A waterborne outbreak with a single clone of Campylobacter jejuni in the Danish town of Køge in May 2010

Gubbels, Sophie; Kuhn, Katrin Gaardbo; Larsson, Jonas; Adelhardt, Marianne; Engberg, Jørgen; Ingildsen, Pernille; Hollesen, Line Wilchen; Muchitsch, Steen; Mølbak, Kåre; Ethelberg, Steen

doi:10.3109/00365548.2012.655773

Cited by 31 publications

(20 citation statements)

References 9 publications

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“…might have played a role in the onset of gastrointestinal symptoms. All these organisms have been previously associated with waterborne transmission [5], [9], [12], [13], [23]. By applying the spatial and microbiological analysis, we could identify the contamination route for this outbreak.…”

Section: Discussionmentioning

confidence: 98%

“…Indeed, waterborne outbreaks with multiple causative organisms, e.g. Campylobacter spp., norovirus-like organisms, Shigella and enterohaemorrhagic Escherichia coli (EHEC) have been described [1], [3], [4], [6], [8], [9]. In particular, when norovirus and sapovirus types are implicated in large scale waterborne outbreaks, this strongly indicates drinking water distribution system contamination by a human faecal sources [10], [11].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Novel Microbiological and Spatial Statistical Methods to Improve Strength of Epidemiological Evidence in a Community-Wide Waterborne Outbreak

Jalava

Rintala²,

Ollgren

et al. 2014

PLoS ONE

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Failures in the drinking water distribution system cause gastrointestinal outbreaks with multiple pathogens. A water distribution pipe breakage caused a community-wide waterborne outbreak in Vuorela, Finland, July 2012. We investigated this outbreak with advanced epidemiological and microbiological methods. A total of 473/2931 inhabitants (16%) responded to a web-based questionnaire. Water and patient samples were subjected to analysis of multiple microbial targets, molecular typing and microbial community analysis. Spatial analysis on the water distribution network was done and we applied a spatial logistic regression model. The course of the illness was mild. Drinking untreated tap water from the defined outbreak area was significantly associated with illness (RR 5.6, 95% CI 1.9–16.4) increasing in a dose response manner. The closer a person lived to the water distribution breakage point, the higher the risk of becoming ill. Sapovirus, enterovirus, single Campylobacter jejuni and EHEC O157:H7 findings as well as virulence genes for EPEC, EAEC and EHEC pathogroups were detected by molecular or culture methods from the faecal samples of the patients. EPEC, EAEC and EHEC virulence genes and faecal indicator bacteria were also detected in water samples. Microbial community sequencing of contaminated tap water revealed abundance of Arcobacter species. The polyphasic approach improved the understanding of the source of the infections, and aided to define the extent and magnitude of this outbreak.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Novel Microbiological and Spatial Statistical Methods to Improve Strength of Epidemiological Evidence in a Community-Wide Waterborne Outbreak

Jalava

Rintala²,

Ollgren

et al. 2014

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Although the simple dot map was the most commonly used method, a wide range of techniques were applied, including more sophisticated data visualisations and analytic tools. Across the range of studies, there were examples of spatial tools being usefully applied throughout the course of an outbreak investigation; from initial confirmation of the outbreak to describing and analysing [11,18-28,30-36,38,40-50,55,56,58-60, 63,67-69,71-76,80,82-85,87-93,96-105] Thematic map 25 [18,19,[21][22][23]28,29,38,41,42,45,46,50,60,68,70,74,80,82,89,91,[93][94][95]103] Rate map 14 [20,30,44,45,49,50,57,63,70,76,79,81,90,101] Smoothed incidence map 13 [11,31,[48][49][50]73,…”

Section: Discussionmentioning

confidence: 99%

“…Measures that aimed to control outbreaks included cleaning implicated cooling towers [40], issuing water boiling orders to areas served by contaminated supplies [41,42], vaccination catch-up campaigns [28], removal of breeding sites for mosquito larvae [43] and targeted information campaigns [36]. For example, Acheson and colleagues placed postcode-targeted information on social networks during an outbreak of heterosexually acquired syphilis in Teesside, UK [44].…”

Section: Executing Prevention Measuresmentioning

confidence: 99%

Spatial methods for infectious disease outbreak investigations: systematic literature review

et al. 2015

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Investigations of infectious disease outbreaks are conventionally framed in terms of person, time and place. Although geographic information systems have increased the range of tools available, spatial analyses are used relatively infrequently. We conducted a systematic review of published reports of outbreak investigations worldwide to estimate the prevalence of spatial methods, describe the techniques applied and explore their utility. We identified 80 reports using spatial methods published between 1979 and 2013, ca 0.4% of the total number of published outbreaks. Environmental or waterborne infections were the most commonly investigated, and most reports were from the United Kingdom. A range of techniques were used, including simple dot maps, cluster analyses and modelling approaches. Spatial tools were usefully applied throughout investigations, from initial confirmation of the outbreak to describing and analysing cases and communicating findings. They provided valuable insights that led to public health actions, but there is scope for much wider implementation and development of new methods.

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“…Waterborne outbreaks are rare in Denmark, with only 5 waterborne outbreaks reported since 1991 [13]–[16] only one of which included NoV. This could be due to the fact that tap-water in Denmark mainly comes from groundwater sources [17], which are rarely contaminated.…”

Section: Introductionmentioning

confidence: 99%

The Application of New Molecular Methods in the Investigation of a Waterborne Outbreak of Norovirus in Denmark, 2012

et al. 2014

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In December 2012, an outbreak of acute gastrointestinal illness occurred in a geographical distinct area in Denmark covering 368 households. A combined microbiological, epidemiological and environmental investigation was initiated to understand the outbreak magnitude, pathogen(s) and vehicle in order to control the outbreak. Norovirus GII.4 New Orleans 2009 variant was detected in 15 of 17 individual stool samples from 14 households. Norovirus genomic material from water samples was detected and quantified and sequencing of longer parts of the viral capsid region (>1000 nt) were applied to patient and water samples. All five purposely selected water samples tested positive for norovirus GII in levels up to 1.8×104 genomic units per 200 ml. Identical norovirus sequences were found in all 5 sequenced stool samples and 1 sequenced water sample, a second sequenced water sample showed 1 nt (<0.1%) difference. In a cohort study, including 256 participants, cases were defined as residents of the area experiencing diarrhoea or vomiting onset on 12–14 December 2012. We found an attack rate of 51%. Being a case was associated with drinking tap-water on 12–13 December (relative risk = 6.0, 95%CI: 1.6–22) and a dose-response relation for the mean glasses of tap-water consumed was observed. Environmental investigations suggested contamination from a sewage pipe to the drinking water due to fall in pressure during water supply system renovations. The combined microbiological, epidemiological and environmental investigations strongly indicates the outbreak was caused by norovirus contamination of the water supply system.

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A waterborne outbreak with a single clone of Campylobacter jejuni in the Danish town of Køge in May 2010

Cited by 31 publications

References 9 publications

Novel Microbiological and Spatial Statistical Methods to Improve Strength of Epidemiological Evidence in a Community-Wide Waterborne Outbreak

Novel Microbiological and Spatial Statistical Methods to Improve Strength of Epidemiological Evidence in a Community-Wide Waterborne Outbreak

Spatial methods for infectious disease outbreak investigations: systematic literature review

The Application of New Molecular Methods in the Investigation of a Waterborne Outbreak of Norovirus in Denmark, 2012

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