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Open AccessArticle

Two Drinking Water Outbreaks Caused by Wastewater Intrusion Including Sapovirus in Finland

1
Department of Health Security, Expert Microbiology Unit, Finnish Institute for Health and Welfare, 70701 Kuopio, Finland
2
Department of Health Security, Expert Microbiology Unit, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
3
Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, 00014 Helsinki, Finland
4
Department of Health Security, Infectious Diseases Control and Vaccinations Unit, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(22), 4376; https://doi.org/10.3390/ijerph16224376
Received: 21 October 2019 / Revised: 6 November 2019 / Accepted: 6 November 2019 / Published: 9 November 2019
Drinking water outbreaks occur worldwide and may be caused by several factors, including raw water contamination, treatment deficiencies, and distribution network failure. This study describes two drinking water outbreaks in Finland in 2016 (outbreak I) and 2018 (outbreak II). Both outbreaks caused approximately 450 illness cases and were due to drinking water pipe breakage and subsequent wastewater intrusion into the distribution system. In both outbreaks, the sapovirus was found in patient samples as the main causative agent. In addition, adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides (outbreak II) were detected in patient samples. Water samples were analyzed for the selected pathogens largely based on the results of patient samples. In addition, traditional fecal indicator bacteria and host-specific microbial source tracking (MST) markers (GenBac3 and HF183) were analyzed from water. In drinking water, sapovirus and enteropathogenic E. coli (EPEC) were found in outbreak II. The MST markers proved useful in the detection of contamination and to ensure the success of contaminant removal from the water distribution system. As mitigation actions, boil water advisory, alternative drinking water sources and chlorination were organized to restrict the outbreaks and to clean the contaminated distribution network. This study highlights the emerging role of sapoviruses as a waterborne pathogen and warrants the need for testing of multiple viruses during outbreak investigation. View Full-Text
Keywords: waterborne outbreak; enteric viruses; contamination; drinking water; wastewater; sapovirus; microbial source tracking; fecal indicators; Dientamoeba fragilis waterborne outbreak; enteric viruses; contamination; drinking water; wastewater; sapovirus; microbial source tracking; fecal indicators; Dientamoeba fragilis
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Kauppinen, A.; Pitkänen, T.; Al-Hello, H.; Maunula, L.; Hokajärvi, A.-M.; Rimhanen-Finne, R.; Miettinen, I.T. Two Drinking Water Outbreaks Caused by Wastewater Intrusion Including Sapovirus in Finland. Int. J. Environ. Res. Public Health 2019, 16, 4376.

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