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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.

There is a large burden of norovirus disease in child-care centers in Australia and around the world. Despite the ubiquity of norovirus outbreaks in child-care centers, little is known about the extent of this burden within the child-care center and the surrounding household clusters. Therefore, we performed an in-depth analysis of a gastroenteritis outbreak to examine the patterns of transmissions, household attack rates and the basic reproduction number (R0) for Norovirus in a child-care facility. We used data from parental interviews of suspected cases sent home with gastroenteritis at a child-care center between 24th of August and 18th of September 2020. A total of 52 persons in 19 household clusters were symptomatic in this outbreak investigation. Of all transmissions, 23 (46.9%) occurred in the child-care center, the rest occurring in households. We found a household attack rate of 36.5% (95% CI 27.3, 47.1%). Serial intervals were estimated as mean 2.5 ± SD1.45 days. The R0, using time-dependent methods during the growth phase of the outbreak (days 2 to 8) was 2.4 (95% CI 1.50, 3.50). The count of affected persons of a child-care center norovirus outbreak is approximately double the count of the total symptomatic staff and attending children. In the study setting, each symptomatic child-care attendee likely infected one other child-care attendee or staff and just over one household contact on average.

We investigated a large gastroenteritis outbreak that occurred in Northern Greece in 2019. A case was defined as anyone presenting with diarrhoea and/or vomiting from 24 January 2019 to 04 February 2019. We conducted a case-control study (CCS) using random selection of participants >16 years of age, residents of town X, who visited the health care centre between 25 and 28 January 2019. Moreover, we conducted a retrospective cohort study (CS) at the four elementary schools of the town. We collected clinical and water samples and the water supply system was inspected. In total, we recorded 638 cases (53% female; median age was 44 years (range 0–93)). Forty-eight cases and 52 controls participated in the CCS and 236 students in the CS. Both CCS and CS indicated tap water as the most likely source (OR 10, 95% CI 2.09–93.4, explaining 95.7% of cases; RR = 2.22, 95% CI 1.42–3.46, respectively). More than one pathogen was detected from stool samples of 6 of the 11 cases tested (norovirus, Campylobacter jejuni, Enterohemorrhagic E. coli (EHEC) and Enteropathogenic E. coli (EPEC)). Water samples, collected after ad-hoc chlorination, tested negative. Technical failures of the water tanks' status were identified. Our results suggested a waterborne outbreak. We recommended regular monitoring of the water supply system and immediate repair of technical failures.

Tese de Doutoramento em Ciências Veterinárias na especialidade de Segurança Alimentar Gastrointestinal infections have consistently been among the most frequent diseases and non-battle injuries, degrading operational effectiveness and force readiness in the military. Noroviruses appear as the most frequent agents causing acute gastrointestinal illness both in maritime and land theatres of operations, as well as in stationed troops or military training centers in many western countries. Nevertheless, little is known on the burden of norovirus gastroenteritis in the Portuguese military. In this work we set out to establish a gastroenteritis outbreak surveillance system (GOSS) to report disease cases to the Bromatology and Biologic Defense Laboratory during the five-year period, 2013-2017. During this period 14 gastroenteritis outbreaks were registered that affected a total of 410 military. Noroviruses were responsible for the majority of the outbreaks (8/14) and disease cases (210/410). Norovirus outbreaks occurred either in military exercises or in military bases and showed to have an impact on force readiness and operational effectiveness. In most cases the origin of the outbreaks was difficult to confirm but five (63%) were likely foodborne (including food handlers) or waterborne and three (37%) had predominant person-to-person transmission. Outbreaks were caused by both genogroup (G) I and II, but G II clearly outnumber those caused by G I (6/8) and case numbers (145/210). Norovirus GI was associated with waterborne outbreaks while GII was associated to foodborne and person-to-person transmission. Each outbreak was caused by a different genotype highlighting the high genetic diversity of the circulating noroviruses. Three of the identified genotypes (GI.9, GII.17 and GII.16-GII.2) were reported for the first time in Portugal. In conclusion, the present thesis identified norovirus as the most important etiologic agent of acute gastroenteritis outbreaks and the most frequent cause of food- and waterborne illness in the Portuguese Army. This work had contributed to change preventive measures and allowed the reinforcement of control actions that minimized the impact of norovirus outbreaks. RESUMO - Surtos de gastrenterite por norovírus no Exército Português - As infeções gastrointestinais encontram-se entre as doenças mais frequentemente reportadas como causa de diminuição da capacidade operacional e da prontidão de uma força militar. Os norovírus são os agentes mais vezes implicados na doença aguda gastrointestinal em teatros de operações, marítimos e terrestres, e em forças estacionadas ou centros de treino militares das Forças Armadas de Países Ocidentais. Esta tese teve como principal objetivo avaliar a relevância da gastrenterite aguda causada por norovírus no Exército Português. Foi estabelecido um sistema de vigilância no Exército, de modo que todos os surtos de gastroenterite são reportados ao Laboratório de Bromatologia e Defesa Biológica. Assim, verificou-se que entre 2013 e 2017 foram registados 14 episódios, que afetaram cerca de 410 militares, tendo os norovírus sido responsáveis pela maioria dos surtos (8/14) e dos casos (210/410). Os surtos ocorreram em exercícios militares e em bases do Exército com impacto na capacidade operacional e funcionamento regular das Unidades. Embora a origem destes tenha sido difícil de confirmar, acredita-se que 5 (63%) tiveram origem alimentar (incluindo os manipuladores de alimentos e a água) e que em 3 (37%) predominou a transmissão pessoa a pessoa. Os surtos foram causados por norovírus dos genogrupos (G) I e II, contudo o G II foi responsável pelo maior número de surtos (6/8) e casos (145/210). O genogrupo I esteve associado à água e o genogrupo II à transmissão pessoa a pessoa ou aos alimentos. Cada surto foi causado por um genótipo distinto, refletindo a grande diversidade genética dos norovírus que se encontram em circulação. Três dos genótipos identificados (GI.9, GII.17 e GII.16-GII.2) foram reportados pela primeira vez em Portugal. Ao identificar o norovírus como o mais importante agente etiológico de surtos de gastroenterite aguda e de doença com origem nos alimentos e na água no Exército Português, o presente trabalho contribuiu para a alteração de medidas preventivas de doenças de origem alimentar e para o reforço de ações de controlo dos surtos causados por este agente. The Present work was partially supported by the Portuguese Army. The author wants to acknowledge the Portuguese Army for the conditions provided for the experimental work, the development of the thesis and the financial support. N/A

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.

In April 2016, an outbreak of gastrointestinal illness (4,136 cases) occurred in Catalonia, Spain. We detected high levels of norovirus genogroups I and II in office water coolers associated with the outbreak. Infectious viral titer estimates were 33-49 genome copies/L for genogroup I and 327-660 genome copies/L for genogroup II.

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.

Raspberries have lately caused several human norovirus (HuNoV) outbreaks in Europe. In this study, we developed and evaluated for HuNoV reverse transcription (RT)-PCR detection in frozen raspberries extraction methods that have equal sensitivity but are less time-consuming than widely used methods based on polyethylene glycol (PEG) precipitation and chloroform-butanol purification. One method was applied to stored frozen raspberries linked to previous HuNoV outbreaks and berries on sale. In the virus elution-based Method 1, sparkling water eluted viruses most efficiently from the berries. Method 2, based on direct nucleic acid extraction with minor PEG supplement, yielded the highest number of positive findings (4 out of 9) at low virus concentration level of 100 genome copies HuNoV genogroup II per 25 g raspberries. Both methods showed approximately equal sensitivity to a method including PEG precipitation and chloroform-butanol purification. Two naturally contaminated berry samples linked to HuNoV outbreaks in 2006 and 2009 were still positive for HuNoV genogroup I, but all berry products purchased from a local store remained negative for HuNoV. In conclusion, this study presents two efficient and rapid methods which can be used in urgent HuNoV outbreak investigations, since the results of the virus analysis are available in a few hours.

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).

Norovirus (NoV) gastroenteritis outbreaks appear frequently in food service operations (FSOs), such as in restaurants and canteens. In this study the presence of NoV and adenovirus (AdV) genomes was investigated on the surfaces of premises, especially in kitchens, of 30 FSOs where foodborne gastroenteritis outbreaks were suspected. The objective was to establish a possible association between the presence of virus genomes on surfaces and a visual hygienic status of the FSOs. NoV genome was found in 11 and AdV genome in 8 out of 30 FSOs. In total, 291 swabs were taken, of which 8.9% contained NoV and 5.8% AdV genome. The presence of NoV genomes on the surfaces was not found to associate with lower hygiene level of the premises when based on visual inspection; most (7/9) of the FSOs with NoV contamination on surfaces and a completed evaluation form had a good hygiene level (the best category). Restaurants had a significantly lower proportion of NoV-positive swabs compared to other FSOs (canteens, cafeteria, schools etc.) taken together (p = 0.00014). The presence of a designated break room for the workers was found to be significantly more common in AdV-negative kitchens (p = 0.046). Our findings suggest that swabbing is necessary for revealing viral contamination of surfaces and emphasis of hygiene inspections should be on the food handling procedures, and the education of food workers on virus transmission. Electronic supplementary material The online version of this article (doi:10.1007/s12560-017-9291-7) contains supplementary material, which is available to authorized users.

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.

During an investigation of an outbreak of gastroenteritis caused by Salmonella enterica serovar Paratyphi B variant L(+) tartrate(+), we identified unpasteurized tempeh as a novel food vehicle and Rhizopus spp. starter culture as the source of the contamination. Safe handling of uncooked, unpasteurized tempeh should be emphasized for prevention of foodborne illnesses.

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.

Introduction This study aimed to monitor the seasonality of rotavirus infection, and gain insight into the variability of Brazilian strains. Methods A total of 28 stool samples were analyzed from 698 revised cases of gastroenteritis during a norovirus outbreak in the summer of 2010 in Guarujá, Brazil. Diagnosis was performed using enzyme-linked immunosorbent assay (ELISA), reverse transcription polymerase chain reaction (RT-PCR), and sequencing. Results Rotavirus infection was detected in 17.9% (5/28) of samples; 4 samples were G2P[4] genotype, and one G2P[4]+P[6] genotype. G2 and P[4] sequences showed a genetic relationship to strains from India and Russia, respectively. Conclusions The seasonal pattern of rotavirus may be a consequence of human activity apart from climate factors.

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.

The first human astrovirus was discovered in 1975 by Madeley and Cosgrove through visualization of viral particles in stool using electron microscopy. Over the course of the next ∼20 years, an additional seven serotypes of human astroviruses were discovered. In the last decade, new technological advances in microarrays and sequencing strategies enabled more sophisticated methods for detecting viruses in clinical and environmental specimens. These methods led to the discovery of many novel viruses from a variety of virus families. They also brought about a dramatic realization that more astroviruses can be found in humans than previously recognized. In fact, the number of astroviruses associated with humans has nearly doubled within the last few years. Furthermore, the discovery of novel astroviruses in human specimens revealed that there is more diversity amongst them than was assumed based on the high level of similarity between human astroviruses 1 and 8. This chapter will describe the discovery and early characterization of the five novel astroviruses initially identified in human stool samples in 2008 and 2009.

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.