Norovirus outbreak in a natural playground: A One Health approach

Abstract

Norovirus constitutes the most frequently identified infectious cause of disease outbreaks associated with untreated recreational water. When investigating outbreaks related to surface water, a One Health approach is insightful. Historically, there has been a focus on potential contamination of recreational water by bird droppings and a recent publication demonstrating human noroviruses in bird faeces suggested this should be investigated in future water-related norovirus outbreaks. Here, we describe a One Health approach investigating a norovirus outbreak in a natural playground. On social media, a large amount of waterfowl were reported to defecate near these playground premises leading to speculations about their potential involvement. Surface water, as well as human and bird faecal specimens, was tested for human noroviruses. Norovirus was found to be the most likely cause of the outbreak but there was no evidence for transmission via waterfowl. Cases had become known on social media prior to notification to the public health service underscoring the potential of online media as an early warning system. In view of known risk factors, advice was given for future outbreak investigations and natural playground design.

Keywords: One Health; birds; faeces; norovirus; social media; water.

Figure 1

Number and age distribution of cases notified via an online social media enquiry. X‐axis: age distribution; Y‐axis: number of cases (total n = 101, n = 55 age unknown) (personal communication moderator Facebook‐platform, published with permission) [Colour figure can be viewed at wileyonlinelibrary.com]

Figure 2

Schematic depiction of natural playground area. Water from the nearby river (A) is pumped into a natural playground area (B) from where it flows into the adjacent lake (C). Waterfowl (insert) reside near the playground area. Map: © OpenStreetMap contributors https://www.openstreetmap.org/copyright [Colour figure can be viewed at wileyonlinelibrary.com]

Figure 3

Phylogenetic tree demonstrating norovirus interrelatedness. Maximum‐likelihood trees of ORF 2 were inferred by phyml 3.0 software using the general time reversible nucleotide substitution model. Scale bars indicate nucleotide substitutions per site. The sequences of two outbreak samples are depicted in red [Colour figure can be viewed at wileyonlinelibrary.com]