In June 2017, the Pennsylvania Department of Health (PADOH) was notified of multiple norovirus outbreaks associated with 179 ill individuals who attended separate events held at an outdoor venue and campground over a month period. Epidemiologic investigations were unable to identify a single exposure route and therefore unable to determine whether there was a persistent contamination source to target for exposure mitigation. Norovirus was detected in a fresh recreational water designated swimming area and a drinking water well. A hydrogeological site evaluation suggested a nearby septic leach field as a potential contamination source via ground water infiltration. Geological characterization revealed a steep dip of the bedrock beneath the septic leach field toward the well, providing a viral transport pathway in a geologic medium not previously documented as high risk for viral ground water contamination. The human-associated microbial source tracking (MST) genetic marker, HF183, was used as a microbial tracer to demonstrate the hydrogeological connection between the malfunctioning septic system, drinking water well, and recreational water area. Based on environmental investigation findings, venue management and local public health officials implemented a series of outbreak prevention strategies including discontinuing the use of the contaminated well, issuing a permit for a new drinking water well, increasing portable toilet and handwashing station availability, and promoting proper hand hygiene. Despite the outbreaks at the venue and evidence of ground water contamination impacting nearby recreational water and the drinking water well, no new norovirus cases were reported during a large event one week after implementing prevention practices. This investigation highlights a new application for human-associated MST methods to trace hydrological connections between multiple fecal pollutant exposure routes in an outbreak scenario. In turn, pollutant source information can be used to develop effective intervention practices to mitigate exposure and prevent future outbreaks associated with human fecal contaminated waters.

2017 年 6 月，宾夕法尼亚州卫生部 (PADOH) 接到通知，与 179 名患者有关的多起诺如病毒爆发有关，这些人参加了一个月内在户外场所和露营地举行的不同活动。流行病学调查无法确定单一的暴露途径，因此无法确定是否存在持久性污染源作为缓解暴露的目标。诺如病毒在指定游泳区的淡水娱乐用水和饮用水井中检测到。水文地质现场评估表明，附近的化粪池渗滤场是地下水渗入的潜在污染源。地质特征显示，化粪池浸出区下方的基岩向井倾斜，在以前没有记录为病毒地下水污染高风险的地质介质中提供病毒运输途径。人类相关微生物源追踪 (MST) 遗传标记 HF183 被用作微生物示踪剂，以证明发生故障的化粪池系统、饮用水井和休闲水域之间的水文地质联系。根据环境调查结果，场馆管理人员和当地公共卫生官员实施了一系列疫情预防策略，包括停止使用受污染的水井、颁发新的饮用水井许可证、增加便携式厕所和洗手站的可用性，以及促进适当的手部卫生。尽管会场爆发了疫情，并且有证据表明地下水污染影响了附近的娱乐用水和饮用水井，但在实施预防措施一周后的大型活动中没有报告新的诺如病毒病例。这项调查突出了与人类相关的 MST 方法的新应用，以追踪爆发情景中多个粪便污染物暴露途径之间的水文联系。反过来，污染物源信息可用于制定有效的干预措施，以减轻暴露并防止未来与人类粪便污染水相关的爆发。这项调查突出了与人类相关的 MST 方法的新应用，以追踪爆发情景中多个粪便污染物暴露途径之间的水文联系。反过来，污染物源信息可用于制定有效的干预措施，以减轻暴露并防止未来与人类粪便污染水相关的爆发。这项调查突出了与人类相关的 MST 方法的新应用，以追踪爆发情景中多个粪便污染物暴露途径之间的水文联系。反过来，污染物源信息可用于制定有效的干预措施，以减轻暴露并防止未来与人类粪便污染水相关的爆发。