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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), M. KUUSI (a1) and Pirkanmaa Waterborne Outbreak Study Group...
Summary
SUMMARY

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.

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Corresponding author
*Author for correspondence: Dr J. Laine, Lylykuja 3, 33100 Tampere, Finland. (Email: janne.laine@fimnet.fi)
References
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1.Pruss A, Kay D, Fewtrell L. Estimating the burden of disease from water, sanitation and hygiene at a global level. Environmental Health Perspectives 2002; 110: 537542.
2.Reynolds KA, Mena KD, Gerba CP. Risk of waterborne illness via drinking water in the United States. Reviews of Environmental Contamination & Toxicology 2008; 192: 117158.
3.Mac Kenzie RW, et al. A massive oubreak in Milwaukee of Cryptosporidium infection transmitted through the public water supply. New England Journal of Medicine 1994; 331: 161167.
4.Auld H, MacIver D, Klaassen J. Heavy rainfall and waterborne disease outbreaks: the Walkerton example. Journal of Toxicology and Environmental Health 2004; 67: 18791887.
5.Smith A, et al. Outbreaks of waterborne infectious intestinal disease in England and Wales, 1992–2003. Epidemiology and Infection 2006; 134: 11411149.
6.Nygård K, et al. A large community outbreak of waterborne giardiasis – delayed detection in a non-endemic urban area. BMC Public Health 2006; 6: 141.
7.Neringer R, Andersson Y, Eitrem R. A waterborne outbreak of giardiasis in Sweden. Scandinavian Journal of Infectious Diseases 1987; 19: 8590.
8.Carrique-Mas J, et al. A Norwalk-like virus waterborne community outbreak in a Swedish village during peak holiday season. Epidemiology and Infection 2003; 131: 737744.
9.Martin S, et al. A case-control study to investigate concomitant waterborne outbreaks of Campylobacter and gastroenteritis in Soderhamn, Sweden. Journal of Water and Health 2006; 4: 417424.
10.Nygård K, et al. Emerging genotype (GGIIb) of Norovirus in drinking water, Sweden. Emerging Infectious Diseases 2003; 9: 15481552.
11.Hrudey EH, Hrudey EJ. Published case studies of waterborne disease outbreaks – evidence of a recurrent threat. Water Environment Research 2007; 79: 233245.
12.Miettinen I, et al. Waterborne epidemics in Finland in 1998–1999. Water Science and Technology 2001; 43: 6771.
13.Lahti K, Hiisvirta L. Causes of waterborne outbreaks in community water systems in Finland: 1980–1992. Water Science and Technology 1995; 31: 3336.
14.Kuusi M, et al. Internet use and epidemiological investigation of gastroenteritis outbreak. Emerging Infectious Diseases 2004; 10: 447450.
15.Kukkula M, et al. Outbreak of viral gastroenteritis due to drinking water contaminated by Norwalk-like viruses. Journal of Infect Diseases 1999; 180: 17711776.
16.Kuusi M, et al. An outbreak of gastroenteritis from a nonchlorinated community water supply. Journal of Epidemiology & Community Health 2004; 58: 273277.
17.Kuusi M, et al. A large outbreak of campylobacteriosis associated with a municipal water supply in Finland. Epidemiology and Infection 2005; 133: 593601.
18.Maunula L, Miettinen I, von Bonsdorff C-H. Norovirus outbreaks from drinking water. Emerging Infectious Diseases 2005; 11: 17161721.
19.Hänninen ML, et al. Detection and typing of Campylobacter jejuni and Campylobacter coli and analysis of indicator organisms in three waterborne outbreaks in Finland. Applied and Environmental Microbiology 2003; 69: 13911396.
20.Maunula L, et al. Enteritic viruses in a large waterborne outbreak of acute gastroenteritis in Finland. Food and Environmental Virology 2009; 1: 3136.
21.Rimhanen-Finne R, et al. Contaminated water caused the first outbreak of giardiasis in Finland, 2007: a descriptive study. Scandinavian Journal of Infectious Diseases (in press).
22.R Development Core Team. R: A language and environment for statistical computing. Vienna: R foundation for statistical computing, 2009 (http://www.R-project.org).
23.Anon. Sewage contamination of drinking water in Bolton. Communicable Disease Report Weekly 1998; 8: 431.
24.Gallay A, et al. A large multi-pathogen waterborne community outbreak linked to faecal contamination of a groundwater system, France, 2000. Clinical Microbiology and Infection 2006; 12: 561570.
25.Vestergaard L, et al. Outbreak of severe gastroenteritis with multiple aetiologies caused by contaminated drinking water in Denmark, January 2007. Eurosurveillance 2007; 12: E070329.1.
26.Häfliger D, Hubner P, Luthy J. Outbreak of viral gastroenteritis due to sewage-contaminated drinking water. International Journal of Food Microbiology 2000; 54: 123126.
27.Hunter P, Syed Q. Community surveys of self-reported diarrhoea can dramatically overestimate the size of outbreaks of waterborne gastroenteritis. Water Science and Technology 2001; 43: 2730.
28.Wheeler J, et al. Study of infectious intestinal disease in England: rates in the community, presenting to general practise, and reported to national surveillance. British Medical Journal 1999; 318: 10461050.
29.Räsänen S, et al. Mixed viral infections causing acute gastroenteritis in children in a waterborne outbreak. Epidemiology and Infection 2010; 138: 12271234.
30.Horman A, et al. Campylobacter spp., Giardia spp., Cryptosporidium spp., noroviruses and indicator organisms in surface water in southwestern Finland, 2000–2001. Applied and Environmental Microbiology 2004; 70: 8795.
31.Kuusi M, Siitonen A, Eklund M.In: Iivonen J, Kela E, Kuusi M, Lyytikäinen O, Ruutu P, eds. Infectious Diseases in Finland 1994–2004. Helsinki, Finland: National Public Health Institute, 2005.
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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
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