pythonist/PubMedQA

1id,title,context,question,answers223,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.3An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.4In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  5On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.6The alert came from a cluster of gastroenteritis in a hotel.7Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.8A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.9Four cases were hospitalized,  all of them children.  10The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).11Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.12Water samples and filters from  the water system also tested positive for norovirus and enterovirus.13A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.14Patients presented with vomiting,  diarrhoea and fever.15On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.16We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.17An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.18Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 19In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  20The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).21When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.22Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.23The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.24Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.25On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 26Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.27Regular water  sampling and testing was performed to monitor the efficiency of  control measures.28Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).29Stool samples obtained from 36 probable  cases were examined at the laboratory.30The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  31 32",What is the date of the event?,"{'answer_start': [114], 'text': ['June 2009']}"3328,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.34An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.35In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  36On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.37The alert came from a cluster of gastroenteritis in a hotel.38Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.39A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.40Four cases were hospitalized,  all of them children.  41The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).42Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.43Water samples and filters from  the water system also tested positive for norovirus and enterovirus.44A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.45Patients presented with vomiting,  diarrhoea and fever.46On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.47We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.48An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.49Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 50In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  51The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).52When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.53Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.54The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.55Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.56On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 57Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.58Regular water  sampling and testing was performed to monitor the efficiency of  control measures.59Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).60Stool samples obtained from 36 probable  cases were examined at the laboratory.61The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  62 63","What is the location of the event?64","{'answer_start': [96], 'text': ['northern Italy']}"6512,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.66An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.67In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  68On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.69The alert came from a cluster of gastroenteritis in a hotel.70Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.71A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.72Four cases were hospitalized,  all of them children.  73The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).74Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.75Water samples and filters from  the water system also tested positive for norovirus and enterovirus.76A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.77Patients presented with vomiting,  diarrhoea and fever.78On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.79We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.80An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.81Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 82In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  83The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).84When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.85Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.86The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.87Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.88On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 89Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.90Regular water  sampling and testing was performed to monitor the efficiency of  control measures.91Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).92Stool samples obtained from 36 probable  cases were examined at the laboratory.93The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  94 95","What is the source that started the event?96","{'answer_start': [202], 'text': ['contaminated municipal water supply']}"9714,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.98An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.99In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  100On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.101The alert came from a cluster of gastroenteritis in a hotel.102Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.103A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.104Four cases were hospitalized,  all of them children.  105The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).106Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.107Water samples and filters from  the water system also tested positive for norovirus and enterovirus.108A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.109Patients presented with vomiting,  diarrhoea and fever.110On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.111We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.112An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.113Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 114In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  115The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).116When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.117Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.118The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.119Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.120On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 121Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.122Regular water  sampling and testing was performed to monitor the efficiency of  control measures.123Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).124Stool samples obtained from 36 probable  cases were examined at the laboratory.125The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  126 127","How was the event first detected?128","{'answer_start': [570], 'text': ['cases of gastroenteritis  among guests of a hotel.']}"1298,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.130An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.131In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  132On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.133The alert came from a cluster of gastroenteritis in a hotel.134Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.135A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.136Four cases were hospitalized,  all of them children.  137The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).138Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.139Water samples and filters from  the water system also tested positive for norovirus and enterovirus.140A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.141Patients presented with vomiting,  diarrhoea and fever.142On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.143We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.144An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.145Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 146In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  147The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).148When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.149Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.150The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.151Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.152On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 153Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.154Regular water  sampling and testing was performed to monitor the efficiency of  control measures.155Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).156Stool samples obtained from 36 probable  cases were examined at the laboratory.157The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  158 159","How many people were ill?160","{'answer_start': [712], 'text': ['299 probable cases']}"1615,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.162An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.163In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  164On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.165The alert came from a cluster of gastroenteritis in a hotel.166Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.167A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.168Four cases were hospitalized,  all of them children.  169The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).170Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.171Water samples and filters from  the water system also tested positive for norovirus and enterovirus.172A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.173Patients presented with vomiting,  diarrhoea and fever.174On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.175We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.176An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.177Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 178In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  179The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).180When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.181Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.182The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.183Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.184On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 185Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.186Regular water  sampling and testing was performed to monitor the efficiency of  control measures.187Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).188Stool samples obtained from 36 probable  cases were examined at the laboratory.189The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  190 191","How many people were hospitalized?192","{'answer_start': [962], 'text': ['Four cases']}"19333,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.194An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.195In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  196On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.197The alert came from a cluster of gastroenteritis in a hotel.198Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.199A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.200Four cases were hospitalized,  all of them children.  201The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).202Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.203Water samples and filters from  the water system also tested positive for norovirus and enterovirus.204A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.205Patients presented with vomiting,  diarrhoea and fever.206On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.207We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.208An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.209Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 210In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  211The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).212When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.213Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.214The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.215Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.216On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 217Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.218Regular water  sampling and testing was performed to monitor the efficiency of  control measures.219Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).220Stool samples obtained from 36 probable  cases were examined at the laboratory.221The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  222 223","What is the attack rate?224","{'answer_start': [1075], 'text': ['8.9%']}"22511,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.226An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.227In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  228On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.229The alert came from a cluster of gastroenteritis in a hotel.230Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.231A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.232Four cases were hospitalized,  all of them children.  233The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).234Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.235Water samples and filters from  the water system also tested positive for norovirus and enterovirus.236A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.237Patients presented with vomiting,  diarrhoea and fever.238On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.239We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.240An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.241Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 242In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  243The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).244When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.245Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.246The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.247Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.248On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 249Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.250Regular water  sampling and testing was performed to monitor the efficiency of  control measures.251Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).252Stool samples obtained from 36 probable  cases were examined at the laboratory.253The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  254 255","What are the pathogens?256","{'answer_start': [1213], 'text': ['norovirus,  rotavirus, enterovirus or astrovirus.']}"25713,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.258An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.259In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  260On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.261The alert came from a cluster of gastroenteritis in a hotel.262Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.263A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.264Four cases were hospitalized,  all of them children.  265The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).266Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.267Water samples and filters from  the water system also tested positive for norovirus and enterovirus.268A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.269Patients presented with vomiting,  diarrhoea and fever.270On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.271We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.272An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.273Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 274In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  275The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).276When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.277Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.278The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.279Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.280On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 281Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.282Regular water  sampling and testing was performed to monitor the efficiency of  control measures.283Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).284Stool samples obtained from 36 probable  cases were examined at the laboratory.285The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  286 287","What is the concentration of the contaminant after analysis?288","{'answer_start': [1744], 'text': ['high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml)']}"28911,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.290An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.291In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  292On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.293The alert came from a cluster of gastroenteritis in a hotel.294Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.295A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.296Four cases were hospitalized,  all of them children.  297The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).298Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.299Water samples and filters from  the water system also tested positive for norovirus and enterovirus.300A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.301Patients presented with vomiting,  diarrhoea and fever.302On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.303We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.304An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.305Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 306In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  307The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).308When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.309Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.310The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.311Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.312On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 313Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.314Regular water  sampling and testing was performed to monitor the efficiency of  control measures.315Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).316Stool samples obtained from 36 probable  cases were examined at the laboratory.317The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  318 319","What are the symptoms?320","{'answer_start': [1628], 'text': ['vomiting,  diarrhoea and fever.']}"32121,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.322An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.323In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  324On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.325The alert came from a cluster of gastroenteritis in a hotel.326Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.327A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.328Four cases were hospitalized,  all of them children.  329The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).330Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.331Water samples and filters from  the water system also tested positive for norovirus and enterovirus.332A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.333Patients presented with vomiting,  diarrhoea and fever.334On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.335We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.336An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.337Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 338In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  339The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).340When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.341Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.342The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.343Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.344On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 345Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.346Regular water  sampling and testing was performed to monitor the efficiency of  control measures.347Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).348Stool samples obtained from 36 probable  cases were examined at the laboratory.349The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  350 351","What is the event?352","{'answer_start': [1898], 'text': ['outbreak of viral gastroenteritis']}"35320,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.354An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.355In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  356On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.357The alert came from a cluster of gastroenteritis in a hotel.358Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.359A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.360Four cases were hospitalized,  all of them children.  361The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).362Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.363Water samples and filters from  the water system also tested positive for norovirus and enterovirus.364A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.365Patients presented with vomiting,  diarrhoea and fever.366On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.367We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.368An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.369Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 370In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  371The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).372When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.373Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.374The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.375Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.376On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 377Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.378Regular water  sampling and testing was performed to monitor the efficiency of  control measures.379Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).380Stool samples obtained from 36 probable  cases were examined at the laboratory.381The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  382 383","What are the initial steps of investigation?384","{'answer_start': [2199], 'text': ['a public hotline']}"38531,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.386An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.387In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  388On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.389The alert came from a cluster of gastroenteritis in a hotel.390Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.391A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.392Four cases were hospitalized,  all of them children.  393The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).394Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.395Water samples and filters from  the water system also tested positive for norovirus and enterovirus.396A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.397Patients presented with vomiting,  diarrhoea and fever.398On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.399We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.400An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.401Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 402In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  403The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).404When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.405Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.406The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.407Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.408On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 409Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.410Regular water  sampling and testing was performed to monitor the efficiency of  control measures.411Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).412Stool samples obtained from 36 probable  cases were examined at the laboratory.413The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  414 415","What is the duration of the event?416","{'answer_start': [3141], 'text': ['Over one month']}"41731,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.418An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.419In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  420On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.421The alert came from a cluster of gastroenteritis in a hotel.422Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.423A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.424Four cases were hospitalized,  all of them children.  425The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).426Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.427Water samples and filters from  the water system also tested positive for norovirus and enterovirus.428A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.429Patients presented with vomiting,  diarrhoea and fever.430On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.431We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.432An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.433Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 434In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  435The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).436When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.437Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.438The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.439Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.440On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 441Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.442Regular water  sampling and testing was performed to monitor the efficiency of  control measures.443Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).444Stool samples obtained from 36 probable  cases were examined at the laboratory.445The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  446 447","From when until when the event happened448","{'answer_start': [3331], 'text': [' between 8 June and 4  July 2009']}"44931,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.450An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.451In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  452On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.453The alert came from a cluster of gastroenteritis in a hotel.454Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.455A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.456Four cases were hospitalized,  all of them children.  457The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).458Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.459Water samples and filters from  the water system also tested positive for norovirus and enterovirus.460A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.461Patients presented with vomiting,  diarrhoea and fever.462On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.463We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.464An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.465Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 466In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  467The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).468When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.469Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.470The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.471Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.472On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 473Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.474Regular water  sampling and testing was performed to monitor the efficiency of  control measures.475Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).476Stool samples obtained from 36 probable  cases were examined at the laboratory.477The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  478 479","What are the first steps of mitigation?480","{'answer_start': [3456], 'text': ['treating the water system with chlorine dioxide']}"48111,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.482An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.483In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  484On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.485The alert came from a cluster of gastroenteritis in a hotel.486Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.487A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.488Four cases were hospitalized,  all of them children.  489The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).490Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.491Water samples and filters from  the water system also tested positive for norovirus and enterovirus.492A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.493Patients presented with vomiting,  diarrhoea and fever.494On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.495We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.496An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.497Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 498In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  499The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).500When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.501Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.502The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.503Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.504On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 505Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.506Regular water  sampling and testing was performed to monitor the efficiency of  control measures.507Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).508Stool samples obtained from 36 probable  cases were examined at the laboratory.509The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  510 511","What did they do to mitigate the event?512","{'answer_start': [3682], 'text': ['restricted the use of municipal water']}"51319,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.514An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.515In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  516On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.517The alert came from a cluster of gastroenteritis in a hotel.518Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.519A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.520Four cases were hospitalized,  all of them children.  521The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).522Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.523Water samples and filters from  the water system also tested positive for norovirus and enterovirus.524A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.525Patients presented with vomiting,  diarrhoea and fever.526On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.527We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.528An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.529Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 530In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  531The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).532When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.533Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.534The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.535Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.536On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 537Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.538Regular water  sampling and testing was performed to monitor the efficiency of  control measures.539Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).540Stool samples obtained from 36 probable  cases were examined at the laboratory.541The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  542 543","What did the local authorities advise?544","{'answer_start': [3916], 'text': ['door-to-door information']}"54523,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.546An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.547In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  548On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.549The alert came from a cluster of gastroenteritis in a hotel.550Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.551A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.552Four cases were hospitalized,  all of them children.  553The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).554Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.555Water samples and filters from  the water system also tested positive for norovirus and enterovirus.556A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.557Patients presented with vomiting,  diarrhoea and fever.558On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.559We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.560An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.561Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 562In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  563The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).564When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.565Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.566The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.567Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.568On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 569Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.570Regular water  sampling and testing was performed to monitor the efficiency of  control measures.571Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).572Stool samples obtained from 36 probable  cases were examined at the laboratory.573The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  574 575",What was the environmental investigation?,"{'answer_start': [2721], 'text': ['interviewing and collecting stool samples for microbiological testing']}"5768,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.577An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.578In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  579On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.580The alert came from a cluster of gastroenteritis in a hotel.581Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.582A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.583Four cases were hospitalized,  all of them children.  584The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).585Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.586Water samples and filters from  the water system also tested positive for norovirus and enterovirus.587A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.588Patients presented with vomiting,  diarrhoea and fever.589On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.590We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.591An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.592Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 593In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  594The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).595When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.596Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.597The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.598Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.599On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 600Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.601Regular water  sampling and testing was performed to monitor the efficiency of  control measures.602Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).603Stool samples obtained from 36 probable  cases were examined at the laboratory.604The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  605 606",What was the outbreak investigation?,"{'answer_start': [2424], 'text': ['collected daily information on case-patients']}"60713,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.608An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.609In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  610On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.611The alert came from a cluster of gastroenteritis in a hotel.612Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.613A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.614Four cases were hospitalized,  all of them children.  615The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).616Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.617Water samples and filters from  the water system also tested positive for norovirus and enterovirus.618A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.619Patients presented with vomiting,  diarrhoea and fever.620On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.621We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.622An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.623Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 624In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  625The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).626When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.627Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.628The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.629Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.630On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 631Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.632Regular water  sampling and testing was performed to monitor the efficiency of  control measures.633Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).634Stool samples obtained from 36 probable  cases were examined at the laboratory.635The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  636 637",What did the authorities do to mitigate the event?,"{'answer_start': [3079], 'text': ['collection of water samples']}"63828,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.639An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.640In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  641On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.642The alert came from a cluster of gastroenteritis in a hotel.643Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.644A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.645Four cases were hospitalized,  all of them children.  646The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).647Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.648Water samples and filters from  the water system also tested positive for norovirus and enterovirus.649A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.650Patients presented with vomiting,  diarrhoea and fever.651On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.652We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.653An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.654Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 655In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  656The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).657When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.658Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.659The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.660Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.661On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 662Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.663Regular water  sampling and testing was performed to monitor the efficiency of  control measures.664Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).665Stool samples obtained from 36 probable  cases were examined at the laboratory.666The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  667 668","What was the age of the affected people?669","{'answer_start': [4739], 'text': ['The mean age of confirmed cases of rotavirus was 29 years ']}"67027,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.671An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.672In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  673On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.674The alert came from a cluster of gastroenteritis in a hotel.675Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.676A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.677Four cases were hospitalized,  all of them children.  678The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).679Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.680Water samples and filters from  the water system also tested positive for norovirus and enterovirus.681A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.682Patients presented with vomiting,  diarrhoea and fever.683On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.684We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.685An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.686Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 687In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  688The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).689When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.690Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.691The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.692Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.693On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 694Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.695Regular water  sampling and testing was performed to monitor the efficiency of  control measures.696Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).697Stool samples obtained from 36 probable  cases were examined at the laboratory.698The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  699 700",What is the source of contamination?,"{'answer_start': [278], 'text': ['municipal water systems']}"70110,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.702An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.703In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  704On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.705The alert came from a cluster of gastroenteritis in a hotel.706Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.707A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.708Four cases were hospitalized,  all of them children.  709The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).710Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.711Water samples and filters from  the water system also tested positive for norovirus and enterovirus.712A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.713Patients presented with vomiting,  diarrhoea and fever.714On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.715We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.716An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.717Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 718In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  719The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).720When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.721Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.722The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.723Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.724On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 725Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.726Regular water  sampling and testing was performed to monitor the efficiency of  control measures.727Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).728Stool samples obtained from 36 probable  cases were examined at the laboratory.729The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  730 731",What was the alert of the event?,"{'answer_start': [643], 'text': ['cluster of gastroenteritis in a hotel.']}"73216,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.733An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.734In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  735On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.736The alert came from a cluster of gastroenteritis in a hotel.737Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.738A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.739Four cases were hospitalized,  all of them children.  740The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).741Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.742Water samples and filters from  the water system also tested positive for norovirus and enterovirus.743A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.744Patients presented with vomiting,  diarrhoea and fever.745On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.746We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.747An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.748Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 749In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  750The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).751When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.752Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.753The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.754Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.755On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 756Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.757Regular water  sampling and testing was performed to monitor the efficiency of  control measures.758Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).759Stool samples obtained from 36 probable  cases were examined at the laboratory.760The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  761 762",How many cases were there?,"{'answer_start': [862], 'text': ['299 persons']}"7636,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.764An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.765In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  766On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.767The alert came from a cluster of gastroenteritis in a hotel.768Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.769A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.770Four cases were hospitalized,  all of them children.  771The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).772Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.773Water samples and filters from  the water system also tested positive for norovirus and enterovirus.774A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.775Patients presented with vomiting,  diarrhoea and fever.776On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.777We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.778An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.779Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 780In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  781The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).782When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.783Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.784The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.785Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.786On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 787Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.788Regular water  sampling and testing was performed to monitor the efficiency of  control measures.789Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).790Stool samples obtained from 36 probable  cases were examined at the laboratory.791The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  792 793",What were the associated pathogens of concern?,"{'answer_start': [1553], 'text': [' norovirus, rotavirus, enterovirus or  astrovirus.']}"79420,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.795An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.796In Italy, municipal water systems have been identified as the source  of water-borne infections in several norovirus outbreaks.  797On 9 June 2009, a general practitioner from the municipality  of San Felice del Benaco notified to the local health authority of  Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis  among guests of a hotel.798The alert came from a cluster of gastroenteritis in a hotel.799Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.800A total of 299 persons fulfilled the outbreak case definition,  including 269 probable and 30 confirmed cases.801Four cases were hospitalized,  all of them children.  802The attack rate for the town of San Felice del Benaco was 8.9%  (299/3,360).803Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.804Water samples and filters from  the water system also tested positive for norovirus and enterovirus.805A confirmed outbreak  case was defined as a person who fulfilled the criteria of a probable  case and whose stool sample was laboratory-confirmed for at least  one of the following viruses: norovirus, rotavirus, enterovirus or  astrovirus.806Patients presented with vomiting,  diarrhoea and fever.807On 16 June 2009, preliminary environmental  investigation results showed abnormally high levels of Clostridium  perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16  UFC/100 ml) in water samples from two public fountains.808We report an outbreak of viral gastroenteritis linked to municipal  drinking water in a town in northern Italy in June 2009.809An outbreak of viral gastroenteritis has been microbiologically  linked to a contaminated municipal water supply in a small town  of Lombardy.810Active case finding was performed as follows: a public hotline was  set up where people could call the health authority for information  regarding the disease and report symptoms, date of onset and  basic demographic data. 811In parallel, the outbreak investigation  team collected daily information on case-patients presenting at the  emergency unit of the local hospital and collected stool samples  when possible.  812The local and regional health authorities initiated an  environmental investigation at the hotel on 9 June 2009, taking  food samples from the kitchen, interviewing and collecting stool  samples for microbiological testing from 20 probable cases (both  guests and hotel staff).813When it was clear that the outbreak was  spreading to the larger community (apart from three campsites with  their own private water supply, where no cases were reported), the  environmental investigation was extended and included collection  of water samples from the municipal water supply.814Over  one month we identified 299 probable cases of whom 30 were  confirmed for at least one of the following viruses: norovirus,  rotavirus, enterovirus or astrovirus.815The outbreak occurred between 8 June and 4  July 2009 and peaked on the 15 and 16 June with 47 outbreak  cases per day.816Control measures included treating the water system with chlorine  dioxide and filters with peracetic acid, while providing temporary  alternative sources of drinking water to the population.817On 17 June 2009, a special ordinance from the municipality  restricted the use of municipal water (inhabitants were told not  to use municipal water for drinking and cooking purposes) and  provided alternative water supplies to the population via water  tankers. 818Local authorities organized a door-to-door information  campaign and distributed leaflets in order to reach as many people  as possible. On 19 June 2009, the municipality started disinfecting  the water system with chlorine dioxide (0.2 mg/l) and sand filters  with peracetic acid.819Regular water  sampling and testing was performed to monitor the efficiency of  control measures.820Samples were sent  to the Lombardy and Emilia Romagna Experimental Zooprophylactic  Institute (IZSLER) to test for the presence of bacterial pathogens  (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157,  Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens  toxins), parasites (Cryptosporidium sp.) and viral pathogens  (norovirus, rotavirus, enterovirus, astrovirus).821Stool samples obtained from 36 probable  cases were examined at the laboratory.822The mean age of confirmed cases of rotavirus was 29 years  (range: 0-71) compared to the mean age of 39 years (range: 0-88)  for cases of norovirus and 39 years (9-88) for cases of enterovirus.  823 824",What was the outbreak?,"{'answer_start': [2013], 'text': ['outbreak of viral gastroenteritis']}"82534,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia  were diagnosed in three counties in central Norway:  21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two  of typhoid type. Three cases were asymptomatic and  clinical information was unavailable for one case. The  mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells.  An increased rodent (lemming) population and snow  melting may have led to contamination of the wells  with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases  (16 female and 23 male) of tularaemia were reported  from the counties of Sr-Trndelag (28 cases), Mre og  Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person  who had clinical symptoms compatible with tularaemia  or had used drinking water from the same source as a  previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described  below. The cases were geographically scattered within  each county, involving 13 different municipalities  (Figure), and were not linked to one common source.  In comparison, seven cases were reported in total  from other parts of the country in the same period. In  2009 and 2010 four and eight cases respectively were  reported from central Norway.   Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are  recognised: tularensis, holarctica, mediasiatica and  novicida. In Europe, the infection is due to subspecies  holarctica which causes in general less severe disease  than subspecies tularensis, which is common in North  America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and  hares, but infection may also be transmitted via insect  bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the  most common clinical presentations in Norway [2].  Oropharyngeal disease is commonly associated with  contaminated food and water, while ulceroglandular  forms are more often seen when there has been skin  contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries  [3,4]. Tularaemia is a notifiable disease in Norway  and during the past 10 years, three outbreaks were  reported in Norway [5-7] and all were associated with  water sources in areas where dead lemmings (Lemmus  lemmus) had been observed previously. From 2001  to 2010, between three and 66 cases of tularaemia  were reported annually in the whole country, with an  increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be  explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy  (glandular/ulceroglandular type, 10 cases). Among the  remaining eight tularaemia cases, two were classified  as respiratory and two as typhoid type, while three  were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology  (microagglutination and an in-house IgG/IgM Elisa) in  30 patients [8], by F. tularensis specific PCR analysis  in seven patients [9] and by blood culture (BactAlert,  BioMerieux) in two patients. The two bacterial isolates  were verified as F. tularensis by PCR and sequencing of  the 16S rDNA gene, and confirmed as non-subspecies  tularensis by pdpA PCR [10].  2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis  DNA was detected by PCR in filtered water from five  different wells tested in Sr-Trndelag. Seven cases in  one municipality were linked to the same water source.  Apart from that, only two cases have been confirmed  to share a common well so far. Follow-up serology has  been recommended for several of the persons exposed  to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and  cervical lymphadenopathy linked to the use of private  wells in the winter season makes contaminated water the most likely source of infection in this outbreak.  Detection of F. tularensis DNA by PCR analyses in some  of the wells supports this assumption for some of the  cases. Use of private wells is relatively common in  rural areas of Norway although exact data on such use  are not available.  The precise mechanism of contamination of the  wells with F. tularensis is as yet unknown. However,  November and December 2010 were unusually cold  months, while in January 2011 temperatures increased  leading to melting of snow and possible contamination  of private wells by surface water contaminated with  bacteria from rodent cadavers or rodent excreta. Since  the incubation period for tularaemia may be up to three  weeks, and time from symptoms until seroconversion  might be up to six weeks, more cases may follow.  Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates  rodents and hares as transmitters of disease. Years  with a great increase in the rodent population are seen  with intervals of about three to four years [11] and in  the summer and autumn of 2010, a high density of  lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian  Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain  hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after  exposure.  The use of small streams and private wells as a source  of drinking water and for other purposes in rural areas  of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes  where the rodents can enter. It is also important to  secure the well from contamination by surface water  after snow melting. In case of proven or suspected  contaminated wells, the water should be disinfected  before further use. However, this may not be feasible  for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with  similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert  and Response. WHO guidelines on tularaemia. Geneva:WHO;  2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf  2. Brantsaeter AB. Twenty-five years of tularaemia in Norway,  19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and  Infectious Diseases. 14th European Congress of Clinical  Microbiology and Infectious Diseases. Prague; 1-4 May 2004.  3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe:  an epidemiological overview. Scand J Infect Dis.  2004;36(5):350-5.  4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser  W, et al. An outbreak of oropharyngeal tularaemia linked to  natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6.  5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia  (harepest) i Midtre Gauldal. [A waterborne outbreak of  tularaemia in Midtre-Gauldal]. Norwegian Institute of Public  Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0  6. Brantsaeter AB, Krogh T, Radtke A, Nygard K.  Tularaemia outbreak in northern Norway. Euro Surveill.  2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165  7.  Melien P, Holsdal RE. Tularemi i Meldal  en vanskelig  diagnose? [Tularaemia in Meldal- a difficult diagnosis?].  Norwegian Institute of Public Health. 18 Mar 2008. Norwegian.  Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0  8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme  immunoassay for antibodies to a 43,000-molecular-weight  Francisella tularensis outer membrane protein in the diagnosis  of tularemia. J Clin Microbiol. 1989;27(5):922-6.  9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of  Francisella tularensis in ulcers of patients with tularaemia by  PCR. J Clin Microbiol. 1997;35(5):1045-8.  10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E,  Landt O, et al. Real-time PCR using hybridization probes for  the rapid and specific identification of Francisella tularensis  subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6.  11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian.  12. Norwegian Veterinary Institute. Flere tilfeller av harepest i  Sr-Norge [Severeal cases of tularaemia in South-Norway].  Norwegian Veterinary Institute. 25 Nov 2010. Norwegian.  Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge 826",What caused the event?,"{'answer_start': [500], 'text': ['contamination of the wells  with infected rodents or rodent excreta']}"8279,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia  were diagnosed in three counties in central Norway:  21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two  of typhoid type. Three cases were asymptomatic and  clinical information was unavailable for one case. The  mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells.  An increased rodent (lemming) population and snow  melting may have led to contamination of the wells  with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases  (16 female and 23 male) of tularaemia were reported  from the counties of Sr-Trndelag (28 cases), Mre og  Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person  who had clinical symptoms compatible with tularaemia  or had used drinking water from the same source as a  previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described  below. The cases were geographically scattered within  each county, involving 13 different municipalities  (Figure), and were not linked to one common source.  In comparison, seven cases were reported in total  from other parts of the country in the same period. In  2009 and 2010 four and eight cases respectively were  reported from central Norway.   Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are  recognised: tularensis, holarctica, mediasiatica and  novicida. In Europe, the infection is due to subspecies  holarctica which causes in general less severe disease  than subspecies tularensis, which is common in North  America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and  hares, but infection may also be transmitted via insect  bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the  most common clinical presentations in Norway [2].  Oropharyngeal disease is commonly associated with  contaminated food and water, while ulceroglandular  forms are more often seen when there has been skin  contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries  [3,4]. Tularaemia is a notifiable disease in Norway  and during the past 10 years, three outbreaks were  reported in Norway [5-7] and all were associated with  water sources in areas where dead lemmings (Lemmus  lemmus) had been observed previously. From 2001  to 2010, between three and 66 cases of tularaemia  were reported annually in the whole country, with an  increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be  explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy  (glandular/ulceroglandular type, 10 cases). Among the  remaining eight tularaemia cases, two were classified  as respiratory and two as typhoid type, while three  were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology  (microagglutination and an in-house IgG/IgM Elisa) in  30 patients [8], by F. tularensis specific PCR analysis  in seven patients [9] and by blood culture (BactAlert,  BioMerieux) in two patients. The two bacterial isolates  were verified as F. tularensis by PCR and sequencing of  the 16S rDNA gene, and confirmed as non-subspecies  tularensis by pdpA PCR [10].  2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis  DNA was detected by PCR in filtered water from five  different wells tested in Sr-Trndelag. Seven cases in  one municipality were linked to the same water source.  Apart from that, only two cases have been confirmed  to share a common well so far. Follow-up serology has  been recommended for several of the persons exposed  to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and  cervical lymphadenopathy linked to the use of private  wells in the winter season makes contaminated water the most likely source of infection in this outbreak.  Detection of F. tularensis DNA by PCR analyses in some  of the wells supports this assumption for some of the  cases. Use of private wells is relatively common in  rural areas of Norway although exact data on such use  are not available.  The precise mechanism of contamination of the  wells with F. tularensis is as yet unknown. However,  November and December 2010 were unusually cold  months, while in January 2011 temperatures increased  leading to melting of snow and possible contamination  of private wells by surface water contaminated with  bacteria from rodent cadavers or rodent excreta. Since  the incubation period for tularaemia may be up to three  weeks, and time from symptoms until seroconversion  might be up to six weeks, more cases may follow.  Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates  rodents and hares as transmitters of disease. Years  with a great increase in the rodent population are seen  with intervals of about three to four years [11] and in  the summer and autumn of 2010, a high density of  lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian  Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain  hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after  exposure.  The use of small streams and private wells as a source  of drinking water and for other purposes in rural areas  of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes  where the rodents can enter. It is also important to  secure the well from contamination by surface water  after snow melting. In case of proven or suspected  contaminated wells, the water should be disinfected  before further use. However, this may not be feasible  for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with  similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert  and Response. WHO guidelines on tularaemia. Geneva:WHO;  2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf  2. Brantsaeter AB. Twenty-five years of tularaemia in Norway,  19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and  Infectious Diseases. 14th European Congress of Clinical  Microbiology and Infectious Diseases. Prague; 1-4 May 2004.  3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe:  an epidemiological overview. Scand J Infect Dis.  2004;36(5):350-5.  4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser  W, et al. An outbreak of oropharyngeal tularaemia linked to  natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6.  5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia  (harepest) i Midtre Gauldal. [A waterborne outbreak of  tularaemia in Midtre-Gauldal]. Norwegian Institute of Public  Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0  6. Brantsaeter AB, Krogh T, Radtke A, Nygard K.  Tularaemia outbreak in northern Norway. Euro Surveill.  2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165  7.  Melien P, Holsdal RE. Tularemi i Meldal  en vanskelig  diagnose? [Tularaemia in Meldal- a difficult diagnosis?].  Norwegian Institute of Public Health. 18 Mar 2008. Norwegian.  Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0  8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme  immunoassay for antibodies to a 43,000-molecular-weight  Francisella tularensis outer membrane protein in the diagnosis  of tularemia. J Clin Microbiol. 1989;27(5):922-6.  9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of  Francisella tularensis in ulcers of patients with tularaemia by  PCR. J Clin Microbiol. 1997;35(5):1045-8.  10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E,  Landt O, et al. Real-time PCR using hybridization probes for  the rapid and specific identification of Francisella tularensis  subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6.  11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian.  12. Norwegian Veterinary Institute. Flere tilfeller av harepest i  Sr-Norge [Severeal cases of tularaemia in South-Norway].  Norwegian Veterinary Institute. 25 Nov 2010. Norwegian.  Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge 828","What is the date of the event?829","{'answer_start': [5], 'text': ['January to March 2011']}"83015,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia  were diagnosed in three counties in central Norway:  21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two  of typhoid type. Three cases were asymptomatic and  clinical information was unavailable for one case. The  mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells.  An increased rodent (lemming) population and snow  melting may have led to contamination of the wells  with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases  (16 female and 23 male) of tularaemia were reported  from the counties of Sr-Trndelag (28 cases), Mre og  Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person  who had clinical symptoms compatible with tularaemia  or had used drinking water from the same source as a  previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described  below. The cases were geographically scattered within  each county, involving 13 different municipalities  (Figure), and were not linked to one common source.  In comparison, seven cases were reported in total  from other parts of the country in the same period. In  2009 and 2010 four and eight cases respectively were  reported from central Norway.   Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are  recognised: tularensis, holarctica, mediasiatica and  novicida. In Europe, the infection is due to subspecies  holarctica which causes in general less severe disease  than subspecies tularensis, which is common in North  America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and  hares, but infection may also be transmitted via insect  bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the  most common clinical presentations in Norway [2].  Oropharyngeal disease is commonly associated with  contaminated food and water, while ulceroglandular  forms are more often seen when there has been skin  contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries  [3,4]. Tularaemia is a notifiable disease in Norway  and during the past 10 years, three outbreaks were  reported in Norway [5-7] and all were associated with  water sources in areas where dead lemmings (Lemmus  lemmus) had been observed previously. From 2001  to 2010, between three and 66 cases of tularaemia  were reported annually in the whole country, with an  increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be  explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy  (glandular/ulceroglandular type, 10 cases). Among the  remaining eight tularaemia cases, two were classified  as respiratory and two as typhoid type, while three  were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology  (microagglutination and an in-house IgG/IgM Elisa) in  30 patients [8], by F. tularensis specific PCR analysis  in seven patients [9] and by blood culture (BactAlert,  BioMerieux) in two patients. The two bacterial isolates  were verified as F. tularensis by PCR and sequencing of  the 16S rDNA gene, and confirmed as non-subspecies  tularensis by pdpA PCR [10].  2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis  DNA was detected by PCR in filtered water from five  different wells tested in Sr-Trndelag. Seven cases in  one municipality were linked to the same water source.  Apart from that, only two cases have been confirmed  to share a common well so far. Follow-up serology has  been recommended for several of the persons exposed  to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and  cervical lymphadenopathy linked to the use of private  wells in the winter season makes contaminated water the most likely source of infection in this outbreak.  Detection of F. tularensis DNA by PCR analyses in some  of the wells supports this assumption for some of the  cases. Use of private wells is relatively common in  rural areas of Norway although exact data on such use  are not available.  The precise mechanism of contamination of the  wells with F. tularensis is as yet unknown. However,  November and December 2010 were unusually cold  months, while in January 2011 temperatures increased  leading to melting of snow and possible contamination  of private wells by surface water contaminated with  bacteria from rodent cadavers or rodent excreta. Since  the incubation period for tularaemia may be up to three  weeks, and time from symptoms until seroconversion  might be up to six weeks, more cases may follow.  Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates  rodents and hares as transmitters of disease. Years  with a great increase in the rodent population are seen  with intervals of about three to four years [11] and in  the summer and autumn of 2010, a high density of  lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian  Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain  hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after  exposure.  The use of small streams and private wells as a source  of drinking water and for other purposes in rural areas  of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes  where the rodents can enter. It is also important to  secure the well from contamination by surface water  after snow melting. In case of proven or suspected  contaminated wells, the water should be disinfected  before further use. However, this may not be feasible  for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with  similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert  and Response. WHO guidelines on tularaemia. Geneva:WHO;  2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf  2. Brantsaeter AB. Twenty-five years of tularaemia in Norway,  19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and  Infectious Diseases. 14th European Congress of Clinical  Microbiology and Infectious Diseases. Prague; 1-4 May 2004.  3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe:  an epidemiological overview. Scand J Infect Dis.  2004;36(5):350-5.  4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser  W, et al. An outbreak of oropharyngeal tularaemia linked to  natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6.  5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia  (harepest) i Midtre Gauldal. [A waterborne outbreak of  tularaemia in Midtre-Gauldal]. Norwegian Institute of Public  Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0  6. Brantsaeter AB, Krogh T, Radtke A, Nygard K.  Tularaemia outbreak in northern Norway. Euro Surveill.  2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165  7.  Melien P, Holsdal RE. Tularemi i Meldal  en vanskelig  diagnose? [Tularaemia in Meldal- a difficult diagnosis?].  Norwegian Institute of Public Health. 18 Mar 2008. Norwegian.  Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0  8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme  immunoassay for antibodies to a 43,000-molecular-weight  Francisella tularensis outer membrane protein in the diagnosis  of tularemia. J Clin Microbiol. 1989;27(5):922-6.  9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of  Francisella tularensis in ulcers of patients with tularaemia by  PCR. J Clin Microbiol. 1997;35(5):1045-8.  10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E,  Landt O, et al. Real-time PCR using hybridization probes for  the rapid and specific identification of Francisella tularensis  subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6.  11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian.  12. Norwegian Veterinary Institute. Flere tilfeller av harepest i  Sr-Norge [Severeal cases of tularaemia in South-Norway].  Norwegian Veterinary Institute. 25 Nov 2010. Norwegian.  Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge 831","What is the location of the event?832","{'answer_start': [96], 'text': ['Norway']}"83319,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia  were diagnosed in three counties in central Norway:  21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two  of typhoid type. Three cases were asymptomatic and  clinical information was unavailable for one case. The  mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells.  An increased rodent (lemming) population and snow  melting may have led to contamination of the wells  with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases  (16 female and 23 male) of tularaemia were reported  from the counties of Sr-Trndelag (28 cases), Mre og  Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person  who had clinical symptoms compatible with tularaemia  or had used drinking water from the same source as a  previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described  below. The cases were geographically scattered within  each county, involving 13 different municipalities  (Figure), and were not linked to one common source.  In comparison, seven cases were reported in total  from other parts of the country in the same period. In  2009 and 2010 four and eight cases respectively were  reported from central Norway.   Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are  recognised: tularensis, holarctica, mediasiatica and  novicida. In Europe, the infection is due to subspecies  holarctica which causes in general less severe disease  than subspecies tularensis, which is common in North  America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and  hares, but infection may also be transmitted via insect  bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the  most common clinical presentations in Norway [2].  Oropharyngeal disease is commonly associated with  contaminated food and water, while ulceroglandular  forms are more often seen when there has been skin  contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries  [3,4]. Tularaemia is a notifiable disease in Norway  and during the past 10 years, three outbreaks were  reported in Norway [5-7] and all were associated with  water sources in areas where dead lemmings (Lemmus  lemmus) had been observed previously. From 2001  to 2010, between three and 66 cases of tularaemia  were reported annually in the whole country, with an  increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be  explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy  (glandular/ulceroglandular type, 10 cases). Among the  remaining eight tularaemia cases, two were classified  as respiratory and two as typhoid type, while three  were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology  (microagglutination and an in-house IgG/IgM Elisa) in  30 patients [8], by F. tularensis specific PCR analysis  in seven patients [9] and by blood culture (BactAlert,  BioMerieux) in two patients. The two bacterial isolates  were verified as F. tularensis by PCR and sequencing of  the 16S rDNA gene, and confirmed as non-subspecies  tularensis by pdpA PCR [10].  2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis  DNA was detected by PCR in filtered water from five  different wells tested in Sr-Trndelag. Seven cases in  one municipality were linked to the same water source.  Apart from that, only two cases have been confirmed  to share a common well so far. Follow-up serology has  been recommended for several of the persons exposed  to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and  cervical lymphadenopathy linked to the use of private  wells in the winter season makes contaminated water the most likely source of infection in this outbreak.  Detection of F. tularensis DNA by PCR analyses in some  of the wells supports this assumption for some of the  cases. Use of private wells is relatively common in  rural areas of Norway although exact data on such use  are not available.  The precise mechanism of contamination of the  wells with F. tularensis is as yet unknown. However,  November and December 2010 were unusually cold  months, while in January 2011 temperatures increased  leading to melting of snow and possible contamination  of private wells by surface water contaminated with  bacteria from rodent cadavers or rodent excreta. Since  the incubation period for tularaemia may be up to three  weeks, and time from symptoms until seroconversion  might be up to six weeks, more cases may follow.  Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates  rodents and hares as transmitters of disease. Years  with a great increase in the rodent population are seen  with intervals of about three to four years [11] and in  the summer and autumn of 2010, a high density of  lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian  Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain  hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after  exposure.  The use of small streams and private wells as a source  of drinking water and for other purposes in rural areas  of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes  where the rodents can enter. It is also important to  secure the well from contamination by surface water  after snow melting. In case of proven or suspected  contaminated wells, the water should be disinfected  before further use. However, this may not be feasible  for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with  similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert  and Response. WHO guidelines on tularaemia. Geneva:WHO;  2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf  2. Brantsaeter AB. Twenty-five years of tularaemia in Norway,  19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and  Infectious Diseases. 14th European Congress of Clinical  Microbiology and Infectious Diseases. Prague; 1-4 May 2004.  3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe:  an epidemiological overview. Scand J Infect Dis.  2004;36(5):350-5.  4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser  W, et al. An outbreak of oropharyngeal tularaemia linked to  natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6.  5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia  (harepest) i Midtre Gauldal. [A waterborne outbreak of  tularaemia in Midtre-Gauldal]. Norwegian Institute of Public  Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0  6. Brantsaeter AB, Krogh T, Radtke A, Nygard K.  Tularaemia outbreak in northern Norway. Euro Surveill.  2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165  7.  Melien P, Holsdal RE. Tularemi i Meldal  en vanskelig  diagnose? [Tularaemia in Meldal- a difficult diagnosis?].  Norwegian Institute of Public Health. 18 Mar 2008. Norwegian.  Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0  8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme  immunoassay for antibodies to a 43,000-molecular-weight  Francisella tularensis outer membrane protein in the diagnosis  of tularemia. J Clin Microbiol. 1989;27(5):922-6.  9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of  Francisella tularensis in ulcers of patients with tularaemia by  PCR. J Clin Microbiol. 1997;35(5):1045-8.  10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E,  Landt O, et al. Real-time PCR using hybridization probes for  the rapid and specific identification of Francisella tularensis  subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6.  11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian.  12. Norwegian Veterinary Institute. Flere tilfeller av harepest i  Sr-Norge [Severeal cases of tularaemia in South-Norway].  Norwegian Veterinary Institute. 25 Nov 2010. Norwegian.  Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge 834","How many people were ill?835","{'answer_start': [28], 'text': ['39 cases']}"8367,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia  were diagnosed in three counties in central Norway:  21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two  of typhoid type. Three cases were asymptomatic and  clinical information was unavailable for one case. The  mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells.  An increased rodent (lemming) population and snow  melting may have led to contamination of the wells  with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases  (16 female and 23 male) of tularaemia were reported  from the counties of Sr-Trndelag (28 cases), Mre og  Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person  who had clinical symptoms compatible with tularaemia  or had used drinking water from the same source as a  previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described  below. The cases were geographically scattered within  each county, involving 13 different municipalities  (Figure), and were not linked to one common source.  In comparison, seven cases were reported in total  from other parts of the country in the same period. In  2009 and 2010 four and eight cases respectively were  reported from central Norway.   Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are  recognised: tularensis, holarctica, mediasiatica and  novicida. In Europe, the infection is due to subspecies  holarctica which causes in general less severe disease  than subspecies tularensis, which is common in North  America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and  hares, but infection may also be transmitted via insect  bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the  most common clinical presentations in Norway [2].  Oropharyngeal disease is commonly associated with  contaminated food and water, while ulceroglandular  forms are more often seen when there has been skin  contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries  [3,4]. Tularaemia is a notifiable disease in Norway  and during the past 10 years, three outbreaks were  reported in Norway [5-7] and all were associated with  water sources in areas where dead lemmings (Lemmus  lemmus) had been observed previously. From 2001  to 2010, between three and 66 cases of tularaemia  were reported annually in the whole country, with an  increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be  explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy  (glandular/ulceroglandular type, 10 cases). Among the  remaining eight tularaemia cases, two were classified  as respiratory and two as typhoid type, while three  were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology  (microagglutination and an in-house IgG/IgM Elisa) in  30 patients [8], by F. tularensis specific PCR analysis  in seven patients [9] and by blood culture (BactAlert,  BioMerieux) in two patients. The two bacterial isolates  were verified as F. tularensis by PCR and sequencing of  the 16S rDNA gene, and confirmed as non-subspecies  tularensis by pdpA PCR [10].  2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis  DNA was detected by PCR in filtered water from five  different wells tested in Sr-Trndelag. Seven cases in  one municipality were linked to the same water source.  Apart from that, only two cases have been confirmed  to share a common well so far. Follow-up serology has  been recommended for several of the persons exposed  to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and  cervical lymphadenopathy linked to the use of private  wells in the winter season makes contaminated water the most likely source of infection in this outbreak.  Detection of F. tularensis DNA by PCR analyses in some  of the wells supports this assumption for some of the  cases. Use of private wells is relatively common in  rural areas of Norway although exact data on such use  are not available.  The precise mechanism of contamination of the  wells with F. tularensis is as yet unknown. However,  November and December 2010 were unusually cold  months, while in January 2011 temperatures increased  leading to melting of snow and possible contamination  of private wells by surface water contaminated with  bacteria from rodent cadavers or rodent excreta. Since  the incubation period for tularaemia may be up to three  weeks, and time from symptoms until seroconversion  might be up to six weeks, more cases may follow.  Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates  rodents and hares as transmitters of disease. Years  with a great increase in the rodent population are seen  with intervals of about three to four years [11] and in  the summer and autumn of 2010, a high density of  lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian  Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain  hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after  exposure.  The use of small streams and private wells as a source  of drinking water and for other purposes in rural areas  of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes  where the rodents can enter. It is also important to  secure the well from contamination by surface water  after snow melting. In case of proven or suspected  contaminated wells, the water should be disinfected  before further use. However, this may not be feasible  for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with  similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert  and Response. WHO guidelines on tularaemia. Geneva:WHO;  2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf  2. Brantsaeter AB. Twenty-five years of tularaemia in Norway,  19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and  Infectious Diseases. 14th European Congress of Clinical  Microbiology and Infectious Diseases. Prague; 1-4 May 2004.  3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe:  an epidemiological overview. Scand J Infect Dis.  2004;36(5):350-5.  4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser  W, et al. An outbreak of oropharyngeal tularaemia linked to  natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6.  5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia  (harepest) i Midtre Gauldal. [A waterborne outbreak of  tularaemia in Midtre-Gauldal]. Norwegian Institute of Public  Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0  6. Brantsaeter AB, Krogh T, Radtke A, Nygard K.  Tularaemia outbreak in northern Norway. Euro Surveill.  2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165  7.  Melien P, Holsdal RE. Tularemi i Meldal  en vanskelig  diagnose? [Tularaemia in Meldal- a difficult diagnosis?].  Norwegian Institute of Public Health. 18 Mar 2008. Norwegian.  Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0  8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme  immunoassay for antibodies to a 43,000-molecular-weight  Francisella tularensis outer membrane protein in the diagnosis  of tularemia. J Clin Microbiol. 1989;27(5):922-6.  9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of  Francisella tularensis in ulcers of patients with tularaemia by  PCR. J Clin Microbiol. 1997;35(5):1045-8.  10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E,  Landt O, et al. Real-time PCR using hybridization probes for  the rapid and specific identification of Francisella tularensis  subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6.  11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian.  12. Norwegian Veterinary Institute. Flere tilfeller av harepest i  Sr-Norge [Severeal cases of tularaemia in South-Norway].  Norwegian Veterinary Institute. 25 Nov 2010. Norwegian.  Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge 837","What are the pathogens?838","{'answer_start': [973], 'text': ['Francisella tularensis']}"8396,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia  were diagnosed in three counties in central Norway:  21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two  of typhoid type. Three cases were asymptomatic and  clinical information was unavailable for one case. The  mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells.  An increased rodent (lemming) population and snow  melting may have led to contamination of the wells  with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases  (16 female and 23 male) of tularaemia were reported  from the counties of Sr-Trndelag (28 cases), Mre og  Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person  who had clinical symptoms compatible with tularaemia  or had used drinking water from the same source as a  previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described  below. The cases were geographically scattered within  each county, involving 13 different municipalities  (Figure), and were not linked to one common source.  In comparison, seven cases were reported in total  from other parts of the country in the same period. In  2009 and 2010 four and eight cases respectively were  reported from central Norway.   Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are  recognised: tularensis, holarctica, mediasiatica and  novicida. In Europe, the infection is due to subspecies  holarctica which causes in general less severe disease  than subspecies tularensis, which is common in North  America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and  hares, but infection may also be transmitted via insect  bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the  most common clinical presentations in Norway [2].  Oropharyngeal disease is commonly associated with  contaminated food and water, while ulceroglandular  forms are more often seen when there has been skin  contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries  [3,4]. Tularaemia is a notifiable disease in Norway  and during the past 10 years, three outbreaks were  reported in Norway [5-7] and all were associated with  water sources in areas where dead lemmings (Lemmus  lemmus) had been observed previously. From 2001  to 2010, between three and 66 cases of tularaemia  were reported annually in the whole country, with an  increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be  explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy  (glandular/ulceroglandular type, 10 cases). Among the  remaining eight tularaemia cases, two were classified  as respiratory and two as typhoid type, while three  were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology  (microagglutination and an in-house IgG/IgM Elisa) in  30 patients [8], by F. tularensis specific PCR analysis  in seven patients [9] and by blood culture (BactAlert,  BioMerieux) in two patients. The two bacterial isolates  were verified as F. tularensis by PCR and sequencing of  the 16S rDNA gene, and confirmed as non-subspecies  tularensis by pdpA PCR [10].  2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis  DNA was detected by PCR in filtered water from five  different wells tested in Sr-Trndelag. Seven cases in  one municipality were linked to the same water source.  Apart from that, only two cases have been confirmed  to share a common well so far. Follow-up serology has  been recommended for several of the persons exposed  to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and  cervical lymphadenopathy linked to the use of private  wells in the winter season makes contaminated water the most likely source of infection in this outbreak.  Detection of F. tularensis DNA by PCR analyses in some  of the wells supports this assumption for some of the  cases. Use of private wells is relatively common in  rural areas of Norway although exact data on such use  are not available.  The precise mechanism of contamination of the  wells with F. tularensis is as yet unknown. However,  November and December 2010 were unusually cold  months, while in January 2011 temperatures increased  leading to melting of snow and possible contamination  of private wells by surface water contaminated with  bacteria from rodent cadavers or rodent excreta. Since  the incubation period for tularaemia may be up to three  weeks, and time from symptoms until seroconversion  might be up to six weeks, more cases may follow.  Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates  rodents and hares as transmitters of disease. Years  with a great increase in the rodent population are seen  with intervals of about three to four years [11] and in  the summer and autumn of 2010, a high density of  lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian  Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain  hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after  exposure.  The use of small streams and private wells as a source  of drinking water and for other purposes in rural areas  of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes  where the rodents can enter. It is also important to  secure the well from contamination by surface water  after snow melting. In case of proven or suspected  contaminated wells, the water should be disinfected  before further use. However, this may not be feasible  for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with  similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert  and Response. WHO guidelines on tularaemia. Geneva:WHO;  2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf  2. Brantsaeter AB. Twenty-five years of tularaemia in Norway,  19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and  Infectious Diseases. 14th European Congress of Clinical  Microbiology and Infectious Diseases. Prague; 1-4 May 2004.  3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe:  an epidemiological overview. Scand J Infect Dis.  2004;36(5):350-5.  4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser  W, et al. An outbreak of oropharyngeal tularaemia linked to  natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6.  5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia  (harepest) i Midtre Gauldal. [A waterborne outbreak of  tularaemia in Midtre-Gauldal]. Norwegian Institute of Public  Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0  6. Brantsaeter AB, Krogh T, Radtke A, Nygard K.  Tularaemia outbreak in northern Norway. Euro Surveill.  2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165  7.  Melien P, Holsdal RE. Tularemi i Meldal  en vanskelig  diagnose? [Tularaemia in Meldal- a difficult diagnosis?].  Norwegian Institute of Public Health. 18 Mar 2008. Norwegian.  Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0  8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme  immunoassay for antibodies to a 43,000-molecular-weight  Francisella tularensis outer membrane protein in the diagnosis  of tularemia. J Clin Microbiol. 1989;27(5):922-6.  9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of  Francisella tularensis in ulcers of patients with tularaemia by  PCR. J Clin Microbiol. 1997;35(5):1045-8.  10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E,  Landt O, et al. Real-time PCR using hybridization probes for  the rapid and specific identification of Francisella tularensis  subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6.  11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian.  12. Norwegian Veterinary Institute. Flere tilfeller av harepest i  Sr-Norge [Severeal cases of tularaemia in South-Norway].  Norwegian Veterinary Institute. 25 Nov 2010. Norwegian.  Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge 840","What are the symptoms?841","{'answer_start': [3005], 'text': ['fever and pharyngitis']}"84219,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia  were diagnosed in three counties in central Norway:  21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two  of typhoid type. Three cases were asymptomatic and  clinical information was unavailable for one case. The  mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells.  An increased rodent (lemming) population and snow  melting may have led to contamination of the wells  with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases  (16 female and 23 male) of tularaemia were reported  from the counties of Sr-Trndelag (28 cases), Mre og  Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person  who had clinical symptoms compatible with tularaemia  or had used drinking water from the same source as a  previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described  below. The cases were geographically scattered within  each county, involving 13 different municipalities  (Figure), and were not linked to one common source.  In comparison, seven cases were reported in total  from other parts of the country in the same period. In  2009 and 2010 four and eight cases respectively were  reported from central Norway.   Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are  recognised: tularensis, holarctica, mediasiatica and  novicida. In Europe, the infection is due to subspecies  holarctica which causes in general less severe disease  than subspecies tularensis, which is common in North  America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and  hares, but infection may also be transmitted via insect  bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the  most common clinical presentations in Norway [2].  Oropharyngeal disease is commonly associated with  contaminated food and water, while ulceroglandular  forms are more often seen when there has been skin  contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries  [3,4]. Tularaemia is a notifiable disease in Norway  and during the past 10 years, three outbreaks were  reported in Norway [5-7] and all were associated with  water sources in areas where dead lemmings (Lemmus  lemmus) had been observed previously. From 2001  to 2010, between three and 66 cases of tularaemia  were reported annually in the whole country, with an  increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be  explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy  (glandular/ulceroglandular type, 10 cases). Among the  remaining eight tularaemia cases, two were classified  as respiratory and two as typhoid type, while three  were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology  (microagglutination and an in-house IgG/IgM Elisa) in  30 patients [8], by F. tularensis specific PCR analysis  in seven patients [9] and by blood culture (BactAlert,  BioMerieux) in two patients. The two bacterial isolates  were verified as F. tularensis by PCR and sequencing of  the 16S rDNA gene, and confirmed as non-subspecies  tularensis by pdpA PCR [10].  2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis  DNA was detected by PCR in filtered water from five  different wells tested in Sr-Trndelag. Seven cases in  one municipality were linked to the same water source.  Apart from that, only two cases have been confirmed  to share a common well so far. Follow-up serology has  been recommended for several of the persons exposed  to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and  cervical lymphadenopathy linked to the use of private  wells in the winter season makes contaminated water the most likely source of infection in this outbreak.  Detection of F. tularensis DNA by PCR analyses in some  of the wells supports this assumption for some of the  cases. Use of private wells is relatively common in  rural areas of Norway although exact data on such use  are not available.  The precise mechanism of contamination of the  wells with F. tularensis is as yet unknown. However,  November and December 2010 were unusually cold  months, while in January 2011 temperatures increased  leading to melting of snow and possible contamination  of private wells by surface water contaminated with  bacteria from rodent cadavers or rodent excreta. Since  the incubation period for tularaemia may be up to three  weeks, and time from symptoms until seroconversion  might be up to six weeks, more cases may follow.  Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates  rodents and hares as transmitters of disease. Years  with a great increase in the rodent population are seen  with intervals of about three to four years [11] and in  the summer and autumn of 2010, a high density of  lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian  Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain  hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after  exposure.  The use of small streams and private wells as a source  of drinking water and for other purposes in rural areas  of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes  where the rodents can enter. It is also important to  secure the well from contamination by surface water  after snow melting. In case of proven or suspected  contaminated wells, the water should be disinfected  before further use. However, this may not be feasible  for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with  similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert  and Response. WHO guidelines on tularaemia. Geneva:WHO;  2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf  2. Brantsaeter AB. Twenty-five years of tularaemia in Norway,  19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and  Infectious Diseases. 14th European Congress of Clinical  Microbiology and Infectious Diseases. Prague; 1-4 May 2004.  3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe:  an epidemiological overview. Scand J Infect Dis.  2004;36(5):350-5.  4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser  W, et al. An outbreak of oropharyngeal tularaemia linked to  natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6.  5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia  (harepest) i Midtre Gauldal. [A waterborne outbreak of  tularaemia in Midtre-Gauldal]. Norwegian Institute of Public  Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0  6. Brantsaeter AB, Krogh T, Radtke A, Nygard K.  Tularaemia outbreak in northern Norway. Euro Surveill.  2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165  7.  Melien P, Holsdal RE. Tularemi i Meldal  en vanskelig  diagnose? [Tularaemia in Meldal- a difficult diagnosis?].  Norwegian Institute of Public Health. 18 Mar 2008. Norwegian.  Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0  8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme  immunoassay for antibodies to a 43,000-molecular-weight  Francisella tularensis outer membrane protein in the diagnosis  of tularemia. J Clin Microbiol. 1989;27(5):922-6.  9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of  Francisella tularensis in ulcers of patients with tularaemia by  PCR. J Clin Microbiol. 1997;35(5):1045-8.  10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E,  Landt O, et al. Real-time PCR using hybridization probes for  the rapid and specific identification of Francisella tularensis  subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6.  11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian.  12. Norwegian Veterinary Institute. Flere tilfeller av harepest i  Sr-Norge [Severeal cases of tularaemia in South-Norway].  Norwegian Veterinary Institute. 25 Nov 2010. Norwegian.  Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge 843","What are the first steps of mitigation?844","{'answer_start': [6310], 'text': ['boil drinking water and inspect the wells for dead rodents']}"84518,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia  were diagnosed in three counties in central Norway:  21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two  of typhoid type. Three cases were asymptomatic and  clinical information was unavailable for one case. The  mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells.  An increased rodent (lemming) population and snow  melting may have led to contamination of the wells  with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases  (16 female and 23 male) of tularaemia were reported  from the counties of Sr-Trndelag (28 cases), Mre og  Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person  who had clinical symptoms compatible with tularaemia  or had used drinking water from the same source as a  previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described  below. The cases were geographically scattered within  each county, involving 13 different municipalities  (Figure), and were not linked to one common source.  In comparison, seven cases were reported in total  from other parts of the country in the same period. In  2009 and 2010 four and eight cases respectively were  reported from central Norway.   Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are  recognised: tularensis, holarctica, mediasiatica and  novicida. In Europe, the infection is due to subspecies  holarctica which causes in general less severe disease  than subspecies tularensis, which is common in North  America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and  hares, but infection may also be transmitted via insect  bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the  most common clinical presentations in Norway [2].  Oropharyngeal disease is commonly associated with  contaminated food and water, while ulceroglandular  forms are more often seen when there has been skin  contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries  [3,4]. Tularaemia is a notifiable disease in Norway  and during the past 10 years, three outbreaks were  reported in Norway [5-7] and all were associated with  water sources in areas where dead lemmings (Lemmus  lemmus) had been observed previously. From 2001  to 2010, between three and 66 cases of tularaemia  were reported annually in the whole country, with an  increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be  explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy  (glandular/ulceroglandular type, 10 cases). Among the  remaining eight tularaemia cases, two were classified  as respiratory and two as typhoid type, while three  were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology  (microagglutination and an in-house IgG/IgM Elisa) in  30 patients [8], by F. tularensis specific PCR analysis  in seven patients [9] and by blood culture (BactAlert,  BioMerieux) in two patients. The two bacterial isolates  were verified as F. tularensis by PCR and sequencing of  the 16S rDNA gene, and confirmed as non-subspecies  tularensis by pdpA PCR [10].  2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis  DNA was detected by PCR in filtered water from five  different wells tested in Sr-Trndelag. Seven cases in  one municipality were linked to the same water source.  Apart from that, only two cases have been confirmed  to share a common well so far. Follow-up serology has  been recommended for several of the persons exposed  to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and  cervical lymphadenopathy linked to the use of private  wells in the winter season makes contaminated water the most likely source of infection in this outbreak.  Detection of F. tularensis DNA by PCR analyses in some  of the wells supports this assumption for some of the  cases. Use of private wells is relatively common in  rural areas of Norway although exact data on such use  are not available.  The precise mechanism of contamination of the  wells with F. tularensis is as yet unknown. However,  November and December 2010 were unusually cold  months, while in January 2011 temperatures increased  leading to melting of snow and possible contamination  of private wells by surface water contaminated with  bacteria from rodent cadavers or rodent excreta. Since  the incubation period for tularaemia may be up to three  weeks, and time from symptoms until seroconversion  might be up to six weeks, more cases may follow.  Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates  rodents and hares as transmitters of disease. Years  with a great increase in the rodent population are seen  with intervals of about three to four years [11] and in  the summer and autumn of 2010, a high density of  lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian  Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain  hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after  exposure.  The use of small streams and private wells as a source  of drinking water and for other purposes in rural areas  of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes  where the rodents can enter. It is also important to  secure the well from contamination by surface water  after snow melting. In case of proven or suspected  contaminated wells, the water should be disinfected  before further use. However, this may not be feasible  for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with  similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert  and Response. WHO guidelines on tularaemia. Geneva:WHO;  2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf  2. Brantsaeter AB. Twenty-five years of tularaemia in Norway,  19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and  Infectious Diseases. 14th European Congress of Clinical  Microbiology and Infectious Diseases. Prague; 1-4 May 2004.  3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe:  an epidemiological overview. Scand J Infect Dis.  2004;36(5):350-5.  4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser  W, et al. An outbreak of oropharyngeal tularaemia linked to  natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6.  5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia  (harepest) i Midtre Gauldal. [A waterborne outbreak of  tularaemia in Midtre-Gauldal]. Norwegian Institute of Public  Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0  6. Brantsaeter AB, Krogh T, Radtke A, Nygard K.  Tularaemia outbreak in northern Norway. Euro Surveill.  2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165  7.  Melien P, Holsdal RE. Tularemi i Meldal  en vanskelig  diagnose? [Tularaemia in Meldal- a difficult diagnosis?].  Norwegian Institute of Public Health. 18 Mar 2008. Norwegian.  Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0  8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme  immunoassay for antibodies to a 43,000-molecular-weight  Francisella tularensis outer membrane protein in the diagnosis  of tularemia. J Clin Microbiol. 1989;27(5):922-6.  9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of  Francisella tularensis in ulcers of patients with tularaemia by  PCR. J Clin Microbiol. 1997;35(5):1045-8.  10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E,  Landt O, et al. Real-time PCR using hybridization probes for  the rapid and specific identification of Francisella tularensis  subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6.  11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian.  12. Norwegian Veterinary Institute. Flere tilfeller av harepest i  Sr-Norge [Severeal cases of tularaemia in South-Norway].  Norwegian Veterinary Institute. 25 Nov 2010. Norwegian.  Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge 846","What measures were taken to prevent the event?847","{'answer_start': [6552], 'text': ['covering every opening and plugging every small holes']}"84833,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia  were diagnosed in three counties in central Norway:  21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two  of typhoid type. Three cases were asymptomatic and  clinical information was unavailable for one case. The  mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells.  An increased rodent (lemming) population and snow  melting may have led to contamination of the wells  with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases  (16 female and 23 male) of tularaemia were reported  from the counties of Sr-Trndelag (28 cases), Mre og  Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person  who had clinical symptoms compatible with tularaemia  or had used drinking water from the same source as a  previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described  below. The cases were geographically scattered within  each county, involving 13 different municipalities  (Figure), and were not linked to one common source.  In comparison, seven cases were reported in total  from other parts of the country in the same period. In  2009 and 2010 four and eight cases respectively were  reported from central Norway.   Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are  recognised: tularensis, holarctica, mediasiatica and  novicida. In Europe, the infection is due to subspecies  holarctica which causes in general less severe disease  than subspecies tularensis, which is common in North  America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and  hares, but infection may also be transmitted via insect  bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the  most common clinical presentations in Norway [2].  Oropharyngeal disease is commonly associated with  contaminated food and water, while ulceroglandular  forms are more often seen when there has been skin  contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries  [3,4]. Tularaemia is a notifiable disease in Norway  and during the past 10 years, three outbreaks were  reported in Norway [5-7] and all were associated with  water sources in areas where dead lemmings (Lemmus  lemmus) had been observed previously. From 2001  to 2010, between three and 66 cases of tularaemia  were reported annually in the whole country, with an  increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be  explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy  (glandular/ulceroglandular type, 10 cases). Among the  remaining eight tularaemia cases, two were classified  as respiratory and two as typhoid type, while three  were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology  (microagglutination and an in-house IgG/IgM Elisa) in  30 patients [8], by F. tularensis specific PCR analysis  in seven patients [9] and by blood culture (BactAlert,  BioMerieux) in two patients. The two bacterial isolates  were verified as F. tularensis by PCR and sequencing of  the 16S rDNA gene, and confirmed as non-subspecies  tularensis by pdpA PCR [10].  2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis  DNA was detected by PCR in filtered water from five  different wells tested in Sr-Trndelag. Seven cases in  one municipality were linked to the same water source.  Apart from that, only two cases have been confirmed  to share a common well so far. Follow-up serology has  been recommended for several of the persons exposed  to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and  cervical lymphadenopathy linked to the use of private  wells in the winter season makes contaminated water the most likely source of infection in this outbreak.  Detection of F. tularensis DNA by PCR analyses in some  of the wells supports this assumption for some of the  cases. Use of private wells is relatively common in  rural areas of Norway although exact data on such use  are not available.  The precise mechanism of contamination of the  wells with F. tularensis is as yet unknown. However,  November and December 2010 were unusually cold  months, while in January 2011 temperatures increased  leading to melting of snow and possible contamination  of private wells by surface water contaminated with  bacteria from rodent cadavers or rodent excreta. Since  the incubation period for tularaemia may be up to three  weeks, and time from symptoms until seroconversion  might be up to six weeks, more cases may follow.  Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates  rodents and hares as transmitters of disease. Years  with a great increase in the rodent population are seen  with intervals of about three to four years [11] and in  the summer and autumn of 2010, a high density of  lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian  Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain  hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after  exposure.  The use of small streams and private wells as a source  of drinking water and for other purposes in rural areas  of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes  where the rodents can enter. It is also important to  secure the well from contamination by surface water  after snow melting. In case of proven or suspected  contaminated wells, the water should be disinfected  before further use. However, this may not be feasible  for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with  similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert  and Response. WHO guidelines on tularaemia. Geneva:WHO;  2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf  2. Brantsaeter AB. Twenty-five years of tularaemia in Norway,  19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and  Infectious Diseases. 14th European Congress of Clinical  Microbiology and Infectious Diseases. Prague; 1-4 May 2004.  3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe:  an epidemiological overview. Scand J Infect Dis.  2004;36(5):350-5.  4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser  W, et al. An outbreak of oropharyngeal tularaemia linked to  natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6.  5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia  (harepest) i Midtre Gauldal. [A waterborne outbreak of  tularaemia in Midtre-Gauldal]. Norwegian Institute of Public  Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0  6. Brantsaeter AB, Krogh T, Radtke A, Nygard K.  Tularaemia outbreak in northern Norway. Euro Surveill.  2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165  7.  Melien P, Holsdal RE. Tularemi i Meldal  en vanskelig  diagnose? [Tularaemia in Meldal- a difficult diagnosis?].  Norwegian Institute of Public Health. 18 Mar 2008. Norwegian.  Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0  8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme  immunoassay for antibodies to a 43,000-molecular-weight  Francisella tularensis outer membrane protein in the diagnosis  of tularemia. J Clin Microbiol. 1989;27(5):922-6.  9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of  Francisella tularensis in ulcers of patients with tularaemia by  PCR. J Clin Microbiol. 1997;35(5):1045-8.  10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E,  Landt O, et al. Real-time PCR using hybridization probes for  the rapid and specific identification of Francisella tularensis  subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6.  11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian.  12. Norwegian Veterinary Institute. Flere tilfeller av harepest i  Sr-Norge [Severeal cases of tularaemia in South-Norway].  Norwegian Veterinary Institute. 25 Nov 2010. Norwegian.  Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge 849","What was the age of the affected people?850","{'answer_start': [317], 'text': ['mean age was 40.3 years']}"8516,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia  were diagnosed in three counties in central Norway:  21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two  of typhoid type. Three cases were asymptomatic and  clinical information was unavailable for one case. The  mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells.  An increased rodent (lemming) population and snow  melting may have led to contamination of the wells  with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases  (16 female and 23 male) of tularaemia were reported  from the counties of Sr-Trndelag (28 cases), Mre og  Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person  who had clinical symptoms compatible with tularaemia  or had used drinking water from the same source as a  previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described  below. The cases were geographically scattered within  each county, involving 13 different municipalities  (Figure), and were not linked to one common source.  In comparison, seven cases were reported in total  from other parts of the country in the same period. In  2009 and 2010 four and eight cases respectively were  reported from central Norway.   Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are  recognised: tularensis, holarctica, mediasiatica and  novicida. In Europe, the infection is due to subspecies  holarctica which causes in general less severe disease  than subspecies tularensis, which is common in North  America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and  hares, but infection may also be transmitted via insect  bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the  most common clinical presentations in Norway [2].  Oropharyngeal disease is commonly associated with  contaminated food and water, while ulceroglandular  forms are more often seen when there has been skin  contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries  [3,4]. Tularaemia is a notifiable disease in Norway  and during the past 10 years, three outbreaks were  reported in Norway [5-7] and all were associated with  water sources in areas where dead lemmings (Lemmus  lemmus) had been observed previously. From 2001  to 2010, between three and 66 cases of tularaemia  were reported annually in the whole country, with an  increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be  explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy  (glandular/ulceroglandular type, 10 cases). Among the  remaining eight tularaemia cases, two were classified  as respiratory and two as typhoid type, while three  were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology  (microagglutination and an in-house IgG/IgM Elisa) in  30 patients [8], by F. tularensis specific PCR analysis  in seven patients [9] and by blood culture (BactAlert,  BioMerieux) in two patients. The two bacterial isolates  were verified as F. tularensis by PCR and sequencing of  the 16S rDNA gene, and confirmed as non-subspecies  tularensis by pdpA PCR [10].  2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis  DNA was detected by PCR in filtered water from five  different wells tested in Sr-Trndelag. Seven cases in  one municipality were linked to the same water source.  Apart from that, only two cases have been confirmed  to share a common well so far. Follow-up serology has  been recommended for several of the persons exposed  to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and  cervical lymphadenopathy linked to the use of private  wells in the winter season makes contaminated water the most likely source of infection in this outbreak.  Detection of F. tularensis DNA by PCR analyses in some  of the wells supports this assumption for some of the  cases. Use of private wells is relatively common in  rural areas of Norway although exact data on such use  are not available.  The precise mechanism of contamination of the  wells with F. tularensis is as yet unknown. However,  November and December 2010 were unusually cold  months, while in January 2011 temperatures increased  leading to melting of snow and possible contamination  of private wells by surface water contaminated with  bacteria from rodent cadavers or rodent excreta. Since  the incubation period for tularaemia may be up to three  weeks, and time from symptoms until seroconversion  might be up to six weeks, more cases may follow.  Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates  rodents and hares as transmitters of disease. Years  with a great increase in the rodent population are seen  with intervals of about three to four years [11] and in  the summer and autumn of 2010, a high density of  lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian  Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain  hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after  exposure.  The use of small streams and private wells as a source  of drinking water and for other purposes in rural areas  of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes  where the rodents can enter. It is also important to  secure the well from contamination by surface water  after snow melting. In case of proven or suspected  contaminated wells, the water should be disinfected  before further use. However, this may not be feasible  for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with  similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert  and Response. WHO guidelines on tularaemia. Geneva:WHO;  2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf  2. Brantsaeter AB. Twenty-five years of tularaemia in Norway,  19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and  Infectious Diseases. 14th European Congress of Clinical  Microbiology and Infectious Diseases. Prague; 1-4 May 2004.  3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe:  an epidemiological overview. Scand J Infect Dis.  2004;36(5):350-5.  4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser  W, et al. An outbreak of oropharyngeal tularaemia linked to  natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6.  5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia  (harepest) i Midtre Gauldal. [A waterborne outbreak of  tularaemia in Midtre-Gauldal]. Norwegian Institute of Public  Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0  6. Brantsaeter AB, Krogh T, Radtke A, Nygard K.  Tularaemia outbreak in northern Norway. Euro Surveill.  2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165  7.  Melien P, Holsdal RE. Tularemi i Meldal  en vanskelig  diagnose? [Tularaemia in Meldal- a difficult diagnosis?].  Norwegian Institute of Public Health. 18 Mar 2008. Norwegian.  Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0  8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme  immunoassay for antibodies to a 43,000-molecular-weight  Francisella tularensis outer membrane protein in the diagnosis  of tularemia. J Clin Microbiol. 1989;27(5):922-6.  9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of  Francisella tularensis in ulcers of patients with tularaemia by  PCR. J Clin Microbiol. 1997;35(5):1045-8.  10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E,  Landt O, et al. Real-time PCR using hybridization probes for  the rapid and specific identification of Francisella tularensis  subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6.  11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian.  12. Norwegian Veterinary Institute. Flere tilfeller av harepest i  Sr-Norge [Severeal cases of tularaemia in South-Norway].  Norwegian Veterinary Institute. 25 Nov 2010. Norwegian.  Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge 852",What is the source of contamination?,"{'answer_start': [4508], 'text': ['contaminated water']}"85319,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.854In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.855The source of the outbreak was a drinking water supply contaminated by human sewage.856The water supply for the ski resort was contaminated with human sewage.857On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.858A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak.859Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).860In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified.861A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006.862Symptoms included nausea, vomiting, or diarrhea.863The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services.864In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.865On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.866A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness.867Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected.868Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities.869Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).870Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis.871Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans.872",What symptoms were developed?,"{'answer_start': [1066], 'text': ['diarrhea or vomiting']}"87326,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.874In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.875The source of the outbreak was a drinking water supply contaminated by human sewage.876The water supply for the ski resort was contaminated with human sewage.877On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.878A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak.879Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).880In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified.881A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006.882Symptoms included nausea, vomiting, or diarrhea.883The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services.884In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.885On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.886A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness.887Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected.888Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities.889Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).890Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis.891Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans.892","What type of samples were analyzed?893","{'answer_start': [2483], 'text': ['Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases']}"89410,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.895In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.896The source of the outbreak was a drinking water supply contaminated by human sewage.897The water supply for the ski resort was contaminated with human sewage.898On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.899A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak.900Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).901In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified.902A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006.903Symptoms included nausea, vomiting, or diarrhea.904The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services.905In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.906On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.907A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness.908Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected.909Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities.910Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).911Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis.912Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans.913","What is the date of the event?914","{'answer_start': [3], 'text': ['July 2006']}"91526,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.916In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.917The source of the outbreak was a drinking water supply contaminated by human sewage.918The water supply for the ski resort was contaminated with human sewage.919On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.920A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak.921Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).922In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified.923A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006.924Symptoms included nausea, vomiting, or diarrhea.925The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services.926In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.927On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.928A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness.929Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected.930Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities.931Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).932Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis.933Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans.934","What is the location of the event?935","{'answer_start': [139], 'text': ['southern New Zealand']}"93618,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.937In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.938The source of the outbreak was a drinking water supply contaminated by human sewage.939The water supply for the ski resort was contaminated with human sewage.940On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.941A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak.942Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).943In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified.944A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006.945Symptoms included nausea, vomiting, or diarrhea.946The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services.947In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.948On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.949A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness.950Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected.951Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities.952Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).953Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis.954Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans.955","What is the source that started the event?956","{'answer_start': [411], 'text': ['water supply for the ski resort was contaminated with human sewage.']}"95717,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.958In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.959The source of the outbreak was a drinking water supply contaminated by human sewage.960The water supply for the ski resort was contaminated with human sewage.961On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.962A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak.963Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).964In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified.965A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006.966Symptoms included nausea, vomiting, or diarrhea.967The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services.968In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.969On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.970A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness.971Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected.972Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities.973Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).974Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis.975Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans.976","How was the event first detected?977","{'answer_start': [496], 'text': ['public health authorities ']}"97813,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.979In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.980The source of the outbreak was a drinking water supply contaminated by human sewage.981The water supply for the ski resort was contaminated with human sewage.982On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.983A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak.984Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).985In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified.986A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006.987Symptoms included nausea, vomiting, or diarrhea.988The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services.989In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.990On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.991A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness.992Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected.993Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities.994Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).995Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis.996Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans.997","How many people were ill?998","{'answer_start': [642], 'text': ['218 cases ']}"99913,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1000In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1001The source of the outbreak was a drinking water supply contaminated by human sewage.1002The water supply for the ski resort was contaminated with human sewage.1003On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1004A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak.1005Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).1006In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified.1007A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006.1008Symptoms included nausea, vomiting, or diarrhea.1009The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services.1010In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1011On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1012A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness.1013Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected.1014Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities.1015Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).1016Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis.1017Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans.1018","What are the pathogens?1019","{'answer_start': [855], 'text': [' norovirus (NoV)']}"102030,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1021In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1022The source of the outbreak was a drinking water supply contaminated by human sewage.1023The water supply for the ski resort was contaminated with human sewage.1024On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1025A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak.1026Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).1027In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified.1028A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006.1029Symptoms included nausea, vomiting, or diarrhea.1030The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services.1031In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1032On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1033A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness.1034Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected.1035Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities.1036Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).1037Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis.1038Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans.1039","What is the concentration of the contaminant after analysis?1040","{'answer_start': [1231], 'text': ['E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml)']}"104132,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1042In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1043The source of the outbreak was a drinking water supply contaminated by human sewage.1044The water supply for the ski resort was contaminated with human sewage.1045On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1046A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak.1047Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).1048In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified.1049A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006.1050Symptoms included nausea, vomiting, or diarrhea.1051The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services.1052In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1053On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1054A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness.1055Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected.1056Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities.1057Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).1058Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis.1059Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans.1060","What are the symptoms?1061","{'answer_start': [1131], 'text': ['nausea, vomiting, or diarrhea']}"106213,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1063In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1064The source of the outbreak was a drinking water supply contaminated by human sewage.1065The water supply for the ski resort was contaminated with human sewage.1066On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1067A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak.1068Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).1069In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified.1070A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006.1071Symptoms included nausea, vomiting, or diarrhea.1072The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services.1073In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1074On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1075A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness.1076Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected.1077Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities.1078Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).1079Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis.1080Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans.1081","What is the event?1082","{'answer_start': [1546], 'text': ['an outbreak of acute gastroenteritis']}"108333,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1084In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1085The source of the outbreak was a drinking water supply contaminated by human sewage.1086The water supply for the ski resort was contaminated with human sewage.1087On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1088A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak.1089Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).1090In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified.1091A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006.1092Symptoms included nausea, vomiting, or diarrhea.1093The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services.1094In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1095On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1096A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness.1097Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected.1098Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities.1099Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).1100Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis.1101Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans.1102","What are the initial steps of investigation?1103","{'answer_start': [1852], 'text': ['a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7)']}"110428,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1105In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1106The source of the outbreak was a drinking water supply contaminated by human sewage.1107The water supply for the ski resort was contaminated with human sewage.1108On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1109A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak.1110Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).1111In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified.1112A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006.1113Symptoms included nausea, vomiting, or diarrhea.1114The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services.1115In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1116On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1117A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness.1118Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected.1119Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities.1120Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).1121Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis.1122Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans.1123","What are the first steps of mitigation?1124","{'answer_start': [2292], 'text': ['work restrictions for sick staff.']}"112520,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1126In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1127The source of the outbreak was a drinking water supply contaminated by human sewage.1128The water supply for the ski resort was contaminated with human sewage.1129On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1130A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak.1131Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).1132In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified.1133A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006.1134Symptoms included nausea, vomiting, or diarrhea.1135The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services.1136In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1137On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1138A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness.1139Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected.1140Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities.1141Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).1142Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis.1143Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans.1144","What type of samples were examined?1145","{'answer_start': [2670], 'text': ['fecal samples ']}"114619,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1147In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1148The source of the outbreak was a drinking water supply contaminated by human sewage.1149The water supply for the ski resort was contaminated with human sewage.1150On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1151A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak.1152Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).1153In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified.1154A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006.1155Symptoms included nausea, vomiting, or diarrhea.1156The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services.1157In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1158On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1159A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness.1160Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected.1161Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities.1162Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).1163Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis.1164Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans.1165",What was the outbreak investigation?,"{'answer_start': [1999], 'text': ['Information was sought from the ski resort management about the design and management of the water supply and the sewerage system.']}"116611,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1167In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1168The source of the outbreak was a drinking water supply contaminated by human sewage.1169The water supply for the ski resort was contaminated with human sewage.1170On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1171A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak.1172Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).1173In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified.1174A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006.1175Symptoms included nausea, vomiting, or diarrhea.1176The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services.1177In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1178On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1179A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness.1180Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected.1181Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities.1182Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).1183Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis.1184Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans.1185","What measures were taken to prevent the event?1186","{'answer_start': [2833], 'text': ['reviewing their approach to water supply management']}"118721,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1188In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1189The source of the outbreak was a drinking water supply contaminated by human sewage.1190The water supply for the ski resort was contaminated with human sewage.1191On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1192A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak.1193Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV).1194In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified.1195A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006.1196Symptoms included nausea, vomiting, or diarrhea.1197The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services.1198In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand.1199On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.1200A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness.

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