Outbreak of viral gastroenteritis due to drinking water contaminated by Norwalk-like viruses

Heinävesi, a Finnish municipality with a population of 4860 inhabitants, had an outbreak of gastroenteritis in March 1998. On the basis of an epidemiologic survey, an estimated 1700-3000 cases of acute gastroenteritis occurred during the outbreak. Municipal water consumption was found to be associated with illness (risk ratio [RR]=3.5, 95% confidence interval, 3.11>RR>3.96). Norwalk-like virus (NLV) genogroup II (GGII) was identified in untreated water, treated water, and 4 tap water samples by use of reverse transcription-polymerase chain reaction. This was the first time NLVs had been detected in municipal tap water. Fifteen of 27 patient stool samples had NLV GGII, with an identical amplification product to that found in the water samples, indicating that the outbreak was caused by this virus. In some patients, NLV genogroup I was also encountered. This virus, however, could not be detected in the water samples. Inadequate chlorination contributed to the survival of the virus in the water.