Incidence of Norwalk virus infections during a prospective epidemiological study of drinking water related gastrointestinal illness

Abstract
To determine the seroprevalence of Norwalk virus and whether Norwalk virus contributed to an observed increase in illness in tap water drinkers participating in a prospective epidemiological study, sera collected during the study were examined for changes in Norwalk virus antibody titer, using a specific enzyme immunoassay. Antibodies to Norwalk virus were measured in sera collected in March, June, and September 1988 and in June 1989, and antibodies were found in 79% of the individuals. Seroprevalence increased with age, being 55% (ages 9–19), 79% (20–39), 87% (40–49), 84% (50–59), and 100% (60 and older). Norwalk infections occurred in 33% of the individuals during the course of the study. The highest rate of infection (expressed as a monthly rate) was observed during the summer of 1988. These results confirm that a large number of infections owing to Norwalk viruses occur throughout the year. A previous seroconversion or a high serum titer were not always protective. Finally, there was no detectable difference in infection rate between consumers of tap water and consumers of water treated by reverse-osmosis units, suggesting that Norwalk virus infections were not responsible for the excess of gastrointestinal illness observed in tap water drinkers during this epidemiological study.Key words: drinking water, Norwalk virus, gastroenteritis, seroprevalence.