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Chadwick PR, Trainor E, Marsden GL, Mills S, Chadwick C, O'Brien SJ, Evans CM, Mullender C, Strazds P, Turner S, Weston V, Toleman MS, de Barros C, Kontkowski G, Bak A. Guidelines for the management of norovirus outbreaks in acute and community health and social care settings. J Hosp Infect 2023:S0195-6701(23)00043-9. [PMID: 36796728 DOI: 10.1016/j.jhin.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/19/2023] [Accepted: 01/22/2023] [Indexed: 02/17/2023]
Affiliation(s)
| | - Eamonn Trainor
- Northern Care Alliance NHS Foundation Trust, Greater Manchester, UK.
| | - Gemma L Marsden
- Healthcare Infection Society, London, UK; Royal College of General Practitioners, London, UK
| | - Samuel Mills
- British Infection Association, Seafield, West Lothian, UK; Oxford University NHS Foundation Trust, Oxford, UK
| | | | | | - Cariad M Evans
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | | | - Pixy Strazds
- Infection Prevention Society, London, UK; St Andrew's Healthcare, Northampton, UK
| | - Sarah Turner
- Infection Prevention Society, London, UK; Stockport Council, Stockport, UK
| | - Valya Weston
- Healthcare Infection Society, London, UK; Infection Prevention Society, London, UK; NHS England, London, UK
| | - Michelle S Toleman
- Healthcare Infection Society, London, UK; Cambridge University Hospitals NHS Trust, Cambridge, UK
| | | | | | - Aggie Bak
- Healthcare Infection Society, London, UK
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Bortagaray V, Girardi V, Pou S, Lizasoain A, Tort LFL, Spilki FR, Colina R, Victoria M. Detection, Quantification, and Microbial Risk Assessment of Group A Rotavirus in Rivers from Uruguay. FOOD AND ENVIRONMENTAL VIROLOGY 2020; 12:89-98. [PMID: 31792742 DOI: 10.1007/s12560-019-09416-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/21/2019] [Indexed: 06/10/2023]
Abstract
The aim of this study was to detect, quantify, and assess the risk of infection and illness for Group A Rotavirus (RVA) in the watersheds of the Santa Lucia and Uruguay rivers in Uruguay. Monthly sampling was carried out for one year in six sites in the watershed of the Santa Lucía River and four in the Uruguay River. All the collection sites are used for recreational activities. Viral concentration was performed with the adsorption-elution method, and detection and quantification of RVA was carried out by TaqMan quantitative PCR (qPCR). Quantitative microbial risk assessment was applied to estimate the daily and annual risk of RVA infection, as well as the daily risk of illness considering direct exposure through recreational activity. RVA was detected in 42% (20/48) of the analyzed samples in the Uruguay River and 40% (29/72) in the Santa Lucía River. The virus was present in all the analyzed points in both watersheds. A pattern of seasonality, characterized by a higher detection frequency of the virus during coldest month of the year, was observed in both basins. The mean concentration for RVA was 1.3 × 105 genomic copies/L. The microbiological risk assessment shows that Santa Lucía watershed presented the highest daily risk of infection (6.41E-01) and illness (3.20E-01) estimated for the point downstream of Florida City; meanwhile for Uruguay River, the highest probabilities of infection (6.82E-01) and illness (3.41E-01) were estimated for the collection site for drinking water intake in Salto city. These results suggest that RVA contamination of these important rivers negatively impact on their microbiological quality since they are used for recreation and drinking water intake, demonstrating that the disposal of waste from cities located in their riverside confers a constant threat of infection for the general population, especially for children.
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Affiliation(s)
- Viviana Bortagaray
- Laboratory of Molecular Virology, CENUR Litoral Norte, Sede Salto, Universidad de la República, Salto, Uruguay
| | - Viviane Girardi
- Laboratório de Saúde Única, Universidade Feevale, Novo Hamburgo, Brazil
| | - Sonia Pou
- Institute of Research in Health Sciences (INICSA), Faculty of Medical Sciences, CONICET and Biostatistics Unit, School of Nutrition, Faculty of Medical SciencesNational University of Córdoba, Córdoba, Argentina
| | - Andrés Lizasoain
- Laboratory of Molecular Virology, CENUR Litoral Norte, Sede Salto, Universidad de la República, Salto, Uruguay
| | - Luis Fernando López Tort
- Laboratory of Molecular Virology, CENUR Litoral Norte, Sede Salto, Universidad de la República, Salto, Uruguay
| | - Fernando R Spilki
- Laboratório de Saúde Única, Universidade Feevale, Novo Hamburgo, Brazil
| | - Rodney Colina
- Laboratory of Molecular Virology, CENUR Litoral Norte, Sede Salto, Universidad de la República, Salto, Uruguay
| | - Matias Victoria
- Laboratory of Molecular Virology, CENUR Litoral Norte, Sede Salto, Universidad de la República, Salto, Uruguay.
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Two Drinking Water Outbreaks Caused by Wastewater Intrusion Including Sapovirus in Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224376. [PMID: 31717479 PMCID: PMC6888097 DOI: 10.3390/ijerph16224376] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 12/27/2022]
Abstract
Drinking water outbreaks occur worldwide and may be caused by several factors, including raw water contamination, treatment deficiencies, and distribution network failure. This study describes two drinking water outbreaks in Finland in 2016 (outbreak I) and 2018 (outbreak II). Both outbreaks caused approximately 450 illness cases and were due to drinking water pipe breakage and subsequent wastewater intrusion into the distribution system. In both outbreaks, the sapovirus was found in patient samples as the main causative agent. In addition, adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides (outbreak II) were detected in patient samples. Water samples were analyzed for the selected pathogens largely based on the results of patient samples. In addition, traditional fecal indicator bacteria and host-specific microbial source tracking (MST) markers (GenBac3 and HF183) were analyzed from water. In drinking water, sapovirus and enteropathogenic E. coli (EPEC) were found in outbreak II. The MST markers proved useful in the detection of contamination and to ensure the success of contaminant removal from the water distribution system. As mitigation actions, boil water advisory, alternative drinking water sources and chlorination were organized to restrict the outbreaks and to clean the contaminated distribution network. This study highlights the emerging role of sapoviruses as a waterborne pathogen and warrants the need for testing of multiple viruses during outbreak investigation.
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De Giglio O, Caggiano G, Bagordo F, Barbuti G, Brigida S, Lugoli F, Grassi T, La Rosa G, Lucentini L, Uricchio VF, De Donno A, Montagna MT. Enteric Viruses and Fecal Bacteria Indicators to Assess Groundwater Quality and Suitability for Irrigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14060558. [PMID: 28538682 PMCID: PMC5486244 DOI: 10.3390/ijerph14060558] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 05/20/2017] [Accepted: 05/22/2017] [Indexed: 11/18/2022]
Abstract
According to Italian Ministerial Decree No. 185 of 12 June 2003, water is considered suitable for irrigation if levels of fecal bacteria (i.e., Escherichia coli and Salmonella) are within certain parameters. The detection of other microorganisms is not required. The aim of this study is to determine the bacteriological quality of groundwater used for irrigation and the occurrence of enteric viruses (Norovirus, Enterovirus, Rotavirus, Hepatovirus A), and to compare the presence of viruses with the fecal bacteria indicators. A total of 182 wells was analyzed. Widespread fecal contamination of Apulian aquifers was detected (141 wells; 77.5%) by the presence of fecal bacteria (i.e., E. coli, Salmonella, total coliforms, and enterococci). Considering bacteria included in Ministerial Decree No. 185, the water from 35 (19.2%) wells was unsuitable for irrigation purposes. Among 147 wells with water considered suitable, Norovirus, Rotavirus, and Enterovirus were detected in 23 (15.6%) wells. No Hepatovirus A was isolated. Consequently, 58 wells (31.9%) posed a potential infectious risk for irrigation use. This study revealed the inadequacy of fecal bacteria indicators to predict the occurrence of viruses in groundwater and it is the first in Italy to describe the presence of human rotaviruses in well water used for irrigation.
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Affiliation(s)
- Osvalda De Giglio
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Giuseppina Caggiano
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Francesco Bagordo
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Via per Monteroni, Campus Ecotekne, Monteroni di Lecce, 73047 Lecce, Italy.
| | - Giovanna Barbuti
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Silvia Brigida
- Water Research Institute, National Research Council, Viale Francesco de Blasio 5, 70132 Bari, Italy.
| | - Federica Lugoli
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Via per Monteroni, Campus Ecotekne, Monteroni di Lecce, 73047 Lecce, Italy.
| | - Tiziana Grassi
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Via per Monteroni, Campus Ecotekne, Monteroni di Lecce, 73047 Lecce, Italy.
| | - Giuseppina La Rosa
- National Institute of Health, Department of Environment and Health, Viale Regina Elena 299, 00100 Rome, Italy.
| | - Luca Lucentini
- National Institute of Health, Department of Environment and Health, Viale Regina Elena 299, 00100 Rome, Italy.
| | - Vito Felice Uricchio
- Water Research Institute, National Research Council, Viale Francesco de Blasio 5, 70132 Bari, Italy.
| | - Antonella De Donno
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Via per Monteroni, Campus Ecotekne, Monteroni di Lecce, 73047 Lecce, Italy.
| | - Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy.
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Kiulia NM, Hofstra N, Vermeulen LC, Obara MA, Medema G, Rose JB. Global occurrence and emission of rotaviruses to surface waters. Pathogens 2015; 4:229-55. [PMID: 25984911 PMCID: PMC4493472 DOI: 10.3390/pathogens4020229] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 01/03/2023] Open
Abstract
Group A rotaviruses (RV) are the major cause of acute gastroenteritis in infants and young children globally. Waterborne transmission of RV and the presence of RV in water sources are of major public health importance. In this paper, we present the Global Waterborne Pathogen model for RV (GloWPa-Rota model) to estimate the global distribution of RV emissions to surface water. To our knowledge, this is the first model to do so. We review the literature to estimate three RV specific variables for the model: incidence, excretion rate and removal during wastewater treatment. We estimate total global RV emissions to be 2 × 1018 viral particles/grid/year, of which 87% is produced by the urban population. Hotspot regions with high RV emissions are urban areas in densely populated parts of the world, such as Bangladesh and Nigeria, while low emissions are found in rural areas in North Russia and the Australian desert. Even for industrialized regions with high population density and without tertiary treatment, such as the UK, substantial emissions are estimated. Modeling exercises like the one presented in this paper provide unique opportunities to further study these emissions to surface water, their sources and scenarios for improved management.
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Affiliation(s)
- Nicholas M Kiulia
- Department of Fisheries and Wildlife, Michigan State University East Lansing, MI 48824, USA.
- Enteric Viruses Research Group, Institute of Primate Research, P.O Box 24481, 00502 Karen, Nairobi, Kenya.
| | - Nynke Hofstra
- Environmental Systems Analysis Group, Wageningen University, P.O. Box 47, 6700 AA, Wageningen, The Netherlands.
| | - Lucie C Vermeulen
- Environmental Systems Analysis Group, Wageningen University, P.O. Box 47, 6700 AA, Wageningen, The Netherlands.
| | - Maureen A Obara
- Department of Fisheries and Wildlife, Michigan State University East Lansing, MI 48824, USA.
| | - Gertjan Medema
- Faculty of Civil Engineering and Geosciences, Delft University of Technology, P.O. Box 5048, 2600 GA, Delft, the Netherlands.
- KWR Watercycle Research Institute, Groningenhaven 7, 3433 PE, Nieuwegein, The Netherlands.
| | - Joan B Rose
- Department of Fisheries and Wildlife, Michigan State University East Lansing, MI 48824, USA.
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Bonkoungou IJO, Sanou I, Bon F, Benon B, Coulibaly SO, Haukka K, Traoré AS, Barro N. Epidemiology of rotavirus infection among young children with acute diarrhoea in Burkina Faso. BMC Pediatr 2010; 10:94. [PMID: 21171984 PMCID: PMC3013080 DOI: 10.1186/1471-2431-10-94] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Accepted: 12/20/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In anticipation of vaccine introduction, we assessed epidemiology of rotavirus disease among children visiting medical centre due to acute diarrhoea in Ouagadougou, Burkina Faso. METHODS Between November 2008 and February 2010, stool specimens from 447 children less than 5 years of age suffering from diarrhoea were tested for the presence of rotavirus by antigen detection using an immunochromatographic test. Sociodemographic, environmental and clinical factors were assessed during the study. RESULTS Rotavirus antigen was detected in 151 (33.8%) of the patients. Most of the cases (94.2%) were in children < 24 months of age. Fever and vomiting were the symptoms most commonly reported in association with rotavirus diarrhoea and the patients were often hospitalized. Rotavirus-associated diarrhoea occurred mostly during the season from December to April (dry season). Rotavirus infection was significantly less frequent in breast-fed than among bottle-fed babies. CONCLUSIONS The results of this study underscore the need to control rotavirus infections among young children in Burkina Faso and may argue a decision on the introduction of rotavirus vaccine in Burkina Faso.
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Affiliation(s)
- Isidore J O Bonkoungou
- Laboratoire de Biochimie et Biologie Moléculaire, CRSBAN/UFR-SVT, Université de Ouagadougou, 03 BP 7021, Ouagadougou, Burkina Faso.
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Lodder WJ, van den Berg HHJL, Rutjes SA, de Roda Husman AM. Presence of enteric viruses in source waters for drinking water production in The Netherlands. Appl Environ Microbiol 2010; 76:5965-71. [PMID: 20622124 PMCID: PMC2935033 DOI: 10.1128/aem.00245-10] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 06/29/2010] [Indexed: 11/20/2022] Open
Abstract
The quality of drinking water in The Netherlands has to comply with the Dutch Drinking Water Directive: less than one infection in 10,000 persons per year may occur due to consumption of unboiled drinking water. Since virus concentrations in drinking waters may be below the detection limit but entail a public health risk, the infection risk from drinking water consumption requires the assessment of the virus concentrations in source waters and of the removal efficiency of treatment processes. In this study, samples of source waters were taken during 4 years of regular sampling (1999 to 2002), and enteroviruses, reoviruses, somatic phages, and F-specific phages were detected in 75% (range, 0.0033 to 5.2 PFU/liter), 83% (0.0030 to 5.9 PFU/liter), 100% (1.1 to 114,156 PFU/liter), and 97% (0.12 to 14,403 PFU/liter), respectively, of 75 tested source water samples originating from 10 locations for drinking water production. By endpoint dilution reverse transcription-PCR (RT-PCR), 45% of the tested source water samples were positive for norovirus RNA (0.22 to 177 PCR-detectable units [PDU]/liter), and 48% were positive for rotavirus RNA (0.65 to 2,249 PDU/liter). Multiple viruses were regularly detected in the source water samples. A significant correlation between the concentrations of the two phages and those of the enteroviruses could be demonstrated. The virus concentrations varied greatly between 10 tested locations, and a seasonal effect was observed. Peak concentrations of pathogenic viruses occur in source waters used for drinking water production. If seasonal and short-term fluctuations coincide with less efficient or failing treatment, an unacceptable public health risk from exposure to this drinking water may occur.
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Affiliation(s)
- W J Lodder
- Laboratory for Zoonoses and Environmental Microbiology, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, P.O. Box 1, NL-3720 BA Bilthoven, The Netherlands.
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Rizzo C, Di Bartolo I, Santantonio M, Coscia MF, Monno R, De Vito D, Ruggeri FM, Rizzo G. Epidemiological and virological investigation of a Norovirus outbreak in a resort in Puglia, Italy. BMC Infect Dis 2007; 7:135. [PMID: 18021429 PMCID: PMC2194716 DOI: 10.1186/1471-2334-7-135] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Accepted: 11/19/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper describes the third large outbreak of Norovirus (NoV) gastroenteritis reported in the Southern Italy region of Puglia. METHODS A matched case control study was conducted, on 19 July 2005, for investigating risk factors, using a structured questionnaire on food consumption. A multivariate analysis was conducted to estimate the adjusted Odds Ratios. Laboratory and environmental investigation were also performed. RESULTS On the day of the study 41 cases were identified and 41 controls were enrolled. Controls were matched for age and gender. The mean age of the cases was 26 years old, and 58% were female. The clinical pattern of the disease was characterised by the presence of diarrhoea (95%), vomiting (70%), abdominal pain (51%) and fever (32%). Of the 41 cases included in the study, the majority (65%) were residents of Northern Italian regions. No food samples were available for testing. The matched univariate analysis revealed that cases were more likely to have consumed raw mussels, eggs or ice cubes made of tap water than controls. In the multivariate conditional logistic regression analysis, having eaten raw mussels or ice became more strongly associated with illness. All of the 20 faecal samples collected were tested for NoVs. Eighteen stools (90% of total examined) were positive by RT-PCR, and sequence analysis performed onto 3 samples confirmed the presence of a GGII NoV. No test specific for NoV was performed on water or food samples. CONCLUSION The most likely hypothesis supported by the findings of the epidemiological investigation was that illness was associated with raw mussels and ice, made with tap water. These hypothesis could not be confirmed by specific microbiologic testing for NoV in food or ice. The lack of clear knowledge of NoV as a major causative agent of epidemic outbreaks of gastroenteritis in Italy is due to the absence of timely reporting of the cases to the local public health offices and the uncommon practice of saving clinical samples for virological analysis after bacteriological testing.
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