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.
Highlights
Noroviruses (NoVs) are a major cause of acute gastroenteritis (AGE) outbreaks worldwide
On 2 February 2017, the Epidemiological Surveillance and Response to Public Health Emergencies Service of the Public Health Agency of Catalonia was informed of several cases of AGE at a school trip
This study describes a waterborne outbreak caused by the ingestion of untreated water from a natural source of the Sanctuary of Santa Maria de Queralt, Catalonia, Spain
Summary
Noroviruses (NoVs) are a major cause of acute gastroenteritis (AGE) outbreaks worldwide. 457 outbreaks of norovirus illness, involving a total number of 1.125 related illnesses, occurred in the European Union (EU) over the last year [1]. The clinical syndrome typically lasts for up to 48 h for most people. Even though AGEs caused by NoV are generally mild and of short duration, illness may be severe, even fatal, especially among people clinically vulnerable, such as young children, the elderly and people with other medical illnesses. NoV infections are currently associated with considerable morbidity, mortality and healthcare costs [2]. After the introduction of rotavirus vaccines, NoV has become the leading cause of acute gastroenteritis in children medically attended [3,4,5]
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