NORWALK-RELATED VIRAL GASTROENTERITIS DUE TO CONTAMINATED DRINKING WATER

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Abstract
An explosive outbreak of gastrointestinal illness clinically compatible with infection by an agent serologically related to Norwalk virus agent occurred in an elementary school in May 1978. Seroconversion by radiolmmunoassay to the Norwalk antigen was noted in two of three III persons, but no viral particles were identified in stool. Illness developed in 72% of students and teachers at the school, and 32% of household contacts of these ill persons. Of household contacts of persons exposed at school but not clinically ill, 11% developed illness. This value, however, was not statistically diflerent from the level of illness observed concurrently in household contacts of students at an unaffected school nearby. Epidemiologic investigation implicated water as the mode of transmission. Average consumption of one or more glasses per day was strongly associated with illness (p < 0.00000001). Among soccer team members with limited school contact, water consumption at the school was as sociated with a 14-fold greater risk of illness (p < 0.000001). Drinking water was most likely contaminated by back-siphonage through a cross-connection between the school's well and septic tank. This contamination occurred approximately 24 to 36 hours before the outbreak developed.