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Coordinating Systems-Based Environmental Public Health Practice With Epidemiology and Laboratory Analysis: A Waterborne Outbreak of Norwalk-Like Virus in the Big Horn Mountains of Wyoming
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| Abstract: | Background: In February 2001, the Wyoming Department of Health received reports of cases of gastroenteritis among persons who had been snowmobiling in the Big Horn Mountains. Laboratory testing suggested that exposure to a Norwalk-like virus was responsible for the illness.
Methods: Environmental health specialists and epidemiologists from several state and federal agencies coordinated an investigation of environmental risk factors and system-based failures. The environmental assessment of three area lodges included food service operations, water supply systems, and sewage disposal. A retrospective cohort study was conducted among 82 guests to identify risk factors associated with illness. Stool and water samples were collected for laboratory analysis.
Results : Statistical analysis suggested that illness was associated with water consumed at one of the three area lodges (RR=3.3, 95% C.I.=(1.4,7.7)). Reverse transcriptase-polymerase chain reaction (RT-PCR) testing on 13 stool samples yielded 8 positives for Norwalk-like virus (NLV) genogroup II, with 3 distinct sequence types detected. Fecal contaminaiton of one of three operating wells was also found and one of the samples tested positive for NLV genogroup II. The environmental assessment of the property revealed that an inadequately installed sewage system was delivering effluent into shallow soil with poor filtering capacity.
Conclusion: This outbreak illustrates waterborne transmission of viral gastroenteritis and the advantages of coordinating a systems-based model of enviromental asssessment with traditional epidemiologic and laboratory practices. Preventing future system deficiencies depends on understanding the relevant protective components of facility operations including the surrounding physical environment, food service, water supply, and sewage systems.
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| Citation: | Seys, S. A., H. M. Mainzer, A. G. Heryford, A. D. Anderson, S. S. Monroe, G. S. Fout, J. P. Sarisky, and K. J. Musgrave. Coordinating Systems-Based Environmental Public Health Practice With Epidemiology and Laboratory Analysis: A Waterborne Outbreak of Norwalk-Like Virus in the Big Horn Mountains of Wyoming. Presented at American Public Health Association Annual Meeting, Philadelphia, PA, November 9-13, 2002. |
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| Contact: |
Mary P. O'Bryant - (919)-541-4871 or obriant.mary@epa.gov
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| Division: |
Microbiological & Chemical Exposure Assessment Division |
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| Branch: |
Biohazard Assessment Research Branch |
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| Product Type: |
Abstrct/Oral |
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| Presented: |
11/09/2002 |
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