Contamination source identification for the prompt management of a gastroenteritis outbreak caused by norovirus in drinking water in Northern Italy
Sara Arnaboldi,
Francesco Righi,
Lucia Mangeri,
Elisa Galuppini,
Barbara Bertasi,
Guido Finazzi,
Giorgio Varisco,
Stefania Ongaro,
Camillo Gandolfi,
Rossella Lamera,
Paolo Amboni,
Elena Rota,
Deborah Balbino,
Constanza Colombo,
Martina Gelmi,
Alessandra Boffelli,
Serena Gasparri,
Virginia Filipello,
Marina-Nadia Losio
Affiliations
Sara Arnaboldi
Food Safety Department, Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna (IZSLER), Via A. Bianchi 9, 25124, Brescia, Italy; Corresponding author.
Francesco Righi
Food Safety Department, Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna (IZSLER), Via A. Bianchi 9, 25124, Brescia, Italy
Lucia Mangeri
Food Safety Department, Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna (IZSLER), Via A. Bianchi 9, 25124, Brescia, Italy
Elisa Galuppini
Food Safety Department, Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna (IZSLER), Via A. Bianchi 9, 25124, Brescia, Italy
Barbara Bertasi
Food Safety Department, Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna (IZSLER), Via A. Bianchi 9, 25124, Brescia, Italy
Guido Finazzi
Food Safety Department, Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna (IZSLER), Via A. Bianchi 9, 25124, Brescia, Italy; National Reference Centre for Emerging Risks in Food Safety (CRESA), Via A. Bianchi 9, 25124, Brescia, Italy
Giorgio Varisco
Food Safety Department, Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna (IZSLER), Via A. Bianchi 9, 25124, Brescia, Italy
Stefania Ongaro
Department of Hygiene and Health, Agenzia di Tutela della Salute (ATS), Via Borgo Palazzo 130, 24100, Bergamo, Italy
Camillo Gandolfi
Department of Hygiene and Health, Agenzia di Tutela della Salute (ATS), Via Borgo Palazzo 130, 24100, Bergamo, Italy
Rossella Lamera
Department of Hygiene and Health, Agenzia di Tutela della Salute (ATS), Via Borgo Palazzo 130, 24100, Bergamo, Italy
Paolo Amboni
Department of Hygiene and Health, Agenzia di Tutela della Salute (ATS), Via Borgo Palazzo 130, 24100, Bergamo, Italy
Elena Rota
Department of Hygiene and Health, Agenzia di Tutela della Salute (ATS), Via Borgo Palazzo 130, 24100, Bergamo, Italy
Deborah Balbino
Department of Hygiene and Health, Agenzia di Tutela della Salute (ATS), Via Borgo Palazzo 130, 24100, Bergamo, Italy
Constanza Colombo
Department of Hygiene and Health, Agenzia di Tutela della Salute (ATS), Via Borgo Palazzo 130, 24100, Bergamo, Italy
Martina Gelmi
Department of Hygiene and Health, Agenzia di Tutela della Salute (ATS), Via Borgo Palazzo 130, 24100, Bergamo, Italy
Alessandra Boffelli
Department of Hygiene and Health, Agenzia di Tutela della Salute (ATS), Via Borgo Palazzo 130, 24100, Bergamo, Italy
Serena Gasparri
Department of Hygiene and Health, Agenzia di Tutela della Salute (ATS), Via Borgo Palazzo 130, 24100, Bergamo, Italy
Virginia Filipello
Food Safety Department, Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna (IZSLER), Via A. Bianchi 9, 25124, Brescia, Italy
Marina-Nadia Losio
Food Safety Department, Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna (IZSLER), Via A. Bianchi 9, 25124, Brescia, Italy
In June 2022, a gastroenteritis outbreak occurred in a town in Northern Italy, possibly associated with the ingestion of norovirus from public drinking water. Noroviruses are highly infectious RNA viruses, with high stability in the environment. They are the primary cause of non-bacterial gastroenteritis worldwide, and despite the fact that the disease is mainly self-limiting, norovirus infection can lead to severe illness in the immunocompromised, the elderly and children. Immediately after the notification of the suspected norovirus outbreak, faecal specimens were collected from hospitalised patients, and water samples were collected from public drinking fountains in the affected area, to confirm the presence of norovirus. Norovirus was detected in 80 % (95 % CI 0.58–0.91) of the faecal specimens, and in 50 % (95 % CI 0.28–0.72) of the water samples using RT (reverse transcription) Real-time PCR. The identification of GII genotype in all samples confirmed public drinking water as the source of norovirus contamination. In addition, in one faeces and one water sample, the co-presence of genotypes GI and GII was detected. The strains were typed by sequencing, with most of them belonging to the genotype GII.3. Immediately after the confirmation of norovirus contamination in public drinking water, the local competent authorities applied safety measures, resulting in a decline in number of cases. Moreover, after the application of disinfection protocols in the water plant, the sampling was repeated with negative results for norovirus in the affected area. However, positive samples were found in the neighbouring area (prevalence 10.00 %, 95 % CI 0.02–0.40) and in the water spring (prevalence 50.00 %, 95 % CI 0.21–0.78), suggesting norovirus persistence and spread from the water source. The prompt identification of the source of contamination, and collaboration with the local authorities guided the implementation of proper procedures to control viral spread, resulting in the successful control of the outbreak.
