How did the noro get into the bottled water?

Over 4000 illnesses linked to bottled water in Spain and there are a few theories how the virus got into the hundreds of coolers and fridges across the country. Maybe someone puked in the bottling plant, spreading virus particles all over. My money goes on the source.

Whatever the cause, it’s likely little comfort to those who were barfing as a result.

Live Science reports that the thousands of ill folks consumed water cooler water in early April.

It’s possible that norovirus contaminated the water at its source where it was bottled, said Benjamin Chapman, an associate professor and food safety specialist at North Carolina State University, who was not involved in the investigation. In this case, the spring water was bottled in Andorra, a small country located in the Pyrenees mountains between Spain and France.amd-water-cooler-jpg

Norovirus is spread through fecal matter, and in past outbreaks, drinking water became contaminated when sewage leaked into the water source, Chapman said. Given that the recent outbreak in Spain was so large, with hundreds of bottles affected, “it’s more likely that it would be source contamination,” as opposed to contamination at some later point in the bottling process, Chapman said.

Still, it’s also possible that the water was contaminated at the manufacturing facility. Norovirus is a very hardy virus, Chapman said, and if someone with the illness vomited at a bottling facility, this could contaminate equipment used for bottling the water, Chapman said.

Crypto in the US

Cryptosporidium is the leading aetiology of waterborne disease outbreaks in the United States. This report briefly describes the temporal and geographical distribution of US cryptosporidiosis cases and presents analyses of cryptosporidiosis case data reported in the United States for 1995–2012.

cryptoThe Cochran–Armitage test was used to assess changes in the proportions of cases by case status (confirmed vs. non-confirmed), sex, race, and ethnicity over the study period. Negative binomial regression models were used to estimate rate ratios (RR) and 95% confidence intervals (CI) for comparing rates across three time periods (1995–2004, 2005–2008, 2009–2012). The proportion of confirmed cases significantly decreased (P < 0·0001), and a crossover from male to female predominance in case-patients occurred (P < 0·0001). Overall, compared to 1995–2004, rates were higher in 2005–2008 (RR 2·92, 95% CI 2·08–4·09) and 2009–2012 (RR 2·66, 95% CI 1·90–3·73). However, rate changes from 2005–2008 to 2009–2012 varied by age group (Pinteraction < 0·0001): 0–14 years (RR 0·55, 95% CI 0·42–0·71), 15–44 years (RR 0·99, 95% CI 0·82–1·19), 45–64 years (RR 1·47, 95% CI 1·21–1·79) and ≥65 years (RR 2·18, 95% CI 1·46–3·25).

The evolving epidemiology of cryptosporidiosis necessitates further identification of risk factors in population subgroups. Adding systematic molecular typing of Cryptosporidium specimens to US national cryptosporidiosis surveillance would help further identify risk factors and markedly expand understanding of cryptosporidiosis epidemiology in the United States.

Evolving epidemiology of reported cryptosporidiosis cases in the United States, 1995–2012

E. Paintera1 c1, J. W. Garganoa2, J. S. Yodera2, s. A. Colliera2 and M. C. Hlavsaa2

a1 Epidemic Intelligence Service Officer, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA

a2 Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA

Epidemiology and Infection, Volume 144, Issue 8, June 2016, pages 1792-1802, DOI:

Over 1200 sick: Campaign launched to fight Norovirus infection in Philippines

It’s gonna to more than edumacation to “effectively prevent and control the spread of the viral infection in Manila.

dude.wash.handsCity Health Officer Dr. Rodel Agbulos said his office has been saturating the different communities with varied information, education and communication (IEC) materials, through health centers and places of convergence in the different barangays.

Through the declaration, the CHO and other concerned offices and agencies and all health institutions in the city have been directed to institute, undertake and implement curative and proactive measures to effectively address and eradicate the outbreak.

CHO Epidemiology Division Chief Dr. Ivy Iturralde said the aggressive campaign will be focused on the practice of hand washing and proper hygiene.

We just distribute the poop: 3166 sick – probably noro — in Spain linked to bottled water

Gastroenteritis caused by bottled water has affected 3,166 people in Catalonia, according to the regional health department.

05_eden LOGOThe origin of the intoxication is a norovirus that was discovered in bottles distributed throughout Barcelona and Tarragona on April 7, 8, 11, 12 and 13.

The water was drawn from a natural spring called Arinsal, in the principality of Andorra between Spain and France. It was distributed in Catalonia by a company named Eden.

Eden notes that it receives the sealed bottles from Andorra and merely distributes them.

Health authorities are calling all businesses that sold the product in a bid to tally a final number of affected customers. Because the gastroenteritis had mild effects, not all patients went to the doctor, department sources said.

The first tests conducted on patient samples show the presence of a norovirus, a microorganism that is responsible for half of all common gastroenteritis. It is present in animal droppings, which can contaminate the water.

678 sick with gastro linked to bottled water in Spain

The health authority of the northeastern Spanish region of Catalonia says more than 670 people have been affected by an outbreak of gastroenteritis linked to bottled water.

05_eden LOGOThe authority said on its official Twitter account that, as of Saturday, 678 people had been treated for symptoms including nausea, vomiting, abdominal pain, diarrhea and high fever.

Catalonia’s regional health agency said in a statement that bottles of water have been withdrawn from retail outlets and scientific samples are being taken from bottling plants and distributors to determine the source of the outbreak. It did not name the company.

The bottled water company Grupo Eden Springs, however, said in a statement it had withdrawn pallets of bottled water that came from its source in Font d’Arinsal, near Barcelona.

Water and friends

I sometimes retweet my friend Jim Fischer’s accounts of his new ventures as a maple syrup producer (Canadian, eh), B&B entrepreneur, forest management dude, and high school supply teacher.

braunwynn.kittens.03He’s lived a rich life, and will continue. Look at his mother (below, left), 92-years-old and pulling the last syrup off this year’s batch, yesterday.

But when I think of Jim, it’s not his passion for agriculture, his family, or how he always terrified my girls when he delivered chickens by telling them that any cats on his dairy farm would be shot, instantly, to reduce the risk of disease (in fairness, Jim did arrange for us to adopt 3 kittens from the Walkerton animal shelter).

When I think of Jim, it’s how he handled the outbreak of E. coli O157 in Walkerton, Ontario in 2000 that killed seven and sickened 2,500 in a town of 5,000.

“Whenever we heard a helicopter, it probably meant someone else had died.”

That outbreak took a huge toll, in numbers, and in personal memories.

Water, so essential, so precious.

Water safety is vital, and the quality of water important in terms of public health. One of the objectives of the Water Quality and Health Strategy of the World Health Organization (WHO) for the 2013 to 2020 period, is to obtain ‘the most rigorous and relevant evidence regarding water quality and health’ [1].

In terms of infectious diseases, water can transport pathogens in the environment through different steps of the water cycle [2,3]. In the water, some physical or chemical parameters, e.g. temperature, pH, salinity, organic matter, may affect the survival of the pathogens [4]. Substances intended to control pathogens or insects (antimicrobials,  antivirals and pesticides) can occur in water subsequent to their use [5,6] or manufacturing process [7,8]. This may paradoxically induce pathogen or vector resistance to these substances [9-12]. Moreover, water can also bear a number of pathogens with resistance acquired through other pathways [13]. Exposure of people to waterborne pathogens may occur by drinking or swallowing water, inhaling aerosolised droplets and contact with water through bathing and recreation [14,15]. Some pathogens may also be disseminated by water further in the environment (e.g. in the soil and air) potentially allowing human exposure. Consuming foods, grown on/in or irrigated with pathogen-contaminated water may also lead to infection [16,17].

fischer.syrup.apr.16As a number of changes to water, e.g. canalisation, temperature, nutrient enrichment, addition of pest-control or antimicrobial/viral substances, and pathogen contamination, result from human activities, it is relevant to understand their impact on infectious disease epidemiology. To provide some examples relevant for European public health, and to present issues related to the detection and identification of cases of waterborne outbreaks and the proof of anthropogenic change to water as the cause, we issued a call for papers [18]. Subsequent to this, we now publish five articles, through which a number of issues arise and which can be summarised as follows.

The challenges of outbreaks potentially caused by microbial contamination of water are first illustrated in a report from Italy, where an outbreak of monophasic Salmonella Typhimurium 1,4 [5],12:i:- with sole resistance to nalidixic acid is described [19]. Attempts to determine the source of this outbreak led to extensive environmental investigations. While its cause could not be ascertained, a number of surface water samples in the outbreak area, including of water used for growing fruit and vegetables, were positive for the outbreak strain. Moreover some water samples from local sewage treatment plants also tested positive, thus leading to the hypothesis that wastewater may have contaminated irrigation water [19]. The epidemiological investigation was complicated and the origin of the outbreak strain and how this strain acquired its resistance to nalidixic acid remain unresolved. The study reinforces the value of detecting waterborne outbreaks early.

Generally, water may become contaminated from a non-point source, such as the runoff of water from manure in agricultural fields, or from a point discharge, such as a hospital wastewater outlet or a sewage treatment plant. The issue of clinical wastewater harbouring microorganisms resistant to antimicrobials, and its subsequent effect on sewage and freshwater is important for public health, particularly if resistant bacteria introduced in the water can not only survive but also grow in wastewater. Acinetobacter baumanni for example, is considered a nosocomial pathogen, but its ecology is as of yet not fully understood and the observation of community outbreaks has made environmental niches suspect. A study from Croatia finds multiresistant A. baumannii strains in both influent and effluent water to a sewage treatment plant in Zagreb, indicating that such strains can evade the treatment process. The study shows moreover that isolated strains can survive and grow in effluent sewage water up to 50 days, posing a potential risk for further dissemination in the recipient river to the plant [20].

As a risk exists for surface water to become contaminated by wastewater pathogens, there is relevance in fully assessing its safety for further human use. A study from Serbia conducted during the bathing season reveals adenovirus and rotavirus genetic materials in recreational waters of the Danube, along popular public beaches in addition to faecal contamination. As the presence of viruses could not necessarily be predicted by the amount of bacteria measured in the water via routine quality control, the authors conclude that viral indicators may be helpful for further assessing the risks posed by water, in particular in areas where the sewer network is insufficient or inadequate [21].

walkertonWhich panels of viruses could serve as relevant indicators of water quality in certain circumstances would need further investigations, as this may depend in part on their infectivity doses and persistence in environmental water. Also this might require to know what potential viruses contaminate the water to begin with, possibly first requiring agnostic screening techniques. In this regard, the development and implementation of assays that can be used for the surveillance of the whole population of viruses in water samples can be of interest. In this special issue, a methodology combining tangential flow filtration of sewage combined with deep sequencing, without the need for cell culture, is presented as an agnostic approach to survey viruses in sewage. The use of this methodology is proposed for the surveillance of poliovirus, but broader applications, including creating new viral sequence databases for retrospective analysis of presently unknown human viruses that may be discovered in the future are suggested [22].

Should it be a priori known what viruses likely contaminate water in an area, defining more specific tools to confirm their presence may be considered. Moreover in terms of further risk assessment, and as also discussed in the Serbian study in this issue [21], assays to determine the presence of infectious virus might also be of value.

As illustrated by some of the above studies [19,21], adequate management of wastewater is crucial. Indeed, water contaminated by wastewater can subsequently cumulate in larger water bodies such as lakes or the ocean. There, its impact may be less clear, as not only pathogens, but supportive nutrients may be carried by the wastewater. In combination with meteorological factors such as temperature, this may lead to the sporadic or intermittent occurrence of ‘exotic’ or ‘unusual’ pathogens in some areas [4]. An article from the Netherlands describes three cases of Vibrio cholera non-O1 serogroup (VCNO) bacteraemia reported in the country. Cases had been prior exposed to fish and/or had contact with surface water. The Dutch study includes a review of the literature to identify sources and risk factors for bacteraemia [23].

In conclusion, this special issue provides some insights into the importance of surveillance of pathogens in the water [19-23] and outbreaks or cases caused by waterborne pathogens [19,21,23]. Wider studies could help further refine criteria for assessing water treatment processes. Through pollution of ground water with antimicrobials and multi-resistant bacteria, waterborne outbreaks of multi-resistant bacteria are likely to become more frequent in the future. The special issue illustrates that addressing the problems due to anthropogenic changes to water on the epidemiology of human pathogens will require a multi-disciplinary approach.

A note from the editors: impact of anthropogenic changes to water on human pathogens

Eurosurveillance, Volume 21, Issue 15, 14 April 2016

Water suspected: 114 sick with Hepatitis A in Kenya

Mombasa residents are living in fear after the county’s health department confirmed that cases of Hepatitis A infections have risen from 21 to 114 as at Tuesday this week.

mqdefaultCounty officials on Wednesday held a crisis meeting to discuss how the menace will be tackled.

Speaking at the Coast General Hospital on Wednesday, the Mombasa County government Secretary Francis Thoya said that the outbreak has sent county health officials into panic mode.

Thoya said the rate at which the cases are increasing is disturbing, adding that the county is working round the clock to stabilise the situation.

“We have set aside eleven million shillings to tackle the problem before it gets out of hand,” said Thoya.

It’s out of control.

Argentine city suspends classes after gastroenteritis kill girl

In all, 56 schools in Berazategui, in metropolitan Buenos Aires, Argentina, suspended classes on Thursday (14) after a gastrointerite outbreak that has reached 250 people and caused the death of a girl. The suspicion is that the water is contaminated.

water.argentinaIn a statement posted on his Facebook account, the mayor of Berazategui, Juan Patricio Muzzi, announced that colleges will not work for 48 hours to carry out “preventive cleaning and take sample of water tanks and troughs.”

“Last week, we serve more than 250 cases. And second was informed today in the Situation Room led by the holder of borense health folder, Zulma Ortiz, hospital Evita Pueblo, the most affected are children,” reported the mayor in the post .

According to him, the first tests of laboratories indicate the cause of shigella bacteria.

I miss my hot tub, I miss my sauna, I don’t miss the viruses

From August to September 2014 a water quality study was conducted on five popular public Danube beaches in Vojvodina, Serbia.

serbia.beach.waterTo assess the safety of Danube water for bathing, physical, chemical, bacteriological tests were performed. While many parameters for monitoring the quality of water are regulated by law, there are neither national nor international legislations addressing the presence of viruses in recreational waters. In this study, we performed analyses that surpassed national requirements, and investigated if adenovirus, enterovirus or rotavirus genetic material was present in samples of recreational water collected for quality monitoring.

Of 90 water samples obtained during the study, enterovirus material was not found in any sample, but adenovirus and rotavirus genetic materials were respectively detected in 60 and 31 samples. Statistical analyses showed a significant correlation between adenovirus DNA and total coliforms in the water. Even when water samples were adequate for recreational use, adenoviruses were detected in 75% (57/76) of such samples. Our results indicate that implementation of viral indicators in recreational water might be helpful to better assess public health safety. This might be particularly relevant in areas where urban wastewater treatment is insufficient and surface waters affected by wastewater are used for recreation.

Testing For Viral Material In Water Of Public Bathing Areas Of The Danube During Summer, Vojvodina, Serbia, 2014

Eurosurveillance, Volume 21, Issue 15, 14 April 2016

A Jovanović Galović, S Bijelović, V Milošević, I Hrnjaković Cvjetkovic, M Popović, G Kovačević , J Radovanov, N Dragić, V Petrović

Blame consumers, Guyana edition: Health ministry says gastro outbreaks possible because of unhygienic practices

While a reoccurrence of an outbreak of gastroenteritis is not unlikely, deliberate efforts have been advanced by the Ministry of Public Health to reduce this possibility. This state of affairs has been vocalised by both Ministers within the Public Health Ministry, Dr. George Norton and Dr. Karen Cummings.



Sporadic outbreaks of gastroenteritis in some hinterland sections of the country over the years have been deemed a challenge to the Ministry. It is, however, one that the Ministry has grown accustomed to.

Nothing speaks government action like, “we’re accustomed to this.”

An outbreak in Region One reported on earlier this year came as no surprise to the Public Health Ministry, said Minister Norton. In January the public health sector reported an outbreak which sickened scores of residents in Baramita, Region One.

Minister Norton in revealing that the outbreak has been linked to contaminated water said, “We know that over the years, usually at the start of some years, we have had gastroenteritis outbreaks. A few years ago we had a few deaths as a result but this time around we had doctors on the ground and medications including rehydration solutions and so on because we were looking out for it. So when it started out in Baramita we managed to control it from the initial stages.”

Prior to the outbreak reported earlier this year, the public health sector was faced with an outbreak in 2013. During that time more than 200 residents in various Region One communities became ill. At least three children died.

According to Minister Cummings, the most recent gastroenteritis outbreak was reported from Baramita and its surrounding settlements. Between December 3, 2015 and January 16, 2016, a total of 102 cases were documented by the Ministry.

However, by January 20, 2016 the cases had mounted to 122 based on data received from the Senior Environmental Officer in Region One, Minister Cummings informed. The Minister shared too that at least one death was linked to the outbreak. The reported death was that of an 11-month-old child on December 27, 2015 who manifested symptoms including malnutrition, diarrhoea and vomiting, consistent with gastroenteritis.

Minister Cummings disclosed that while follow up visits to the Region One villages revealed that the majority of villagers are adhering to the use of purification tablets or chlorine and some had even erected ventilated pit latrines, the fact that there are some who are not adhering suggest that a repeat outbreak is not unlikely.

“The possibility exists because villagers are not 100 per cent compliant in maintaining hygienic standards, despite sensitization efforts, because of health behaviour and cultural practices,” Minister Cummings said.