Abstract
An extensive drinking water-associated gastroenteritis outbreak took place in the town of Nokia in Southern Finland in 2007. 53% of the exposed came down with gastroenteritis and 7% had arthritis-like symptoms (joint swelling, redness, warmth or pain in movement) according to a population-based questionnaire study at 8 weeks after the incident. Campylobacter and norovirus were the main pathogens.A follow-up questionnaire study was carried out 15 months after the outbreak to evaluate the duration of gastrointestinal and joint symptoms. 323 residents of the original contaminated area were included. The response rate was 53%. Participants were inquired about having gastroenteritis during the outbreak and the duration of symptoms.Of those with gastroenteritis, 43% reported loose stools and abdominal pain or distension after the acute disease. The prevalence of symptoms declined promptly during the first 3 months but at 15 months, 11% reported continuing symptoms. 32% of the respondents with gastroenteritis reported subsequent arthritis-like symptoms. The disappearance of arthritis-like symptoms was more gradual and they levelled off only after 5 months. 19% showed symptoms at 15 months. Prolonged gastrointestinal symptoms correlated to prolonged arthritis-like symptoms.High proportion of respondents continued to have arthritis-like symptoms at 15 months after the epidemic. The gastrointestinal symptoms, instead, had declined to a low level.
Highlights
Acute gastroenteritis is a common disease, little is known about its consequences after passing the acute phase of the disease
According to the Walkerton Health Study, increased risk of reactive arthritis, irritable bowel syndrome, pregnancy-related hypertension, hypertension, kidney disease, and even cardiovascular events has been observed after the epidemic [5,6,7,8,9,10]
A valve connecting the wastewater plant’s effluent line and household water distribution line was opened and it was accidentally left open for two days
Summary
Acute gastroenteritis is a common disease, little is known about its consequences after passing the acute phase of the disease. As nearly everyone meets episodes of acute gastroenteritis occasionally, the possible connection with later health problems is missed. Reactive arthritis (ReA) and milder forms of joint complaints are well known and fairly common acute complications of bacterial gastroenteritis [1]. There is growing evidence of increased incidence of irritable bowel syndrome (IBS) after bacterial [2,3] and possibly viral [4] gastroenteritis. The most intensively studied waterborne outbreak is the Walkerton epidemic in Ontario, Canada. According to the Walkerton Health Study, increased risk of reactive arthritis, irritable bowel syndrome, pregnancy-related hypertension, hypertension, kidney disease, and even cardiovascular events has been observed after the epidemic [5,6,7,8,9,10]
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