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_id': 275041, 'document_id': 450707, 'question_id': 138427, 'text': 'sapovirus', 'answer_start': 294, 'answer_category': 'SHORT'}