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Prevention, protocols, and lab capacity: lessons from a norovirus outbreak in the Algarve

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Abstract

This brief report presents the findings of an epidemiological investigation into a large-scale outbreak of norovirus gastroenteritis that occurred in a hotel in Algarve, Portugal, in August 2022. A total of 244 cases were reported, primarily affecting Portuguese families, with the parents aged 40-50 years and the children aged 0-19 years. Reported symptoms included vomiting, nausea, abdominal pain, and diarrhoea. Norovirus genotype GI.3 [P3] was detected in stool samples from eight probable cases, while food samples tested negative for norovirus and common pathogenic bacteria. The investigation data collected suggest that the source of the outbreak was likely in the hotel's common areas, with subsequent person-to-person transmission in other areas. The final report emphasizes the importance of improving outbreak prevention and control measures, including the development of a foodborne outbreak investigation protocol, the establishment of an outbreak response team, and the enhancement of regional laboratory capacity.

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Availability of data and materials

Data will not be available by default. Upon request authors can send relevant documentation or data in order to verify the validity of the results presented. Sensitive information in the form of confidential or proprietary data is excluded.

Abbreviations

GHPs:

Good hygiene practices

HACCP:

Hazard analysis and critical control point

LED:

Local emergency health department

INSA:

National Institute of Health Doutor Ricardo Jorge

NoV:

Norovirus

PHU:

Public health unit

RT-PCR:

Real-time reverse transcription polymerase chain reaction

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Acknowledgements

The authors would like to thank the healthcare professionals who collaborated in the diagnosis and the management of patients, as well as the managers of the hotel for their cooperation during the investigation process and for their support in establishing preventive measures. The members of Outbreak Investigation Team are mentioned here: Carlos Lopes: Public Health Unit, Algarve Central Health Centre Grouping, Regional Health Administration of Algarve, Portugal, Ana Fonseca: Public Health Unit, Algarve Central Health Centre Grouping, Regional Health Administration of Algarve, Portugal, Soraia Almeida: Public Health Unit, Algarve Central Health Centre Grouping, Regional Health Administration of Algarve, Portugal, Maria Jesus Ferreira: Personalized Health Care Unit (UCSP) Albufeira, Algarve Central Health Centre Grouping, Regional Health Administration of Algarve, Portugal, Tiago Almendra: Personalized Health Care Unit (UCSP) Albufeira, Algarve Central Health Centre Grouping, Regional Health Administration of Algarve, Portugal, Natalie das Neves: Personalized Health Care Unit (UCSP) Albufeira, Algarve Central Health Centre Grouping, Regional Health Administration of Algarve, Portugal, Aida Fernandes: Laura Ayres Laboratory, Regional Health Administration of Algarve, Portugal, Carolina Queiroz: Aqualab Laboratory, Portugal, Carla Maia: Department of Food and Nutrition, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal, Joaquim Bodião: Regional Public Health Department, Regional Health Administration of Algarve, Portugal, Ana Cristina Guerreiro: Regional Public Health Department, Regional Health Administration of Algarve, Portugal.

Funding

The financing of this study is the one inherent to personnel and structures, already foreseen in the Public Health Services budget, since investigation is one of the legislated functions.

Author information

Authors and Affiliations

  1. Public Health Unit, Algarve Central Health Centre Grouping, Regional Health Administration of Algarve, Faro, Portugal

    Regina Sá, Joana Roque, Pedro Marques Mendes & Filomena Horta Correia

  2. Public Health Unit, Algarve Barlavento Health Centre Grouping, Regional Health Administration of Algarve, Portimão, Portugal

    Inês Gonçalves

  3. Personalized Health Care Unit (UCSP) Albufeira, Algarve Central Health Centre Grouping, Regional Health Administration of Algarve, Albufeira, Portugal

    Judite Sousa & Cátia Matos

  4. Algarve University Hospital Centre, Faro, Portugal

    Álvaro Júnior

  5. Department of Food and Nutrition, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal

    Anabela Coelho & Cristina Belo Correia

  6. Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal

    Vera Manageiro, Corrado Minetti & Rita de Sousa

  7. European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden

    Vera Manageiro & Corrado Minetti

Authors
  1. Regina Sá
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  2. Joana Roque
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  3. Pedro Marques Mendes
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Consortia

Outbreak Investigation Team

  • Carlos Lopes
  • , Ana Fonseca
  • , Soraia Almeida
  • , Maria Jesus Ferreira
  • , Tiago Almendra
  • , Natalie des Neves
  • , Aida Fernandes
  • , Carolina Queiroz
  • , Carla Maia
  • , Joaquim Bodião
  •  & Ana Cristina Guerreiro

Corresponding author

Correspondence to Regina Sá.

Ethics declarations

Conflict of interest

None.

Ethical approval and consent to participate

This research was conducted in accordance with ethical principles with due respect for human dignity and human rights. Approval was obtained from an ethics commission on 19 April 2023 (Comissão de Ética e Saúde da ARS Algarve - process 08/2023). Epidemiological data were collected according to the principles applying to health authorities in this context. Informed verbal consent was given by the patients for the collection of biological samples. Irreversibly anonymised data were used for the analysis, no identifiable characteristics of individuals are described in this study, and only aggregated data are presented.

Additional information

Handling Editor: Tim Skern

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The members of the Outbreak Investigation Team are mentioned in Acknowledgement section.

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Sá, R., Roque, J., Marques Mendes, P. et al. Prevention, protocols, and lab capacity: lessons from a norovirus outbreak in the Algarve. Arch Virol 168, 299 (2023). https://doi.org/10.1007/s00705-023-05926-z

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  • DOI: https://doi.org/10.1007/s00705-023-05926-z

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