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Objectives To determine the aetiological agent causing a gastroenteritis outbreak in two hotels in Majorca (Spain) on August and September 2014. Methods An epidemiological study was carried out. Environmental and stool samples were analyzed for different pathogens, including norovirus. Results Epidemiological analysis detected 79 cases among the tourists hosted in the affected hotels over the period 18th August to 3rd September. They included 52 (attack rate: 6.4%) and 27 (attack rate: 3.0%) cases in hotel A and B, respectively. Seven of the staff members were also affected. Microbiological analyses detected genotype 2 norovirus in patient's stool samples, in rooms and in common areas’ surfaces. The specific control plan rapidly implemented at the beginning of the outbreak, and further adapted for norovirus elimination, allowed to control the outbreak. Conclusions Our study demonstrates that the outbreak was caused by genotype 2 norovirus, and reflects the importance of a rapid analysis and response for its control.

Vibrio cholerae is a human pathogen, which is transmitted by the consumption of contaminated food or water. V. cholerae strains belonging to the serogroups O1 and O139 can cause cholera outbreaks and epidemics, a severe life-threatening diarrheal disease. In contrast, serogroups other than O1 and O139, denominated as non-O1/non-O139, have been mainly associated with sporadic cases of moderate or mild diarrhea, bacteremia and wound infections. Here we investigated the virulence determinants and phylogenetic origin of a non-O1/non-O139 V. cholerae strain that caused a gastroenteritis outbreak in Santiago, Chile, 2018. We found that this outbreak strain lacks the classical virulence genes harboured by O1 and O139 strains, including the cholera toxin (CT) and the toxin-coregulated pilus (TCP). However, this strain carries genomic islands (GIs) encoding Type III and Type VI secretion systems (T3SS/T6SS) and antibiotic resistance genes. Moreover, we found these GIs are wide distributed among several lineages of non-O1/non-O139 strains. Our results suggest that the acquisition of these GIs may enhance the virulence of non-O1/non-O139 strains that lack the CT and TCP-encoding genes. Our results highlight the pathogenic potential of these V. cholerae strains.DATA SUMMARYSequence data were submitted to GenBank under the accession number SRLP00000000. The authors confirm that all supporting data and protocols have been provided within the article or through supplementary data files.Data statementAll supporting data, code and protocols have been provided within the article or through supplementary data files. Four supplementary tables are available with the online version of this article.

Several suspected cases of zoonotic transmission of group A rotavirus (RVA)-related gastroenteritis were reported previously. In August 2012, G8P[14] RVA was detected in fecal specimens from a community gastroenteritis outbreak occurring during a school trip. In this study, additional analyses were performed and it was found that this strain had the G8-P[14]-I2-R2-C2-M2-A3-N2-T6-E2-H3 sequence, similar to bovine-like RVA strains. Some contamination by emesis and diarrheic feces was observed near a rest room in the lodging area. Contact history with animals was unknown in members of this school trip, and this case implied that the strain may have acquired the ability for person-to-person transmission.

In May 2016 a Norovirus (NoV) gastroenteritis outbreak involved a high school class visiting a seaside resort near Taormina (Mascali, Sicily). Twenty-four students and a teacher were affected and 17 of them showed symptoms on the second day of the journey, while the others got ill within the following 2 days. Symptoms included vomiting, diarrhoea and fever, and 12 students required hospitalisation. Stool samples tested positive for NoV genome by Real-Time polymerase chain reaction assay in all 25 symptomatic subjects. The GII.P2/GII.2 NoV genotype was linked to the outbreak by ORF1/ORF2 sequence analysis. The epidemiological features of the outbreak were consistent with food/waterborne followed by person-to-person and/or vomit transmission. Food consumed at a shared lunch on the first day of the trip was associated to illness and drinking un-bottled tap water was also considered as a risk factor. The analysis of water samples revealed the presence of bacterial indicators of faecal contamination in the water used in the resort as well as in other areas of the municipal water network, linking the NoV gastroenteritis outbreak to tap water pollution from sewage leakage. From a single water sample, an amplicon whose sequence corresponded to the capsid genotype recovered from patients could be obtained.

Ulam is a group of traditional Malay vegetables, which is typically consumed raw and recognized as a popular dish in Malay culture. A number of previous studies have highlighted that Ulam are commonly used by the Malaysian natives in treating stomach pain. However, the findings have not yet been scientifically proven. The aim of this study is to investigate the antibacterial activity of four types of Ulam, Anacardium occidentale, Solanum tarvum, Diplazium esculentum, and Euodia redlevi against three gastroenteric pathogens isolated from patients involved in gastroenteritis outbreak which were obtained from the National Public Health Laboratory, Sungai Buloh. Three methods were applied in this research. The first one was the phytochemical screening to test the presence of alkaloids, flavonoids, saponins, and phenols in the methanolic extracts of the four plants. The second method was determining the total phenolic content (TPC) using the Follin-Ciocalteu method and thirdly, the Kirby-Bauer Disk Diffusion method, to test the antimicrobial activity of all plant extracts. Phytochemical screening reveals the presence of all constituents in the four extracts. The Ulam extracts also have shown positive results in inhibiting the activity of three enteric pathogens, indicated by the presence of a zone of inhibition. The evidence from this study suggests that the four Malaysian salads (Ulam), which are commonly used by Malaysian natives as herbal remedies in treating stomach pain, does contain the bioactive compounds that are the potential to be natural antibacterial in treating gastrointestinal tract disease.

Objectives To establish the agent responsible for a gastroenteritis outbreak in a hotel in Menorca (Spain) in September 2016. Methods The study included epidemiological and laboratory analysis. Environmental and stool samples were examined for bacterial and viral pathogens. Results One hundred and fifty-one cases were detected, 123 among the tourists staying in the hotel and 28 affecting the staff. The presence of genotype 2 norovirus was discovered in the microbiological studies of patient’s faeces, as well as in the surface samples of rooms and common areas. The control plan implemented allowed for control of the outbreak. Conclusions This study on a genotype 2 norovirus outbreak reveals the importance of a rapid response for controlling these types of outbreaks.

Norovirus (NoV) is responsible for an estimated 90 % of all epidemic nonbacterial outbreaks of gastroenteritis worldwide. Waterborne outbreaks of NoV are commonly reported. A novel GII.17 NoV strain emerged as a major cause of gastroenteritis outbreaks in China during the winter of 2014/2015. During this time, an outbreak of gastroenteritis occurred at a hotel in a ski park in Hebei Province, China. Epidemiological investigations indicated that one water well, which had only recently been in use, was the probable source. GII.17 NoV was detected by real-time reverse-transcription polymerase chain reaction from samples taken from cases, from concentrated water samples from water well, and from the nearby sewage settling tank. Nucleotide sequences of NoV extracted from clinical and water specimens were genetically identical and had 99 % homology with Beijing/CHN/2015. All epidemiological data indicated that GII.17 NoV was responsible for this outbreak. This is the first reported laboratory-confirmed waterborne outbreak caused by GII.17 NoV genotype in China. Strengthening management of well drinking water and systematica monitoring of NoV is essential for preventing future outbreaks.

Virus-contaminated frozen berries have been frequently identified as cause of foodborne disease outbreaks. To provide new tools for virus detection and characterization in berries, next generation sequencing (NGS) and reverse transcription-digital PCR (RT-dPCR) techniques were tested here with strawberries previously involved in a large-scale norovirus (NoV) gastroenteritis outbreak in Germany. By NGS, about 29 million sequence reads were generated, which mainly showed identities to sequences from the plant matrix and from the bacterial flora. Most abundant virus sequences originated from plant-specific viruses, whereas sequences with high identity to human viruses were rare. Only two sequence reads showed homologies to human NoV. They were identical to GII.P16/GII.13 NoV sequences from patients and a strawberry sample independently analyzed during the outbreak. Quantification of the GII NoV RNA of the berries using RT-dPCR confirmed a low mean virus amount of 185 copies/25 g, which is similar to independently assessed RT-qPCR results (257 copies/25 g). The study shows that identification of human-pathogenic viruses in naturally contaminated frozen berries is possible using NGS technologies. However, the method needs to be further optimized in order to enable convenient and reproducible detection of a low amount of human-pathogenic virus sequences in a background of highly abundant nucleic acids of other sources.

We report here the complete genome sequence of a novel recombinant GII.P16-GII.1 norovirus identified from eight fecal samples collected during an acute gastroenteritis outbreak in Jinan, Shandong Province, China, in 2017. The virus had nucleotide identities of 99% and 91% in the ORF1 and ORF2 genes of related strains, respectively.

Background This is the report of an outbreak of human astrovirus type 5 gastroenteritis that occurred in a residential care home for older people in June 2013 in Tayside, Scotland, and which involved seven staff members and thirteen residents. This type of astrovirus has not been found in Scotland before and is rarely described in the literature. Objectives Using molecular methods such as PCR and sequencing to detect the cause of this gastroenteritis outbreak and to contain the outbreak using Public Health measures. Study design Following an epidemiological investigation, stool samples were sent for routine virology and microbiology testing at the local microbiology and virology laboratory and were found to be negative. Further testing with real-time PCR and gene sequencing at the West of Scotland Specialist Virology Centre was performed. Data on the epidemiology and the response to the outbreak was collected. Results All samples had a 99% match to human astrovirus type 5. The use of standard infection control precautions with the addition of transmission-based precautions most likely contained the spread of the virus in this situation. Conclusions This report illustrates the importance of using PCR and sequencing to identify pathogens such as astrovirus in outbreaks of vomiting and diarrhoea in older people particularly if routine virology and microbiology tests are negative.

Multiplex PCR can provide rapid diagnosis for patients presenting with an acute undifferentiated febrile illness. Such technology is useful in deployed settings, where access to conventional microbiological diagnosis is limited. It was used in Sierra Leone to guide management of febrile healthcare workers, in whom Ebola virus disease was a possible cause. In particular, it informed appropriate antibiotic treatment while minimising the risk to clinicians of exposure to the causative organism.

In March 2010, Kountdookyu Manson was admitted to the Suburban Private Hospital emergency room due to a severe episode of paranoia. He appeared terrified, insisting that he was getting “messages from the Pope!” His helpless mother explained that his current antipsychotic medications (olanzapine, aripiprazole, and fluphenazine) had stopped working, so she had no choice but to bring him to the hospital in the middle of the night. After examination, the attending psychiatrist, Dr. Fritz, administered clozapine to manage his symptoms. Within 2 weeks, Kountdookyu’s paranoia subsided, and he was transferred to the inpatient medical ward. Unfortunately, a gastroenteritis outbreak at the hospital did not spare Kountdookyu. He quickly developed a high fever, explosive diarrhea, and pneumonia. His blood pressure fell and his heart became inflamed. This inopportune conglomeration of acute conditions shocked the medical staff! Clozapine was thought to be responsible, and thus it was immediately discontinued. An air ambulance helicopter transferred Kountdookyu to Ivy League University Hospital to receive appropriate treatment, but the doctors could not save him. Kountdookyu passed away at the age of 22 (Figs. 14.1 and 14.2).

In mid-2016, norovirus GII.2 emerged as a major cause of gastroenteritis outbreak in Japan with overall detection rate of 56.3% of norovirus cases. The differences in ORF1 and ORF2 of some norovirus GII were observed. Inter-subtype recombinants GII.Pe/GII.2, GII.P16/GII.2 and GII.P17/GII.2 were detected. Three amino acid substitutions were noted at P2 antigenic site of GII.P16/GII.2 recombinants. Furthermore, this study revealed that the current immunochromatographic kit available in Japan could be used effectively for the detection of recent GII.2 genotype.

Vibrio parahaemolyticus is a ubiquitous marine bacterium that has become an important public-health concern worldwide. Consumption of food contaminated with V. parahaemolyticus causes acute gastroenteritis in humans. To gain understanding of epidemiological characteristics of V. parahaemolyticus gastroenteritis outbreak in China, we summarized data on 2003–2008 V. parahaemolyticus gastroenteritis outbreaks in 12 provinces reported to China National Foodborne Diseases Surveillance Network. A food item was implicated if V. parahaemolyticus was isolated from food or based on epidemiologic evidence. From 2003 to 2008, 322 gastroenteritis outbreaks due to V. parahaemolyticus were reported, resulting in 9041 illnesses and 3948 hospitalizations. Outbreak size ranged from 2 to 244 cases, with a median of 20 cases. Most of the outbreaks occurred during April and October. A single food commodity was implicated in 187 (58%) outbreaks, of which 58 (31%) involved meat and meat products, and 52 (28%) involved aquatic products. Outbreaks most frequently occurred in restaurants (39%), cafeterias (30%), and private residences (15%). Outbreaks most frequently attributed to cross contamination (50%). To prevent and control V. parahaemolyticus gastroenteritis outbreaks, food workers and consumers should receive training on avoiding cross contamination of ready-to-eat foods with uncooked seafoods, particularly in warm weather months.

Background : On the 28 th of October, 12 students from a Senior -High-School (SHS) in the Akwapim North-District-Ghana, reported to the district hospital with abdominal cramps, diarrhea and vomiting. We investigated to identify the cause, the source of infection and to recommend control measures. Methods: We conducted a descriptive investigation; with activ

An emerging recombinant norovirus GII.P16/GII.4 Sydney 2012 strain caused a gastroenteritis outbreak amongst attendees at a large health function in regional New South Wales, Australia. This was the third outbreak caused by the recombinant GII.P16/GII.4 Sydney 2012 strain in this region in 2017, which appears to be emerging as a common strain in the Hunter New England region.

Drinking water outbreaks occur worldwide and may be caused by several factors, including raw water contamination, treatment deficiencies, and distribution network failure. This study describes two drinking water outbreaks in Finland in 2016 (outbreak I) and 2018 (outbreak II). Both outbreaks caused approximately 450 illness cases and were due to drinking water pipe breakage and subsequent wastewater intrusion into the distribution system. In both outbreaks, the sapovirus was found in patient samples as the main causative agent. In addition, adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides (outbreak II) were detected in patient samples. Water samples were analyzed for the selected pathogens largely based on the results of patient samples. In addition, traditional fecal indicator bacteria and host-specific microbial source tracking (MST) markers (GenBac3 and HF183) were analyzed from water. In drinking water, sapovirus and enteropathogenic E. coli (EPEC) were found in outbreak II. The MST markers proved useful in the detection of contamination and to ensure the success of contaminant removal from the water distribution system. As mitigation actions, boil water advisory, alternative drinking water sources and chlorination were organized to restrict the outbreaks and to clean the contaminated distribution network. This study highlights the emerging role of sapoviruses as a waterborne pathogen and warrants the need for testing of multiple viruses during outbreak investigation.

The purpose of the study was to assess the 1-year outcome of definitive reactive arthritis (ReA) after a waterborne outbreak. A cohort of 21 patients (15 females and 6 males, median age 54 years) with ReA related to an extensive waterborne outbreak in Finland was clinically followed-up by rheumatologists with visits at baseline, at 1 month and 3, 6 and 12 months. Although the outcome was in general favourable, 1/3 of the patients had chronic course; 7 (33 %) of the 21 patients needed disease-modifying anti-rheumatic drugs (DMARDs) and even 8 (38 %) of them used glucocorticoids at 12 months. Four (19 %) were using non-steroidal anti-inflammatory drugs and nine (43 %) other analgesics. Many patients had articular pain and impaired physical function still at 12 months, even though inflammatory parameters and the number of swollen joints were low. Only one patient (5 %) was human leucocyte antigen-B27-positive. She had the most severe ReA and also additional infectious arthritis caused by Salmonella serotype enteritidis leading to osteonecrosis of her hip joint with subsequent need for arthroplasty. ReA as observed in our study was overall fairly mild, but in many individuals, postinfectious arthralgia and DMARD use continued at least up to 1 year.

In March 2010, a massive outbreak of gastroenteritis started in the region of Antofagasta (northern Chile). The outbreak was mainly attributed to Norovirus genogroup II although ETEC strains were also isolated with high frequency from clinical samples. We review this outbreak and determined that ETEC was an underestimated etiologic agent.

Norovirus (NoV) is a prevalent pathogen of foodborne diseases; however, its detection in foods other than shellfish is often time consuming and unsuccessful. In 2010, an outbreak of acute gastroenteritis occurred on a cruise ship in Brazil, and NoV was the etiologic agent suspected. The objectives of this study were to report that a handy in-house methodology was suitable for NoV detection in naturally contaminated food, and perform the molecular characterization of food strains. Food samples (blue cheese, Indian sauce, herbal butter, soup, and white sauce) were analyzed by ELISA, two methods of RNA extraction, TRIzol(®) and QIAamp(®), following conventional RT-PCR. The qPCR was used in order to confirm the NoV genogroups. GI and GII NoV genogroups were identified by conventional RT-PCR after RNA extraction by means of the TRIzol(®) method. Two GII NoV samples were successfully sequenced, classified as GII.4; and they displayed a genetic relationship with strains from the Asian continent also isolated in 2010. GII and GI NoV were identified in distinct food matrices suggesting that it was not a common source of contamination. TRIzol(®) extraction followed by conventional RT-PCR was a suitable methodology in order to identify NoV in naturally contaminated food. Moreover, food samples could be processed within 8 h indicating the value of the method used for NoV detection, and its potential to identify foodborne gastroenteritis outbreaks in food products other than shellfish. This is the first description in Brazil of NoV detection in naturally contaminated food other than shellfish involved in a foodborne outbreak.

Summary We describe an outbreak of acute gastroenteritis (AGE) in dogs in March 2011 in a Portuguese kennel after the introduction of imported Russian dogs. Canine norovirus was detected in faecal samples of all dogs with AGE symptoms. Partial sequence analysis of the RT-PCR products confirmed that all canine norovirus strains were identical. The canine norovirus infection disseminated rapidly in 2 days to all dogs in the kennel demonstrating the highly contagious nature of this virus. The incubation period was

Hellenic Center for Disease Control and Prevention, Athens 15123, Greece; E-Mails: kmellou@gmail.com (K.M.); gspala@gmail.com (G.S.) * Author to whom correspondence should be addressed; E-Mail: avanta@upatras.gr; Tel.: +30-26-10969875; Fax: +30-26-10969875. Received: 20 July 2011; in revised form: 12 August 2011 / Accepted: 16 August 2011 / Published: 22 August 2011 Abstract: In June 2006, an outbreak alert regarding cases of acute gastroenteritis in a region in North Eastern Greece (population 100,882 inhabitants), triggered investigations to guide control measures. The outbreak started the first days of June, and peaked in July. A descriptive epidemiological study, a virological characterization of the viral agent identified from cases as well as a phylogenetic analysis was performed. From June 5 to September 3, 2006 (weeks 23–44), 1,640 cases of gastroenteritis (45.2% male and 54.8% female, aged 3 months to 89 years) were reported. The overall attack rate for the period was 16.3 cases/1,000 inhabitants. About 57% of cases observed were under the age of 15 years. Αnalysis of faecal samples identified Norovirus GII strains. Fifteen different Norovirus GII strains were recorded, presenting a homology of 94.8% (86–97%) to GII strains obtained from GenBank. The long duration of the outbreak suggests an important role of person-to-person transmission, while the emergence of the outbreak was possibly due to contaminated potable water, although no viruses were detected in any tested water samples. This outbreak underscores the need for a national surveillance system for acute non-bacterial gastroenteritis outbreaks.

Noroviruses and rotaviruses from a gastroenteritis outbreak affecting >300 people near Garda Lake (Northern Italy) in 2009 were investigated. Characterization of viruses from 40 patient stool samples and 5 environmental samples identified three distinct rotavirus and five norovirus genotypes; two of the latter were detected in both patient and environmental samples.

To assess the occurrence, clinical picture, and triggering infections of reactive arthritis (ReA) associated with a large waterborne gastroenteritis outbreak.After an extensive sewage contamination of the water supply system, an estimated 8453 of the 30 016 inhabitants of the town of Nokia fell ill. General practitioners and occupational physicians were advised to refer any patients with suspicion of new ReA to rheumatological examination including faecal culture, human leucocyte antigen (HLA)-B27 and antibody tests for Campylobacter, Salmonella, and Yersinia.Forty-five patients (33 females, 12 males) aged 16-77 years (median 53) were referred. ReA was diagnosed in 21, postinfectious arthralgia in 13, and other musculoskeletal conditions in 11 patients. HLA-B27 was positive in five out of 44 patients (11%). Of the 21 patients with ReA, possible triggering infections were observed in seven (33%), Campylobacter in four, Yersinia in three, and Salmonella in one, who also had Campylobacter infection. ReA was mild in all but one patient who presented with persistent Salmonella enterica serotype enteritidis infection.Taking into account the large population contaminated with potentially arthritogenic agents, the occurrence of ReA was rare and mild in character.

Human astroviruses are one of the known pathogens of gastroenteritis in infants, children and rarely in elderly. It causes 4.2-7.3% of the sporadic gastroenteritis cases with diarrhea and vomiting in children. The etiological role of astrovirus has not been confirmed yet in outbreaks of gastroenteritis in Hungary. Aims: The first description of the detection and molecular epidemiology of astrovirus in outbreaks of gastroenteritis in Hungary. Materials and methods: Stool samples originated from Komárom-Esztergom County, from a day-care center (nursery) where a gastroenteritis outbreak occurred in June, 2010. Astrovirus was detected by RT-PCR methods. The nucleotide sequence of the nearly complete genome was sequenced. Clinical and epidemiological data were collected by epidemiological investigation. Results: Out of the 29 exposed persons (24 children and 5 adults) 7 (24.1%) children had gastroenteritis with diarrhea, and vomiting in one case, in the period of June 4-15, 2010. Bacterial pathogens, rotavirus, adenovirus and norovirus were not detected, but genotype 1 astrovirus could be identified in 3 (42.8%) stool samples (HQ398856). The nucleotide sequence of the astrovirus ORF1a/ORF1b/ORF2/3’UTR regions was determined. The source of the outbreak was presumably the firstly recognized ill child and the virus was spread by fecal-oral route with direct contact in the children community. Conclusions: Epidemiologic and clinical characteristics of the astrovirus outbreak in the nursery are described in details to prove that the possible etiological role of astroviruses in viral gastroenteritis which should not forget in order after rotaviruses, caliciviruses (norovirus and sapovirus) and enteric adenoviruses. Orv. Hetil., 2011, 152, 45–50.

In 2007, sewage contamination of a water supply system caused an outbreak of gastroenteritis in the town of Nokia in Finland. Campylobacter was the most frequent pathogen found in faecal cultures o...

Noroviruses (NoVs) cause gastroenteritis in all age groups. To investigate an acute gastroenteritis outbreak in Shenzhen, South China, we analyzed the presence of NoVs in fecal specimens and drinking water samples. Viral RNAs were extracted from fecal suspensions and water concentrates made by membrane adsorption-elution, and NoV was detected by reverse transcription-polymerase chain reaction (RT-PCR). Among the 43 diseased workers at the two factories and one construction site, NoVs were detected in 19 out of 28 stool specimens (68%) and 3 out of 16 water samples (19%). Importantly, the six NoV strains identified from the water and the stool samples share over 99% sequence identity and all belong to GII 4 viruses. Epidemiological survey also identified a water pipe breakage possibly causing the water contamination, and confirmed that the contaminated drinking water largely contributed to the NoV gastroenteritis outbreak. To our knowledge, this is the first time that a viral concentration and detection method for waterborne NoV is applied to a gastroenteritis outbreak in China.

Objectives: The molecular and epidemiological features of community-based norovirus-associated sporadic gastroenteritis incidents (NASGIs) are poorly understood. This study examined these features and compared the findings with studies of community-based and institutional norovirus-associated gastroenteritis outbreaks (NAGOs). Methods: Fecal specimens from NASGIs and NAGOs that occurred in Victoria, Australia (2002–2007) were tested for norovirus by reverse transcription-polymerase chain reaction methodology. Norovirus genotype was determined by nucleotide sequence analysis. Results: 106 community-based NASGIs, 116 community-based NAGOs and 902 institutional NAGOs were identified. The mean age and gender ratio of individuals associated with community-based NASGIs and community-based NAGOs were similar but differed from that found for institutional NAGOs. Although GII.4 was the predominant genotype associated with all three incident types, the mix of genotypes was similar for community-based NASGIs and community-based NAGOs but that for institutional NAGOs was different. All three incident types had a similar seasonal periodicity due to the pronounced seasonal periodicity of GII.4 incidents. Conclusions: The molecular and epidemiological features of noroviruses associated with community-based NASGIs and community-based NAGOs are similar but are different from those found for institutional NAGOs.

A norovirus gastroenteritis outbreak at a wedding reception hall in Nagano Prefecture in April 2008 affected that hall's reception participants and waiters, but not waiters or food handlers at another hall. To determine the infection route, dust in three vacuum cleaners used to clean the venue were tested for norovirus using real-time reverse transcriptase polymerase chain reaction (RT-PCR), with norovirus RNA detected from all three. Sequencing analysis of a 280-nt portion of the capsid region showed that 9 specimens from infected reception participants and waiters and dust samples had 100% nucleotide identity. This suggests that the infection route was dust transmission, that the reception venue floor had been contaminated with norovirus, and that participants and staff had been exposed to norovirus in dust during the wedding reception. Dust thus requires specific attention as a potential infection source because norovirus cDNA copies were 1.7 x 10(4) to 1.6 x 10(5) per gram in dust specimens.

A calicivírusok közé tartozó sapovírus a csecsemő- és kisgyermekkori – ritkán a felnőttkori – szórványos gastroenteritis-fertőzések egyik ismert kórokozója. A calicivírusok molekuláris laboratóriumi vizsgálatainak kezdete óta (az 1990-es évek közepe) rendkívül ritkán (~5 évente egyszer), egy-egy járvány kiváltójaként is leírták. A szerzők immár 10 év óta követik a calicivírusok hazai cirkulációját molekuláris epidemiológiai módszerekkel. A közel 800 nem bakteriális gastroenteritis-járvány vizsgálata során sapovírust még nem mutattak ki. A nemzetközi calicivírus surveillance munkacsoportunk észleléséből származó informális adatok alapján 2008-ban a sapovírus okozta járványok számának szokatlan emelkedése volt megfigyelhető Európában. A járványok egyetlen, a GI2 genotípusú sapovírushoz köthetők.Célkitűzés:Az első igazolt sapovírus okozta gastroenteritis-járvány molekuláris epidemiológiai bemutatása hazánkban.Módszer:A vizsgált székletminták egy Bács-Kiskun megyei, szellemi fogyatékosokat gondozó otthonban kialakult gastroenteralis járványból származtak 2008 szeptemberéből. A sapovírus RNS-polimeráz génjének felsokszorozását RT-PCR módszerrel végeztük, majd a terméket szekvenáltuk és filogenetikailag elemeztük. A klinikai és epidemiológiai adatokat a járványügyi felderítőmunka során gyűjtöttük.Eredmények:A 135 exponált közül 17-en (12,6%) betegedtek meg a hányással, hasmenéssel járó gastroenteritisben 2008. szeptember 11–22-e között. Bakteriális kórokozót, rotavírust, adenovírust, norovírust nem, de a 4 megvizsgált székletmintából 1-ben (25%) sapovírust sikerült kimutatni. A járvány forrása feltehetően a beteg ápoló volt, a vírus pedig közvetlen kontaktussal terjedt a fogyatékos ápoltak ellátása során. Az RNS-polimeráz régió alapján a vírus genetikailag a GI2 sapovírus genotípusba tartozik.Következtetések:A közleményben a sapovírus első hazai kimutatásáról számoltunk be gastroenteritis-járványból. A felnőttkori, szellemi fogyatékosokat gondozó otthonban lezajlott járvány részletes epidemiológiai és klinikai jellegzetességeinek leírásával felhívjuk a figyelmet, hogy nem minden „calicivírus-fertőzést” és „-járványt” okoz a jelenleg diagnosztikus módszerekkel vizsgálható másik calicivírus, a norovírus. Elképzelhető, hogy az észlelt járvány, amelyet a GI2-es genotípusú sapovírus okozott, része egy nagyobb földrajzi régióra kiterjedő nemzetközi epidémiának.

Noroviruses exhibit a wide genomic and antigenic diversity, making laboratory diagnosis difficult. The abrupt onset of the illness does often not allow timely sample collection. Three different methods (a commercially available ELISA, a published RT-PCR and an RT-booster-PCR) were compared for detecting noroviruses in stools collected after the end of a gastroenteritis outbreak. Both ELISA and the RT-PCR detected noroviruses in 6 samples out of the 41 samples collected and tested. The RT-booster-PCR, however, was able to detect noroviruses in 23 (56%) of the samples with 20 of the samples confirmed by sequencing. Confirmation of PCR products was also undertaken by Southern hybridisation with controversial results (e.g. lack of confirmation on samples positive by sequencing). The results show that common molecular diagnostic methods may fail sometimes to detect the presence of noroviruses in a relevant proportion of samples. A sensitive detection method, such as the RT-booster-PCR described below may resolve the cases.

IntroductionIn late October of 2012, Hurricane Sandy struck the northeast United States and shelters were established throughout the impacted region. Numerous cases of infectious viral gastroenteritis occurred in several of these shelters. Such outbreaks are common and have been well described in the past. Early monitoring for, and recognition of, the outbreak allowed for implementation of aggressive infection control measures. However, these measures required intensive medical response team involvement. Little is known about how such outbreaks affect the medical teams responding to the incident.Hypothesis/ProblemDescribe the impact of an infectious viral gastroenteritis outbreak within a single shelter on a responding medical team.MethodsThe number of individuals staying in the single shelter each night (as determined by shelter staff) and the number of patients treated for symptoms of viral gastroenteritis were recorded each day. On return from deployment, members of a single responding medical team were surveyed to determine how many team members became ill during, or immediately following, their deployment.ResultsThe shelter population peaked on November 5, 2012 with 811 individuals sleeping in the shelter. The first patients presented to the shelter clinic with symptoms of viral gastroenteritis on November 4, 2012, and the last case was seen on November 21, 2012. A total of 64 patients were treated for nausea, vomiting, or diarrhea over the 17-day period. A post-deployment survey was sent to 66 deployed medical team members and 45 completed the survey. Twelve (26.7%) of the team members who responded to the survey experienced symptoms of probable viral gastroenteritis. Team members reported onset of symptoms during deployment as well as after returning home. Symptoms started on days 4-8, 8-14, on the trip home, and after returning home in four, four, two, and two team members, respectively.ConclusionMedical teams providing shelter care during viral gastroenteritis outbreaks are susceptible to contracting the virus while caring for patients. When responding to similar incidents in the future, teams should not only be ready to implement aggressive infectious control measures but also be prepared to care for team members who become ill.GaitherJB, PageR, PratherC, PaavolaF, GarrettAL. Impact of a hurricane shelter viral gastroenteritis outbreak on a responding medical team. Prehosp Disaster Med. 2015;30(4):1–4.

Aim: To provide a practical action plan for effective infection control of norovirus outbreak in acute paediatric wards. Methods: We report the infection control measures that were implemented to terminate and to prevent nosocomial spread of norovirus gastroenteritis in an open-designed paediatric ward. Results: Nine children, one visitor, and one medical student were affected in a norovirus gastroenteritis outbreak in an acute paediatric ward. Vomiting was the main presenting symptom. The outbreak was rapidly terminated three days after implementation of stringent infection control measures and there was no second wave of attack. These measures included strict contact precautions, prompt isolation and cohorting of symptomatic patients, vigorous environmental cleansing with concentrated disinfectant (hypochlorite solution 1000 ppm), meticulous handling of waste products, and efficient contact tracing of exposed patients, family members, and medical students. Conclusion: Prompt implementation of stringent infection control measures and contact tracing can rapidly terminate the norovirus outbreak and prevent a second wave of infection. Children with unexplained vomiting and those with contact history of gastroenteritis should be properly triaged, isolated, and investigated for possible infective causes, including norovirus-induced gastroenteritis.

Gastroenteritis affected many British military personnel during the war in Iraq. In the first month, 1,340 cases were seen; 73% of patients required hospital admission and 36% were hospital staff. In a survey of 500 hospital staff, 76% reported gastroenteritis, which was more likely in clinical workers. Investigations showed only caliciviruses.

Salmonella enterica serovar Weltevreden and Vibrio fluvialis were identified as etiological agents of a foodborne gastroenteritis outbreak after an Iftar feast in North Dumdum. Of the 278 cases admitted to the Infectious Diseases Hospital, Kolkata, 44 stool samples were tested for the enteric pathogens. Six were positive for Salmonella Weltevreden, 5 for Vibrio fluvialis, and 8 contained both of the pathogens. Consumption of mutton-ghogni might have been the likely vehicle of this outbreak. In the pulsed-field gel electrophoresis, Salmonella Weltevreden was identified as a single clone but the V. fluvialis strains were heterogeneous.

In July 2001, an outbreak of gastroenteritis occurred in Helsinki among children and adults after bathing in an outdoor wading pool. The epidemiological survey revealed that at least 242 persons were affected. Microbiological testing of both patient stool samples and of the pool water revealed the presence of two different gastroenteritis viruses: a norovirus (NV) and an astrovirus. Amplicon sequencing of the NV samples showed nucleotide sequence identity between the virus from patients and the water. After changing the pool water and the sand at the bottom of the pool followed by shock chlorination, no virus could be detected in the water. However, NV was continuously detected in the water outlet well as much as 8 months after the incident. Here we show how molecular methods aided in tracing the source of the epidemic and in finding the causative pathogens both in patients and in the environment.

Three different studies are reported concerning the environmental pollution caused by viruses in Albania. The first study describes an outbreak of gastroenteritis in the capital city, involving 2,722 children attending the Paediatric Unit of Tirana Hospital. The age group with the highest morbidity was 0-5 years, with 89.5%; no fatalities were recorded during the outbreak. Rotavirus was detected in 26/28 faecal samples by RT-PCR, although astrovirus, adenovirus and calicivirus were also present. The second study describes an outbreak of hepatitis A virus involving the city of Lac. Two hundred cases were recorded, with the highest incidence in the age-group 5-9 years. Phylogenetic analysis of the VP1/2A region showed the presence of a unique sequence: genotype IA. Rotavirus was identified in drinking-water samples collected during the outbreak. The third study describes the prevalence of HAV and HEV in 202 sera randomly collected from 12 different cities in Albania. HAV showed a high incidence (66.2%), whereas none was positive for HEV. The genomic analysis of the VP1/2A junction revealed the presence of only one genotype (IA) with few point mutations and just two amino acid substitutions at codons 22 and 34. Additionally, two potential antigenic variants were detected, the first at position 46 of VP3 and the second at position 23 of VP1.

During November 2015, the North Carolina Division of Public Health was notified by the Pitt County Health Department (PCHD) that approximately 40 persons who attended a catered company Thanksgiving lunch the previous day were ill with diarrhea and abdominal pain. The North Carolina Division of Public Health and PCHD worked together to investigate the source of illness and implement control measures. Within hours of notification, investigators developed and distributed an online survey to all lunch attendees regarding symptoms and foods consumed and initiated a cohort study. A case of illness was defined as abdominal pain or diarrhea in a lunch attendee with illness onset

Shellfish have been implicated in norovirus (NoV) infection outbreaks worldwide. This study presents data obtained from various batches of shellfish and fishery products from a Belgian seafood company over a 6-month period. For the intact shellfish (oysters, mussels, and clams), 21 of 65 samples from 12 of 34 batches were positive for NoVs; 9 samples contained quantitative NoV levels at 3,300 to 14,300 genomic copies per g. For the semiprocessed fishery products (scallops and common sole rolls with scallop fragments), 29 of 36 samples from all eight batches were positive for NoVs; 17 samples contained quantitative NoV levels at 200 to 1,800 copies per g. This convenience study demonstrated the performance and robustness of the reverse transcription quantitative PCR detection and interpretation method and the added value of NoV testing in the framework of periodic control of seafood products bought internationally and distributed by a Belgian seafood processing company to Belgian food markets.

Background: Human Bocavirus (HBoV) is considered to be responsible for lower respiratory tract infections in small children. Recent publications also reported the detection of HBoV in stool samples of gastroenteritis patients. Therefore HBoV might be associated with gastroenteritis cases. Objectives: To investigate the prevalence and the causative role of HBoV in gastroenteritis outbreaks in day care facilities for children. Study design: We examined 307 stool samples using a real time PCR protocol for HBoV load. Samples were collected from 48 independent outbreaks of gastroenteritis in day care facilities. Results: HBoV was detected in 14/307 stool samples (4.6%). HBoV load in the samples was low and the 14 HBoV positive samples were distributed among 13 different outbreaks. Coinfections with Norovirus in single samples were frequent (57.1%), but no gastroenteritis outbreak could be associated with HBoV infection or coinfection. Conclusions: This study indicates that HBoV is not a causative agent for gastroenteritis outbreaks.

We report a cluster of 3 cases of invasive salmonellosis without gastroenteritis among prisoners, in the absence of a gastroenteritis outbreak. Raw foods illicitly taken from the prison kitchen and improperly stored and prepared were possible sources of infection. We describe the investigation of this cluster and discuss the unique implications of invasive, nongastroenteritis salmonellosis in the prison setting, both for clinicians and for public health agencies that seek to control infections in prisons.

In January of 2008, during the peak of the rotavirus season in Guatemala, a gastroenteritis outbreak with high mortality among infants was reported in Guatemala. Despite extensive efforts, the investigation was limited by the lack of bulk stool specimens collected, particularly from the more severely dehydrated or deceased children.We evaluated the diagnostic performance of rectal swab specimens compared with bulk stool for the detection of rotavirus and norovirus.Patients with diarrhea (≥3 loose stools in 24 h) were enrolled through an ongoing surveillance system in Guatemala. From January through March 2009, we attempted to enroll 100 patients5 years old captured by the diarrhea surveillance, and collected paired bulk stool and rectal swabs specimens from them. Specimens were tested for norovirus using real-time reverse transcription-polymerase chain reaction and for rotavirus via enzyme immunoassay.We enrolled 102 patients with paired specimens; 91% of 100 paired specimens tested for rotavirus yielded concordant results positive for rotavirus with a negativity rate of 83%. Among 100 paired specimens tested for norovirus, 86% were concordant norovirus detection and the negativity rate was 85%. The diagnostic performance for rotavirus and norovirus detection did not differ significantly between the two specimen types.Testing of properly collected fecal specimens using rectal swabs may be a viable alternative to bulk stool for detection of rotavirus and norovirus, particularly during outbreaks where collection of bulk stool may be difficult.

During September/October 2012, a norovirus gastroenteritis outbreak affecting about 11,000 people occurred in Germany. Epidemiological studies suggested that frozen strawberries represented the vehicle of infection. We describe here the analysis of frozen strawberries for the presence of norovirus. Samples were taken by applying a stratified subsampling scheme. Two different methods for virus extraction from strawberries were compared. First, viruses were eluted from strawberries under alkaline conditions and concentrated using a polyethylene glycol precipitation. Second, ultrafiltration was applied for concentration of viruses rinsed off of the berries. In both cases, RNA was extracted and analyzed by real-time RT-PCR. Application of the ultrafiltration method generally resulted in a lower detection rate. Noroviruses were detected in 7/11 samples derived from the lot of strawberries implicated in the outbreak using the precipitation method. Typing of norovirus revealed three different genotypes including a combination of norovirus genotype II.16 (viral polymerase) and II.13 (viral capsid). This genotype combination was also found in some of the patients that were involved in the outbreak, but that had not been reported in Germany so far. In conclusion, heterogeneously distributed noroviruses in frozen strawberries can be detected by applying an optimized combination of sampling procedures, virus extraction methods, and real-time RT-PCR protocols. The detection of several different genotypes in the strawberries may suggest contamination from sewage rather than from a single infected food handler.

Strains of Bacillus cereus and B. thuringiensis were tested by the Tecra VIA kit for the ability to produce a diarrhoeal enterotoxin. The strains of B. thuringiensis were isolated from commercial B. thuringiensis-based insecticides (BactimosTM, DiPelTM, FlorbacTM FC, ForayTM 48B, NovodorTM FC, TurexTM, VecTobacTM, XenTariTM). The production of diarrhoeal enterotoxin varied by a factor of more than 100 among the different strains tested. B. cereus (F4433/73) produced the highest amount of enterotoxin and the B. thuringiensis strain isolated from DiPelTM the lowest. The products were tested for their content of diarrhoeal enterotoxin and all products, except MVPTM which does not contain viable B. thuringiensis spores, contained diarrhoeal enterotoxins. The results indicates an potential risk for gastroenteritis outbreak caused by B. thuringiensis.

Copyright © 2012 Rajko-Nenow et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited., Norovirus (NoV) is the single most important agent of foodborne viral gastroenteritis worldwide. Bivalve shellfish, such as oysters, grown in areas contaminated with human faecal waste may become contaminated with human pathogens including NoV. A study was undertaken to investigate NoV contamination in oysters (Crassostrea gigas) from a shellfishery over a 24 month period from October 2007 to September 2009. Oyster samples were collected monthly from a commercial shellfish harvest area classified as category B under EU regulations, but that had had been closed for commercial harvesting due to its previous association with NoV outbreaks. Real-time reverse transcription quantitative PCR (RT-qPCR) was used to determine the concentration of human NoV genogroups I and II (GI and GII) in monthly samples. Total NoV (GI and GII) concentrations in NoV positive oysters ranged from 97 to 20,080 genome copies g− 1 of digestive tissue and displayed a strong seasonal trend with greater concentrations occurring during the winter months. While NoV GII concentrations detected in oysters during both years were similar, NoV GI concentrations were significantly greater in oysters during the winter of 2008/09 than during the winter of 2007/08. To examine the NoV genotypes present in oyster samples, sequence analysis of nested RT-PCR products was undertaken. Although NoV GII.4 is responsible for the vast majority of reports of outbreaks in the community, multiple NoV genotypes were identified in oysters during this study: GI.4, GI.3, GI.2, GII.4, GII.b, GII.2, GII.12, and GII.e. NoV GI.4 was the most frequently detected genotype throughout the study period and was detected in 88.9% of positive samples, this was followed by GII.4 (43.7%) and GII.b (37.5%). This data demonstrates the diversity of NoV genotypes that can be present in sewage contaminated shellfish and that a disproportionate number of non-NoV GII.4 genotypes can be found in environmental samples compared to the number of recorded human infections associated with non-NoV GII.4 genotypes.