Epidemiological Approach, Control Measures and Challenges of a Norovirus-Associated Waterborne Outbreak in Unye District in August 2017

Özgüler, Zeynep Özge; Temel, Fehminaz; Duman, Pınar; Şahin, Çağrı Emin

doi:10.5505/turkhijyen.2019.80106

Cited by 1 publication

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“…They have explained that this could cause the water to be supplied at endpoints without having the contact time with the minimum required chlorine levels to enable disinfection. Similarly, low chlorine levels were reported during other waterborne outbreaks in Turkey (Duman et al 2016;Özgüler et al 2019). Water sample results indicating contamination related to non-chlorinated water supply and disinfection deficiencies are mentioned for E. coli and norovirus outbreaks outside of Turkey as well (Huerta et al 2000;Olsen 2002;Murphy et al 2016;Park et al 2018).…”

Section: Environmental Investigationmentioning

confidence: 72%

“…As for the causes of viral gastroenteritis, noroviruses and rotaviruses are the most common pathogens (Leclerc et al 2002;Jain & Jain 2014). Multi-pathogen gastroenteritis outbreaks are common in Turkey caused by drinking contaminated water, and prevalent pathogens, such as E. coli and norovirus, may lead to waterborne outbreaks in Turkey (Sezen et al 2015;Sahan et al 2017;Özgüler et al 2019). For low-and middle-income regions, water supply systems of rural areas are assessed to have shown higher contaminations with enteric pathogens compared to urban areas.…”

Section: Resultsmentioning

confidence: 99%

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An acute gastroenteritis outbreak associated with a contaminated water supply system, Turkey, 2018

Özgüler

Priyakanta²,

Coban

et al. 2022

Journal of Water and Health

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Disruption of routine monitorization and chlorination of the water supply system during a week-long holiday led to a multi-organism gastroenteritis outbreak in a district with limited laboratory support. More than a 10-fold increase in patients with gastroenteritis was reported. Enteropathogenic Escherichia coli, Enteroaggregative E. coli, and norovirus were detected in human specimen samples. The main water tank and pipes were rusted; 13 out of the 19 water samples tested positive for total Coliform (1–920 colony-forming units (CFU)/100 ml) and E. coli (1–720 CFU/100 ml). Chlorine levels were below 0.2 ppm in seven of the nine samples. Information of 1,815 cases was obtained from the hospital records with a crude attack rate of 2.9%. Cases widespread in the district increased throughout the holiday, epidemic curve revealed a point-source outbreak. The case–control study revealed that consumption of drinking tap water and using it to clean vegetables/fruits were significantly associated with the illness. While drinking only bottled water had a protective effect against the illness. The culture technique showed that the water supply samples were positive for pathogenic bacteria. Upon decision in a multi-stakeholder meeting, the water tank was cleaned, and the Municipality initiated the renovation of the water supply system.

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