%), and headache (42.9%).…”

Norovirus GII.3[P12] Outbreak Associated with the Drinking Water Supply in a Rural Area in Galicia, Spain, 2021

“…Consequently, noroviruses are not directly detected in water samples in most suspected norovirus waterborne outbreaks. In Spain, waterborne outbreaks associated with norovirus infection have been rarely reported in the literature, with only 6 outbreak investigations published since 1995 ( 8 – 13 ). These outbreaks were associated with sources of infection such as bottled mineral water, spring water, or municipal drinking water systems, but norovirus was directly detected in water samples in only half of these outbreaks.…”