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Journal of Clinical Microbiology, March 2005, p. 1093-1098, Vol. 43, No. 3
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.3.1093-1098.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Multiprefectural Spread of Gastroenteritis Outbreaks Attributable to a Single Genogroup II Norovirus Strain from a Tourist Restaurant in Nagasaki, Japan

Yoichi Hirakata,1* Kokichi Arisawa,2,{dagger} Osamu Nishio,3 and Osamu Nakagomi2

Department of Laboratory Medicine, Nagasaki University School of Medicine and Dentistry,1 Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki,2 Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan3

Received 28 June 2004/ Returned for modification 19 August 2004/ Accepted 4 November 2004

A series of gastroenteritis outbreaks caused by noroviruses (NVs) among tourist groups from several prefectures was associated with eating a lunch prepared by a restaurant in Nagasaki City, Japan, on 18 and 19 November 2003. A retrospective cohort study was performed to estimate the magnitude of the outbreak and identify the source of infection. Epidemiological information was obtained through the local public health centers in the areas where the illness occurred. Stool and vomit specimens and food and environmental samples were analyzed by reverse transcription-PCR with genogroup-specific primers. Positive samples were sequenced and analyzed phylogenetically. Of 1,492 tourists who ate a lunch prepared by the restaurant during the 2-day period, 660 (44.2%) developed illness, with an average incubation time of 31.2 h. Whereas NVs were not detected in any food samples, identical sequences most closely related to the Mexico genotype of genogroup II NV were found in specimens from case patients, restaurant staff, and the kitchen table. Food handlers were concluded to be the source of the outbreak as a result of the contamination of several meals. The series of outbreaks described here exemplifies the role of tourism as a contemporary way to distribute a single infectious agent to multiple and geographically remote areas.

* Corresponding author. Mailing address: Department of Laboratory Medicine, Nagasaki University School of Medicine and Dentistry, Nagasaki 852-8501, Japan. Phone: 81958497418. Fax: 81958497257. E-mail: hirakata{at}net.nagasaki-u.ac.jp.

{dagger} Present address: Department of Preventive Medicine, The University of Tokushima Graduate School Institute of Health Biosciences, Tokushima. Japan.

Journal of Clinical Microbiology, March 2005, p. 1093-1098, Vol. 43, No. 3
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.3.1093-1098.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



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