Norwalk virus enteric illness acquired by swimming exposure

In an epidemic of gastrointestinal illness strongly associated with swimming at a recreational park in Macomb County, Michigan, in July, 1979, the authors demonstrated the value of serologic testing to detect Norwalk virus infection. Rises in antibody titer to Norwalk virus were noted in all 11 individuals tested. Electron microscopy on stools from 20 ill individuals revealed only one with Norwalk virus-like particles. This particle was shown by radioimmunoassay and immune electron microscopy not to be Norwalk virus and not to have stimulated detectable antibodies in this individual. These results not only indicate that electron microscopy is insensitive in detecting Norwalk virus, but that it has the potential to mislead. A low rate of respiratory symptoms was associated with gastrointestinal illness in this Norwalk virus outbreak. The route of exposure might have been important for this. The outbreak was also noteworthy in that, although there was evidence of familial clusters of resistance, a very high percentage of the population was proved to be susceptible to the Norwalk virus.