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Outbreak of Norwalk virus in a Caribbean island resort: application of molecular diagnostics to ascertain the vehicle of infection

Published online by Cambridge University Press:  16 July 2001

C. M. BROWN ,
J. W. CANN ,
G. SIMONS ,
R. L. FANKHAUSER ,
W. THOMAS ,
U. D. PARASHAR  and
M. J. LEWIS
C. M. BROWN
Affiliation:
Epidemiology Division, Caribbean Epidemiology Centre, Pan America Health Organization, 16-18 Jamaica Boulevard, Federation Park, Republic of Trinidad and Tobago
J. W. CANN
Affiliation:
Department of Health, Bermuda Ministry of Health
G. SIMONS
Affiliation:
Department of Health, Bermuda Ministry of Health
R. L. FANKHAUSER
Affiliation:
Viral Gastroenteritis Section, Respiratory and Enteric Viruses Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
W. THOMAS
Affiliation:
Environmental Health Advisor, Jamaica PAHO/WHO Representative Office, Pan America Health Organization
U. D. PARASHAR
Affiliation:
Viral Gastroenteritis Section, Respiratory and Enteric Viruses Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
M. J. LEWIS
Affiliation:
Epidemiology Division, Caribbean Epidemiology Centre, Pan America Health Organization, 16-18 Jamaica Boulevard, Federation Park, Republic of Trinidad and Tobago
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Abstract

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In 1998, an outbreak of gastroenteritis affected at least 448 persons including 122 staff at a resort hotel in Bermuda. A survey among staff indicated that gastroenteritis was associated with eating or drinking at the hotel (OR = 6·0, 95% CI = 2·4–15·1). Multiple specimens of drinking water had elevated faecal coliform levels and Escherichia coli present, suggestive of faecal contamination. Stools from 18 of the 19 persons with gastroenteritis that were tested were positive for genogroup-II Norwalk-like viruses (NLVs). RT–PCR analysis of a 3 l specimen of water produced a genogroup-II NLV genome with a sequence identical to that of NLVs in the stools of three ill persons. This outbreak shows the value of new molecular diagnostics to link illness with a contaminated source through the use of sequence analysis. The risk of outbreaks such as these could be reduced in tourism dependent regions like Bermuda and the Caribbean by regular evaluation of data from the inspection and monitoring of drinking water supplies and waste water systems, by ensuring the chlorination of supplemental drinking water supplies and by establishing food-safety initiatives.

Type
Research Article
Information
Epidemiology & Infection , Volume 126 , Issue 3 , June 2001 , pp. 425 - 432
Copyright
© 2001 Cambridge University Press