학술논문
Outbreak of viral gastroenteritis due to a contaminated well: international consequences
Document Type
Academic Journal
Author
Source
JAMA, The Journal of the American Medical Association. August 20, 1997, Vol. v278 Issue n7, p563, 6 p.
Subject
Language
ISSN
0098-7484
Abstract
An outbreak of viral gastrointestinal disease in Alaska illustrates the necessity for cooperation between national health departments. A hotel operator in Fairbanks, Alaska notified the state health department after noticing that several hotel residents who arrived by bus were ill. Ill bus passengers were also found in hotels in Skagway and Valdez. They had all stopped at a restaurant in the Yukon Territory of Canada. The illness was traced to the restaurant's water supply, which came from a well. One employee lived in a building with a septic pit, which was the source of the contamination.
Context. -- Small round-structured viruses (SRSVs) are known to cause viral gastroenteritis, but until now have not been confirmed in the implicated vehicle in outbreaks. Objective. -- Investigation of a gastroenteritis outbreak. Design. -- After applying epidemiologic methods to locate the outbreak source, we conducted environmental and laboratory investigations to elucidate the cause. Setting. -- Tourists traveling by bus through Alaska and the Yukon Territory of Canada. Participants. -- Staff of a restaurant at a business complex implicated as the outbreak source, convenience sample of persons on buses that had stopped there, and bus employees. Main Outcome Measures. -- Odds ratios (ORs) for illness associated with exposures. Water samples from the restaurant and stool specimens from tourists and restaurant staff were examined by nucleic acid amplification using reverse transcription polymerase chain reaction and sequencing of viral amplification products. Results. -- The itineraries of groups of tourists manifesting vomiting or diarrhea were traced back to a restaurant where buses had stopped 33 to 36 hours-previously. Water consumption was associated with illness (OR, 5.3; 95% confidence interval [CI], 2.3-12.6). Eighteen of 26 employees of the business complex were ill; although not the index case, an employee ill shortly before the outbreak lived in a building connected to a septic pit, which was found to contaminate the well supplying the restaurant's water. Genotype 2/P2B SRSV was identified in stool specimens of 2 tourists and 1 restaurant employee. Stools and water samples yielded identical amplification product sequences. Conclusions. -- The investigation documented SRSVS in a vehicle epidamiologically linked to a gastroenteritis outbreak. The findings demonstrate the power of molecular detection and identification and underscore the importance of fundamental public health practices such as restaurant inspection, assurance of a safe water supply, and disease surveillance. JAMA. 1997;278:563-568
Context. -- Small round-structured viruses (SRSVs) are known to cause viral gastroenteritis, but until now have not been confirmed in the implicated vehicle in outbreaks. Objective. -- Investigation of a gastroenteritis outbreak. Design. -- After applying epidemiologic methods to locate the outbreak source, we conducted environmental and laboratory investigations to elucidate the cause. Setting. -- Tourists traveling by bus through Alaska and the Yukon Territory of Canada. Participants. -- Staff of a restaurant at a business complex implicated as the outbreak source, convenience sample of persons on buses that had stopped there, and bus employees. Main Outcome Measures. -- Odds ratios (ORs) for illness associated with exposures. Water samples from the restaurant and stool specimens from tourists and restaurant staff were examined by nucleic acid amplification using reverse transcription polymerase chain reaction and sequencing of viral amplification products. Results. -- The itineraries of groups of tourists manifesting vomiting or diarrhea were traced back to a restaurant where buses had stopped 33 to 36 hours-previously. Water consumption was associated with illness (OR, 5.3; 95% confidence interval [CI], 2.3-12.6). Eighteen of 26 employees of the business complex were ill; although not the index case, an employee ill shortly before the outbreak lived in a building connected to a septic pit, which was found to contaminate the well supplying the restaurant's water. Genotype 2/P2B SRSV was identified in stool specimens of 2 tourists and 1 restaurant employee. Stools and water samples yielded identical amplification product sequences. Conclusions. -- The investigation documented SRSVS in a vehicle epidamiologically linked to a gastroenteritis outbreak. The findings demonstrate the power of molecular detection and identification and underscore the importance of fundamental public health practices such as restaurant inspection, assurance of a safe water supply, and disease surveillance. JAMA. 1997;278:563-568