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Volume 11, Number 11—November 2005

Norovirus Outbreaks from Drinking Water

Leena Maunula*†, Ilkka T. Miettinen‡, and Carl-Henrik von Bonsdorff*†
Author affiliations: *HUCH Laboratory Diagnostics, Helsinki, Finland; †University of Helsinki, Helsinki, Finland; ‡National Public Health Institute, Kuopio, Finland

Main Article

Table 1

Suspected and identified norovirus outbreaks, Finland, 1998–2003

Outbreak Date No. exposed/no. ill Water source
E1, community* Mar 1998 5,000/2,500 Surface water used as tap water
E2, community Apr 1998 15,000/2,000 Ground water
E3, rental camp cottage Jul 1998 45/13 Well
E4, camp on island Aug 1998 120/40 Communal, well
E5, community Jan 1999 2,500/200 Ground water
E6, factory area Feb 1999 250/100 Ground water
E7, community Apr 1999 160/58 Ground water
E8, spa Jul 1999 100/60 Well
E9, community* Mar 2000 10,000/5,500 Ground water
E10, private household Aug 2000 14/13 Well (drilled)
E11, community Dec 2000 2,200/300 Ground water
E12, farm (for guests) Apr 2002 50/25 Well (dug)
E13, community Oct 2002 960/300 Ground water
E14, guest house Feb 2003 13/11 Lake water used for drinking
E15, community May 2003 150/95 Well (drilled)
E16, rental cottage Aug 2003 25/20 Well
E17, holiday camp May 2003 56/40 Surface water (river)
E18, community Apr 2003 90/40 Ground water, broken pipe

*Detailed descriptions of the epidemics E1 and E9 have been published (10,19).

Main Article

  1. Wyn-Jones  A, Sellwood  J. Enteric viruses in the aquatic environment. J Appl Microbiol. 2001;91:94562. DOIPubMedGoogle Scholar
  2. Green  KY, Chanock  M, Kapikian  AZ. Human caliciviruses. In: Knipe D, editor. Fields virology. 4th ed. Philadelphia: Lippincott, Williams and Wilkins; 2001. p. 841–74.
  3. Vinje  J, Hamidjaja  RA, Sobsey  MD. Development and application of a capsid VP1 (region D) based reverse transcription PCR assay for genotyping of genogroup I and II noroviruses. J Virol Methods. 2004;116:10917. DOIPubMedGoogle Scholar
  4. Koopmans  M, von Bonsdorff  CH, Vinje  J, de Medici  D, Monroe  S. Foodborne viruses. FEMS Microbiol Rev. 2002;26:187205.PubMedGoogle Scholar
  5. Mead  P, Slutsker  L, Dietz  V, McCaig  LF, Bresee  JS, Shapiro  C, Food-related illness and death in the United States. Emerg Infect Dis. 1999;5:60725. DOIPubMedGoogle Scholar
  6. Kaplan  JE, Goodman  RA, Schonberger  LB, Lippy  EC, Gary  GW. Gastroenteritis due to Norwalk virus: an outbreak associated with a municipal water system. J Infect Dis. 1982;146:1907. DOIPubMedGoogle Scholar
  7. Blackburn  BG, Craun  GF, Yoder  JS, Hill  V, Calderon  RL, Chen  N, Surveillance for waterborne-disease outbreaks associated with drinking water—United States, 2001–2002. MMWR Surveill Summ. 2004;53:2345.PubMedGoogle Scholar
  8. Beller  M, Ellis  A, Lee  SH, Drebot  MA, Jenkerson  SA, Funk  E, Outbreak of viral gastroenteritis due to a contaminated well. International consequences. JAMA. 1997;278:5638. DOIPubMedGoogle Scholar
  9. Vinje  J, Vennema  H, Maunula  L, von Bonsdorff  CH, Hoehne  M, Schreier  E, International collaborative study to compare reverse transcriptase PCR assays for detection and genotyping of noroviruses. J Clin Microbiol. 2003;41:142333. DOIPubMedGoogle Scholar
  10. Kukkula  M, Maunula  L, Silvennoinen  E, von Bonsdorff  CH. Outbreak of viral gastroenteritis due to drinking water contaminated by Norwalk-like viruses. J Infect Dis. 1999;180:17716. DOIPubMedGoogle Scholar
  11. PHLS Communicable Disease Surveillance Centre. Strength of association between human illness and water: revised definitions for use in outbreak investigation. Commun Dis Rep CDR Wkly. 1996;6:65,8.
  12. Gilgen  M, Germann  D, Lüthy  J, Hübner  P. Three-step isolation method for sensitive detection of enterovirus, rotavirus, hepatitis A virus, and small round structured viruses in water samples. Int J Food Microbiol. 1997;•••:18999. DOIPubMedGoogle Scholar
  13. Maunula  L, Piiparinen  H, von Bonsdorff  CH. Confirmation of Norwalk-like virus amplicons after RT-PCR by microplate hybridization and direct sequencing. J Virol Methods. 1999;83:12534. DOIPubMedGoogle Scholar
  14. Le Guyader  F, Estes  MK, Hardy  ME, Neill  FH, Green  J, Brown  DW, Evaluation of a degenerate primer for the PCR detection of human caliciviruses. Arch Virol. 1996;141:222535. DOIPubMedGoogle Scholar
  15. Wang  J, Jiang  X, Madore  HP, Gray  J, Desselberger  U, Ando  T, Sequence diversity of small, round-structured viruses in the Norwalk virus group. J Virol. 1994;68:598290.PubMedGoogle Scholar
  16. Green  J, Gallimore  CI, Norcott  JP, Lewis  D, Brown  DW. Broadly reactive reverse transcriptase polymerase chain reaction for the diagnosis of SRSV-associated gastroenteritis. J Med Virol. 1995;47:3928. DOIPubMedGoogle Scholar
  17. Vinje  J, Green  J, Lewis  DC, Gallimore  CI, Brown  DW, Koopmans  MP. Genetic polymorphism across regions of the three open reading frames of "Norwalk-like viruses.". Arch Virol. 2000;145:22341. DOIPubMedGoogle Scholar
  18. Koopmans  M, Vennema  H, Heersma  H, van Strien  E, van Duynhoven  Y, Brown  D, Early identification of common-source foodborne virus outbreaks in Europe. Emerg Infect Dis. 2003;9:113642.PubMedGoogle Scholar
  19. Kuusi  M, Nuorti  JP, Maunula  L, Miettinen  I, Pesonen  H, von Bonsdorff  CH. Internet use and epidemiologic investigation of gastroenteritis outbreak. Emerg Infect Dis. 2004;10:44750.PubMedGoogle Scholar
  20. Lopman  B, Vennema  H, Kohli  E, Pothier  P, Sanchez  A, Negredo  A, Increase in viral gastroenteritis outbreaks in Europe and epidemic spread of new norovirus variant. Lancet. 2004;363:6828. DOIPubMedGoogle Scholar
  21. Maunula  L, von Bonsdorff  C-H. Norovirus genotypes causing gastroenteritis outbreaks in Finland 1998–2002. J Clin Virol. Epub 2005 May 20.PubMedGoogle Scholar
  22. Parshionikar  SU, Willian-True  S, Fout  GS, Robbins  DE, Seys  SA, Cassady  JD, Waterborne outbreak of gastroenteritis associated with a norovirus. Appl Environ Microbiol. 2003;69:52638. DOIPubMedGoogle Scholar
  23. Hoebe  CJ, Vennema  H, Husman  AM, van Duynhoven  YT. Norovirus outbreak among primary schoolchildren who had played in a recreational water fountain. J Infect Dis. 2004;189:699705. DOIPubMedGoogle Scholar
  24. Noel  JS, Fankhauser  RL, Ando  T, Monroe  SS, Glass  RI. Identification of a distinct common strain of "Norwalk-like viruses" having a global distribution. J Infect Dis. 1999;179:133444. DOIPubMedGoogle Scholar
  25. Fankhauser  RL, Monroe  SS, Noel  JS, Humphrey  CD, Bresee  JS, Parashar  UD, Epidemiologic and molecular trends of "Norwalk-like viruses" associated with outbreaks of gastroenteritis in the United States. J Infect Dis. 2002;186:17. DOIPubMedGoogle Scholar
  26. Nygard  K, Torven  M, Ancker  C, Knauth  SB, Hedlund  KO, Giesecke  J, Emerging genotype (GGIIb) of norovirus in drinking water, Sweden. Emerg Infect Dis. 2003;9:154852.PubMedGoogle Scholar
  27. Lapinleimu  K, Stenvik  M. The efficacy of polio vaccination in Finland. Dev Biol Stand. 1978;41:1379.PubMedGoogle Scholar
  28. Boccia  D, Tozzi  AE, Cotter  B, Rizzo  C, Russo  T, Buttinelli  G, Waterborne outbreak of Norwalk-like virus gastroenteritis at a tourist resort, Italy. Emerg Infect Dis. 2002;8:5638.PubMedGoogle Scholar
  29. Anderson  AD, Heryford  AG, Sarisky  JP, Higgins  C, Monroe  SS, Beard  RS, A waterborne outbreak of Norwalk-like virus among snowmobilers—Wyoming, 2001. J Infect Dis. 2003;187:3036. DOIPubMedGoogle Scholar
  30. Kageyama  T, Kojima  S, Shinohara  M, Uchida  K, Fukushi  S, Hoshino  FB, Broadly reactive and highly sensitive assay for Norwalk-like viruses based on real-time quantitative reverse transcription-PCR. J Clin Microbiol. 2003;41:154857. DOIPubMedGoogle Scholar
  31. Hohne  M, Schreier  E. Detection and characterization of norovirus outbreaks in Germany: application of a one-tube RT-PCR using a fluorogenic real-time detection system. J Med Virol. 2004;72:3129. DOIPubMedGoogle Scholar
  32. Beuret  C. Simultaneous detection of enteric viruses by multiplex real-time RT-PCR. J Virol Methods. 2004;115:18. DOIPubMedGoogle Scholar
  33. World Health Organization. Guidelines for drinking-water quality. 3rd ed [monograph on the Internet]. 2004 [cited 2005 Sep 8]. Available from
  34. Payment  P, Franco  E, Fout  GS. Incidence of Norwalk virus infections during a prospective epidemiological study of drinking water-related gastrointestinal illness. Can J Microbiol. 1994;40:8059. DOIPubMedGoogle Scholar
  35. Lees  D. Viruses and bivalve shellfish. Int J Food Microbiol. 2000;59:81116. DOIPubMedGoogle Scholar

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