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VIRAL GASTROENTERITIS - ITALY: (BRESCIA) NOROVIRUS SUSPECTED
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A ProMED-mail post
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International Society for Infectious Diseases
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Date: Fri 26 Jun 2009
From: Giorgio Varisco
<giorgio.varisco@izsler.it>
Viral Gastroenteritis Outbreak
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In recent days local and national newspapers have reported data and
information on several cases of gastroenteritis outbreaks involving
humans in a small town, named San Felice del Benaco, on Lake Garda,
North Italy [Brescia province, Lombardy region]. At the moment more
than 2000 people seem to have been affected, showing a variable degree
of severity of clinical signs and at least 100 people have asked for
assistance at local hospitals.
Since the occurrence of cases of diarrhoea was initially related by
local health authorities to a potential contamination of public water
distribution, samples of water and faecal samples from affected
patients were taken by personnel of the ASL of Brescia (the local
Public Health body) and sent to the Istituto Zooprofilattico
Sperimentale della Lombardia e dell'Emilia Romagna (IZSLER) for
laboratory investigations in order to ascertain if any infectious
agent (enteric viruses and or bacteria such as _Clostridium
perfrigens_, _Escherichia coli_, _Salmonella_ sp., _Shigella_ sp.,
etc.) was involved as the causative agent of the outbreak of enteritis.
At IZSLER (a governmental institute that offers services in the
Veterinary Public Health sector) diagnostic investigations were
performed on samples from over 40 individuals using different methods
(bacteriologic and parasitologic routine tests, negative staining
electron microscopy, PCR etc). The preliminary results indicated the
presence of different infectious agents both viruses (norovirus and
rotavirus) and bacteria in any type of samples examined; i.e., public
water supply and faeces of affected diarrhoeic patients.
These data indicate a likely multiple contamination of drinking water
as origin of the outbreak. The clinical course and the symptoms
observed are suggestive of a viral gastroenteritis and correlate well
with previous cases of infections with norovirus genotype 1 and 2
(both isolated in faecal and water samples). More diagnostic
investigation will be performed at IZSLER in order to better define
some aspects of the pathogenesis of the outbreak and in particular to
identify exactly all the infectious agents involved and determine
their respective role as primary agents of disease, or alternatively
as agents of secondary infections.
The results of further investigations will be communicated as soon as
available.
--
Prof. Stefano Cinotti
General Director
IZSLER
Brescia Italy
<giorgio.varisco@izsler.it>
[The town of San Felice del Benaco is located near Lake Garda in the
province of Brescia, in the Lombardy region of Italy. Its position can
be found using the HealthMap/ProMED-mail interactive map: see,
<http://healthmap.org/promed/en?name=San%20Felice%20del%20Benaco,%20Lombardy,%20Italy&g=3168392&v=45.589,10.552,5>.
It is clear from Professor Cinotti's description that this is a
waterborne outbreak and that a norovirus is a likely culprit on
account of the extent of the outbreak and its acute nature. As noted
above, noroviruses belonging to genogroups I and II have been
associated frequently with outbreaks of water-borne gastroenteritis
elsewhere in Europe and worldwide. ProMED-mail is indebted to Prof.
Cinotti for provision of this information. A final verdict on the
identity of the principal etiologic agent is awaited. - Mod.CP]
[see also:
2008
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Norovirus - UK 20080103.0027
2007
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Norovirus, food-borne - Spain, USA 20071123.3795
Norovirus, new strains - USA, Europe 20070330.1096
2006
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Norovirus, increased activity - Europe 20061214.3522
2005
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Viral gastroenteritis update 2005 (11) 20050624.1768
2003
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Viral gastroenteritis update 2003 (23) 20031031.2716]
....................cp/ejp/jw
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