

@article {8046,
	title = {{Novel microbiological and spatial statistical methods to improve strength of epidemiological evidence in a community-wide waterborne outbreak.}},
	journal = {PloS one},
	volume = {9},
	number = {8},
	year = {2014},
	pages = {e104713},
	abstract = {Failures in the drinking water distribution system cause gastrointestinal outbreaks with multiple pathogens. A water distribution pipe breakage caused a community-wide waterborne outbreak in Vuorela, Finland, July 2012. We investigated this outbreak with advanced epidemiological and microbiological methods. A total of 473/2931 inhabitants (16{\%}) responded to a web-based questionnaire. Water and patient samples were subjected to analysis of multiple microbial targets, molecular typing and microbial community analysis. Spatial analysis on the water distribution network was done and we applied a spatial logistic regression model. The course of the illness was mild. Drinking untreated tap water from the defined outbreak area was significantly associated with illness (RR 5.6, 95{\%} CI 1.9-16.4) increasing in a dose response manner. The closer a person lived to the water distribution breakage point, the higher the risk of becoming ill. Sapovirus, enterovirus, single Campylobacter jejuni and EHEC O157:H7 findings as well as virulence genes for EPEC, EAEC and EHEC pathogroups were detected by molecular or culture methods from the faecal samples of the patients. EPEC, EAEC and EHEC virulence genes and faecal indicator bacteria were also detected in water samples. Microbial community sequencing of contaminated tap water revealed abundance of Arcobacter species. The polyphasic approach improved the understanding of the source of the infections, and aided to define the extent and magnitude of this outbreak.},
	issn = {1932-6203},
	doi = {10.1371/journal.pone.0104713},
	url = {http://www.ncbi.nlm.nih.gov/pubmed/25147923 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4141750},
	author = {Jalava, Katri and Rintala, Hanna and Ollgren, Jukka and Maunula, Leena and Gomez-Alvarez, Vicente and Revez, Joana and Palander, Marja and Antikainen, Jenni and Kauppinen, Ari and R{\"a}s{\"a}nen, Pia and Siponen, Sallamaari and Nyholm, Outi and Kyyhkynen, Aino and Hakkarainen, Sirpa and Merentie, Juhani and P{\"a}rn{\"a}nen, Martti and Loginov, Raisa and Ryu, Hodon and Kuusi, Markku and Siitonen, Anja and Miettinen, Ilkka and Santo Domingo, Jorge W and Marja L H{\"a}nninen and Pitkanen, Tarja}
}
