The application of new molecular methods in the investigation of a waterborne outbreak of norovirus in Denmark, 2012

PLoS One. 2014 Sep 15;9(9):e105053. doi: 10.1371/journal.pone.0105053. eCollection 2014.

Abstract

In December 2012, an outbreak of acute gastrointestinal illness occurred in a geographical distinct area in Denmark covering 368 households. A combined microbiological, epidemiological and environmental investigation was initiated to understand the outbreak magnitude, pathogen(s) and vehicle in order to control the outbreak. Norovirus GII.4 New Orleans 2009 variant was detected in 15 of 17 individual stool samples from 14 households. Norovirus genomic material from water samples was detected and quantified and sequencing of longer parts of the viral capsid region (>1000 nt) were applied to patient and water samples. All five purposely selected water samples tested positive for norovirus GII in levels up to 1.8×10(4) genomic units per 200 ml. Identical norovirus sequences were found in all 5 sequenced stool samples and 1 sequenced water sample, a second sequenced water sample showed 1 nt (<0.1%) difference. In a cohort study, including 256 participants, cases were defined as residents of the area experiencing diarrhoea or vomiting onset on 12-14 December 2012. We found an attack rate of 51%. Being a case was associated with drinking tap-water on 12-13 December (relative risk = 6.0, 95%CI: 1.6-22) and a dose-response relation for the mean glasses of tap-water consumed was observed. Environmental investigations suggested contamination from a sewage pipe to the drinking water due to fall in pressure during water supply system renovations. The combined microbiological, epidemiological and environmental investigations strongly indicates the outbreak was caused by norovirus contamination of the water supply system.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Caliciviridae Infections / epidemiology
  • Caliciviridae Infections / virology*
  • Capsid Proteins / chemistry
  • Capsid Proteins / genetics
  • Cohort Studies
  • Denmark / epidemiology
  • Disease Outbreaks
  • Drinking Water / virology*
  • Environmental Monitoring
  • Genome, Viral
  • Norovirus / genetics*
  • Norovirus / isolation & purification
  • Phylogeny
  • Water Purification
  • Water Supply

Substances

  • Capsid Proteins
  • Drinking Water

Grants and funding

Financial support of the viral analyses of water was provided by: VISK (EU Interreg IV A) and Aquavalens (EU FP7-KBBE-2012-6). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.