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Shushant

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ContaminationQA

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Contamination Question Answering

On 25 March 2012, the Norwegian Institute of Public Health (NIPH) was notified about several cases of gastroenteritis in schoolchildren following a stay at a Norwegian holiday farm. Cryptosporidium oocysts were identified in faecal samples from some of the children. A retrospective cohort study was conducted in school- children, teachers and farm staff who had been on the holiday farm during the period 5-23 March 2012. For the analytical study, the case definition was restricted to a person who had been on the farm in the relevant period, and had experienced diarrhoea or at least two of the following symptoms within 2 weeks of the visit: vomiting, nausea, abdominal pain, fever, with duration of illness >1 day. The water samples were analysed using the NVH internal method for Cryptosporidium oocysts and Giardia cysts. Of the 209 respondents, 78 reported gastrointestinal illness following the visit (75 children, three adults). The first case reported symptoms on the evening of 5 March and the last on 18 April. Illness onset of the farm staff was between 15 and 21 March. The most common symptoms were abdominal pain, nausea and headache (Table 1). Median duration of symptoms was 45 days, ranging from a few hours to >2 weeks. Most cases included in the analytical study (43%, 17/40) reported symptoms 79 days after arrival at the farm (Fig. 1). Of the pupils answering the questionnaire and reporting illness, Cryptosporidium oocysts were detected in faecal samples from eight cases. Most laboratory-diagnosed cases (100%, 8/8) expressed abdominal pain, diarrhoea (7/8), fever (7/8), nausea (6/8) and headache (5/8). Half of the cases reported vomiting (50%, 4/8) (Table 1). Only three of the cases reported contact with ill persons before symptom onset. Only 40 matched the case definition of the analytical study (attack rate 19%), and all were aged between 10-14 years. Nine faecal samples received early in the investigation were analysed for Salmonella, Shigella, Yersinia, Campylobacter, norovirus, sapovirus, Giardia cysts and Cryptosporidium oocysts; all were positive for Cryptosporidium and negative for other enteropathogens. Most of these samples contained low oocyst concentrations, but the faecal sample from one lamb contained a very high concentration of Cryptosporidium oocysts (>1*10^6 oocysts/g faeces). This investigation indicates that the outbreak was probably due to direct or indirect contact with infected animals. The source of this outbreak was probably oocysts in the faeces of infected lambs and/or goat kids.

What are the symptoms?

{'answer_start': [565], 'text': ['diarrhoea']}

Contamination Question Answering

On 25 March 2012, the Norwegian Institute of Public Health (NIPH) was notified about several cases of gastroenteritis in schoolchildren following a stay at a Norwegian holiday farm. Cryptosporidium oocysts were identified in faecal samples from some of the children. A retrospective cohort study was conducted in school- children, teachers and farm staff who had been on the holiday farm during the period 5-23 March 2012. For the analytical study, the case definition was restricted to a person who had been on the farm in the relevant period, and had experienced diarrhoea or at least two of the following symptoms within 2 weeks of the visit: vomiting, nausea, abdominal pain, fever, with duration of illness >1 day. The water samples were analysed using the NVH internal method for Cryptosporidium oocysts and Giardia cysts. Of the 209 respondents, 78 reported gastrointestinal illness following the visit (75 children, three adults). The first case reported symptoms on the evening of 5 March and the last on 18 April. Illness onset of the farm staff was between 15 and 21 March. The most common symptoms were abdominal pain, nausea and headache (Table 1). Median duration of symptoms was 45 days, ranging from a few hours to >2 weeks. Most cases included in the analytical study (43%, 17/40) reported symptoms 79 days after arrival at the farm (Fig. 1). Of the pupils answering the questionnaire and reporting illness, Cryptosporidium oocysts were detected in faecal samples from eight cases. Most laboratory-diagnosed cases (100%, 8/8) expressed abdominal pain, diarrhoea (7/8), fever (7/8), nausea (6/8) and headache (5/8). Half of the cases reported vomiting (50%, 4/8) (Table 1). Only three of the cases reported contact with ill persons before symptom onset. Only 40 matched the case definition of the analytical study (attack rate 19%), and all were aged between 10-14 years. Nine faecal samples received early in the investigation were analysed for Salmonella, Shigella, Yersinia, Campylobacter, norovirus, sapovirus, Giardia cysts and Cryptosporidium oocysts; all were positive for Cryptosporidium and negative for other enteropathogens. Most of these samples contained low oocyst concentrations, but the faecal sample from one lamb contained a very high concentration of Cryptosporidium oocysts (>1*10^6 oocysts/g faeces). This investigation indicates that the outbreak was probably due to direct or indirect contact with infected animals. The source of this outbreak was probably oocysts in the faeces of infected lambs and/or goat kids.

What is the event?

{'answer_start': [85], 'text': ['several cases of gastroenteritis']}

Contamination Question Answering

On 25 March 2012, the Norwegian Institute of Public Health (NIPH) was notified about several cases of gastroenteritis in schoolchildren following a stay at a Norwegian holiday farm. Cryptosporidium oocysts were identified in faecal samples from some of the children. A retrospective cohort study was conducted in school- children, teachers and farm staff who had been on the holiday farm during the period 5-23 March 2012. For the analytical study, the case definition was restricted to a person who had been on the farm in the relevant period, and had experienced diarrhoea or at least two of the following symptoms within 2 weeks of the visit: vomiting, nausea, abdominal pain, fever, with duration of illness >1 day. The water samples were analysed using the NVH internal method for Cryptosporidium oocysts and Giardia cysts. Of the 209 respondents, 78 reported gastrointestinal illness following the visit (75 children, three adults). The first case reported symptoms on the evening of 5 March and the last on 18 April. Illness onset of the farm staff was between 15 and 21 March. The most common symptoms were abdominal pain, nausea and headache (Table 1). Median duration of symptoms was 45 days, ranging from a few hours to >2 weeks. Most cases included in the analytical study (43%, 17/40) reported symptoms 79 days after arrival at the farm (Fig. 1). Of the pupils answering the questionnaire and reporting illness, Cryptosporidium oocysts were detected in faecal samples from eight cases. Most laboratory-diagnosed cases (100%, 8/8) expressed abdominal pain, diarrhoea (7/8), fever (7/8), nausea (6/8) and headache (5/8). Half of the cases reported vomiting (50%, 4/8) (Table 1). Only three of the cases reported contact with ill persons before symptom onset. Only 40 matched the case definition of the analytical study (attack rate 19%), and all were aged between 10-14 years. Nine faecal samples received early in the investigation were analysed for Salmonella, Shigella, Yersinia, Campylobacter, norovirus, sapovirus, Giardia cysts and Cryptosporidium oocysts; all were positive for Cryptosporidium and negative for other enteropathogens. Most of these samples contained low oocyst concentrations, but the faecal sample from one lamb contained a very high concentration of Cryptosporidium oocysts (>1*10^6 oocysts/g faeces). This investigation indicates that the outbreak was probably due to direct or indirect contact with infected animals. The source of this outbreak was probably oocysts in the faeces of infected lambs and/or goat kids.

What are the initial steps of investigation?

{'answer_start': [267], 'text': ['A retrospective cohort study was conducted']}

Contamination Question Answering

On 25 March 2012, the Norwegian Institute of Public Health (NIPH) was notified about several cases of gastroenteritis in schoolchildren following a stay at a Norwegian holiday farm. Cryptosporidium oocysts were identified in faecal samples from some of the children. A retrospective cohort study was conducted in school- children, teachers and farm staff who had been on the holiday farm during the period 5-23 March 2012. For the analytical study, the case definition was restricted to a person who had been on the farm in the relevant period, and had experienced diarrhoea or at least two of the following symptoms within 2 weeks of the visit: vomiting, nausea, abdominal pain, fever, with duration of illness >1 day. The water samples were analysed using the NVH internal method for Cryptosporidium oocysts and Giardia cysts. Of the 209 respondents, 78 reported gastrointestinal illness following the visit (75 children, three adults). The first case reported symptoms on the evening of 5 March and the last on 18 April. Illness onset of the farm staff was between 15 and 21 March. The most common symptoms were abdominal pain, nausea and headache (Table 1). Median duration of symptoms was 45 days, ranging from a few hours to >2 weeks. Most cases included in the analytical study (43%, 17/40) reported symptoms 79 days after arrival at the farm (Fig. 1). Of the pupils answering the questionnaire and reporting illness, Cryptosporidium oocysts were detected in faecal samples from eight cases. Most laboratory-diagnosed cases (100%, 8/8) expressed abdominal pain, diarrhoea (7/8), fever (7/8), nausea (6/8) and headache (5/8). Half of the cases reported vomiting (50%, 4/8) (Table 1). Only three of the cases reported contact with ill persons before symptom onset. Only 40 matched the case definition of the analytical study (attack rate 19%), and all were aged between 10-14 years. Nine faecal samples received early in the investigation were analysed for Salmonella, Shigella, Yersinia, Campylobacter, norovirus, sapovirus, Giardia cysts and Cryptosporidium oocysts; all were positive for Cryptosporidium and negative for other enteropathogens. Most of these samples contained low oocyst concentrations, but the faecal sample from one lamb contained a very high concentration of Cryptosporidium oocysts (>1*10^6 oocysts/g faeces). This investigation indicates that the outbreak was probably due to direct or indirect contact with infected animals. The source of this outbreak was probably oocysts in the faeces of infected lambs and/or goat kids.

From when until when the event happened

{'answer_start': [939], 'text': ['The first case reported symptoms on the evening of 5 March and the last on 18 April']}

Contamination Question Answering

On 25 March 2012, the Norwegian Institute of Public Health (NIPH) was notified about several cases of gastroenteritis in schoolchildren following a stay at a Norwegian holiday farm. Cryptosporidium oocysts were identified in faecal samples from some of the children. A retrospective cohort study was conducted in school- children, teachers and farm staff who had been on the holiday farm during the period 5-23 March 2012. For the analytical study, the case definition was restricted to a person who had been on the farm in the relevant period, and had experienced diarrhoea or at least two of the following symptoms within 2 weeks of the visit: vomiting, nausea, abdominal pain, fever, with duration of illness >1 day. The water samples were analysed using the NVH internal method for Cryptosporidium oocysts and Giardia cysts. Of the 209 respondents, 78 reported gastrointestinal illness following the visit (75 children, three adults). The first case reported symptoms on the evening of 5 March and the last on 18 April. Illness onset of the farm staff was between 15 and 21 March. The most common symptoms were abdominal pain, nausea and headache (Table 1). Median duration of symptoms was 45 days, ranging from a few hours to >2 weeks. Most cases included in the analytical study (43%, 17/40) reported symptoms 79 days after arrival at the farm (Fig. 1). Of the pupils answering the questionnaire and reporting illness, Cryptosporidium oocysts were detected in faecal samples from eight cases. Most laboratory-diagnosed cases (100%, 8/8) expressed abdominal pain, diarrhoea (7/8), fever (7/8), nausea (6/8) and headache (5/8). Half of the cases reported vomiting (50%, 4/8) (Table 1). Only three of the cases reported contact with ill persons before symptom onset. Only 40 matched the case definition of the analytical study (attack rate 19%), and all were aged between 10-14 years. Nine faecal samples received early in the investigation were analysed for Salmonella, Shigella, Yersinia, Campylobacter, norovirus, sapovirus, Giardia cysts and Cryptosporidium oocysts; all were positive for Cryptosporidium and negative for other enteropathogens. Most of these samples contained low oocyst concentrations, but the faecal sample from one lamb contained a very high concentration of Cryptosporidium oocysts (>1*10^6 oocysts/g faeces). This investigation indicates that the outbreak was probably due to direct or indirect contact with infected animals. The source of this outbreak was probably oocysts in the faeces of infected lambs and/or goat kids.

What type of samples were examined?

{'answer_start': [225], 'text': ['faecal samples ']}

Contamination Question Answering

On 25 March 2012, the Norwegian Institute of Public Health (NIPH) was notified about several cases of gastroenteritis in schoolchildren following a stay at a Norwegian holiday farm. Cryptosporidium oocysts were identified in faecal samples from some of the children. A retrospective cohort study was conducted in school- children, teachers and farm staff who had been on the holiday farm during the period 5-23 March 2012. For the analytical study, the case definition was restricted to a person who had been on the farm in the relevant period, and had experienced diarrhoea or at least two of the following symptoms within 2 weeks of the visit: vomiting, nausea, abdominal pain, fever, with duration of illness >1 day. The water samples were analysed using the NVH internal method for Cryptosporidium oocysts and Giardia cysts. Of the 209 respondents, 78 reported gastrointestinal illness following the visit (75 children, three adults). The first case reported symptoms on the evening of 5 March and the last on 18 April. Illness onset of the farm staff was between 15 and 21 March. The most common symptoms were abdominal pain, nausea and headache (Table 1). Median duration of symptoms was 45 days, ranging from a few hours to >2 weeks. Most cases included in the analytical study (43%, 17/40) reported symptoms 79 days after arrival at the farm (Fig. 1). Of the pupils answering the questionnaire and reporting illness, Cryptosporidium oocysts were detected in faecal samples from eight cases. Most laboratory-diagnosed cases (100%, 8/8) expressed abdominal pain, diarrhoea (7/8), fever (7/8), nausea (6/8) and headache (5/8). Half of the cases reported vomiting (50%, 4/8) (Table 1). Only three of the cases reported contact with ill persons before symptom onset. Only 40 matched the case definition of the analytical study (attack rate 19%), and all were aged between 10-14 years. Nine faecal samples received early in the investigation were analysed for Salmonella, Shigella, Yersinia, Campylobacter, norovirus, sapovirus, Giardia cysts and Cryptosporidium oocysts; all were positive for Cryptosporidium and negative for other enteropathogens. Most of these samples contained low oocyst concentrations, but the faecal sample from one lamb contained a very high concentration of Cryptosporidium oocysts (>1*10^6 oocysts/g faeces). This investigation indicates that the outbreak was probably due to direct or indirect contact with infected animals. The source of this outbreak was probably oocysts in the faeces of infected lambs and/or goat kids.

What was the age of the affected people?

{'answer_start': [1867], 'text': ['between 10-14 years']}

Contamination Question Answering

On 25 March 2012, the Norwegian Institute of Public Health (NIPH) was notified about several cases of gastroenteritis in schoolchildren following a stay at a Norwegian holiday farm. Cryptosporidium oocysts were identified in faecal samples from some of the children. A retrospective cohort study was conducted in school- children, teachers and farm staff who had been on the holiday farm during the period 5-23 March 2012. For the analytical study, the case definition was restricted to a person who had been on the farm in the relevant period, and had experienced diarrhoea or at least two of the following symptoms within 2 weeks of the visit: vomiting, nausea, abdominal pain, fever, with duration of illness >1 day. The water samples were analysed using the NVH internal method for Cryptosporidium oocysts and Giardia cysts. Of the 209 respondents, 78 reported gastrointestinal illness following the visit (75 children, three adults). The first case reported symptoms on the evening of 5 March and the last on 18 April. Illness onset of the farm staff was between 15 and 21 March. The most common symptoms were abdominal pain, nausea and headache (Table 1). Median duration of symptoms was 45 days, ranging from a few hours to >2 weeks. Most cases included in the analytical study (43%, 17/40) reported symptoms 79 days after arrival at the farm (Fig. 1). Of the pupils answering the questionnaire and reporting illness, Cryptosporidium oocysts were detected in faecal samples from eight cases. Most laboratory-diagnosed cases (100%, 8/8) expressed abdominal pain, diarrhoea (7/8), fever (7/8), nausea (6/8) and headache (5/8). Half of the cases reported vomiting (50%, 4/8) (Table 1). Only three of the cases reported contact with ill persons before symptom onset. Only 40 matched the case definition of the analytical study (attack rate 19%), and all were aged between 10-14 years. Nine faecal samples received early in the investigation were analysed for Salmonella, Shigella, Yersinia, Campylobacter, norovirus, sapovirus, Giardia cysts and Cryptosporidium oocysts; all were positive for Cryptosporidium and negative for other enteropathogens. Most of these samples contained low oocyst concentrations, but the faecal sample from one lamb contained a very high concentration of Cryptosporidium oocysts (>1*10^6 oocysts/g faeces). This investigation indicates that the outbreak was probably due to direct or indirect contact with infected animals. The source of this outbreak was probably oocysts in the faeces of infected lambs and/or goat kids.

What is the source of contamination?

{'answer_start': [2405], 'text': ['direct or indirect contact with infected animals']}

Contamination Question Answering

Seven people, some of them children, have been diagnosed with E.coli 0157 in a single village. A further eight people who share the same private water supply are also being tested for the infection. The water is shared by eight homes in Auchinclech, near Westhill in Aberdeenshire. Two of the affected people were treated at Aberdeen Royal Infirmary and have now been discharged. The remainder were seen by their GPs. Health officials at NHS Grampian said the infection was not affecting public water supplies. A spokesman said: "None of those affected are currently giving cause for concern." Householders in the affected homes are being advised to boil their water while the inquiry to identify the source of the infection continues. Dr Helen Howie, a consultant in public health medicine at NHS Grampian, said: "A letter went out to all residents last night to let them know what is going on." She added that investigators were examining whether heavy rainfall in the area in recent weeks could have led to the outbreak. Dr Howie said: "This outbreak highlights the risks associated with private water supplies. "Such supplies are liable to bacteriological contamination causing infections such as E.coli O157. "Householders are encouraged to contact the Environmental Health Service and seek advice on how to improve their supply." E.coli O157 is most commonly found in the intestines of cattle. Humans can become infected by contaminated water or foods, inadequately cooked meat and dairy products, direct contact with animals and by person-to-person spread. Symptoms include nausea, vomiting and diarrhoea. In 1996 the O157 strain of the bug killed 21 elderly people in Wishaw, Lanarkshire, during the world's worst recorded instance of E.coli poisoning.

What is the location of the event?

{'answer_start': [267], 'text': ['Aberdeenshire']}

Contamination Question Answering

Seven people, some of them children, have been diagnosed with E.coli 0157 in a single village. A further eight people who share the same private water supply are also being tested for the infection. The water is shared by eight homes in Auchinclech, near Westhill in Aberdeenshire. Two of the affected people were treated at Aberdeen Royal Infirmary and have now been discharged. The remainder were seen by their GPs. Health officials at NHS Grampian said the infection was not affecting public water supplies. A spokesman said: "None of those affected are currently giving cause for concern." Householders in the affected homes are being advised to boil their water while the inquiry to identify the source of the infection continues. Dr Helen Howie, a consultant in public health medicine at NHS Grampian, said: "A letter went out to all residents last night to let them know what is going on." She added that investigators were examining whether heavy rainfall in the area in recent weeks could have led to the outbreak. Dr Howie said: "This outbreak highlights the risks associated with private water supplies. "Such supplies are liable to bacteriological contamination causing infections such as E.coli O157. "Householders are encouraged to contact the Environmental Health Service and seek advice on how to improve their supply." E.coli O157 is most commonly found in the intestines of cattle. Humans can become infected by contaminated water or foods, inadequately cooked meat and dairy products, direct contact with animals and by person-to-person spread. Symptoms include nausea, vomiting and diarrhoea. In 1996 the O157 strain of the bug killed 21 elderly people in Wishaw, Lanarkshire, during the world's worst recorded instance of E.coli poisoning.

What pathogen was connected to the outbreak?

{'answer_start': [1201], 'text': ['E.coli O157']}

Contamination Question Answering

Seven people, some of them children, have been diagnosed with E.coli 0157 in a single village. A further eight people who share the same private water supply are also being tested for the infection. The water is shared by eight homes in Auchinclech, near Westhill in Aberdeenshire. Two of the affected people were treated at Aberdeen Royal Infirmary and have now been discharged. The remainder were seen by their GPs. Health officials at NHS Grampian said the infection was not affecting public water supplies. A spokesman said: "None of those affected are currently giving cause for concern." Householders in the affected homes are being advised to boil their water while the inquiry to identify the source of the infection continues. Dr Helen Howie, a consultant in public health medicine at NHS Grampian, said: "A letter went out to all residents last night to let them know what is going on." She added that investigators were examining whether heavy rainfall in the area in recent weeks could have led to the outbreak. Dr Howie said: "This outbreak highlights the risks associated with private water supplies. "Such supplies are liable to bacteriological contamination causing infections such as E.coli O157. "Householders are encouraged to contact the Environmental Health Service and seek advice on how to improve their supply." E.coli O157 is most commonly found in the intestines of cattle. Humans can become infected by contaminated water or foods, inadequately cooked meat and dairy products, direct contact with animals and by person-to-person spread. Symptoms include nausea, vomiting and diarrhoea. In 1996 the O157 strain of the bug killed 21 elderly people in Wishaw, Lanarkshire, during the world's worst recorded instance of E.coli poisoning.

How many people were ill?

{'answer_start': [0], 'text': ['Seven']}

Contamination Question Answering

Seven people, some of them children, have been diagnosed with E.coli 0157 in a single village. A further eight people who share the same private water supply are also being tested for the infection. The water is shared by eight homes in Auchinclech, near Westhill in Aberdeenshire. Two of the affected people were treated at Aberdeen Royal Infirmary and have now been discharged. The remainder were seen by their GPs. Health officials at NHS Grampian said the infection was not affecting public water supplies. A spokesman said: "None of those affected are currently giving cause for concern." Householders in the affected homes are being advised to boil their water while the inquiry to identify the source of the infection continues. Dr Helen Howie, a consultant in public health medicine at NHS Grampian, said: "A letter went out to all residents last night to let them know what is going on." She added that investigators were examining whether heavy rainfall in the area in recent weeks could have led to the outbreak. Dr Howie said: "This outbreak highlights the risks associated with private water supplies. "Such supplies are liable to bacteriological contamination causing infections such as E.coli O157. "Householders are encouraged to contact the Environmental Health Service and seek advice on how to improve their supply." E.coli O157 is most commonly found in the intestines of cattle. Humans can become infected by contaminated water or foods, inadequately cooked meat and dairy products, direct contact with animals and by person-to-person spread. Symptoms include nausea, vomiting and diarrhoea. In 1996 the O157 strain of the bug killed 21 elderly people in Wishaw, Lanarkshire, during the world's worst recorded instance of E.coli poisoning.

What are the pathogens?

{'answer_start': [62], 'text': ['E.coli 0157']}

Contamination Question Answering

Seven people, some of them children, have been diagnosed with E.coli 0157 in a single village. A further eight people who share the same private water supply are also being tested for the infection. The water is shared by eight homes in Auchinclech, near Westhill in Aberdeenshire. Two of the affected people were treated at Aberdeen Royal Infirmary and have now been discharged. The remainder were seen by their GPs. Health officials at NHS Grampian said the infection was not affecting public water supplies. A spokesman said: "None of those affected are currently giving cause for concern." Householders in the affected homes are being advised to boil their water while the inquiry to identify the source of the infection continues. Dr Helen Howie, a consultant in public health medicine at NHS Grampian, said: "A letter went out to all residents last night to let them know what is going on." She added that investigators were examining whether heavy rainfall in the area in recent weeks could have led to the outbreak. Dr Howie said: "This outbreak highlights the risks associated with private water supplies. "Such supplies are liable to bacteriological contamination causing infections such as E.coli O157. "Householders are encouraged to contact the Environmental Health Service and seek advice on how to improve their supply." E.coli O157 is most commonly found in the intestines of cattle. Humans can become infected by contaminated water or foods, inadequately cooked meat and dairy products, direct contact with animals and by person-to-person spread. Symptoms include nausea, vomiting and diarrhoea. In 1996 the O157 strain of the bug killed 21 elderly people in Wishaw, Lanarkshire, during the world's worst recorded instance of E.coli poisoning.

What are the symptoms?

{'answer_start': [1581], 'text': ['nausea, vomiting and diarrhoea']}

Contamination Question Answering

Seven people, some of them children, have been diagnosed with E.coli 0157 in a single village. A further eight people who share the same private water supply are also being tested for the infection. The water is shared by eight homes in Auchinclech, near Westhill in Aberdeenshire. Two of the affected people were treated at Aberdeen Royal Infirmary and have now been discharged. The remainder were seen by their GPs. Health officials at NHS Grampian said the infection was not affecting public water supplies. A spokesman said: "None of those affected are currently giving cause for concern." Householders in the affected homes are being advised to boil their water while the inquiry to identify the source of the infection continues. Dr Helen Howie, a consultant in public health medicine at NHS Grampian, said: "A letter went out to all residents last night to let them know what is going on." She added that investigators were examining whether heavy rainfall in the area in recent weeks could have led to the outbreak. Dr Howie said: "This outbreak highlights the risks associated with private water supplies. "Such supplies are liable to bacteriological contamination causing infections such as E.coli O157. "Householders are encouraged to contact the Environmental Health Service and seek advice on how to improve their supply." E.coli O157 is most commonly found in the intestines of cattle. Humans can become infected by contaminated water or foods, inadequately cooked meat and dairy products, direct contact with animals and by person-to-person spread. Symptoms include nausea, vomiting and diarrhoea. In 1996 the O157 strain of the bug killed 21 elderly people in Wishaw, Lanarkshire, during the world's worst recorded instance of E.coli poisoning.

What are the first steps of mitigation?

{'answer_start': [649], 'text': [' boil their water ']}

Contamination Question Answering

On 25 June 2008 the local Health Protection Unit was informed by Anglian Water of an exceedence in the level of Cryptosporidium oocysts found in water supplied from the Pitsford Reservoir in Northamptonshire, United Kingdom, during 19 to 24 June 2008 [25]. The reservoir supplied a population of more than 250,000 in the Northampton area. A notice advising people in the affected areas to boil all drinking water was issued on 25 June 2008 and public health messages were circulated to local health services and to the general public via the media. Those members of the public who were concerned about health risks associated with the incident were asked to ring NHS Direct for clinical advice [26]. The HPA wrote to local GPs and hospitals asking them to monitor potential patients for signs and symptoms of Cryptosporidium infection and to submit faecal specimens to the local hospital diagnostic laboratory if patients presented with diarrhoea. Samples from 34 patients where Cryptosporidium infection was identified were sent to the UK Cryptosporidium reference unit for typing. On 30 June 2008, the Cryptosporidium oocysts found in the reservoir water were confirmed as being of the rabbit genotype Cryptosporidium cuniculus [27]. Subsequently, a dead rabbit was found in a treated water tank at the water treatment works. The genotype of Cryptosporidium oocysts in the rabbits large bowel was indistinguishable from that of the oocysts found in the water [27]. After remediation of the water supply and distribution, the boil water notice was lifted on 4 July and the following day the first case of cryptosporidiosis linked to the incident was identified by the reference laboratory (this case was infected with C. cuniculus). During the course of the outbreak (24 June- 18 July 2008, the dates of symptom onset in the first and last case, respectively), 23 cases of cryptosporidiosis were confirmed as being infected with C. cuniculus; one of the 23 was a secondary case. NHS Direct call proportions for gastrointestinal syndromes (diarrhoea and vomiting) for the East Midlands region in England, where Northampton is situated, were examined during the outbreak (24 June- 18 July 2008) and compared with those for England and Wales.

What type of samples were analyzed?

{'answer_start': [849], 'text': ['faecal specimens']}

Contamination Question Answering

On 25 June 2008 the local Health Protection Unit was informed by Anglian Water of an exceedence in the level of Cryptosporidium oocysts found in water supplied from the Pitsford Reservoir in Northamptonshire, United Kingdom, during 19 to 24 June 2008 [25]. The reservoir supplied a population of more than 250,000 in the Northampton area. A notice advising people in the affected areas to boil all drinking water was issued on 25 June 2008 and public health messages were circulated to local health services and to the general public via the media. Those members of the public who were concerned about health risks associated with the incident were asked to ring NHS Direct for clinical advice [26]. The HPA wrote to local GPs and hospitals asking them to monitor potential patients for signs and symptoms of Cryptosporidium infection and to submit faecal specimens to the local hospital diagnostic laboratory if patients presented with diarrhoea. Samples from 34 patients where Cryptosporidium infection was identified were sent to the UK Cryptosporidium reference unit for typing. On 30 June 2008, the Cryptosporidium oocysts found in the reservoir water were confirmed as being of the rabbit genotype Cryptosporidium cuniculus [27]. Subsequently, a dead rabbit was found in a treated water tank at the water treatment works. The genotype of Cryptosporidium oocysts in the rabbits large bowel was indistinguishable from that of the oocysts found in the water [27]. After remediation of the water supply and distribution, the boil water notice was lifted on 4 July and the following day the first case of cryptosporidiosis linked to the incident was identified by the reference laboratory (this case was infected with C. cuniculus). During the course of the outbreak (24 June- 18 July 2008, the dates of symptom onset in the first and last case, respectively), 23 cases of cryptosporidiosis were confirmed as being infected with C. cuniculus; one of the 23 was a secondary case. NHS Direct call proportions for gastrointestinal syndromes (diarrhoea and vomiting) for the East Midlands region in England, where Northampton is situated, were examined during the outbreak (24 June- 18 July 2008) and compared with those for England and Wales.

What symptoms did people report?

{'answer_start': [2040], 'text': ['diarrhoea and vomiting']}

Contamination Question Answering

On 25 June 2008 the local Health Protection Unit was informed by Anglian Water of an exceedence in the level of Cryptosporidium oocysts found in water supplied from the Pitsford Reservoir in Northamptonshire, United Kingdom, during 19 to 24 June 2008 [25]. The reservoir supplied a population of more than 250,000 in the Northampton area. A notice advising people in the affected areas to boil all drinking water was issued on 25 June 2008 and public health messages were circulated to local health services and to the general public via the media. Those members of the public who were concerned about health risks associated with the incident were asked to ring NHS Direct for clinical advice [26]. The HPA wrote to local GPs and hospitals asking them to monitor potential patients for signs and symptoms of Cryptosporidium infection and to submit faecal specimens to the local hospital diagnostic laboratory if patients presented with diarrhoea. Samples from 34 patients where Cryptosporidium infection was identified were sent to the UK Cryptosporidium reference unit for typing. On 30 June 2008, the Cryptosporidium oocysts found in the reservoir water were confirmed as being of the rabbit genotype Cryptosporidium cuniculus [27]. Subsequently, a dead rabbit was found in a treated water tank at the water treatment works. The genotype of Cryptosporidium oocysts in the rabbits large bowel was indistinguishable from that of the oocysts found in the water [27]. After remediation of the water supply and distribution, the boil water notice was lifted on 4 July and the following day the first case of cryptosporidiosis linked to the incident was identified by the reference laboratory (this case was infected with C. cuniculus). During the course of the outbreak (24 June- 18 July 2008, the dates of symptom onset in the first and last case, respectively), 23 cases of cryptosporidiosis were confirmed as being infected with C. cuniculus; one of the 23 was a secondary case. NHS Direct call proportions for gastrointestinal syndromes (diarrhoea and vomiting) for the East Midlands region in England, where Northampton is situated, were examined during the outbreak (24 June- 18 July 2008) and compared with those for England and Wales.

What is the initial cause of the event?

{'answer_start': [1250], 'text': ['a dead rabbit was found in a treated water tank at the water treatment works']}

Contamination Question Answering

On 25 June 2008 the local Health Protection Unit was informed by Anglian Water of an exceedence in the level of Cryptosporidium oocysts found in water supplied from the Pitsford Reservoir in Northamptonshire, United Kingdom, during 19 to 24 June 2008 [25]. The reservoir supplied a population of more than 250,000 in the Northampton area. A notice advising people in the affected areas to boil all drinking water was issued on 25 June 2008 and public health messages were circulated to local health services and to the general public via the media. Those members of the public who were concerned about health risks associated with the incident were asked to ring NHS Direct for clinical advice [26]. The HPA wrote to local GPs and hospitals asking them to monitor potential patients for signs and symptoms of Cryptosporidium infection and to submit faecal specimens to the local hospital diagnostic laboratory if patients presented with diarrhoea. Samples from 34 patients where Cryptosporidium infection was identified were sent to the UK Cryptosporidium reference unit for typing. On 30 June 2008, the Cryptosporidium oocysts found in the reservoir water were confirmed as being of the rabbit genotype Cryptosporidium cuniculus [27]. Subsequently, a dead rabbit was found in a treated water tank at the water treatment works. The genotype of Cryptosporidium oocysts in the rabbits large bowel was indistinguishable from that of the oocysts found in the water [27]. After remediation of the water supply and distribution, the boil water notice was lifted on 4 July and the following day the first case of cryptosporidiosis linked to the incident was identified by the reference laboratory (this case was infected with C. cuniculus). During the course of the outbreak (24 June- 18 July 2008, the dates of symptom onset in the first and last case, respectively), 23 cases of cryptosporidiosis were confirmed as being infected with C. cuniculus; one of the 23 was a secondary case. NHS Direct call proportions for gastrointestinal syndromes (diarrhoea and vomiting) for the East Midlands region in England, where Northampton is situated, were examined during the outbreak (24 June- 18 July 2008) and compared with those for England and Wales.

What is the date of the event?

{'answer_start': [6], 'text': ['June 2008']}

Contamination Question Answering

On 25 June 2008 the local Health Protection Unit was informed by Anglian Water of an exceedence in the level of Cryptosporidium oocysts found in water supplied from the Pitsford Reservoir in Northamptonshire, United Kingdom, during 19 to 24 June 2008 [25]. The reservoir supplied a population of more than 250,000 in the Northampton area. A notice advising people in the affected areas to boil all drinking water was issued on 25 June 2008 and public health messages were circulated to local health services and to the general public via the media. Those members of the public who were concerned about health risks associated with the incident were asked to ring NHS Direct for clinical advice [26]. The HPA wrote to local GPs and hospitals asking them to monitor potential patients for signs and symptoms of Cryptosporidium infection and to submit faecal specimens to the local hospital diagnostic laboratory if patients presented with diarrhoea. Samples from 34 patients where Cryptosporidium infection was identified were sent to the UK Cryptosporidium reference unit for typing. On 30 June 2008, the Cryptosporidium oocysts found in the reservoir water were confirmed as being of the rabbit genotype Cryptosporidium cuniculus [27]. Subsequently, a dead rabbit was found in a treated water tank at the water treatment works. The genotype of Cryptosporidium oocysts in the rabbits large bowel was indistinguishable from that of the oocysts found in the water [27]. After remediation of the water supply and distribution, the boil water notice was lifted on 4 July and the following day the first case of cryptosporidiosis linked to the incident was identified by the reference laboratory (this case was infected with C. cuniculus). During the course of the outbreak (24 June- 18 July 2008, the dates of symptom onset in the first and last case, respectively), 23 cases of cryptosporidiosis were confirmed as being infected with C. cuniculus; one of the 23 was a secondary case. NHS Direct call proportions for gastrointestinal syndromes (diarrhoea and vomiting) for the East Midlands region in England, where Northampton is situated, were examined during the outbreak (24 June- 18 July 2008) and compared with those for England and Wales.

What is the location of the event?

{'answer_start': [209], 'text': ['United Kingdom']}

Contamination Question Answering

On 25 June 2008 the local Health Protection Unit was informed by Anglian Water of an exceedence in the level of Cryptosporidium oocysts found in water supplied from the Pitsford Reservoir in Northamptonshire, United Kingdom, during 19 to 24 June 2008 [25]. The reservoir supplied a population of more than 250,000 in the Northampton area. A notice advising people in the affected areas to boil all drinking water was issued on 25 June 2008 and public health messages were circulated to local health services and to the general public via the media. Those members of the public who were concerned about health risks associated with the incident were asked to ring NHS Direct for clinical advice [26]. The HPA wrote to local GPs and hospitals asking them to monitor potential patients for signs and symptoms of Cryptosporidium infection and to submit faecal specimens to the local hospital diagnostic laboratory if patients presented with diarrhoea. Samples from 34 patients where Cryptosporidium infection was identified were sent to the UK Cryptosporidium reference unit for typing. On 30 June 2008, the Cryptosporidium oocysts found in the reservoir water were confirmed as being of the rabbit genotype Cryptosporidium cuniculus [27]. Subsequently, a dead rabbit was found in a treated water tank at the water treatment works. The genotype of Cryptosporidium oocysts in the rabbits large bowel was indistinguishable from that of the oocysts found in the water [27]. After remediation of the water supply and distribution, the boil water notice was lifted on 4 July and the following day the first case of cryptosporidiosis linked to the incident was identified by the reference laboratory (this case was infected with C. cuniculus). During the course of the outbreak (24 June- 18 July 2008, the dates of symptom onset in the first and last case, respectively), 23 cases of cryptosporidiosis were confirmed as being infected with C. cuniculus; one of the 23 was a secondary case. NHS Direct call proportions for gastrointestinal syndromes (diarrhoea and vomiting) for the East Midlands region in England, where Northampton is situated, were examined during the outbreak (24 June- 18 July 2008) and compared with those for England and Wales.

What pathogen was connected to the outbreak?

{'answer_start': [809], 'text': ['Cryptosporidium ']}

Contamination Question Answering

On 25 June 2008 the local Health Protection Unit was informed by Anglian Water of an exceedence in the level of Cryptosporidium oocysts found in water supplied from the Pitsford Reservoir in Northamptonshire, United Kingdom, during 19 to 24 June 2008 [25]. The reservoir supplied a population of more than 250,000 in the Northampton area. A notice advising people in the affected areas to boil all drinking water was issued on 25 June 2008 and public health messages were circulated to local health services and to the general public via the media. Those members of the public who were concerned about health risks associated with the incident were asked to ring NHS Direct for clinical advice [26]. The HPA wrote to local GPs and hospitals asking them to monitor potential patients for signs and symptoms of Cryptosporidium infection and to submit faecal specimens to the local hospital diagnostic laboratory if patients presented with diarrhoea. Samples from 34 patients where Cryptosporidium infection was identified were sent to the UK Cryptosporidium reference unit for typing. On 30 June 2008, the Cryptosporidium oocysts found in the reservoir water were confirmed as being of the rabbit genotype Cryptosporidium cuniculus [27]. Subsequently, a dead rabbit was found in a treated water tank at the water treatment works. The genotype of Cryptosporidium oocysts in the rabbits large bowel was indistinguishable from that of the oocysts found in the water [27]. After remediation of the water supply and distribution, the boil water notice was lifted on 4 July and the following day the first case of cryptosporidiosis linked to the incident was identified by the reference laboratory (this case was infected with C. cuniculus). During the course of the outbreak (24 June- 18 July 2008, the dates of symptom onset in the first and last case, respectively), 23 cases of cryptosporidiosis were confirmed as being infected with C. cuniculus; one of the 23 was a secondary case. NHS Direct call proportions for gastrointestinal syndromes (diarrhoea and vomiting) for the East Midlands region in England, where Northampton is situated, were examined during the outbreak (24 June- 18 July 2008) and compared with those for England and Wales.

How was the event first detected?

{'answer_start': [16], 'text': ['the local Health Protection Unit was informed by Anglian Water of an exceedence in the level of Cryptosporidium oocysts found in water']}

Contamination Question Answering

On 25 June 2008 the local Health Protection Unit was informed by Anglian Water of an exceedence in the level of Cryptosporidium oocysts found in water supplied from the Pitsford Reservoir in Northamptonshire, United Kingdom, during 19 to 24 June 2008 [25]. The reservoir supplied a population of more than 250,000 in the Northampton area. A notice advising people in the affected areas to boil all drinking water was issued on 25 June 2008 and public health messages were circulated to local health services and to the general public via the media. Those members of the public who were concerned about health risks associated with the incident were asked to ring NHS Direct for clinical advice [26]. The HPA wrote to local GPs and hospitals asking them to monitor potential patients for signs and symptoms of Cryptosporidium infection and to submit faecal specimens to the local hospital diagnostic laboratory if patients presented with diarrhoea. Samples from 34 patients where Cryptosporidium infection was identified were sent to the UK Cryptosporidium reference unit for typing. On 30 June 2008, the Cryptosporidium oocysts found in the reservoir water were confirmed as being of the rabbit genotype Cryptosporidium cuniculus [27]. Subsequently, a dead rabbit was found in a treated water tank at the water treatment works. The genotype of Cryptosporidium oocysts in the rabbits large bowel was indistinguishable from that of the oocysts found in the water [27]. After remediation of the water supply and distribution, the boil water notice was lifted on 4 July and the following day the first case of cryptosporidiosis linked to the incident was identified by the reference laboratory (this case was infected with C. cuniculus). During the course of the outbreak (24 June- 18 July 2008, the dates of symptom onset in the first and last case, respectively), 23 cases of cryptosporidiosis were confirmed as being infected with C. cuniculus; one of the 23 was a secondary case. NHS Direct call proportions for gastrointestinal syndromes (diarrhoea and vomiting) for the East Midlands region in England, where Northampton is situated, were examined during the outbreak (24 June- 18 July 2008) and compared with those for England and Wales.

How many people were ill?

{'answer_start': [1862], 'text': ['23 cases']}

Contamination Question Answering

On 25 June 2008 the local Health Protection Unit was informed by Anglian Water of an exceedence in the level of Cryptosporidium oocysts found in water supplied from the Pitsford Reservoir in Northamptonshire, United Kingdom, during 19 to 24 June 2008 [25]. The reservoir supplied a population of more than 250,000 in the Northampton area. A notice advising people in the affected areas to boil all drinking water was issued on 25 June 2008 and public health messages were circulated to local health services and to the general public via the media. Those members of the public who were concerned about health risks associated with the incident were asked to ring NHS Direct for clinical advice [26]. The HPA wrote to local GPs and hospitals asking them to monitor potential patients for signs and symptoms of Cryptosporidium infection and to submit faecal specimens to the local hospital diagnostic laboratory if patients presented with diarrhoea. Samples from 34 patients where Cryptosporidium infection was identified were sent to the UK Cryptosporidium reference unit for typing. On 30 June 2008, the Cryptosporidium oocysts found in the reservoir water were confirmed as being of the rabbit genotype Cryptosporidium cuniculus [27]. Subsequently, a dead rabbit was found in a treated water tank at the water treatment works. The genotype of Cryptosporidium oocysts in the rabbits large bowel was indistinguishable from that of the oocysts found in the water [27]. After remediation of the water supply and distribution, the boil water notice was lifted on 4 July and the following day the first case of cryptosporidiosis linked to the incident was identified by the reference laboratory (this case was infected with C. cuniculus). During the course of the outbreak (24 June- 18 July 2008, the dates of symptom onset in the first and last case, respectively), 23 cases of cryptosporidiosis were confirmed as being infected with C. cuniculus; one of the 23 was a secondary case. NHS Direct call proportions for gastrointestinal syndromes (diarrhoea and vomiting) for the East Midlands region in England, where Northampton is situated, were examined during the outbreak (24 June- 18 July 2008) and compared with those for England and Wales.

What are the pathogens?

{'answer_start': [112], 'text': ['Cryptosporidium oocysts']}

Contamination Question Answering

On 25 June 2008 the local Health Protection Unit was informed by Anglian Water of an exceedence in the level of Cryptosporidium oocysts found in water supplied from the Pitsford Reservoir in Northamptonshire, United Kingdom, during 19 to 24 June 2008 [25]. The reservoir supplied a population of more than 250,000 in the Northampton area. A notice advising people in the affected areas to boil all drinking water was issued on 25 June 2008 and public health messages were circulated to local health services and to the general public via the media. Those members of the public who were concerned about health risks associated with the incident were asked to ring NHS Direct for clinical advice [26]. The HPA wrote to local GPs and hospitals asking them to monitor potential patients for signs and symptoms of Cryptosporidium infection and to submit faecal specimens to the local hospital diagnostic laboratory if patients presented with diarrhoea. Samples from 34 patients where Cryptosporidium infection was identified were sent to the UK Cryptosporidium reference unit for typing. On 30 June 2008, the Cryptosporidium oocysts found in the reservoir water were confirmed as being of the rabbit genotype Cryptosporidium cuniculus [27]. Subsequently, a dead rabbit was found in a treated water tank at the water treatment works. The genotype of Cryptosporidium oocysts in the rabbits large bowel was indistinguishable from that of the oocysts found in the water [27]. After remediation of the water supply and distribution, the boil water notice was lifted on 4 July and the following day the first case of cryptosporidiosis linked to the incident was identified by the reference laboratory (this case was infected with C. cuniculus). During the course of the outbreak (24 June- 18 July 2008, the dates of symptom onset in the first and last case, respectively), 23 cases of cryptosporidiosis were confirmed as being infected with C. cuniculus; one of the 23 was a secondary case. NHS Direct call proportions for gastrointestinal syndromes (diarrhoea and vomiting) for the East Midlands region in England, where Northampton is situated, were examined during the outbreak (24 June- 18 July 2008) and compared with those for England and Wales.

What are the symptoms?

{'answer_start': [937], 'text': ['diarrhoea']}

Contamination Question Answering

On 25 June 2008 the local Health Protection Unit was informed by Anglian Water of an exceedence in the level of Cryptosporidium oocysts found in water supplied from the Pitsford Reservoir in Northamptonshire, United Kingdom, during 19 to 24 June 2008 [25]. The reservoir supplied a population of more than 250,000 in the Northampton area. A notice advising people in the affected areas to boil all drinking water was issued on 25 June 2008 and public health messages were circulated to local health services and to the general public via the media. Those members of the public who were concerned about health risks associated with the incident were asked to ring NHS Direct for clinical advice [26]. The HPA wrote to local GPs and hospitals asking them to monitor potential patients for signs and symptoms of Cryptosporidium infection and to submit faecal specimens to the local hospital diagnostic laboratory if patients presented with diarrhoea. Samples from 34 patients where Cryptosporidium infection was identified were sent to the UK Cryptosporidium reference unit for typing. On 30 June 2008, the Cryptosporidium oocysts found in the reservoir water were confirmed as being of the rabbit genotype Cryptosporidium cuniculus [27]. Subsequently, a dead rabbit was found in a treated water tank at the water treatment works. The genotype of Cryptosporidium oocysts in the rabbits large bowel was indistinguishable from that of the oocysts found in the water [27]. After remediation of the water supply and distribution, the boil water notice was lifted on 4 July and the following day the first case of cryptosporidiosis linked to the incident was identified by the reference laboratory (this case was infected with C. cuniculus). During the course of the outbreak (24 June- 18 July 2008, the dates of symptom onset in the first and last case, respectively), 23 cases of cryptosporidiosis were confirmed as being infected with C. cuniculus; one of the 23 was a secondary case. NHS Direct call proportions for gastrointestinal syndromes (diarrhoea and vomiting) for the East Midlands region in England, where Northampton is situated, were examined during the outbreak (24 June- 18 July 2008) and compared with those for England and Wales.

What is the event?

{'answer_start': [85], 'text': ['exceedence in the level of Cryptosporidium oocysts found in water']}

Contamination Question Answering

On 25 June 2008 the local Health Protection Unit was informed by Anglian Water of an exceedence in the level of Cryptosporidium oocysts found in water supplied from the Pitsford Reservoir in Northamptonshire, United Kingdom, during 19 to 24 June 2008 [25]. The reservoir supplied a population of more than 250,000 in the Northampton area. A notice advising people in the affected areas to boil all drinking water was issued on 25 June 2008 and public health messages were circulated to local health services and to the general public via the media. Those members of the public who were concerned about health risks associated with the incident were asked to ring NHS Direct for clinical advice [26]. The HPA wrote to local GPs and hospitals asking them to monitor potential patients for signs and symptoms of Cryptosporidium infection and to submit faecal specimens to the local hospital diagnostic laboratory if patients presented with diarrhoea. Samples from 34 patients where Cryptosporidium infection was identified were sent to the UK Cryptosporidium reference unit for typing. On 30 June 2008, the Cryptosporidium oocysts found in the reservoir water were confirmed as being of the rabbit genotype Cryptosporidium cuniculus [27]. Subsequently, a dead rabbit was found in a treated water tank at the water treatment works. The genotype of Cryptosporidium oocysts in the rabbits large bowel was indistinguishable from that of the oocysts found in the water [27]. After remediation of the water supply and distribution, the boil water notice was lifted on 4 July and the following day the first case of cryptosporidiosis linked to the incident was identified by the reference laboratory (this case was infected with C. cuniculus). During the course of the outbreak (24 June- 18 July 2008, the dates of symptom onset in the first and last case, respectively), 23 cases of cryptosporidiosis were confirmed as being infected with C. cuniculus; one of the 23 was a secondary case. NHS Direct call proportions for gastrointestinal syndromes (diarrhoea and vomiting) for the East Midlands region in England, where Northampton is situated, were examined during the outbreak (24 June- 18 July 2008) and compared with those for England and Wales.

What is the duration of the event?

{'answer_start': [1769], 'text': ['24 June- 18 July 2008']}

Contamination Question Answering

On 25 June 2008 the local Health Protection Unit was informed by Anglian Water of an exceedence in the level of Cryptosporidium oocysts found in water supplied from the Pitsford Reservoir in Northamptonshire, United Kingdom, during 19 to 24 June 2008 [25]. The reservoir supplied a population of more than 250,000 in the Northampton area. A notice advising people in the affected areas to boil all drinking water was issued on 25 June 2008 and public health messages were circulated to local health services and to the general public via the media. Those members of the public who were concerned about health risks associated with the incident were asked to ring NHS Direct for clinical advice [26]. The HPA wrote to local GPs and hospitals asking them to monitor potential patients for signs and symptoms of Cryptosporidium infection and to submit faecal specimens to the local hospital diagnostic laboratory if patients presented with diarrhoea. Samples from 34 patients where Cryptosporidium infection was identified were sent to the UK Cryptosporidium reference unit for typing. On 30 June 2008, the Cryptosporidium oocysts found in the reservoir water were confirmed as being of the rabbit genotype Cryptosporidium cuniculus [27]. Subsequently, a dead rabbit was found in a treated water tank at the water treatment works. The genotype of Cryptosporidium oocysts in the rabbits large bowel was indistinguishable from that of the oocysts found in the water [27]. After remediation of the water supply and distribution, the boil water notice was lifted on 4 July and the following day the first case of cryptosporidiosis linked to the incident was identified by the reference laboratory (this case was infected with C. cuniculus). During the course of the outbreak (24 June- 18 July 2008, the dates of symptom onset in the first and last case, respectively), 23 cases of cryptosporidiosis were confirmed as being infected with C. cuniculus; one of the 23 was a secondary case. NHS Direct call proportions for gastrointestinal syndromes (diarrhoea and vomiting) for the East Midlands region in England, where Northampton is situated, were examined during the outbreak (24 June- 18 July 2008) and compared with those for England and Wales.

From when until when the event happened

{'answer_start': [2171], 'text': ['24 June- 18 July 2008']}

Contamination Question Answering

On 25 June 2008 the local Health Protection Unit was informed by Anglian Water of an exceedence in the level of Cryptosporidium oocysts found in water supplied from the Pitsford Reservoir in Northamptonshire, United Kingdom, during 19 to 24 June 2008 [25]. The reservoir supplied a population of more than 250,000 in the Northampton area. A notice advising people in the affected areas to boil all drinking water was issued on 25 June 2008 and public health messages were circulated to local health services and to the general public via the media. Those members of the public who were concerned about health risks associated with the incident were asked to ring NHS Direct for clinical advice [26]. The HPA wrote to local GPs and hospitals asking them to monitor potential patients for signs and symptoms of Cryptosporidium infection and to submit faecal specimens to the local hospital diagnostic laboratory if patients presented with diarrhoea. Samples from 34 patients where Cryptosporidium infection was identified were sent to the UK Cryptosporidium reference unit for typing. On 30 June 2008, the Cryptosporidium oocysts found in the reservoir water were confirmed as being of the rabbit genotype Cryptosporidium cuniculus [27]. Subsequently, a dead rabbit was found in a treated water tank at the water treatment works. The genotype of Cryptosporidium oocysts in the rabbits large bowel was indistinguishable from that of the oocysts found in the water [27]. After remediation of the water supply and distribution, the boil water notice was lifted on 4 July and the following day the first case of cryptosporidiosis linked to the incident was identified by the reference laboratory (this case was infected with C. cuniculus). During the course of the outbreak (24 June- 18 July 2008, the dates of symptom onset in the first and last case, respectively), 23 cases of cryptosporidiosis were confirmed as being infected with C. cuniculus; one of the 23 was a secondary case. NHS Direct call proportions for gastrointestinal syndromes (diarrhoea and vomiting) for the East Midlands region in England, where Northampton is situated, were examined during the outbreak (24 June- 18 July 2008) and compared with those for England and Wales.

What are the first steps of mitigation?

{'answer_start': [389], 'text': ['boil all drinking water']}

Contamination Question Answering

On 25 June 2008 the local Health Protection Unit was informed by Anglian Water of an exceedence in the level of Cryptosporidium oocysts found in water supplied from the Pitsford Reservoir in Northamptonshire, United Kingdom, during 19 to 24 June 2008 [25]. The reservoir supplied a population of more than 250,000 in the Northampton area. A notice advising people in the affected areas to boil all drinking water was issued on 25 June 2008 and public health messages were circulated to local health services and to the general public via the media. Those members of the public who were concerned about health risks associated with the incident were asked to ring NHS Direct for clinical advice [26]. The HPA wrote to local GPs and hospitals asking them to monitor potential patients for signs and symptoms of Cryptosporidium infection and to submit faecal specimens to the local hospital diagnostic laboratory if patients presented with diarrhoea. Samples from 34 patients where Cryptosporidium infection was identified were sent to the UK Cryptosporidium reference unit for typing. On 30 June 2008, the Cryptosporidium oocysts found in the reservoir water were confirmed as being of the rabbit genotype Cryptosporidium cuniculus [27]. Subsequently, a dead rabbit was found in a treated water tank at the water treatment works. The genotype of Cryptosporidium oocysts in the rabbits large bowel was indistinguishable from that of the oocysts found in the water [27]. After remediation of the water supply and distribution, the boil water notice was lifted on 4 July and the following day the first case of cryptosporidiosis linked to the incident was identified by the reference laboratory (this case was infected with C. cuniculus). During the course of the outbreak (24 June- 18 July 2008, the dates of symptom onset in the first and last case, respectively), 23 cases of cryptosporidiosis were confirmed as being infected with C. cuniculus; one of the 23 was a secondary case. NHS Direct call proportions for gastrointestinal syndromes (diarrhoea and vomiting) for the East Midlands region in England, where Northampton is situated, were examined during the outbreak (24 June- 18 July 2008) and compared with those for England and Wales.

What were the associated pathogens of concern?

{'answer_start': [979], 'text': ['Cryptosporidium ']}

Contamination Question Answering

This study describes two drinking water outbreaks in Finland in 2016 (outbreak I) and 2018 (outbreak II). Both outbreaks caused approximately 450 illness cases and were due to drinking water pipe breakage and subsequent wastewater intrusion into the distribution system. In both outbreaks, the sapovirus was found in patient samples as the main causative agent. In addition, adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides (outbreak II) were detected in patient samples. Water samples were analyzed for the selected pathogens largely based on the results of patient samples. In drinking water, sapovirus and enteropathogenic E. coli (EPEC) were found in outbreak II. As mitigation actions, boil water advisory, alternative drinking water sources and chlorination were organized to restrict the outbreaks and to clean the contaminated distribution network. This study describes two waterborne outbreaks both caused by the intrusion of wastewater into a drinking water distribution system due to pipe breakage. In outbreak I, the cause of the contamination was a maintenance well containing the air release valves of both drinking water and wastewater pipes. Due to pipe breakage on the road construction site on 12th October 2016, the under pressure in the drinking water network caused the wastewater inflow from the maintenance well through the air release valve into the drinking water distribution system. Mitigation actions during the outbreak included the boil water advisory for two months (from 16th October to 16th December 2016) and chlorination for 50 days (from 16th October to 5th December 2016). When respondents� family members with gastrointestinal illness were taken into account, the estimated number of patients was 458. In order to estimate the magnitude of illness, questionnaires were sent to the households of the contaminated area. The median duration of the symptoms was one to two days and the most frequently reported symptoms included abdominal pain (94%, 101/107), nausea (91%, 100/110), diarrhea (89%, 100/112), abdominal swelling (83%, 86/104), muscular pain (66%, 64/97), vomiting (53%, 52/98) and fever (46%, 42/91). In the acute phase of the outbreak, stool samples were collected from patients between 19th October and 3rd November 2016, and were analyzed in clinical laboratories with routine tests for enteric viruses, pathogenic bacteria, and protozoans (Table 1). During January�February, 463 persons with gastrointestinal illness contacted local primary health care. Symptoms lasted on average for two days and included diarrhea (76%, 352/463), vomiting (65%, 299/463) and fever (32%, 150/463).

What symptoms were developed?

{'answer_start': [2707], 'text': ['diarrhea (76%, 352/463), vomiting (65%, 299/463) and fever']}

Contamination Question Answering

This study describes two drinking water outbreaks in Finland in 2016 (outbreak I) and 2018 (outbreak II). Both outbreaks caused approximately 450 illness cases and were due to drinking water pipe breakage and subsequent wastewater intrusion into the distribution system. In both outbreaks, the sapovirus was found in patient samples as the main causative agent. In addition, adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides (outbreak II) were detected in patient samples. Water samples were analyzed for the selected pathogens largely based on the results of patient samples. In drinking water, sapovirus and enteropathogenic E. coli (EPEC) were found in outbreak II. As mitigation actions, boil water advisory, alternative drinking water sources and chlorination were organized to restrict the outbreaks and to clean the contaminated distribution network. This study describes two waterborne outbreaks both caused by the intrusion of wastewater into a drinking water distribution system due to pipe breakage. In outbreak I, the cause of the contamination was a maintenance well containing the air release valves of both drinking water and wastewater pipes. Due to pipe breakage on the road construction site on 12th October 2016, the under pressure in the drinking water network caused the wastewater inflow from the maintenance well through the air release valve into the drinking water distribution system. Mitigation actions during the outbreak included the boil water advisory for two months (from 16th October to 16th December 2016) and chlorination for 50 days (from 16th October to 5th December 2016). When respondents� family members with gastrointestinal illness were taken into account, the estimated number of patients was 458. In order to estimate the magnitude of illness, questionnaires were sent to the households of the contaminated area. The median duration of the symptoms was one to two days and the most frequently reported symptoms included abdominal pain (94%, 101/107), nausea (91%, 100/110), diarrhea (89%, 100/112), abdominal swelling (83%, 86/104), muscular pain (66%, 64/97), vomiting (53%, 52/98) and fever (46%, 42/91). In the acute phase of the outbreak, stool samples were collected from patients between 19th October and 3rd November 2016, and were analyzed in clinical laboratories with routine tests for enteric viruses, pathogenic bacteria, and protozoans (Table 1). During January�February, 463 persons with gastrointestinal illness contacted local primary health care. Symptoms lasted on average for two days and included diarrhea (76%, 352/463), vomiting (65%, 299/463) and fever (32%, 150/463).

What type of samples were analyzed?

{'answer_start': [619], 'text': ['Water samples']}

Contamination Question Answering

This study describes two drinking water outbreaks in Finland in 2016 (outbreak I) and 2018 (outbreak II). Both outbreaks caused approximately 450 illness cases and were due to drinking water pipe breakage and subsequent wastewater intrusion into the distribution system. In both outbreaks, the sapovirus was found in patient samples as the main causative agent. In addition, adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides (outbreak II) were detected in patient samples. Water samples were analyzed for the selected pathogens largely based on the results of patient samples. In drinking water, sapovirus and enteropathogenic E. coli (EPEC) were found in outbreak II. As mitigation actions, boil water advisory, alternative drinking water sources and chlorination were organized to restrict the outbreaks and to clean the contaminated distribution network. This study describes two waterborne outbreaks both caused by the intrusion of wastewater into a drinking water distribution system due to pipe breakage. In outbreak I, the cause of the contamination was a maintenance well containing the air release valves of both drinking water and wastewater pipes. Due to pipe breakage on the road construction site on 12th October 2016, the under pressure in the drinking water network caused the wastewater inflow from the maintenance well through the air release valve into the drinking water distribution system. Mitigation actions during the outbreak included the boil water advisory for two months (from 16th October to 16th December 2016) and chlorination for 50 days (from 16th October to 5th December 2016). When respondents� family members with gastrointestinal illness were taken into account, the estimated number of patients was 458. In order to estimate the magnitude of illness, questionnaires were sent to the households of the contaminated area. The median duration of the symptoms was one to two days and the most frequently reported symptoms included abdominal pain (94%, 101/107), nausea (91%, 100/110), diarrhea (89%, 100/112), abdominal swelling (83%, 86/104), muscular pain (66%, 64/97), vomiting (53%, 52/98) and fever (46%, 42/91). In the acute phase of the outbreak, stool samples were collected from patients between 19th October and 3rd November 2016, and were analyzed in clinical laboratories with routine tests for enteric viruses, pathogenic bacteria, and protozoans (Table 1). During January�February, 463 persons with gastrointestinal illness contacted local primary health care. Symptoms lasted on average for two days and included diarrhea (76%, 352/463), vomiting (65%, 299/463) and fever (32%, 150/463).

What caused the event?

{'answer_start': [1069], 'text': ['intrusion of wastewater\ninto a drinking water distribution system due to pipe breakage']}

Contamination Question Answering

This study describes two drinking water outbreaks in Finland in 2016 (outbreak I) and 2018 (outbreak II). Both outbreaks caused approximately 450 illness cases and were due to drinking water pipe breakage and subsequent wastewater intrusion into the distribution system. In both outbreaks, the sapovirus was found in patient samples as the main causative agent. In addition, adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides (outbreak II) were detected in patient samples. Water samples were analyzed for the selected pathogens largely based on the results of patient samples. In drinking water, sapovirus and enteropathogenic E. coli (EPEC) were found in outbreak II. As mitigation actions, boil water advisory, alternative drinking water sources and chlorination were organized to restrict the outbreaks and to clean the contaminated distribution network. This study describes two waterborne outbreaks both caused by the intrusion of wastewater into a drinking water distribution system due to pipe breakage. In outbreak I, the cause of the contamination was a maintenance well containing the air release valves of both drinking water and wastewater pipes. Due to pipe breakage on the road construction site on 12th October 2016, the under pressure in the drinking water network caused the wastewater inflow from the maintenance well through the air release valve into the drinking water distribution system. Mitigation actions during the outbreak included the boil water advisory for two months (from 16th October to 16th December 2016) and chlorination for 50 days (from 16th October to 5th December 2016). When respondents� family members with gastrointestinal illness were taken into account, the estimated number of patients was 458. In order to estimate the magnitude of illness, questionnaires were sent to the households of the contaminated area. The median duration of the symptoms was one to two days and the most frequently reported symptoms included abdominal pain (94%, 101/107), nausea (91%, 100/110), diarrhea (89%, 100/112), abdominal swelling (83%, 86/104), muscular pain (66%, 64/97), vomiting (53%, 52/98) and fever (46%, 42/91). In the acute phase of the outbreak, stool samples were collected from patients between 19th October and 3rd November 2016, and were analyzed in clinical laboratories with routine tests for enteric viruses, pathogenic bacteria, and protozoans (Table 1). During January�February, 463 persons with gastrointestinal illness contacted local primary health care. Symptoms lasted on average for two days and included diarrhea (76%, 352/463), vomiting (65%, 299/463) and fever (32%, 150/463).

What caused the outbreak?

{'answer_start': [176], 'text': ['drinking water pipe breakage and subsequent wastewater intrusion into the distribution system']}

Contamination Question Answering

This study describes two drinking water outbreaks in Finland in 2016 (outbreak I) and 2018 (outbreak II). Both outbreaks caused approximately 450 illness cases and were due to drinking water pipe breakage and subsequent wastewater intrusion into the distribution system. In both outbreaks, the sapovirus was found in patient samples as the main causative agent. In addition, adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides (outbreak II) were detected in patient samples. Water samples were analyzed for the selected pathogens largely based on the results of patient samples. In drinking water, sapovirus and enteropathogenic E. coli (EPEC) were found in outbreak II. As mitigation actions, boil water advisory, alternative drinking water sources and chlorination were organized to restrict the outbreaks and to clean the contaminated distribution network. This study describes two waterborne outbreaks both caused by the intrusion of wastewater into a drinking water distribution system due to pipe breakage. In outbreak I, the cause of the contamination was a maintenance well containing the air release valves of both drinking water and wastewater pipes. Due to pipe breakage on the road construction site on 12th October 2016, the under pressure in the drinking water network caused the wastewater inflow from the maintenance well through the air release valve into the drinking water distribution system. Mitigation actions during the outbreak included the boil water advisory for two months (from 16th October to 16th December 2016) and chlorination for 50 days (from 16th October to 5th December 2016). When respondents� family members with gastrointestinal illness were taken into account, the estimated number of patients was 458. In order to estimate the magnitude of illness, questionnaires were sent to the households of the contaminated area. The median duration of the symptoms was one to two days and the most frequently reported symptoms included abdominal pain (94%, 101/107), nausea (91%, 100/110), diarrhea (89%, 100/112), abdominal swelling (83%, 86/104), muscular pain (66%, 64/97), vomiting (53%, 52/98) and fever (46%, 42/91). In the acute phase of the outbreak, stool samples were collected from patients between 19th October and 3rd November 2016, and were analyzed in clinical laboratories with routine tests for enteric viruses, pathogenic bacteria, and protozoans (Table 1). During January�February, 463 persons with gastrointestinal illness contacted local primary health care. Symptoms lasted on average for two days and included diarrhea (76%, 352/463), vomiting (65%, 299/463) and fever (32%, 150/463).

What is the date of the event?

{'answer_start': [64], 'text': ['2016 (outbreak I) and 2018 ']}

Contamination Question Answering

This study describes two drinking water outbreaks in Finland in 2016 (outbreak I) and 2018 (outbreak II). Both outbreaks caused approximately 450 illness cases and were due to drinking water pipe breakage and subsequent wastewater intrusion into the distribution system. In both outbreaks, the sapovirus was found in patient samples as the main causative agent. In addition, adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides (outbreak II) were detected in patient samples. Water samples were analyzed for the selected pathogens largely based on the results of patient samples. In drinking water, sapovirus and enteropathogenic E. coli (EPEC) were found in outbreak II. As mitigation actions, boil water advisory, alternative drinking water sources and chlorination were organized to restrict the outbreaks and to clean the contaminated distribution network. This study describes two waterborne outbreaks both caused by the intrusion of wastewater into a drinking water distribution system due to pipe breakage. In outbreak I, the cause of the contamination was a maintenance well containing the air release valves of both drinking water and wastewater pipes. Due to pipe breakage on the road construction site on 12th October 2016, the under pressure in the drinking water network caused the wastewater inflow from the maintenance well through the air release valve into the drinking water distribution system. Mitigation actions during the outbreak included the boil water advisory for two months (from 16th October to 16th December 2016) and chlorination for 50 days (from 16th October to 5th December 2016). When respondents� family members with gastrointestinal illness were taken into account, the estimated number of patients was 458. In order to estimate the magnitude of illness, questionnaires were sent to the households of the contaminated area. The median duration of the symptoms was one to two days and the most frequently reported symptoms included abdominal pain (94%, 101/107), nausea (91%, 100/110), diarrhea (89%, 100/112), abdominal swelling (83%, 86/104), muscular pain (66%, 64/97), vomiting (53%, 52/98) and fever (46%, 42/91). In the acute phase of the outbreak, stool samples were collected from patients between 19th October and 3rd November 2016, and were analyzed in clinical laboratories with routine tests for enteric viruses, pathogenic bacteria, and protozoans (Table 1). During January�February, 463 persons with gastrointestinal illness contacted local primary health care. Symptoms lasted on average for two days and included diarrhea (76%, 352/463), vomiting (65%, 299/463) and fever (32%, 150/463).

What is the location of the event?

{'answer_start': [53], 'text': ['Finland']}

Contamination Question Answering

This study describes two drinking water outbreaks in Finland in 2016 (outbreak I) and 2018 (outbreak II). Both outbreaks caused approximately 450 illness cases and were due to drinking water pipe breakage and subsequent wastewater intrusion into the distribution system. In both outbreaks, the sapovirus was found in patient samples as the main causative agent. In addition, adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides (outbreak II) were detected in patient samples. Water samples were analyzed for the selected pathogens largely based on the results of patient samples. In drinking water, sapovirus and enteropathogenic E. coli (EPEC) were found in outbreak II. As mitigation actions, boil water advisory, alternative drinking water sources and chlorination were organized to restrict the outbreaks and to clean the contaminated distribution network. This study describes two waterborne outbreaks both caused by the intrusion of wastewater into a drinking water distribution system due to pipe breakage. In outbreak I, the cause of the contamination was a maintenance well containing the air release valves of both drinking water and wastewater pipes. Due to pipe breakage on the road construction site on 12th October 2016, the under pressure in the drinking water network caused the wastewater inflow from the maintenance well through the air release valve into the drinking water distribution system. Mitigation actions during the outbreak included the boil water advisory for two months (from 16th October to 16th December 2016) and chlorination for 50 days (from 16th October to 5th December 2016). When respondents� family members with gastrointestinal illness were taken into account, the estimated number of patients was 458. In order to estimate the magnitude of illness, questionnaires were sent to the households of the contaminated area. The median duration of the symptoms was one to two days and the most frequently reported symptoms included abdominal pain (94%, 101/107), nausea (91%, 100/110), diarrhea (89%, 100/112), abdominal swelling (83%, 86/104), muscular pain (66%, 64/97), vomiting (53%, 52/98) and fever (46%, 42/91). In the acute phase of the outbreak, stool samples were collected from patients between 19th October and 3rd November 2016, and were analyzed in clinical laboratories with routine tests for enteric viruses, pathogenic bacteria, and protozoans (Table 1). During January�February, 463 persons with gastrointestinal illness contacted local primary health care. Symptoms lasted on average for two days and included diarrhea (76%, 352/463), vomiting (65%, 299/463) and fever (32%, 150/463).

How many people were ill?

{'answer_start': [2575], 'text': ['463 persons']}

Contamination Question Answering

This study describes two drinking water outbreaks in Finland in 2016 (outbreak I) and 2018 (outbreak II). Both outbreaks caused approximately 450 illness cases and were due to drinking water pipe breakage and subsequent wastewater intrusion into the distribution system. In both outbreaks, the sapovirus was found in patient samples as the main causative agent. In addition, adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides (outbreak II) were detected in patient samples. Water samples were analyzed for the selected pathogens largely based on the results of patient samples. In drinking water, sapovirus and enteropathogenic E. coli (EPEC) were found in outbreak II. As mitigation actions, boil water advisory, alternative drinking water sources and chlorination were organized to restrict the outbreaks and to clean the contaminated distribution network. This study describes two waterborne outbreaks both caused by the intrusion of wastewater into a drinking water distribution system due to pipe breakage. In outbreak I, the cause of the contamination was a maintenance well containing the air release valves of both drinking water and wastewater pipes. Due to pipe breakage on the road construction site on 12th October 2016, the under pressure in the drinking water network caused the wastewater inflow from the maintenance well through the air release valve into the drinking water distribution system. Mitigation actions during the outbreak included the boil water advisory for two months (from 16th October to 16th December 2016) and chlorination for 50 days (from 16th October to 5th December 2016). When respondents� family members with gastrointestinal illness were taken into account, the estimated number of patients was 458. In order to estimate the magnitude of illness, questionnaires were sent to the households of the contaminated area. The median duration of the symptoms was one to two days and the most frequently reported symptoms included abdominal pain (94%, 101/107), nausea (91%, 100/110), diarrhea (89%, 100/112), abdominal swelling (83%, 86/104), muscular pain (66%, 64/97), vomiting (53%, 52/98) and fever (46%, 42/91). In the acute phase of the outbreak, stool samples were collected from patients between 19th October and 3rd November 2016, and were analyzed in clinical laboratories with routine tests for enteric viruses, pathogenic bacteria, and protozoans (Table 1). During January�February, 463 persons with gastrointestinal illness contacted local primary health care. Symptoms lasted on average for two days and included diarrhea (76%, 352/463), vomiting (65%, 299/463) and fever (32%, 150/463).

What are the pathogens?

{'answer_start': [294], 'text': ['sapovirus']}

Contamination Question Answering

This study describes two drinking water outbreaks in Finland in 2016 (outbreak I) and 2018 (outbreak II). Both outbreaks caused approximately 450 illness cases and were due to drinking water pipe breakage and subsequent wastewater intrusion into the distribution system. In both outbreaks, the sapovirus was found in patient samples as the main causative agent. In addition, adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides (outbreak II) were detected in patient samples. Water samples were analyzed for the selected pathogens largely based on the results of patient samples. In drinking water, sapovirus and enteropathogenic E. coli (EPEC) were found in outbreak II. As mitigation actions, boil water advisory, alternative drinking water sources and chlorination were organized to restrict the outbreaks and to clean the contaminated distribution network. This study describes two waterborne outbreaks both caused by the intrusion of wastewater into a drinking water distribution system due to pipe breakage. In outbreak I, the cause of the contamination was a maintenance well containing the air release valves of both drinking water and wastewater pipes. Due to pipe breakage on the road construction site on 12th October 2016, the under pressure in the drinking water network caused the wastewater inflow from the maintenance well through the air release valve into the drinking water distribution system. Mitigation actions during the outbreak included the boil water advisory for two months (from 16th October to 16th December 2016) and chlorination for 50 days (from 16th October to 5th December 2016). When respondents� family members with gastrointestinal illness were taken into account, the estimated number of patients was 458. In order to estimate the magnitude of illness, questionnaires were sent to the households of the contaminated area. The median duration of the symptoms was one to two days and the most frequently reported symptoms included abdominal pain (94%, 101/107), nausea (91%, 100/110), diarrhea (89%, 100/112), abdominal swelling (83%, 86/104), muscular pain (66%, 64/97), vomiting (53%, 52/98) and fever (46%, 42/91). In the acute phase of the outbreak, stool samples were collected from patients between 19th October and 3rd November 2016, and were analyzed in clinical laboratories with routine tests for enteric viruses, pathogenic bacteria, and protozoans (Table 1). During January�February, 463 persons with gastrointestinal illness contacted local primary health care. Symptoms lasted on average for two days and included diarrhea (76%, 352/463), vomiting (65%, 299/463) and fever (32%, 150/463).

What are the symptoms?

{'answer_start': [2110], 'text': ['abdominal pain (94%, 101/107), nausea (91%, 100/110), diarrhea (89%, 100/112), abdominal swelling (83%, 86/104), muscular pain (66%, 64/97), vomiting (53%, 52/98) and feve']}

Contamination Question Answering

This study describes two drinking water outbreaks in Finland in 2016 (outbreak I) and 2018 (outbreak II). Both outbreaks caused approximately 450 illness cases and were due to drinking water pipe breakage and subsequent wastewater intrusion into the distribution system. In both outbreaks, the sapovirus was found in patient samples as the main causative agent. In addition, adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides (outbreak II) were detected in patient samples. Water samples were analyzed for the selected pathogens largely based on the results of patient samples. In drinking water, sapovirus and enteropathogenic E. coli (EPEC) were found in outbreak II. As mitigation actions, boil water advisory, alternative drinking water sources and chlorination were organized to restrict the outbreaks and to clean the contaminated distribution network. This study describes two waterborne outbreaks both caused by the intrusion of wastewater into a drinking water distribution system due to pipe breakage. In outbreak I, the cause of the contamination was a maintenance well containing the air release valves of both drinking water and wastewater pipes. Due to pipe breakage on the road construction site on 12th October 2016, the under pressure in the drinking water network caused the wastewater inflow from the maintenance well through the air release valve into the drinking water distribution system. Mitigation actions during the outbreak included the boil water advisory for two months (from 16th October to 16th December 2016) and chlorination for 50 days (from 16th October to 5th December 2016). When respondents� family members with gastrointestinal illness were taken into account, the estimated number of patients was 458. In order to estimate the magnitude of illness, questionnaires were sent to the households of the contaminated area. The median duration of the symptoms was one to two days and the most frequently reported symptoms included abdominal pain (94%, 101/107), nausea (91%, 100/110), diarrhea (89%, 100/112), abdominal swelling (83%, 86/104), muscular pain (66%, 64/97), vomiting (53%, 52/98) and fever (46%, 42/91). In the acute phase of the outbreak, stool samples were collected from patients between 19th October and 3rd November 2016, and were analyzed in clinical laboratories with routine tests for enteric viruses, pathogenic bacteria, and protozoans (Table 1). During January�February, 463 persons with gastrointestinal illness contacted local primary health care. Symptoms lasted on average for two days and included diarrhea (76%, 352/463), vomiting (65%, 299/463) and fever (32%, 150/463).

What are the initial steps of investigation?

{'answer_start': [1934], 'text': ['questionnaires']}

Contamination Question Answering

This study describes two drinking water outbreaks in Finland in 2016 (outbreak I) and 2018 (outbreak II). Both outbreaks caused approximately 450 illness cases and were due to drinking water pipe breakage and subsequent wastewater intrusion into the distribution system. In both outbreaks, the sapovirus was found in patient samples as the main causative agent. In addition, adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides (outbreak II) were detected in patient samples. Water samples were analyzed for the selected pathogens largely based on the results of patient samples. In drinking water, sapovirus and enteropathogenic E. coli (EPEC) were found in outbreak II. As mitigation actions, boil water advisory, alternative drinking water sources and chlorination were organized to restrict the outbreaks and to clean the contaminated distribution network. This study describes two waterborne outbreaks both caused by the intrusion of wastewater into a drinking water distribution system due to pipe breakage. In outbreak I, the cause of the contamination was a maintenance well containing the air release valves of both drinking water and wastewater pipes. Due to pipe breakage on the road construction site on 12th October 2016, the under pressure in the drinking water network caused the wastewater inflow from the maintenance well through the air release valve into the drinking water distribution system. Mitigation actions during the outbreak included the boil water advisory for two months (from 16th October to 16th December 2016) and chlorination for 50 days (from 16th October to 5th December 2016). When respondents� family members with gastrointestinal illness were taken into account, the estimated number of patients was 458. In order to estimate the magnitude of illness, questionnaires were sent to the households of the contaminated area. The median duration of the symptoms was one to two days and the most frequently reported symptoms included abdominal pain (94%, 101/107), nausea (91%, 100/110), diarrhea (89%, 100/112), abdominal swelling (83%, 86/104), muscular pain (66%, 64/97), vomiting (53%, 52/98) and fever (46%, 42/91). In the acute phase of the outbreak, stool samples were collected from patients between 19th October and 3rd November 2016, and were analyzed in clinical laboratories with routine tests for enteric viruses, pathogenic bacteria, and protozoans (Table 1). During January�February, 463 persons with gastrointestinal illness contacted local primary health care. Symptoms lasted on average for two days and included diarrhea (76%, 352/463), vomiting (65%, 299/463) and fever (32%, 150/463).

What are the first steps of mitigation?

{'answer_start': [838], 'text': ['boil water advisory, alternative drinking water sources and chlorination']}

Contamination Question Answering

This study describes two drinking water outbreaks in Finland in 2016 (outbreak I) and 2018 (outbreak II). Both outbreaks caused approximately 450 illness cases and were due to drinking water pipe breakage and subsequent wastewater intrusion into the distribution system. In both outbreaks, the sapovirus was found in patient samples as the main causative agent. In addition, adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides (outbreak II) were detected in patient samples. Water samples were analyzed for the selected pathogens largely based on the results of patient samples. In drinking water, sapovirus and enteropathogenic E. coli (EPEC) were found in outbreak II. As mitigation actions, boil water advisory, alternative drinking water sources and chlorination were organized to restrict the outbreaks and to clean the contaminated distribution network. This study describes two waterborne outbreaks both caused by the intrusion of wastewater into a drinking water distribution system due to pipe breakage. In outbreak I, the cause of the contamination was a maintenance well containing the air release valves of both drinking water and wastewater pipes. Due to pipe breakage on the road construction site on 12th October 2016, the under pressure in the drinking water network caused the wastewater inflow from the maintenance well through the air release valve into the drinking water distribution system. Mitigation actions during the outbreak included the boil water advisory for two months (from 16th October to 16th December 2016) and chlorination for 50 days (from 16th October to 5th December 2016). When respondents� family members with gastrointestinal illness were taken into account, the estimated number of patients was 458. In order to estimate the magnitude of illness, questionnaires were sent to the households of the contaminated area. The median duration of the symptoms was one to two days and the most frequently reported symptoms included abdominal pain (94%, 101/107), nausea (91%, 100/110), diarrhea (89%, 100/112), abdominal swelling (83%, 86/104), muscular pain (66%, 64/97), vomiting (53%, 52/98) and fever (46%, 42/91). In the acute phase of the outbreak, stool samples were collected from patients between 19th October and 3rd November 2016, and were analyzed in clinical laboratories with routine tests for enteric viruses, pathogenic bacteria, and protozoans (Table 1). During January�February, 463 persons with gastrointestinal illness contacted local primary health care. Symptoms lasted on average for two days and included diarrhea (76%, 352/463), vomiting (65%, 299/463) and fever (32%, 150/463).

What type of samples were examined?

{'answer_start': [2333], 'text': ['stool samples']}

Contamination Question Answering

This study describes two drinking water outbreaks in Finland in 2016 (outbreak I) and 2018 (outbreak II). Both outbreaks caused approximately 450 illness cases and were due to drinking water pipe breakage and subsequent wastewater intrusion into the distribution system. In both outbreaks, the sapovirus was found in patient samples as the main causative agent. In addition, adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides (outbreak II) were detected in patient samples. Water samples were analyzed for the selected pathogens largely based on the results of patient samples. In drinking water, sapovirus and enteropathogenic E. coli (EPEC) were found in outbreak II. As mitigation actions, boil water advisory, alternative drinking water sources and chlorination were organized to restrict the outbreaks and to clean the contaminated distribution network. This study describes two waterborne outbreaks both caused by the intrusion of wastewater into a drinking water distribution system due to pipe breakage. In outbreak I, the cause of the contamination was a maintenance well containing the air release valves of both drinking water and wastewater pipes. Due to pipe breakage on the road construction site on 12th October 2016, the under pressure in the drinking water network caused the wastewater inflow from the maintenance well through the air release valve into the drinking water distribution system. Mitigation actions during the outbreak included the boil water advisory for two months (from 16th October to 16th December 2016) and chlorination for 50 days (from 16th October to 5th December 2016). When respondents� family members with gastrointestinal illness were taken into account, the estimated number of patients was 458. In order to estimate the magnitude of illness, questionnaires were sent to the households of the contaminated area. The median duration of the symptoms was one to two days and the most frequently reported symptoms included abdominal pain (94%, 101/107), nausea (91%, 100/110), diarrhea (89%, 100/112), abdominal swelling (83%, 86/104), muscular pain (66%, 64/97), vomiting (53%, 52/98) and fever (46%, 42/91). In the acute phase of the outbreak, stool samples were collected from patients between 19th October and 3rd November 2016, and were analyzed in clinical laboratories with routine tests for enteric viruses, pathogenic bacteria, and protozoans (Table 1). During January�February, 463 persons with gastrointestinal illness contacted local primary health care. Symptoms lasted on average for two days and included diarrhea (76%, 352/463), vomiting (65%, 299/463) and fever (32%, 150/463).

How many cases were there?

{'answer_start': [1882], 'text': ['458']}

Contamination Question Answering

This study describes two drinking water outbreaks in Finland in 2016 (outbreak I) and 2018 (outbreak II). Both outbreaks caused approximately 450 illness cases and were due to drinking water pipe breakage and subsequent wastewater intrusion into the distribution system. In both outbreaks, the sapovirus was found in patient samples as the main causative agent. In addition, adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides (outbreak II) were detected in patient samples. Water samples were analyzed for the selected pathogens largely based on the results of patient samples. In drinking water, sapovirus and enteropathogenic E. coli (EPEC) were found in outbreak II. As mitigation actions, boil water advisory, alternative drinking water sources and chlorination were organized to restrict the outbreaks and to clean the contaminated distribution network. This study describes two waterborne outbreaks both caused by the intrusion of wastewater into a drinking water distribution system due to pipe breakage. In outbreak I, the cause of the contamination was a maintenance well containing the air release valves of both drinking water and wastewater pipes. Due to pipe breakage on the road construction site on 12th October 2016, the under pressure in the drinking water network caused the wastewater inflow from the maintenance well through the air release valve into the drinking water distribution system. Mitigation actions during the outbreak included the boil water advisory for two months (from 16th October to 16th December 2016) and chlorination for 50 days (from 16th October to 5th December 2016). When respondents� family members with gastrointestinal illness were taken into account, the estimated number of patients was 458. In order to estimate the magnitude of illness, questionnaires were sent to the households of the contaminated area. The median duration of the symptoms was one to two days and the most frequently reported symptoms included abdominal pain (94%, 101/107), nausea (91%, 100/110), diarrhea (89%, 100/112), abdominal swelling (83%, 86/104), muscular pain (66%, 64/97), vomiting (53%, 52/98) and fever (46%, 42/91). In the acute phase of the outbreak, stool samples were collected from patients between 19th October and 3rd November 2016, and were analyzed in clinical laboratories with routine tests for enteric viruses, pathogenic bacteria, and protozoans (Table 1). During January�February, 463 persons with gastrointestinal illness contacted local primary health care. Symptoms lasted on average for two days and included diarrhea (76%, 352/463), vomiting (65%, 299/463) and fever (32%, 150/463).

What were the associated pathogens of concern?

{'answer_start': [375], 'text': ['adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides']}