1887
Surveillance and outbreak report Open Access
Like 0

Abstract

In October 2016, an outbreak of norovirus occurred among attendees of a Halloween-themed party at a public swimming pool in the south-east of England. Norovirus genogroup II was confirmed in 11 cases. In the retrospective cohort study of pool users, 68 individuals (37 female and 31 male), with a median age of 11 years (range: 0–50 years), met the case definition of developing diarrhoea or vomiting between 6 and 72 h after the pool visit. Multivariable analysis showed that increasing age was associated with a reduced risk of illness (odds ratio = 0.91; 95% confidence interval: 0.83–0.99). Pool behaviours (swallowing water) and the timing of visit (attending pool party after automatic dosing system was switched off) were independently associated with increased risk. Environmental investigations revealed that the automatic dosing system was switched off to reduce chlorine levels to an intended range of 0.5–1 parts per million to facilitate the use of a commercial red dye. There was a lack of compliance with the operator's own pool operating procedures, particularly on maintaining effective chlorine levels in pool water, recording of test results and recording of actions undertaken. This outbreak highlights the risks of lowering chlorine levels when using pool water colourants.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2018.23.44.1700773
2018-11-01
2024-11-23
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2018.23.44.1700773
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/23/44/eurosurv-23-44-2.html?itemId=/content/10.2807/1560-7917.ES.2018.23.44.1700773&mimeType=html&fmt=ahah

References

  1. Tam CC, Rodrigues LC, Viviani L, Dodds JP, Evans MR, Hunter PR, et al. Longitudinal study of infectious intestinal disease in the UK (IID2 study): incidence in the community and presenting to general practice. Gut. 2012;61(1):69-77.  https://doi.org/10.1136/gut.2011.238386  PMID: 21708822 
  2. Yoder JS, Blackburn BG, Craun GF, Hill V, Levy DA, Chen N, et al. Surveillance for waterborne-disease outbreaks associated with recreational water--United States, 2001-2002. MMWR Surveill Summ. 2004;53(8):1-22. PMID: 15499306 
  3. Pool Water Treatment Advisory Group (PWTAG). Code of practice: The management and treatment of swimming pool water. Fazeley: PWTAG; 2015. Available from: https://www.pwtag.org.uk/_data/cop/Prime-Doc-1-CoP-May-2015.pdf
  4. Podewils LJ, Zanardi Blevins L, Hagenbuch M, Itani D, Burns A, Otto C, et al. Outbreak of norovirus illness associated with a swimming pool. Epidemiol Infect. 2007;135(5):827-33.  https://doi.org/10.1017/S0950268806007370  PMID: 17076938 
  5. Atmar RL, Opekun AR, Gilger MA, Estes MK, Crawford SE, Neill FH, et al. Norwalk virus shedding after experimental human infection. Emerg Infect Dis. 2008;14(10):1553-7.  https://doi.org/10.3201/eid1410.080117  PMID: 18826818 
  6. Graham DY, Jiang X, Tanaka T, Opekun AR, Madore HP, Estes MK. Norwalk virus infection of volunteers: new insights based on improved assays. J Infect Dis. 1994;170(1):34-43.  https://doi.org/10.1093/infdis/170.1.34  PMID: 8014518 
  7. Gerba CP. Assessment of enteric pathogen shedding by bathers during recreational activity and its impact on water quality. Quant Microbiol. 2000;2(1):55-68.  https://doi.org/10.1023/A:1010000230103 
  8. Rose JB, Sun G-S, Gerba CP, Sinclair NA. Microbial quality and persistence of enteric pathogens in graywater from various household sources. Water Res. 1991;25(1):37-42.  https://doi.org/10.1016/0043-1354(91)90096-9 
  9. Meschke JS, Sobsey MD. Human caliciviruses: basic virology. Encyclopedia of environmental microbiology. Vol. 2. Bitton G, editor. New York: John Wiley and Sons; 2001.
  10. Sinclair RG, Jones EL, Gerba CP. Viruses in recreational water-borne disease outbreaks: a review. J Appl Microbiol. 2009;107(6):1769-80.  https://doi.org/10.1111/j.1365-2672.2009.04367.x  PMID: 19486213 
  11. Centers for Disease Control and Prevention (CDC). Effect of chlorination on inactivating selected pathogen. Atlanta: CDC; 2012. Available from: https://www.cdc.gov/safewater/effectiveness-on-pathogens.html
  12. Thurston-Enriquez JA, Haas CN, Jacangelo J, Gerba CP. Chlorine inactivation of adenovirus type 40 and feline calicivirus. Appl Environ Microbiol. 2003;69(7):3979-85.  https://doi.org/10.1128/AEM.69.7.3979-3985.2003  PMID: 12839771 
  13. Centers for Disease Control and Prevention (CDC). 2016 model aquatic health code. Atlanta: CDC; 2016. Available from: https://www.cdc.gov/mahc/pdf/2016-mahc-code-final.pdf
  14. Parkin RT, Soller JA, Olivieri AW. Incorporating susceptible subpopulations in microbial risk assessment: pediatric exposures to enteroviruses in river water. J Expo Anal Environ Epidemiol. 2003;13(2):161-8.  https://doi.org/10.1038/sj.jea.7500265  PMID: 12679796 
  15. Seyfried PL, Tobin RS, Brown NE, Ness PF. A prospective study of swimming-related illness. I. Swimming-associated health risk. Am J Public Health. 1985;75(9):1068-70.  https://doi.org/10.2105/AJPH.75.9.1068  PMID: 4025656 
  16. Robinton ED, Mood EW. A quantitative and qualitative appraisal of microbial pollution of water by swimmers: a preliminary report. J Hyg (Lond). 1966;64(4):489-99.  https://doi.org/10.1017/S0022172400040808  PMID: 5224767 
/content/10.2807/1560-7917.ES.2018.23.44.1700773
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error