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Int. J. Environ. Res. Public Health 2018, 15(11), 2550;

Norovirus Outbreak Associated with Swimming in a Recreational Lake Not Influenced by External Human Fecal Sources in The Netherlands, August 2012

National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
Public Health Service Veiligheids-en Gezondheidsregio Gelderland-Midden, Postbus 5364, 6802 EJ Arnhem, The Netherlands
Province of Gelderland, Postbus 9090, 6800 GX Arnhem, The Netherlands
Author to whom correspondence should be addressed.
Received: 28 September 2018 / Revised: 6 November 2018 / Accepted: 9 November 2018 / Published: 14 November 2018
(This article belongs to the Special Issue Recreational Water Illnesses)
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Swimming in fecally contaminated recreational water may lead to gastrointestinal illness. A recreational water-associated outbreak of norovirus (NoV) infections affecting at least 100 people in The Netherlands occurred in August 2012. Questionnaire responses from patients indicated swimming in recreational lake Zeumeren as the most likely cause of illness. Most patients visited the lake during the weekend of 18–19 August, during which the weather was exceptionally warm (maximum temperatures 32–33 °C), and visitor numbers elevated. Patients, mostly children, became ill with gastroenteritis 1–6 days (median 2 days) after exposure. Four stool samples from patients were NoV GI positive. Subsurface sandy soil from one of the beaches where most patients swam was NoV GI positive; the water sample was negative. The epidemiological curve and the timeline of investigation based on reported symptoms demonstrate the difficulty in discovering the source in recreational water outbreaks. A NoV outbreak in a recreational lake that is not subjected to external fecal contamination sources shows the need for active communication about human shedding of viruses during and after diarrheal episodes and the advice to refrain from swimming, even a few weeks after the symptoms have resolved. View Full-Text
Keywords: outbreak; recreational water; norovirus; swimming outbreak; recreational water; norovirus; swimming

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Schets, F.M.; Van den Berg, H.H.J.L.; Vennema, H.; Pelgrim, M.T.M.; Collé, C.; Rutjes, S.A.; Lodder, W.J. Norovirus Outbreak Associated with Swimming in a Recreational Lake Not Influenced by External Human Fecal Sources in The Netherlands, August 2012. Int. J. Environ. Res. Public Health 2018, 15, 2550.

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