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February 8, 1995

An Outbreak of Norwalk Virus Gastroenteritis Associated With Eating Raw OystersImplications for Maintaining Safe Oyster Beds

Author Affiliations

From the Epidemic Intelligence Service (Dr Kohn), the Division of Field Epidemiology (Drs Kohn, Farley, and Baron), and the Medical Student Elective Program (Dr Curtis), Epidemiology Program Office, and the Division of Viral and Rickettsial Diseases (Drs Ando, Jin, Monroe, and Glass), Centers for Disease Control and Prevention, Atlanta, Ga; and the Louisiana Department of Health and Hospitals, New Orleans (Drs Kohn, Farley, and McFarland and Ms Wilson).

JAMA. 1995;273(6):466-471. doi:10.1001/jama.1995.03520300040034

Objective.  —To determine the characteristics and the cause of an outbreak of gastroenteritis associated with eating raw oysters.

Design.  —Survey of groups of persons reporting illness to the health department after eating oysters; survey of convenience sample of oyster harvesters; and tracing of implicated oysters.

Setting.  —General community.

Main Outcome Measures.  —Relative risk for illness after oyster consumption, source bed of contaminated oysters, presence of antibodies to Norwalk virus in serum, presence of a Norwalk virus in stool by direct electron microscopy and reverse transcription—polymerase chain reaction (RT-PCR), and DNA sequences of RT-PCR products.

Results.  —Seventy (83%) of 84 persons who ate raw oysters became ill vs three (7%) of 43 people who did not eat raw oysters (relative risk, 11.9; 95% confidence interval, 4.0 to 34.2). Eleven (79%) of 14 serum pairs had at least a fourfold increase in antibody to Norwalk virus. All 12 stool samples tested were positive by electron microscopy and/or RT-PCR for Norwalk virus. The RT-PCR products from all seven stool samples tested had identical DNA sequences. Implicated oysters were harvested November 9 through 13, 1993, from a remote oyster bed. Crews from 22 (85%) of 26 oyster harvesting boats working in this area reported routine overboard disposal of sewage. One harvester with a high level of antibodies to Norwalk virus reported having gastroenteritis November 7 through 10 and overboard disposal of feces into the oyster bed.

Conclusions.  —This outbreak was caused by contamination of oysters in the oyster bed, probably by stool from one or more ill harvesters. Education of oyster harvesters and enforcement of regulations governing waste disposal by oyster harvesting boats might prevent similar outbreaks.(JAMA. 1995;273:466-471)