Mixed viral infections causing acute gastroenteritis in children in a waterborne outbreak

We examined stool specimens for viral pathogens from 50 children referred to hospital due to acute gastroenteritis (AGE) resulting from consuming drinking water contaminated with sewage in a Finnish community using PCR methods. Rotavirus was detected in 33 (66%), human calicivirus in 31 (62%), and both in 40% of cases. Of the caliciviruses, 20/31 (65%) were noroviruses and 11 (35%) sapoviruses. Furthermore, Aichi virus was detected in 25 (50%), adenovirus in six (12%) and bocavirus in four (8%) cases. Campylobacter jejuni was present in 20 (61%) and Salmonella in four (12%) of the 33 stools cultured for bacteria. On a 20-point scale median severity score of AGE in the 28 hospitalized children was 17; the severity was similar regardless of viruses detected. Bloody diarrhoea occurred only when C. jejuni was present. To conclude, massive exposure to several AGE viruses caused mixed infections and severe AGE regardless of the aetiological agents.