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An extensive gastroenteritis outbreak after drinking-water contamination by sewage effluent, Finland

  • J. LAINE (a1) (a2), E. HUOVINEN (a1), M. J. VIRTANEN (a1), M. SNELLMAN (a1), J. LUMIO (a2) (a3), P. RUUTU (a1), E. KUJANSUU (a4), R. VUENTO (a3) (a5), T. PITKÄNEN (a1), I. MIETTINEN (a1), J. HERRALA (a2), O. LEPISTÖ (a6), J. ANTONEN (a2) (a4), J. HELENIUS (a3), M.-L. HÄNNINEN (a7), L. MAUNULA (a7), J. MUSTONEN (a2) (a4) and M. KUUSI (a1)
  • DOI:
  • Published online: 15 September 2010

An inappropriate cross-connection between sewage- and drinking-water pipelines contaminated tap water in a Finnish town, resulting in an extensive waterborne gastroenteritis outbreak in this developed country. According to a database and a line-list, altogether 1222 subjects sought medical care as a result of this exposure. Seven pathogens were found in patient samples of those who sought treatment. To establish the true disease burden from this exposure, we undertook a population-based questionnaire investigation with a control population, infrequently used to study waterborne outbreaks. The study covered three areas, contaminated and uncontaminated parts of the town and a control town. An estimated 8453 residents fell ill during the outbreak, the excess number of illnesses being 6501. Attack rates were 53% [95% confidence interval (CI) 49·5–56·4] in the contaminated area, 15·6% (95% CI 13·1–18·5) in the uncontaminated area and 6·5% (95% CI 4·8–8·8) in the control population. Using a control population allowed us to differentiate baseline morbidity from the observed morbidity caused by the water contamination, thus enabling a more accurate estimate of the disease burden of this outbreak.

Corresponding author
*Author for correspondence: Dr J. Laine, Lylykuja 3, 33100 Tampere, Finland. (Email:
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