Outbreak of Norovirus and E. coli on a U.S. Navy Ship
Author Information
Author(s): Gonzaga Victor E., Ramos Mariana, Maves Ryan C., Freeman Randal, Montgomery Joel M.
Primary Institution: United States Naval Medical Research Unit Six (NAMRU-6), Lima, Peru
Hypothesis
What were the causes and factors associated with a gastrointestinal outbreak on a U.S. Navy ship following a visit to Lima, Peru?
Conclusion
The outbreak was primarily caused by Norovirus, with Enterotoxigenic E. coli also detected, and visiting a specific location in Lima was significantly associated with illness.
Supporting Evidence
- Norovirus was identified in 82% of stool samples from symptomatic patients.
- ETEC was detected in 73% of stool samples tested.
- The clinical attack rate was 28.3% among the crew.
- Visiting 'Pizza Alley' was associated with a significantly increased risk of illness.
- Consumption of bottled water was shown to be highly protective against infection.
Takeaway
Some sailors got sick after visiting a place in Lima, Peru, and it was caused by a virus and bacteria they caught there.
Methodology
An unmatched case-control study was conducted among crew members, with data collected through questionnaires and testing of stool and emesis samples.
Potential Biases
Potential bias due to reliance on self-reported data from crew members.
Limitations
Control samples were not collected, which may have helped better define the role of ETEC in the outbreak.
Participant Demographics
Mean age of participants was 28.7 years, with 85.3% male.
Statistical Information
P-Value
0.03
Confidence Interval
1.22 to 52.73
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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