Norovirus Outbreak Associated with Swimming in a Recreational Lake Not Influenced by External Human Fecal Sources in The Netherlands, August 2012.
Schets, Franciska M van den Berg, Harold H J L Vennema, Harry Pelgrim, Manon T M Collé, Cees Rutjes, Saskia A Lodder, Willemijn J
Schets, Franciska M
van den Berg, Harold H J L
Vennema, Harry
Pelgrim, Manon T M
Collé, Cees
Rutjes, Saskia A
Lodder, Willemijn J
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Open Access
Type
Article
Language
en
Date of publication
2018-11-14
Year of publication
Research Projects
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Journal Issue
Title
Norovirus Outbreak Associated with Swimming in a Recreational Lake Not Influenced by External Human Fecal Sources in The Netherlands, August 2012.
Translated Title
Published in
Int J Environ Res Public Health 2018; 15(11):pii.e2550
Abstract
Swimming in fecally contaminated recreational water may lead to gastrointestinal illness. A recreational water-associated outbreak of norovirus (NoV) infections affecting at least 100 people in The Netherlands occurred in August 2012. Questionnaire responses from patients indicated swimming in recreational lake Zeumeren as the most likely cause of illness. Most patients visited the lake during the weekend of 18⁻19 August, during which the weather was exceptionally warm (maximum temperatures 32⁻33 °C), and visitor numbers elevated. Patients, mostly children, became ill with gastroenteritis 1⁻6 days (median 2 days) after exposure. Four stool samples from patients were NoV GI positive. Subsurface sandy soil from one of the beaches where most patients swam was NoV GI positive; the water sample was negative. The epidemiological curve and the timeline of investigation based on reported symptoms demonstrate the difficulty in discovering the source in recreational water outbreaks. A NoV outbreak in a recreational lake that is not subjected to external fecal contamination sources shows the need for active communication about human shedding of viruses during and after diarrheal episodes and the advice to refrain from swimming, even a few weeks after the symptoms have resolved.