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Large waterborne Campylobacter outbreak: use of multiple approaches to investigate contamination of the drinking water supply system, Norway, June 2019
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Susanne Hyllestad1,2
, Arild Iversen3 , Emily MacDonald1 , Ettore Amato1,4 , Bengt Åge Sørby Borge3 , Anton Bøe3 , Aslaug Sandvin5 , Lin T Brandal1 , Trude Marie Lyngstad1 , Umaer Naseer1 , Karin Nygård1 , Lamprini Veneti1 , Line Vold1
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View Affiliations Hide AffiliationsAffiliations: 1 Department of Zoonoses, Food- and Waterborne Diseases, Norwegian Institute of Public Health, Oslo, Norway 2 University of Oslo, Faculty of Medicine, Institute of Health and Society, Oslo, Norway 3 Municipality of Askøy, Norway 4 European Programme for Public Health Microbiology Training (EUPHEM), European Centre for Disease Control and Prevention (ECDC), Stockholm, Sweden 5 Norwegian Food Safety Authority, Bergen, NorwaySusanne Hyllestadsusanne.hyllestad fhi.no
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Citation style for this article: Hyllestad Susanne, Iversen Arild, MacDonald Emily, Amato Ettore, Borge Bengt Åge Sørby, Bøe Anton, Sandvin Aslaug, Brandal Lin T, Lyngstad Trude Marie, Naseer Umaer, Nygård Karin, Veneti Lamprini, Vold Line. Large waterborne Campylobacter outbreak: use of multiple approaches to investigate contamination of the drinking water supply system, Norway, June 2019. Euro Surveill. 2020;25(35):pii=2000011. https://doi.org/10.2807/1560-7917.ES.2020.25.35.2000011 Received: 27 Dec 2019; Accepted: 08 Jul 2020
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Abstract
On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Askøy. A reservoir in a water supply system was suspected as the source of the outbreak because of the acute onset and geographical distribution of cases. We investigated the outbreak to confirm the source, extent of the outbreak and effect of control measures. A case was defined as a person in a household served by Water Supply System A (WSS-A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. System information of WSS-A was collected. Whole genome sequencing on human and environmental isolates was performed. Among 6,108 individuals, 1,573 fulfilled the case definition. Residents served by the reservoir had a 4.6× higher risk of illness than others. Campylobacter jejuni isolated from cases (n = 24) and water samples (n = 4) had identical core genome MLST profiles. Contamination through cracks in the reservoir most probably occurred during heavy rainfall. Water supply systems are susceptible to contamination, particularly to certain weather conditions. This highlights the importance of water safety planning and risk-based surveillance to mitigate risks.

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References
-
World Health Organization (WHO). Campylobacter. Key facts. Geneva: WHO. [Accessed: May 2020]. Available from: https://www.who.int/news-room/fact-sheets/detail/campylobacter
-
Silva J, Leite D, Fernandes M, Mena C, Gibbs PA, Teixeira P. Campylobacter spp. as a foodborne pathogen: a review. Front Microbiol. 2011;2:200. https://doi.org/10.3389/fmicb.2011.00200 PMID: 21991264
-
Kaakoush NO, Castaño-Rodríguez N, Mitchell HM, Man SM. Global epidemiology of campylobacter infection. Clin Microbiol Rev. 2015;28(3):687-720. https://doi.org/10.1128/CMR.00006-15 PMID: 26062576
-
Kapperud G, Espeland G, Wahl E, Walde A, Herikstad H, Gustavsen S, et al. Factors associated with increased and decreased risk of Campylobacter infection: a prospective case-control study in Norway. Am J Epidemiol. 2003;158(3):234-42. https://doi.org/10.1093/aje/kwg139 PMID: 12882945
-
Jakopanec I, Borgen K, Vold L, Lund H, Forseth T, Hannula R, et al. A large waterborne outbreak of campylobacteriosis in Norway: the need to focus on distribution system safety. BMC Infect Dis. 2008;8(1):128. https://doi.org/10.1186/1471-2334-8-128 PMID: 18816387
-
Sandberg M, Nygård K, Meldal H, Valle PS, Kruse H, Skjerve E. Incidence trend and risk factors for campylobacter infections in humans in Norway. BMC Public Health. 2006;6(1):179. https://doi.org/10.1186/1471-2458-6-179 PMID: 16827925
-
Mac Kenzie WR, Hoxie NJ, Proctor ME, Gradus MS, Blair KA, Peterson DE, et al. A massive outbreak in Milwaukee of cryptosporidium infection transmitted through the public water supply. N Engl J Med. 1994;331(3):161-7. https://doi.org/10.1056/NEJM199407213310304 PMID: 7818640
-
O’Connor DR. Report of the Walkerton inquiry: The events of May 2000 and related issues: A summary. Toronto: Ministry of the Attorney General; 2002. Report No.: 0779425588. Available from: http://www.archives.gov.on.ca/en/e_records/walkerton/index.html
-
Widerström M, Schönning C, Lilja M, Lebbad M, Ljung T, Allestam G, et al. Large outbreak of Cryptosporidium hominis infection transmitted through the public water supply, Sweden. Emerg Infect Dis. 2014;20(4):581-9. https://doi.org/10.3201/eid2004.121415 PMID: 24655474
-
Moreira NA, Bondelind M. Safe drinking water and waterborne outbreaks. J Water Health. 2017;15(1):83-96. https://doi.org/10.2166/wh.2016.103 PMID: 28151442
-
World Health Organization (WHO). Guidelines for drinking-water quality, 3rd edition: Volume 1 - Recommendations. Geneva: WHO; 2004. Available from: https://www.who.int/water_sanitation_health/publications/gdwq3/en/
-
Ercumen A, Gruber JS, Colford JM Jr. Water distribution system deficiencies and gastrointestinal illness: a systematic review and meta-analysis. Environ Health Perspect. 2014;122(7):651-60. https://doi.org/10.1289/ehp.1306912 PMID: 24659576
-
Nygård K, Wahl E, Krogh T, Tveit OA, Bøhleng E, Tverdal A, et al. Breaks and maintenance work in the water distribution systems and gastrointestinal illness: a cohort study. Int J Epidemiol. 2007;36(4):873-80. https://doi.org/10.1093/ije/dym029 PMID: 17389718
-
European Food Safety Authority and European Centre for Disease Prevention and Control (EFSA and ECDC). The European Union One Health 2018 Zoonoses Report. Parma: EFSA; Stockholm: ECDC; 2019. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/zoonoses-EU-one-health-2018-report.pdf
-
Guzman-Herrador B, de Blasio BF, Lund V, MacDonald E, Vold L, Wahl E, et al. Vannbårne utbrudd i Norge i perioden 2003-12. [Waterborne outbreaks in Norway 2003-2012]. Tidsskr Nor Laegeforen. 2016;136(7):612-6. Norwegian. https://doi.org/10.4045/tidsskr.15.0114 PMID: 27094662
-
Guzman-Herrador B, Carlander A, Ethelberg S, Freiesleben de Blasio B, Kuusi M, Lund V, et al. Waterborne outbreaks in the Nordic countries, 1998 to 2012. Euro Surveill. 2015;20(24):21160. https://doi.org/10.2807/1560-7917.ES2015.20.24.21160 PMID: 26111239
-
Nygård K, Schimmer B, Søbstad Ø, Walde A, Tveit I, Langeland N, et al. A large community outbreak of waterborne giardiasis-delayed detection in a non-endemic urban area. BMC Public Health. 2006;6(1):141. https://doi.org/10.1186/1471-2458-6-141 PMID: 16725025
-
Jolley KA, Bray JE, Maiden MCJ. Open-access bacterial population genomics: BIGSdb software, the PubMLST.org website and their applications. Wellcome Open Res. 2018;3:124. https://doi.org/10.12688/wellcomeopenres.14826.1 PMID: 30345391
-
Cody AJ, McCarthy ND, Jansen van Rensburg M, Isinkaye T, Bentley SD, Parkhill J, et al. Real-time genomic epidemiological evaluation of human Campylobacter isolates by use of whole-genome multilocus sequence typing. J Clin Microbiol. 2013;51(8):2526-34.
-
Lahti E, Rehn M, Ockborn G, Hansson I, Ågren J, Engvall EO, et al. Outbreak of campylobacteriosis following a dairy farm visit: confirmation by genotyping. Foodborne Pathog Dis. 2017;14(6):326-32. https://doi.org/10.1089/fpd.2016.2257 PMID: 28350214
-
Lovdata. Forskrift om vannforsyning og drikkevann (drikkevannsforskriften). [The Norwegian legislation on water supply and drinking water]. Oslo: Lovdata; 2017. Norwegian. Available from: https://lovdata.no/dokument/LTI/forskrift/2016-12-22-1868
-
Rosenquist H, Bengtsson A, Hansen TB. A collaborative study on a Nordic standard protocol for detection and enumeration of thermotolerant Campylobacter in food (NMKL 119, 3. Ed., 2007). Int J Food Microbiol. 2007;118(2):201-13. https://doi.org/10.1016/j.ijfoodmicro.2007.07.037 PMID: 17761333
-
Braeye T, DE Schrijver K, Wollants E, van Ranst M, Verhaegen J. A large community outbreak of gastroenteritis associated with consumption of drinking water contaminated by river water, Belgium, 2010. Epidemiol Infect. 2015;143(4):711-9. https://doi.org/10.1017/S0950268814001629 PMID: 25062494
-
Gubbels SM, Kuhn KG, Larsson JT, Adelhardt M, Engberg J, Ingildsen P, et al. A waterborne outbreak with a single clone of Campylobacter jejuni in the Danish town of Køge in May 2010. Scand J Infect Dis. 2012;44(8):586-94. https://doi.org/10.3109/00365548.2012.655773 PMID: 22385125
-
Bruce-Grey-Owen Sound Health Unit. Waterborne outbreak of gastroenteritis associated with a contaminated municipal water supply, Walkerton, Ontario, May-June 2000. Can Commun Dis Rep. 2000;26(20):170-3. PMID: 11211701
-
Bartholomew N, Brunton C, Mitchell P, Williamson J, Gilpin B. A waterborne outbreak of campylobacteriosis in the South Island of New Zealand due to a failure to implement a multi-barrier approach. J Water Health. 2014;12(3):555-63. https://doi.org/10.2166/wh.2014.155 PMID: 25252359
-
Kuhn KG, Falkenhorst G, Emborg HD, Ceper T, Torpdahl M, Krogfelt KA, et al. Epidemiological and serological investigation of a waterborne Campylobacter jejuni outbreak in a Danish town. Epidemiol Infect. 2017;145(4):701-9. https://doi.org/10.1017/S0950268816002788 PMID: 27903324
-
Mouly D, Van Cauteren D, Vincent N, Vaissiere E, Beaudeau P, Ducrot C, et al. Description of two waterborne disease outbreaks in France: a comparative study with data from cohort studies and from health administrative databases. Epidemiol Infect. 2016;144(3):591-601. https://doi.org/10.1017/S0950268815001673 PMID: 26194500
-
Kuusi M, Klemets P, Miettinen I, Laaksonen I, Sarkkinen H, Hänninen ML, et al. An outbreak of gastroenteritis from a non-chlorinated community water supply. J Epidemiol Community Health. 2004;58(4):273-7. https://doi.org/10.1136/jech.2003.009928 PMID: 15026434
-
Kuusi M, Nuorti JP, Hänninen ML, Koskela M, Jussila V, Kela E, et al. A large outbreak of campylobacteriosis associated with a municipal water supply in Finland. Epidemiol Infect. 2005;133(4):593-601. https://doi.org/10.1017/S0950268805003808 PMID: 16050503
-
Karagiannis I, Sideroglou T, Gkolfinopoulou K, Tsouri A, Lampousaki D, Velonakis EN, et al. A waterborne Campylobacter jejuni outbreak on a Greek island. Epidemiol Infect. 2010;138(12):1726-34. https://doi.org/10.1017/S0950268810002116 PMID: 20836911
-
Laine J, Huovinen E, Virtanen MJ, Snellman M, Lumio J, Ruutu P, et al. An extensive gastroenteritis outbreak after drinking-water contamination by sewage effluent, Finland. Epidemiol Infect. 2011;139(7):1105-13. https://doi.org/10.1017/S0950268810002141 PMID: 20843387
-
Hrudey SE, Hrudey EJ. Published case studies of waterborne disease outbreaks—evidence of a recurrent threat. Water Environ Res. 2007;79(3):233-45.
-
Hrudey SE, Conant B, Douglas IP, Fawell J, Gillespie T, Hill D, et al. Managing uncertainty in the provision of safe drinking water. Water Sci Technol Water Supply. 2011;11:675. . Available from: https://cwn-rce.ca/wp-content/uploads/2014/06/managing-uncertainty-in-the-provision-of-safe-drinking-water.pdf https://doi.org/10.2166/ws.2011.075
-
Rizak S, Hrudey SE. Achieving safe drinking water — risk management based on experience and reality. Environ Rev. 2007;15(1):169-74.
-
Rizak S, Hrudey SE. Evidence of water quality monitoring limitations for outbreak detection. Environ Health. 2007;7(1):11-21.
-
Storey MV, van der Gaag B, Burns BP. Advances in on-line drinking water quality monitoring and early warning systems. Water Res. 2011;45(2):741-7. https://doi.org/10.1016/j.watres.2010.08.049 PMID: 20851446
-
World Health Organization Regional Office for Europe (WHO/Europe). Strengthening drinking-water surveillance using risk-based approaches. Copenhagen: WHO/Europe; 2019. Available from: http://www.euro.who.int/en/health-topics/environment-and-health/water-and-sanitation/publications/2019/strengthening-drinking-water-surveillance-using-risk-based-approaches-2019
-
Widerström M, Schönning C, Lilja M, Lebbad M, Ljung T, Allestam G, et al. Large outbreak of Cryptosporidium hominis infection transmitted through the public water supply, Sweden. Emerg Infect Dis. 2014;20(4):581-9. https://doi.org/10.3201/eid2004.121415 PMID: 24655474
-
Andersson T, Bjelkmar P, Hulth A, Lindh J, Stenmark S, Widerström M. Syndromic surveillance for local outbreak detection and awareness: evaluating outbreak signals of acute gastroenteritis in telephone triage, web-based queries and over-the-counter pharmacy sales. Epidemiol Infect. 2014;142(2):303-13. https://doi.org/10.1017/S0950268813001088 PMID: 23672877
-
Shortridge JE, Guikema SD. Public health and pipe breaks in water distribution systems: analysis with internet search volume as a proxy. Water Res. 2014;53:26-34. https://doi.org/10.1016/j.watres.2014.01.013 PMID: 24495984
-
Bjelkmar P, Hansen A, Schönning C, Bergström J, Löfdahl M, Lebbad M, et al. Early outbreak detection by linking health advice line calls to water distribution areas retrospectively demonstrated in a large waterborne outbreak of cryptosporidiosis in Sweden. BMC Public Health. 2017;17(1):328. https://doi.org/10.1186/s12889-017-4233-8 PMID: 28420373
-
United States Environmental Protection Agency (EPA). Water quality surveillance and response. Washington DC: EPA. [Accessed: 8 Jun 2020]. Available from: https://www.epa.gov/waterqualitysurveillance

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