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Home Eurosurveillance Weekly Release  2004: Volume 8/ Issue 33 Article 1
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Eurosurveillance, Volume 8, Issue 33, 12 August 2004

Citation style for this article: Norovirus outbreak at an international scout jamboree in the Netherlands, July-August 2004: international alert. Euro Surveill. 2004;8(33):pii=2523. Available online:

Norovirus outbreak at an international scout jamboree in the Netherlands, July-August 2004: international alert

Erwin Duizer1 (, Aura Timen2, Gabriella Morroy3, Ana Maria de Roda Husman4

1Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, Rijksinstituut voor Volksgezondheid en Milieu, Bilthoven, the Netherlands
2National Co-ordination Structure for Outbreak Management (LCI)
3Regional Public Health Service (GGD Hart voor Brabant)
4Health Related Watermicrobiology, Microbiological Laboratory for Health Protection (MGB), RIVM

A norovirus outbreak at an international scout summer camp in the Netherlands has affected approximately 250 people (scouts and staff members) out of 4500 participants. Thirty five participants were ill on the last night, and two children were ill before the start of the camp on 26 July.

Symptoms have generally been mild with most patients experiencing vomiting and diarrhoea, although 47 patients were admitted to a local hospital for rehydration. Infection control measures have been put in place in order to contain the outbreak. The regional municipal health service (GGD Hart voor Brabant) has been involved in managing the outbreak. Norovirus has been epidemiologically implicated as the causative agent.

The presence of norovirus was confirmed in vomit samples at the Rijksinstituut voor Volksgezondheid en Milieu (RIVM, National Institute of Public Health) using a standard RT-PCR protocol. Faecal samples are currently under investigation. The two children, one from Scotland and one from the Netherlands, who are reported to have been ill before joining the summer camp may be the index cases, but we have not yet been able to obtain and analyse samples from these two children. From the first series of positive samples, 4 noroviruses have been sequenced for typing, and this yielded three norovirus variants: NoV GGI.4 ("Malta"), NoV GGI.5 ("Butlins") and a NoV GGII.4 ("Grimsby"). Sequencing of other positive samples (mostly vomit) from the outbreak is in progress.

In this outbreak, there are clear indications of multiple introductions of viruses by sick people., Generally, the presence of more than one virus strain in an outbreak is indicative of food- or waterborne introduction. Preliminary epidemiological data do not implicate food as a vector in this outbreak. The scouts had swum in a recreational lake that complied with European standards for faecal contamination. Currently, water samples are being analysed for the presence of norovirus. Questionnaires have been distributed among the scouts, and data collection and analysis is ongoing.

The national jamboree campsite hosted over 3700 participants (between 11-17 years of age) and about 800 staff members. Besides a large number of Dutch participants, about 1000 scouts came from 31 other countries, including Belgium, the United Kingdom, Germany, Ukraine, Serbia, Kosovo, Turkey, the United States, Australia, Hong Kong, Indonesia, Pakistan, Algeria, Tunisia, Nigeria and Kenya. The jamboree ended on 5 August and several more cases have been reported in the past seven days. Since the shedding of norovirus continues after recovery from illness, and can also occur in the absence of illness, thorough hygienic measures, emphasising handwashing, of all participants leaving the camp will be essential to reduce further spread of the virus.

Suspected cases connected with this outbreak in any country maybe reported to Erwin Duizer (email, telephone +31 30 274 4142, fax +31 30 274 4418)

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