diff --git "a/test.csv" "b/test.csv" new file mode 100644--- /dev/null +++ "b/test.csv" @@ -0,0 +1,2916 @@ +id,title,context,question,answers +23,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +","What is the date of the event? +","{'answer_start': [114], 'text': ['June 2009']}" +28,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +","What is the location of the event? +","{'answer_start': [96], 'text': ['northern Italy']}" +12,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +","What is the source that started the event? +","{'answer_start': [202], 'text': ['contaminated municipal water supply']}" +14,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +","How was the event first detected? +","{'answer_start': [570], 'text': ['cases of gastroenteritis among guests of a hotel.']}" +8,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +","How many people were ill? +","{'answer_start': [712], 'text': ['299 probable cases']}" +5,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +","How many people were hospitalized? +","{'answer_start': [962], 'text': ['Four cases']}" +33,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +","What is the attack rate? +","{'answer_start': [1075], 'text': ['8.9%']}" +11,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +","What are the pathogens? +","{'answer_start': [1213], 'text': ['norovirus, rotavirus, enterovirus or astrovirus.']}" +13,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +","What is the concentration of the contaminant after analysis? +","{'answer_start': [1744], 'text': ['high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml)']}" +11,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +","What are the symptoms? +","{'answer_start': [1628], 'text': ['vomiting, diarrhoea and fever.']}" +21,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +","What is the event? +","{'answer_start': [1898], 'text': ['outbreak of viral gastroenteritis']}" +20,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +","What are the initial steps of investigation? +","{'answer_start': [2199], 'text': ['a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data.']}" +31,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +","What is the duration of the event? +","{'answer_start': [3141], 'text': ['Over one month']}" +31,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +","From when until when the event happened +","{'answer_start': [3331], 'text': [' between 8 June and 4 July 2009']}" +31,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +","What are the first steps of mitigation? +","{'answer_start': [3456], 'text': ['treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population.']}" +11,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +","What did they do to mitigate the event? +","{'answer_start': [3682], 'text': ['restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. ']}" +19,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +","What did the local authorities advise? +","{'answer_start': [3916], 'text': ['door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid.']}" +23,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +",What was the environmental investigation?,"{'answer_start': [2626], 'text': ['environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff).']}" +16,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +","What type of samples were examined? +","{'answer_start': [4372], 'text': ['test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus).']}" +8,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +",What was the outbreak investigation?,"{'answer_start': [2424], 'text': ['ollected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. ']}" +13,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +",What did the authorities do to mitigate the event?,"{'answer_start': [3079], 'text': ['collection of water samples from the municipal water supply.']}" +28,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +","What was the age of the affected people? +","{'answer_start': [4739], 'text': ['The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus.']}" +27,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +",What is the source of contamination?,"{'answer_start': [278], 'text': ['municipal water systems']}" +10,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +",What was the alert of the event?,"{'answer_start': [643], 'text': ['cluster of gastroenteritis in a hotel.']}" +16,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +",How many cases were there?,"{'answer_start': [862], 'text': ['299 persons']}" +6,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +",What were the associated pathogens of concern?,"{'answer_start': [1553], 'text': [' norovirus, rotavirus, enterovirus or astrovirus.']}" +20,Contamination Question Answering,"We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +In Italy, municipal water systems have been identified as the source of water-borne infections in several norovirus outbreaks. +On 9 June 2009, a general practitioner from the municipality of San Felice del Benaco notified to the local health authority of Brescia (Lombardy region, north Italy) 21 cases of gastroenteritis among guests of a hotel. +The alert came from a cluster of gastroenteritis in a hotel. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +A total of 299 persons fulfilled the outbreak case definition, including 269 probable and 30 confirmed cases. +Four cases were hospitalized, all of them children. +The attack rate for the town of San Felice del Benaco was 8.9% (299/3,360). +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Water samples and filters from the water system also tested positive for norovirus and enterovirus. +A confirmed outbreak case was defined as a person who fulfilled the criteria of a probable case and whose stool sample was laboratory-confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +Patients presented with vomiting, diarrhoea and fever. +On 16 June 2009, preliminary environmental investigation results showed abnormally high levels of Clostridium perfringens (4 UFC/100 ml) and Aeromonas hydrophyla (16 UFC/100 ml) in water samples from two public fountains. +We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. +An outbreak of viral gastroenteritis has been microbiologically linked to a contaminated municipal water supply in a small town of Lombardy. +Active case finding was performed as follows: a public hotline was set up where people could call the health authority for information regarding the disease and report symptoms, date of onset and basic demographic data. +In parallel, the outbreak investigation team collected daily information on case-patients presenting at the emergency unit of the local hospital and collected stool samples when possible. +The local and regional health authorities initiated an environmental investigation at the hotel on 9 June 2009, taking food samples from the kitchen, interviewing and collecting stool samples for microbiological testing from 20 probable cases (both guests and hotel staff). +When it was clear that the outbreak was spreading to the larger community (apart from three campsites with their own private water supply, where no cases were reported), the environmental investigation was extended and included collection of water samples from the municipal water supply. +Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. +The outbreak occurred between 8 June and 4 July 2009 and peaked on the 15 and 16 June with 47 outbreak cases per day. +Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population. +On 17 June 2009, a special ordinance from the municipality restricted the use of municipal water (inhabitants were told not to use municipal water for drinking and cooking purposes) and provided alternative water supplies to the population via water tankers. +Local authorities organized a door-to-door information campaign and distributed leaflets in order to reach as many people as possible. On 19 June 2009, the municipality started disinfecting the water system with chlorine dioxide (0.2 mg/l) and sand filters with peracetic acid. +Regular water sampling and testing was performed to monitor the efficiency of control measures. +Samples were sent to the Lombardy and Emilia Romagna Experimental Zooprophylactic Institute (IZSLER) to test for the presence of bacterial pathogens (Salmonella sp., Shigella sp., Campylobacter sp., E. coli O157, Yersinia enterocolitica, Aeromonas sp., Clostridium perfringens toxins), parasites (Cryptosporidium sp.) and viral pathogens (norovirus, rotavirus, enterovirus, astrovirus). +Stool samples obtained from 36 probable cases were examined at the laboratory. +The mean age of confirmed cases of rotavirus was 29 years (range: 0-71) compared to the mean age of 39 years (range: 0-88) for cases of norovirus and 39 years (9-88) for cases of enterovirus. + +",What was the outbreak?,"{'answer_start': [2013], 'text': ['outbreak of viral gastroenteritis']}" +34,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia were diagnosed in three counties in central Norway: 21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two of typhoid type. Three cases were asymptomatic and clinical information was unavailable for one case. The mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells. An increased rodent (lemming) population and snow melting may have led to contamination of the wells with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases (16 female and 23 male) of tularaemia were reported from the counties of Sr-Trndelag (28 cases), Mre og Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person who had clinical symptoms compatible with tularaemia or had used drinking water from the same source as a previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described below. The cases were geographically scattered within each county, involving 13 different municipalities (Figure), and were not linked to one common source. In comparison, seven cases were reported in total from other parts of the country in the same period. In 2009 and 2010 four and eight cases respectively were reported from central Norway. Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are recognised: tularensis, holarctica, mediasiatica and novicida. In Europe, the infection is due to subspecies holarctica which causes in general less severe disease than subspecies tularensis, which is common in North America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and hares, but infection may also be transmitted via insect bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the most common clinical presentations in Norway [2]. Oropharyngeal disease is commonly associated with contaminated food and water, while ulceroglandular forms are more often seen when there has been skin contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries [3,4]. Tularaemia is a notifiable disease in Norway and during the past 10 years, three outbreaks were reported in Norway [5-7] and all were associated with water sources in areas where dead lemmings (Lemmus lemmus) had been observed previously. From 2001 to 2010, between three and 66 cases of tularaemia were reported annually in the whole country, with an increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy (glandular/ulceroglandular type, 10 cases). Among the remaining eight tularaemia cases, two were classified as respiratory and two as typhoid type, while three were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology (microagglutination and an in-house IgG/IgM Elisa) in 30 patients [8], by F. tularensis specific PCR analysis in seven patients [9] and by blood culture (BactAlert, BioMerieux) in two patients. The two bacterial isolates were verified as F. tularensis by PCR and sequencing of the 16S rDNA gene, and confirmed as non-subspecies tularensis by pdpA PCR [10]. 2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis DNA was detected by PCR in filtered water from five different wells tested in Sr-Trndelag. Seven cases in one municipality were linked to the same water source. Apart from that, only two cases have been confirmed to share a common well so far. Follow-up serology has been recommended for several of the persons exposed to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and cervical lymphadenopathy linked to the use of private wells in the winter season makes contaminated water the most likely source of infection in this outbreak. Detection of F. tularensis DNA by PCR analyses in some of the wells supports this assumption for some of the cases. Use of private wells is relatively common in rural areas of Norway although exact data on such use are not available. The precise mechanism of contamination of the wells with F. tularensis is as yet unknown. However, November and December 2010 were unusually cold months, while in January 2011 temperatures increased leading to melting of snow and possible contamination of private wells by surface water contaminated with bacteria from rodent cadavers or rodent excreta. Since the incubation period for tularaemia may be up to three weeks, and time from symptoms until seroconversion might be up to six weeks, more cases may follow. Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates rodents and hares as transmitters of disease. Years with a great increase in the rodent population are seen with intervals of about three to four years [11] and in the summer and autumn of 2010, a high density of lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after exposure. The use of small streams and private wells as a source of drinking water and for other purposes in rural areas of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes where the rodents can enter. It is also important to secure the well from contamination by surface water after snow melting. In case of proven or suspected contaminated wells, the water should be disinfected before further use. However, this may not be feasible for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert and Response. WHO guidelines on tularaemia. Geneva:WHO; 2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf 2. Brantsaeter AB. Twenty-five years of tularaemia in Norway, 19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and Infectious Diseases. 14th European Congress of Clinical Microbiology and Infectious Diseases. Prague; 1-4 May 2004. 3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe: an epidemiological overview. Scand J Infect Dis. 2004;36(5):350-5. 4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser W, et al. An outbreak of oropharyngeal tularaemia linked to natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6. 5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia (harepest) i Midtre Gauldal. [A waterborne outbreak of tularaemia in Midtre-Gauldal]. Norwegian Institute of Public Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0 6. Brantsaeter AB, Krogh T, Radtke A, Nygard K. Tularaemia outbreak in northern Norway. Euro Surveill. 2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165 7. Melien P, Holsdal RE. Tularemi i Meldal en vanskelig diagnose? [Tularaemia in Meldal- a difficult diagnosis?]. Norwegian Institute of Public Health. 18 Mar 2008. Norwegian. Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0 8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme immunoassay for antibodies to a 43,000-molecular-weight Francisella tularensis outer membrane protein in the diagnosis of tularemia. J Clin Microbiol. 1989;27(5):922-6. 9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of Francisella tularensis in ulcers of patients with tularaemia by PCR. J Clin Microbiol. 1997;35(5):1045-8. 10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E, Landt O, et al. Real-time PCR using hybridization probes for the rapid and specific identification of Francisella tularensis subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6. 11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian. 12. Norwegian Veterinary Institute. Flere tilfeller av harepest i Sr-Norge [Severeal cases of tularaemia in South-Norway]. Norwegian Veterinary Institute. 25 Nov 2010. Norwegian. Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge +",What caused the event?,"{'answer_start': [426], 'text': ['An increased rodent (lemming) population and snow melting may have led to contamination of the wells with infected rodents or rodent excreta']}" +9,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia were diagnosed in three counties in central Norway: 21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two of typhoid type. Three cases were asymptomatic and clinical information was unavailable for one case. The mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells. An increased rodent (lemming) population and snow melting may have led to contamination of the wells with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases (16 female and 23 male) of tularaemia were reported from the counties of Sr-Trndelag (28 cases), Mre og Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person who had clinical symptoms compatible with tularaemia or had used drinking water from the same source as a previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described below. The cases were geographically scattered within each county, involving 13 different municipalities (Figure), and were not linked to one common source. In comparison, seven cases were reported in total from other parts of the country in the same period. In 2009 and 2010 four and eight cases respectively were reported from central Norway. Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are recognised: tularensis, holarctica, mediasiatica and novicida. In Europe, the infection is due to subspecies holarctica which causes in general less severe disease than subspecies tularensis, which is common in North America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and hares, but infection may also be transmitted via insect bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the most common clinical presentations in Norway [2]. Oropharyngeal disease is commonly associated with contaminated food and water, while ulceroglandular forms are more often seen when there has been skin contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries [3,4]. Tularaemia is a notifiable disease in Norway and during the past 10 years, three outbreaks were reported in Norway [5-7] and all were associated with water sources in areas where dead lemmings (Lemmus lemmus) had been observed previously. From 2001 to 2010, between three and 66 cases of tularaemia were reported annually in the whole country, with an increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy (glandular/ulceroglandular type, 10 cases). Among the remaining eight tularaemia cases, two were classified as respiratory and two as typhoid type, while three were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology (microagglutination and an in-house IgG/IgM Elisa) in 30 patients [8], by F. tularensis specific PCR analysis in seven patients [9] and by blood culture (BactAlert, BioMerieux) in two patients. The two bacterial isolates were verified as F. tularensis by PCR and sequencing of the 16S rDNA gene, and confirmed as non-subspecies tularensis by pdpA PCR [10]. 2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis DNA was detected by PCR in filtered water from five different wells tested in Sr-Trndelag. Seven cases in one municipality were linked to the same water source. Apart from that, only two cases have been confirmed to share a common well so far. Follow-up serology has been recommended for several of the persons exposed to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and cervical lymphadenopathy linked to the use of private wells in the winter season makes contaminated water the most likely source of infection in this outbreak. Detection of F. tularensis DNA by PCR analyses in some of the wells supports this assumption for some of the cases. Use of private wells is relatively common in rural areas of Norway although exact data on such use are not available. The precise mechanism of contamination of the wells with F. tularensis is as yet unknown. However, November and December 2010 were unusually cold months, while in January 2011 temperatures increased leading to melting of snow and possible contamination of private wells by surface water contaminated with bacteria from rodent cadavers or rodent excreta. Since the incubation period for tularaemia may be up to three weeks, and time from symptoms until seroconversion might be up to six weeks, more cases may follow. Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates rodents and hares as transmitters of disease. Years with a great increase in the rodent population are seen with intervals of about three to four years [11] and in the summer and autumn of 2010, a high density of lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after exposure. The use of small streams and private wells as a source of drinking water and for other purposes in rural areas of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes where the rodents can enter. It is also important to secure the well from contamination by surface water after snow melting. In case of proven or suspected contaminated wells, the water should be disinfected before further use. However, this may not be feasible for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert and Response. WHO guidelines on tularaemia. Geneva:WHO; 2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf 2. Brantsaeter AB. Twenty-five years of tularaemia in Norway, 19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and Infectious Diseases. 14th European Congress of Clinical Microbiology and Infectious Diseases. Prague; 1-4 May 2004. 3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe: an epidemiological overview. Scand J Infect Dis. 2004;36(5):350-5. 4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser W, et al. An outbreak of oropharyngeal tularaemia linked to natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6. 5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia (harepest) i Midtre Gauldal. [A waterborne outbreak of tularaemia in Midtre-Gauldal]. Norwegian Institute of Public Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0 6. Brantsaeter AB, Krogh T, Radtke A, Nygard K. Tularaemia outbreak in northern Norway. Euro Surveill. 2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165 7. Melien P, Holsdal RE. Tularemi i Meldal en vanskelig diagnose? [Tularaemia in Meldal- a difficult diagnosis?]. Norwegian Institute of Public Health. 18 Mar 2008. Norwegian. Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0 8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme immunoassay for antibodies to a 43,000-molecular-weight Francisella tularensis outer membrane protein in the diagnosis of tularemia. J Clin Microbiol. 1989;27(5):922-6. 9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of Francisella tularensis in ulcers of patients with tularaemia by PCR. J Clin Microbiol. 1997;35(5):1045-8. 10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E, Landt O, et al. Real-time PCR using hybridization probes for the rapid and specific identification of Francisella tularensis subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6. 11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian. 12. Norwegian Veterinary Institute. Flere tilfeller av harepest i Sr-Norge [Severeal cases of tularaemia in South-Norway]. Norwegian Veterinary Institute. 25 Nov 2010. Norwegian. Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge +","What is the date of the event? +","{'answer_start': [5], 'text': ['January to March 2011']}" +15,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia were diagnosed in three counties in central Norway: 21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two of typhoid type. Three cases were asymptomatic and clinical information was unavailable for one case. The mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells. An increased rodent (lemming) population and snow melting may have led to contamination of the wells with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases (16 female and 23 male) of tularaemia were reported from the counties of Sr-Trndelag (28 cases), Mre og Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person who had clinical symptoms compatible with tularaemia or had used drinking water from the same source as a previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described below. The cases were geographically scattered within each county, involving 13 different municipalities (Figure), and were not linked to one common source. In comparison, seven cases were reported in total from other parts of the country in the same period. In 2009 and 2010 four and eight cases respectively were reported from central Norway. Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are recognised: tularensis, holarctica, mediasiatica and novicida. In Europe, the infection is due to subspecies holarctica which causes in general less severe disease than subspecies tularensis, which is common in North America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and hares, but infection may also be transmitted via insect bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the most common clinical presentations in Norway [2]. Oropharyngeal disease is commonly associated with contaminated food and water, while ulceroglandular forms are more often seen when there has been skin contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries [3,4]. Tularaemia is a notifiable disease in Norway and during the past 10 years, three outbreaks were reported in Norway [5-7] and all were associated with water sources in areas where dead lemmings (Lemmus lemmus) had been observed previously. From 2001 to 2010, between three and 66 cases of tularaemia were reported annually in the whole country, with an increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy (glandular/ulceroglandular type, 10 cases). Among the remaining eight tularaemia cases, two were classified as respiratory and two as typhoid type, while three were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology (microagglutination and an in-house IgG/IgM Elisa) in 30 patients [8], by F. tularensis specific PCR analysis in seven patients [9] and by blood culture (BactAlert, BioMerieux) in two patients. The two bacterial isolates were verified as F. tularensis by PCR and sequencing of the 16S rDNA gene, and confirmed as non-subspecies tularensis by pdpA PCR [10]. 2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis DNA was detected by PCR in filtered water from five different wells tested in Sr-Trndelag. Seven cases in one municipality were linked to the same water source. Apart from that, only two cases have been confirmed to share a common well so far. Follow-up serology has been recommended for several of the persons exposed to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and cervical lymphadenopathy linked to the use of private wells in the winter season makes contaminated water the most likely source of infection in this outbreak. Detection of F. tularensis DNA by PCR analyses in some of the wells supports this assumption for some of the cases. Use of private wells is relatively common in rural areas of Norway although exact data on such use are not available. The precise mechanism of contamination of the wells with F. tularensis is as yet unknown. However, November and December 2010 were unusually cold months, while in January 2011 temperatures increased leading to melting of snow and possible contamination of private wells by surface water contaminated with bacteria from rodent cadavers or rodent excreta. Since the incubation period for tularaemia may be up to three weeks, and time from symptoms until seroconversion might be up to six weeks, more cases may follow. Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates rodents and hares as transmitters of disease. Years with a great increase in the rodent population are seen with intervals of about three to four years [11] and in the summer and autumn of 2010, a high density of lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after exposure. The use of small streams and private wells as a source of drinking water and for other purposes in rural areas of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes where the rodents can enter. It is also important to secure the well from contamination by surface water after snow melting. In case of proven or suspected contaminated wells, the water should be disinfected before further use. However, this may not be feasible for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert and Response. WHO guidelines on tularaemia. Geneva:WHO; 2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf 2. Brantsaeter AB. Twenty-five years of tularaemia in Norway, 19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and Infectious Diseases. 14th European Congress of Clinical Microbiology and Infectious Diseases. Prague; 1-4 May 2004. 3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe: an epidemiological overview. Scand J Infect Dis. 2004;36(5):350-5. 4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser W, et al. An outbreak of oropharyngeal tularaemia linked to natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6. 5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia (harepest) i Midtre Gauldal. [A waterborne outbreak of tularaemia in Midtre-Gauldal]. Norwegian Institute of Public Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0 6. Brantsaeter AB, Krogh T, Radtke A, Nygard K. Tularaemia outbreak in northern Norway. Euro Surveill. 2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165 7. Melien P, Holsdal RE. Tularemi i Meldal en vanskelig diagnose? [Tularaemia in Meldal- a difficult diagnosis?]. Norwegian Institute of Public Health. 18 Mar 2008. Norwegian. Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0 8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme immunoassay for antibodies to a 43,000-molecular-weight Francisella tularensis outer membrane protein in the diagnosis of tularemia. J Clin Microbiol. 1989;27(5):922-6. 9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of Francisella tularensis in ulcers of patients with tularaemia by PCR. J Clin Microbiol. 1997;35(5):1045-8. 10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E, Landt O, et al. Real-time PCR using hybridization probes for the rapid and specific identification of Francisella tularensis subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6. 11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian. 12. Norwegian Veterinary Institute. Flere tilfeller av harepest i Sr-Norge [Severeal cases of tularaemia in South-Norway]. Norwegian Veterinary Institute. 25 Nov 2010. Norwegian. Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge +","What is the location of the event? +","{'answer_start': [96], 'text': ['Norway']}" +19,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia were diagnosed in three counties in central Norway: 21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two of typhoid type. Three cases were asymptomatic and clinical information was unavailable for one case. The mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells. An increased rodent (lemming) population and snow melting may have led to contamination of the wells with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases (16 female and 23 male) of tularaemia were reported from the counties of Sr-Trndelag (28 cases), Mre og Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person who had clinical symptoms compatible with tularaemia or had used drinking water from the same source as a previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described below. The cases were geographically scattered within each county, involving 13 different municipalities (Figure), and were not linked to one common source. In comparison, seven cases were reported in total from other parts of the country in the same period. In 2009 and 2010 four and eight cases respectively were reported from central Norway. Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are recognised: tularensis, holarctica, mediasiatica and novicida. In Europe, the infection is due to subspecies holarctica which causes in general less severe disease than subspecies tularensis, which is common in North America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and hares, but infection may also be transmitted via insect bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the most common clinical presentations in Norway [2]. Oropharyngeal disease is commonly associated with contaminated food and water, while ulceroglandular forms are more often seen when there has been skin contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries [3,4]. Tularaemia is a notifiable disease in Norway and during the past 10 years, three outbreaks were reported in Norway [5-7] and all were associated with water sources in areas where dead lemmings (Lemmus lemmus) had been observed previously. From 2001 to 2010, between three and 66 cases of tularaemia were reported annually in the whole country, with an increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy (glandular/ulceroglandular type, 10 cases). Among the remaining eight tularaemia cases, two were classified as respiratory and two as typhoid type, while three were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology (microagglutination and an in-house IgG/IgM Elisa) in 30 patients [8], by F. tularensis specific PCR analysis in seven patients [9] and by blood culture (BactAlert, BioMerieux) in two patients. The two bacterial isolates were verified as F. tularensis by PCR and sequencing of the 16S rDNA gene, and confirmed as non-subspecies tularensis by pdpA PCR [10]. 2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis DNA was detected by PCR in filtered water from five different wells tested in Sr-Trndelag. Seven cases in one municipality were linked to the same water source. Apart from that, only two cases have been confirmed to share a common well so far. Follow-up serology has been recommended for several of the persons exposed to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and cervical lymphadenopathy linked to the use of private wells in the winter season makes contaminated water the most likely source of infection in this outbreak. Detection of F. tularensis DNA by PCR analyses in some of the wells supports this assumption for some of the cases. Use of private wells is relatively common in rural areas of Norway although exact data on such use are not available. The precise mechanism of contamination of the wells with F. tularensis is as yet unknown. However, November and December 2010 were unusually cold months, while in January 2011 temperatures increased leading to melting of snow and possible contamination of private wells by surface water contaminated with bacteria from rodent cadavers or rodent excreta. Since the incubation period for tularaemia may be up to three weeks, and time from symptoms until seroconversion might be up to six weeks, more cases may follow. Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates rodents and hares as transmitters of disease. Years with a great increase in the rodent population are seen with intervals of about three to four years [11] and in the summer and autumn of 2010, a high density of lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after exposure. The use of small streams and private wells as a source of drinking water and for other purposes in rural areas of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes where the rodents can enter. It is also important to secure the well from contamination by surface water after snow melting. In case of proven or suspected contaminated wells, the water should be disinfected before further use. However, this may not be feasible for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert and Response. WHO guidelines on tularaemia. Geneva:WHO; 2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf 2. Brantsaeter AB. Twenty-five years of tularaemia in Norway, 19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and Infectious Diseases. 14th European Congress of Clinical Microbiology and Infectious Diseases. Prague; 1-4 May 2004. 3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe: an epidemiological overview. Scand J Infect Dis. 2004;36(5):350-5. 4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser W, et al. An outbreak of oropharyngeal tularaemia linked to natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6. 5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia (harepest) i Midtre Gauldal. [A waterborne outbreak of tularaemia in Midtre-Gauldal]. Norwegian Institute of Public Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0 6. Brantsaeter AB, Krogh T, Radtke A, Nygard K. Tularaemia outbreak in northern Norway. Euro Surveill. 2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165 7. Melien P, Holsdal RE. Tularemi i Meldal en vanskelig diagnose? [Tularaemia in Meldal- a difficult diagnosis?]. Norwegian Institute of Public Health. 18 Mar 2008. Norwegian. Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0 8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme immunoassay for antibodies to a 43,000-molecular-weight Francisella tularensis outer membrane protein in the diagnosis of tularemia. J Clin Microbiol. 1989;27(5):922-6. 9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of Francisella tularensis in ulcers of patients with tularaemia by PCR. J Clin Microbiol. 1997;35(5):1045-8. 10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E, Landt O, et al. Real-time PCR using hybridization probes for the rapid and specific identification of Francisella tularensis subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6. 11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian. 12. Norwegian Veterinary Institute. Flere tilfeller av harepest i Sr-Norge [Severeal cases of tularaemia in South-Norway]. Norwegian Veterinary Institute. 25 Nov 2010. Norwegian. Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge +","How many people were ill? +","{'answer_start': [28], 'text': ['39 cases']}" +7,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia were diagnosed in three counties in central Norway: 21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two of typhoid type. Three cases were asymptomatic and clinical information was unavailable for one case. The mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells. An increased rodent (lemming) population and snow melting may have led to contamination of the wells with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases (16 female and 23 male) of tularaemia were reported from the counties of Sr-Trndelag (28 cases), Mre og Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person who had clinical symptoms compatible with tularaemia or had used drinking water from the same source as a previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described below. The cases were geographically scattered within each county, involving 13 different municipalities (Figure), and were not linked to one common source. In comparison, seven cases were reported in total from other parts of the country in the same period. In 2009 and 2010 four and eight cases respectively were reported from central Norway. Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are recognised: tularensis, holarctica, mediasiatica and novicida. In Europe, the infection is due to subspecies holarctica which causes in general less severe disease than subspecies tularensis, which is common in North America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and hares, but infection may also be transmitted via insect bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the most common clinical presentations in Norway [2]. Oropharyngeal disease is commonly associated with contaminated food and water, while ulceroglandular forms are more often seen when there has been skin contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries [3,4]. Tularaemia is a notifiable disease in Norway and during the past 10 years, three outbreaks were reported in Norway [5-7] and all were associated with water sources in areas where dead lemmings (Lemmus lemmus) had been observed previously. From 2001 to 2010, between three and 66 cases of tularaemia were reported annually in the whole country, with an increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy (glandular/ulceroglandular type, 10 cases). Among the remaining eight tularaemia cases, two were classified as respiratory and two as typhoid type, while three were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology (microagglutination and an in-house IgG/IgM Elisa) in 30 patients [8], by F. tularensis specific PCR analysis in seven patients [9] and by blood culture (BactAlert, BioMerieux) in two patients. The two bacterial isolates were verified as F. tularensis by PCR and sequencing of the 16S rDNA gene, and confirmed as non-subspecies tularensis by pdpA PCR [10]. 2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis DNA was detected by PCR in filtered water from five different wells tested in Sr-Trndelag. Seven cases in one municipality were linked to the same water source. Apart from that, only two cases have been confirmed to share a common well so far. Follow-up serology has been recommended for several of the persons exposed to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and cervical lymphadenopathy linked to the use of private wells in the winter season makes contaminated water the most likely source of infection in this outbreak. Detection of F. tularensis DNA by PCR analyses in some of the wells supports this assumption for some of the cases. Use of private wells is relatively common in rural areas of Norway although exact data on such use are not available. The precise mechanism of contamination of the wells with F. tularensis is as yet unknown. However, November and December 2010 were unusually cold months, while in January 2011 temperatures increased leading to melting of snow and possible contamination of private wells by surface water contaminated with bacteria from rodent cadavers or rodent excreta. Since the incubation period for tularaemia may be up to three weeks, and time from symptoms until seroconversion might be up to six weeks, more cases may follow. Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates rodents and hares as transmitters of disease. Years with a great increase in the rodent population are seen with intervals of about three to four years [11] and in the summer and autumn of 2010, a high density of lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after exposure. The use of small streams and private wells as a source of drinking water and for other purposes in rural areas of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes where the rodents can enter. It is also important to secure the well from contamination by surface water after snow melting. In case of proven or suspected contaminated wells, the water should be disinfected before further use. However, this may not be feasible for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert and Response. WHO guidelines on tularaemia. Geneva:WHO; 2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf 2. Brantsaeter AB. Twenty-five years of tularaemia in Norway, 19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and Infectious Diseases. 14th European Congress of Clinical Microbiology and Infectious Diseases. Prague; 1-4 May 2004. 3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe: an epidemiological overview. Scand J Infect Dis. 2004;36(5):350-5. 4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser W, et al. An outbreak of oropharyngeal tularaemia linked to natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6. 5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia (harepest) i Midtre Gauldal. [A waterborne outbreak of tularaemia in Midtre-Gauldal]. Norwegian Institute of Public Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0 6. Brantsaeter AB, Krogh T, Radtke A, Nygard K. Tularaemia outbreak in northern Norway. Euro Surveill. 2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165 7. Melien P, Holsdal RE. Tularemi i Meldal en vanskelig diagnose? [Tularaemia in Meldal- a difficult diagnosis?]. Norwegian Institute of Public Health. 18 Mar 2008. Norwegian. Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0 8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme immunoassay for antibodies to a 43,000-molecular-weight Francisella tularensis outer membrane protein in the diagnosis of tularemia. J Clin Microbiol. 1989;27(5):922-6. 9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of Francisella tularensis in ulcers of patients with tularaemia by PCR. J Clin Microbiol. 1997;35(5):1045-8. 10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E, Landt O, et al. Real-time PCR using hybridization probes for the rapid and specific identification of Francisella tularensis subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6. 11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian. 12. Norwegian Veterinary Institute. Flere tilfeller av harepest i Sr-Norge [Severeal cases of tularaemia in South-Norway]. Norwegian Veterinary Institute. 25 Nov 2010. Norwegian. Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge +","What are the pathogens? +","{'answer_start': [973], 'text': ['Francisella tularensis']}" +6,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia were diagnosed in three counties in central Norway: 21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two of typhoid type. Three cases were asymptomatic and clinical information was unavailable for one case. The mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells. An increased rodent (lemming) population and snow melting may have led to contamination of the wells with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases (16 female and 23 male) of tularaemia were reported from the counties of Sr-Trndelag (28 cases), Mre og Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person who had clinical symptoms compatible with tularaemia or had used drinking water from the same source as a previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described below. The cases were geographically scattered within each county, involving 13 different municipalities (Figure), and were not linked to one common source. In comparison, seven cases were reported in total from other parts of the country in the same period. In 2009 and 2010 four and eight cases respectively were reported from central Norway. Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are recognised: tularensis, holarctica, mediasiatica and novicida. In Europe, the infection is due to subspecies holarctica which causes in general less severe disease than subspecies tularensis, which is common in North America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and hares, but infection may also be transmitted via insect bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the most common clinical presentations in Norway [2]. Oropharyngeal disease is commonly associated with contaminated food and water, while ulceroglandular forms are more often seen when there has been skin contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries [3,4]. Tularaemia is a notifiable disease in Norway and during the past 10 years, three outbreaks were reported in Norway [5-7] and all were associated with water sources in areas where dead lemmings (Lemmus lemmus) had been observed previously. From 2001 to 2010, between three and 66 cases of tularaemia were reported annually in the whole country, with an increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy (glandular/ulceroglandular type, 10 cases). Among the remaining eight tularaemia cases, two were classified as respiratory and two as typhoid type, while three were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology (microagglutination and an in-house IgG/IgM Elisa) in 30 patients [8], by F. tularensis specific PCR analysis in seven patients [9] and by blood culture (BactAlert, BioMerieux) in two patients. The two bacterial isolates were verified as F. tularensis by PCR and sequencing of the 16S rDNA gene, and confirmed as non-subspecies tularensis by pdpA PCR [10]. 2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis DNA was detected by PCR in filtered water from five different wells tested in Sr-Trndelag. Seven cases in one municipality were linked to the same water source. Apart from that, only two cases have been confirmed to share a common well so far. Follow-up serology has been recommended for several of the persons exposed to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and cervical lymphadenopathy linked to the use of private wells in the winter season makes contaminated water the most likely source of infection in this outbreak. Detection of F. tularensis DNA by PCR analyses in some of the wells supports this assumption for some of the cases. Use of private wells is relatively common in rural areas of Norway although exact data on such use are not available. The precise mechanism of contamination of the wells with F. tularensis is as yet unknown. However, November and December 2010 were unusually cold months, while in January 2011 temperatures increased leading to melting of snow and possible contamination of private wells by surface water contaminated with bacteria from rodent cadavers or rodent excreta. Since the incubation period for tularaemia may be up to three weeks, and time from symptoms until seroconversion might be up to six weeks, more cases may follow. Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates rodents and hares as transmitters of disease. Years with a great increase in the rodent population are seen with intervals of about three to four years [11] and in the summer and autumn of 2010, a high density of lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after exposure. The use of small streams and private wells as a source of drinking water and for other purposes in rural areas of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes where the rodents can enter. It is also important to secure the well from contamination by surface water after snow melting. In case of proven or suspected contaminated wells, the water should be disinfected before further use. However, this may not be feasible for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert and Response. WHO guidelines on tularaemia. Geneva:WHO; 2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf 2. Brantsaeter AB. Twenty-five years of tularaemia in Norway, 19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and Infectious Diseases. 14th European Congress of Clinical Microbiology and Infectious Diseases. Prague; 1-4 May 2004. 3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe: an epidemiological overview. Scand J Infect Dis. 2004;36(5):350-5. 4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser W, et al. An outbreak of oropharyngeal tularaemia linked to natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6. 5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia (harepest) i Midtre Gauldal. [A waterborne outbreak of tularaemia in Midtre-Gauldal]. Norwegian Institute of Public Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0 6. Brantsaeter AB, Krogh T, Radtke A, Nygard K. Tularaemia outbreak in northern Norway. Euro Surveill. 2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165 7. Melien P, Holsdal RE. Tularemi i Meldal en vanskelig diagnose? [Tularaemia in Meldal- a difficult diagnosis?]. Norwegian Institute of Public Health. 18 Mar 2008. Norwegian. Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0 8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme immunoassay for antibodies to a 43,000-molecular-weight Francisella tularensis outer membrane protein in the diagnosis of tularemia. J Clin Microbiol. 1989;27(5):922-6. 9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of Francisella tularensis in ulcers of patients with tularaemia by PCR. J Clin Microbiol. 1997;35(5):1045-8. 10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E, Landt O, et al. Real-time PCR using hybridization probes for the rapid and specific identification of Francisella tularensis subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6. 11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian. 12. Norwegian Veterinary Institute. Flere tilfeller av harepest i Sr-Norge [Severeal cases of tularaemia in South-Norway]. Norwegian Veterinary Institute. 25 Nov 2010. Norwegian. Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge +","What are the symptoms? +","{'answer_start': [3005], 'text': ['fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy']}" +19,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia were diagnosed in three counties in central Norway: 21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two of typhoid type. Three cases were asymptomatic and clinical information was unavailable for one case. The mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells. An increased rodent (lemming) population and snow melting may have led to contamination of the wells with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases (16 female and 23 male) of tularaemia were reported from the counties of Sr-Trndelag (28 cases), Mre og Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person who had clinical symptoms compatible with tularaemia or had used drinking water from the same source as a previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described below. The cases were geographically scattered within each county, involving 13 different municipalities (Figure), and were not linked to one common source. In comparison, seven cases were reported in total from other parts of the country in the same period. In 2009 and 2010 four and eight cases respectively were reported from central Norway. Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are recognised: tularensis, holarctica, mediasiatica and novicida. In Europe, the infection is due to subspecies holarctica which causes in general less severe disease than subspecies tularensis, which is common in North America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and hares, but infection may also be transmitted via insect bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the most common clinical presentations in Norway [2]. Oropharyngeal disease is commonly associated with contaminated food and water, while ulceroglandular forms are more often seen when there has been skin contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries [3,4]. Tularaemia is a notifiable disease in Norway and during the past 10 years, three outbreaks were reported in Norway [5-7] and all were associated with water sources in areas where dead lemmings (Lemmus lemmus) had been observed previously. From 2001 to 2010, between three and 66 cases of tularaemia were reported annually in the whole country, with an increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy (glandular/ulceroglandular type, 10 cases). Among the remaining eight tularaemia cases, two were classified as respiratory and two as typhoid type, while three were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology (microagglutination and an in-house IgG/IgM Elisa) in 30 patients [8], by F. tularensis specific PCR analysis in seven patients [9] and by blood culture (BactAlert, BioMerieux) in two patients. The two bacterial isolates were verified as F. tularensis by PCR and sequencing of the 16S rDNA gene, and confirmed as non-subspecies tularensis by pdpA PCR [10]. 2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis DNA was detected by PCR in filtered water from five different wells tested in Sr-Trndelag. Seven cases in one municipality were linked to the same water source. Apart from that, only two cases have been confirmed to share a common well so far. Follow-up serology has been recommended for several of the persons exposed to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and cervical lymphadenopathy linked to the use of private wells in the winter season makes contaminated water the most likely source of infection in this outbreak. Detection of F. tularensis DNA by PCR analyses in some of the wells supports this assumption for some of the cases. Use of private wells is relatively common in rural areas of Norway although exact data on such use are not available. The precise mechanism of contamination of the wells with F. tularensis is as yet unknown. However, November and December 2010 were unusually cold months, while in January 2011 temperatures increased leading to melting of snow and possible contamination of private wells by surface water contaminated with bacteria from rodent cadavers or rodent excreta. Since the incubation period for tularaemia may be up to three weeks, and time from symptoms until seroconversion might be up to six weeks, more cases may follow. Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates rodents and hares as transmitters of disease. Years with a great increase in the rodent population are seen with intervals of about three to four years [11] and in the summer and autumn of 2010, a high density of lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after exposure. The use of small streams and private wells as a source of drinking water and for other purposes in rural areas of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes where the rodents can enter. It is also important to secure the well from contamination by surface water after snow melting. In case of proven or suspected contaminated wells, the water should be disinfected before further use. However, this may not be feasible for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert and Response. WHO guidelines on tularaemia. Geneva:WHO; 2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf 2. Brantsaeter AB. Twenty-five years of tularaemia in Norway, 19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and Infectious Diseases. 14th European Congress of Clinical Microbiology and Infectious Diseases. Prague; 1-4 May 2004. 3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe: an epidemiological overview. Scand J Infect Dis. 2004;36(5):350-5. 4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser W, et al. An outbreak of oropharyngeal tularaemia linked to natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6. 5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia (harepest) i Midtre Gauldal. [A waterborne outbreak of tularaemia in Midtre-Gauldal]. Norwegian Institute of Public Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0 6. Brantsaeter AB, Krogh T, Radtke A, Nygard K. Tularaemia outbreak in northern Norway. Euro Surveill. 2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165 7. Melien P, Holsdal RE. Tularemi i Meldal en vanskelig diagnose? [Tularaemia in Meldal- a difficult diagnosis?]. Norwegian Institute of Public Health. 18 Mar 2008. Norwegian. Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0 8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme immunoassay for antibodies to a 43,000-molecular-weight Francisella tularensis outer membrane protein in the diagnosis of tularemia. J Clin Microbiol. 1989;27(5):922-6. 9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of Francisella tularensis in ulcers of patients with tularaemia by PCR. J Clin Microbiol. 1997;35(5):1045-8. 10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E, Landt O, et al. Real-time PCR using hybridization probes for the rapid and specific identification of Francisella tularensis subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6. 11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian. 12. Norwegian Veterinary Institute. Flere tilfeller av harepest i Sr-Norge [Severeal cases of tularaemia in South-Norway]. Norwegian Veterinary Institute. 25 Nov 2010. Norwegian. Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge +","What are the first steps of mitigation? +","{'answer_start': [6310], 'text': ['boil drinking water and inspect the wells for dead rodents']}" +18,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia were diagnosed in three counties in central Norway: 21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two of typhoid type. Three cases were asymptomatic and clinical information was unavailable for one case. The mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells. An increased rodent (lemming) population and snow melting may have led to contamination of the wells with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases (16 female and 23 male) of tularaemia were reported from the counties of Sr-Trndelag (28 cases), Mre og Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person who had clinical symptoms compatible with tularaemia or had used drinking water from the same source as a previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described below. The cases were geographically scattered within each county, involving 13 different municipalities (Figure), and were not linked to one common source. In comparison, seven cases were reported in total from other parts of the country in the same period. In 2009 and 2010 four and eight cases respectively were reported from central Norway. Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are recognised: tularensis, holarctica, mediasiatica and novicida. In Europe, the infection is due to subspecies holarctica which causes in general less severe disease than subspecies tularensis, which is common in North America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and hares, but infection may also be transmitted via insect bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the most common clinical presentations in Norway [2]. Oropharyngeal disease is commonly associated with contaminated food and water, while ulceroglandular forms are more often seen when there has been skin contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries [3,4]. Tularaemia is a notifiable disease in Norway and during the past 10 years, three outbreaks were reported in Norway [5-7] and all were associated with water sources in areas where dead lemmings (Lemmus lemmus) had been observed previously. From 2001 to 2010, between three and 66 cases of tularaemia were reported annually in the whole country, with an increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy (glandular/ulceroglandular type, 10 cases). Among the remaining eight tularaemia cases, two were classified as respiratory and two as typhoid type, while three were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology (microagglutination and an in-house IgG/IgM Elisa) in 30 patients [8], by F. tularensis specific PCR analysis in seven patients [9] and by blood culture (BactAlert, BioMerieux) in two patients. The two bacterial isolates were verified as F. tularensis by PCR and sequencing of the 16S rDNA gene, and confirmed as non-subspecies tularensis by pdpA PCR [10]. 2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis DNA was detected by PCR in filtered water from five different wells tested in Sr-Trndelag. Seven cases in one municipality were linked to the same water source. Apart from that, only two cases have been confirmed to share a common well so far. Follow-up serology has been recommended for several of the persons exposed to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and cervical lymphadenopathy linked to the use of private wells in the winter season makes contaminated water the most likely source of infection in this outbreak. Detection of F. tularensis DNA by PCR analyses in some of the wells supports this assumption for some of the cases. Use of private wells is relatively common in rural areas of Norway although exact data on such use are not available. The precise mechanism of contamination of the wells with F. tularensis is as yet unknown. However, November and December 2010 were unusually cold months, while in January 2011 temperatures increased leading to melting of snow and possible contamination of private wells by surface water contaminated with bacteria from rodent cadavers or rodent excreta. Since the incubation period for tularaemia may be up to three weeks, and time from symptoms until seroconversion might be up to six weeks, more cases may follow. Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates rodents and hares as transmitters of disease. Years with a great increase in the rodent population are seen with intervals of about three to four years [11] and in the summer and autumn of 2010, a high density of lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after exposure. The use of small streams and private wells as a source of drinking water and for other purposes in rural areas of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes where the rodents can enter. It is also important to secure the well from contamination by surface water after snow melting. In case of proven or suspected contaminated wells, the water should be disinfected before further use. However, this may not be feasible for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert and Response. WHO guidelines on tularaemia. Geneva:WHO; 2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf 2. Brantsaeter AB. Twenty-five years of tularaemia in Norway, 19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and Infectious Diseases. 14th European Congress of Clinical Microbiology and Infectious Diseases. Prague; 1-4 May 2004. 3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe: an epidemiological overview. Scand J Infect Dis. 2004;36(5):350-5. 4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser W, et al. An outbreak of oropharyngeal tularaemia linked to natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6. 5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia (harepest) i Midtre Gauldal. [A waterborne outbreak of tularaemia in Midtre-Gauldal]. Norwegian Institute of Public Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0 6. Brantsaeter AB, Krogh T, Radtke A, Nygard K. Tularaemia outbreak in northern Norway. Euro Surveill. 2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165 7. Melien P, Holsdal RE. Tularemi i Meldal en vanskelig diagnose? [Tularaemia in Meldal- a difficult diagnosis?]. Norwegian Institute of Public Health. 18 Mar 2008. Norwegian. Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0 8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme immunoassay for antibodies to a 43,000-molecular-weight Francisella tularensis outer membrane protein in the diagnosis of tularemia. J Clin Microbiol. 1989;27(5):922-6. 9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of Francisella tularensis in ulcers of patients with tularaemia by PCR. J Clin Microbiol. 1997;35(5):1045-8. 10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E, Landt O, et al. Real-time PCR using hybridization probes for the rapid and specific identification of Francisella tularensis subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6. 11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian. 12. Norwegian Veterinary Institute. Flere tilfeller av harepest i Sr-Norge [Severeal cases of tularaemia in South-Norway]. Norwegian Veterinary Institute. 25 Nov 2010. Norwegian. Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge +","What measures were taken to prevent the event? +","{'answer_start': [6552], 'text': ['covering every opening and plugging every small holes where the rodents can enter']}" +33,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia were diagnosed in three counties in central Norway: 21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two of typhoid type. Three cases were asymptomatic and clinical information was unavailable for one case. The mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells. An increased rodent (lemming) population and snow melting may have led to contamination of the wells with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases (16 female and 23 male) of tularaemia were reported from the counties of Sr-Trndelag (28 cases), Mre og Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person who had clinical symptoms compatible with tularaemia or had used drinking water from the same source as a previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described below. The cases were geographically scattered within each county, involving 13 different municipalities (Figure), and were not linked to one common source. In comparison, seven cases were reported in total from other parts of the country in the same period. In 2009 and 2010 four and eight cases respectively were reported from central Norway. Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are recognised: tularensis, holarctica, mediasiatica and novicida. In Europe, the infection is due to subspecies holarctica which causes in general less severe disease than subspecies tularensis, which is common in North America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and hares, but infection may also be transmitted via insect bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the most common clinical presentations in Norway [2]. Oropharyngeal disease is commonly associated with contaminated food and water, while ulceroglandular forms are more often seen when there has been skin contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries [3,4]. Tularaemia is a notifiable disease in Norway and during the past 10 years, three outbreaks were reported in Norway [5-7] and all were associated with water sources in areas where dead lemmings (Lemmus lemmus) had been observed previously. From 2001 to 2010, between three and 66 cases of tularaemia were reported annually in the whole country, with an increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy (glandular/ulceroglandular type, 10 cases). Among the remaining eight tularaemia cases, two were classified as respiratory and two as typhoid type, while three were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology (microagglutination and an in-house IgG/IgM Elisa) in 30 patients [8], by F. tularensis specific PCR analysis in seven patients [9] and by blood culture (BactAlert, BioMerieux) in two patients. The two bacterial isolates were verified as F. tularensis by PCR and sequencing of the 16S rDNA gene, and confirmed as non-subspecies tularensis by pdpA PCR [10]. 2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis DNA was detected by PCR in filtered water from five different wells tested in Sr-Trndelag. Seven cases in one municipality were linked to the same water source. Apart from that, only two cases have been confirmed to share a common well so far. Follow-up serology has been recommended for several of the persons exposed to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and cervical lymphadenopathy linked to the use of private wells in the winter season makes contaminated water the most likely source of infection in this outbreak. Detection of F. tularensis DNA by PCR analyses in some of the wells supports this assumption for some of the cases. Use of private wells is relatively common in rural areas of Norway although exact data on such use are not available. The precise mechanism of contamination of the wells with F. tularensis is as yet unknown. However, November and December 2010 were unusually cold months, while in January 2011 temperatures increased leading to melting of snow and possible contamination of private wells by surface water contaminated with bacteria from rodent cadavers or rodent excreta. Since the incubation period for tularaemia may be up to three weeks, and time from symptoms until seroconversion might be up to six weeks, more cases may follow. Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates rodents and hares as transmitters of disease. Years with a great increase in the rodent population are seen with intervals of about three to four years [11] and in the summer and autumn of 2010, a high density of lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after exposure. The use of small streams and private wells as a source of drinking water and for other purposes in rural areas of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes where the rodents can enter. It is also important to secure the well from contamination by surface water after snow melting. In case of proven or suspected contaminated wells, the water should be disinfected before further use. However, this may not be feasible for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert and Response. WHO guidelines on tularaemia. Geneva:WHO; 2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf 2. Brantsaeter AB. Twenty-five years of tularaemia in Norway, 19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and Infectious Diseases. 14th European Congress of Clinical Microbiology and Infectious Diseases. Prague; 1-4 May 2004. 3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe: an epidemiological overview. Scand J Infect Dis. 2004;36(5):350-5. 4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser W, et al. An outbreak of oropharyngeal tularaemia linked to natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6. 5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia (harepest) i Midtre Gauldal. [A waterborne outbreak of tularaemia in Midtre-Gauldal]. Norwegian Institute of Public Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0 6. Brantsaeter AB, Krogh T, Radtke A, Nygard K. Tularaemia outbreak in northern Norway. Euro Surveill. 2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165 7. Melien P, Holsdal RE. Tularemi i Meldal en vanskelig diagnose? [Tularaemia in Meldal- a difficult diagnosis?]. Norwegian Institute of Public Health. 18 Mar 2008. Norwegian. Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0 8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme immunoassay for antibodies to a 43,000-molecular-weight Francisella tularensis outer membrane protein in the diagnosis of tularemia. J Clin Microbiol. 1989;27(5):922-6. 9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of Francisella tularensis in ulcers of patients with tularaemia by PCR. J Clin Microbiol. 1997;35(5):1045-8. 10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E, Landt O, et al. Real-time PCR using hybridization probes for the rapid and specific identification of Francisella tularensis subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6. 11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian. 12. Norwegian Veterinary Institute. Flere tilfeller av harepest i Sr-Norge [Severeal cases of tularaemia in South-Norway]. Norwegian Veterinary Institute. 25 Nov 2010. Norwegian. Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge +","What was the age of the affected people? +","{'answer_start': [317], 'text': ['mean age was 40.3 years (range 2-89 years)']}" +6,Contamination Question Answering,"From January to March 2011, 39 cases of tularaemia were diagnosed in three counties in central Norway: 21 cases of oropharyngeal type, 10 cases of glandular/ulceroglandular type, two of respiratory and two of typhoid type. Three cases were asymptomatic and clinical information was unavailable for one case. The mean age was 40.3 years (range 2-89 years). Thirty- four reported use of drinking water from private wells. An increased rodent (lemming) population and snow melting may have led to contamination of the wells with infected rodents or rodent excreta. From 1 January to 25 March 2011, 39 confirmed cases (16 female and 23 male) of tularaemia were reported from the counties of Sr-Trndelag (28 cases), Mre og Romsdal (5 cases) and Nord-Trndelag (6 cases) in cen- tral Norway. A confirmed case was defined as a person who had clinical symptoms compatible with tularaemia or had used drinking water from the same source as a previous case, and in whom Francisella tularensis infection was confirmed by a laboratory test as described below. The cases were geographically scattered within each county, involving 13 different municipalities (Figure), and were not linked to one common source. In comparison, seven cases were reported in total from other parts of the country in the same period. In 2009 and 2010 four and eight cases respectively were reported from central Norway. Tularaemia is a zoonotic disease caused by the bac- terium F. tularensis. Four F. tularensis subspecies are recognised: tularensis, holarctica, mediasiatica and novicida. In Europe, the infection is due to subspecies holarctica which causes in general less severe disease than subspecies tularensis, which is common in North America. Several vectors may be involved in transmit- ting the disease to humans, commonly rodents and hares, but infection may also be transmitted via insect bites [1]. Several clinical forms are recognised, with oropha- ryngeal and ulceroglandular disease being the most common clinical presentations in Norway [2]. Oropharyngeal disease is commonly associated with contaminated food and water, while ulceroglandular forms are more often seen when there has been skin contact with infected animals or after insect bites [3]. Outbreaks of oropharyngeal tularaemia have previ- ously been reported from several European countries [3,4]. Tularaemia is a notifiable disease in Norway and during the past 10 years, three outbreaks were reported in Norway [5-7] and all were associated with water sources in areas where dead lemmings (Lemmus lemmus) had been observed previously. From 2001 to 2010, between three and 66 cases of tularaemia were reported annually in the whole country, with an increase from 16 to 32 cases on average (data avail- able from: www.msis.no). This increase may in part be explained by the outbreaks mentioned above. Diagnosis and clinical presentation In the outbreak described here, the most common clini- cal presentation was fever and pharyngitis (oropharyn- geal type, 21 cases) and cervical lymphadenopathy (glandular/ulceroglandular type, 10 cases). Among the remaining eight tularaemia cases, two were classified as respiratory and two as typhoid type, while three were asymptomatic and clinical information was una- vailable for one case. The diagnosis was primarily established by serology (microagglutination and an in-house IgG/IgM Elisa) in 30 patients [8], by F. tularensis specific PCR analysis in seven patients [9] and by blood culture (BactAlert, BioMerieux) in two patients. The two bacterial isolates were verified as F. tularensis by PCR and sequencing of the 16S rDNA gene, and confirmed as non-subspecies tularensis by pdpA PCR [10]. 2 www.eurosurveillance.org Thirty-four of the 39 diagnosed cases had been drinking water from a private well or a stream. F. tularensis DNA was detected by PCR in filtered water from five different wells tested in Sr-Trndelag. Seven cases in one municipality were linked to the same water source. Apart from that, only two cases have been confirmed to share a common well so far. Follow-up serology has been recommended for several of the persons exposed to some of the putative water sources. Discussion The current outbreak involves a large number of munic- ipalities in three counties in central Norway. The clinical presentation with oropharyngeal tularaemia and cervical lymphadenopathy linked to the use of private wells in the winter season makes contaminated water the most likely source of infection in this outbreak. Detection of F. tularensis DNA by PCR analyses in some of the wells supports this assumption for some of the cases. Use of private wells is relatively common in rural areas of Norway although exact data on such use are not available. The precise mechanism of contamination of the wells with F. tularensis is as yet unknown. However, November and December 2010 were unusually cold months, while in January 2011 temperatures increased leading to melting of snow and possible contamination of private wells by surface water contaminated with bacteria from rodent cadavers or rodent excreta. Since the incubation period for tularaemia may be up to three weeks, and time from symptoms until seroconversion might be up to six weeks, more cases may follow. Tularaemia has traditionally been called both lem- ming fever and hare plague and this clearly indicates rodents and hares as transmitters of disease. Years with a great increase in the rodent population are seen with intervals of about three to four years [11] and in the summer and autumn of 2010, a high density of lemmings could be observed in the southern and cen- tral parts of Norway. Simultaneously, the Norwegian Veterinary Institute observed a wide geographical dis- tribution of fatal cases of tularaemia in the mountain hare (Lepus timidus) in these regions [12]. The moun- tain hare is very susceptible to this infection and nor- mally dies from septicaemia within a few days after exposure. The use of small streams and private wells as a source of drinking water and for other purposes in rural areas of Norway is a matter of concern. In existing guidelines issued by the National Institute of Public Health the population is advised to boil drinking water and inspect the wells for dead rodents in case of suspected or confirmed cases of waterborne tularaemia. Every well owner should make the necessary effort to prevent small rodents from entering the well water by carefully covering every opening and plugging every small holes where the rodents can enter. It is also important to secure the well from contamination by surface water after snow melting. In case of proven or suspected contaminated wells, the water should be disinfected before further use. However, this may not be feasible for persons who use drinking water from a stream. The Norwegian Food Safety Authority has recently released information to the media and to the general public with similar advice and information in relation to the current outbreak. The local health authority in each municipality is responsible for instituting infection control measures including advice to the public and investigations of the putative drinking water sources. References 1. World Health Organization (WHO) Epidemic and Pandemic Alert and Response. WHO guidelines on tularaemia. Geneva:WHO; 2007. Available from: http://www.who.int/csr/resources/ publications/WHO_CDS_EPR_2007_7.pdf 2. Brantsaeter AB. Twenty-five years of tularaemia in Norway, 19782002. Abstract number: 10.1111/j.1198-743X.2004.902_ o142.x. European Society of Clinical Microbiology and Infectious Diseases. 14th European Congress of Clinical Microbiology and Infectious Diseases. Prague; 1-4 May 2004. 3. Trnvik A, Priebe HS, Grunow R. Tularaemia in Europe: an epidemiological overview. Scand J Infect Dis. 2004;36(5):350-5. 4. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstsser W, et al. An outbreak of oropharyngeal tularaemia linked to natural spring water. J Med Microbiol. 2009;58(Pt 1):112-6. 5. Rike HF, Vigerust A, Bergh K. Vannbrent utbrudd av tularemia (harepest) i Midtre Gauldal. [A waterborne outbreak of tularaemia in Midtre-Gauldal]. Norwegian Institute of Public Health. 27 Oct 2003. Norwegian. Available from: http://www. fhi.no/eway/default.aspx?pid=233&trg=MainLeft_5669&MainL eft_5669=5544:27208::0:5667:1:::0:0 6. Brantsaeter AB, Krogh T, Radtke A, Nygard K. Tularaemia outbreak in northern Norway. Euro Surveill. 2007;12(13):pii=3165. Available from: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=3165 7. Melien P, Holsdal RE. Tularemi i Meldal en vanskelig diagnose? [Tularaemia in Meldal- a difficult diagnosis?]. Norwegian Institute of Public Health. 18 Mar 2008. Norwegian. Available from: http://www.fhi.no/eway/default.aspx?pid =233&trg=Area_5626&MainArea_5661=5619:0:15,4427:1: 0:0:::0:0&MainLeft_5619=5626:68396::1:5625:1:::0:0&Ar ea_5626=5544:68400::1:5628:1:::0:0 8. Bevanger L, Maeland JA, Naess AI. Competitive enzyme immunoassay for antibodies to a 43,000-molecular-weight Francisella tularensis outer membrane protein in the diagnosis of tularemia. J Clin Microbiol. 1989;27(5):922-6. 9. Sjstedt A, Erikson U, Berglund L, Trnvik A. Detection of Francisella tularensis in ulcers of patients with tularaemia by PCR. J Clin Microbiol. 1997;35(5):1045-8. 10. Tomaso H, Scholz HC, Neubauer H, Al Dahouk S, Seibold E, Landt O, et al. Real-time PCR using hybridization probes for the rapid and specific identification of Francisella tularensis subspecies tularensis. Mol Cell Probes. 2007;21(1):12-6. 11. Semb-Johaansson A, Ims RA. Smgnagerne [Rodents]. Semb- Johansson A, Frislid R, editors. Oslo;1990. 121-71. Norwegian. 12. Norwegian Veterinary Institute. Flere tilfeller av harepest i Sr-Norge [Severeal cases of tularaemia in South-Norway]. Norwegian Veterinary Institute. 25 Nov 2010. Norwegian. Available from: http://www.vetinst.no/index.php/nor/Nyheter/ Flere-tilfeller-av-harepest-i-Soer-Norge +",What is the source of contamination?,"{'answer_start': [4508], 'text': ['contaminated water']}" +19,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +The source of the outbreak was a drinking water supply contaminated by human sewage. +The water supply for the ski resort was contaminated with human sewage. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified. +A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006. +Symptoms included nausea, vomiting, or diarrhea. +The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness. +Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected. +Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis. +Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans. +",What symptoms were developed?,"{'answer_start': [1066], 'text': ['diarrhea or vomiting']}" +26,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +The source of the outbreak was a drinking water supply contaminated by human sewage. +The water supply for the ski resort was contaminated with human sewage. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified. +A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006. +Symptoms included nausea, vomiting, or diarrhea. +The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness. +Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected. +Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis. +Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans. +","What type of samples were analyzed? +","{'answer_start': [2483], 'text': ['Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases']}" +10,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +The source of the outbreak was a drinking water supply contaminated by human sewage. +The water supply for the ski resort was contaminated with human sewage. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified. +A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006. +Symptoms included nausea, vomiting, or diarrhea. +The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness. +Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected. +Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis. +Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans. +","What is the date of the event? +","{'answer_start': [3], 'text': ['July 2006']}" +26,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +The source of the outbreak was a drinking water supply contaminated by human sewage. +The water supply for the ski resort was contaminated with human sewage. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified. +A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006. +Symptoms included nausea, vomiting, or diarrhea. +The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness. +Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected. +Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis. +Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans. +","What is the location of the event? +","{'answer_start': [139], 'text': ['southern New Zealand']}" +18,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +The source of the outbreak was a drinking water supply contaminated by human sewage. +The water supply for the ski resort was contaminated with human sewage. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified. +A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006. +Symptoms included nausea, vomiting, or diarrhea. +The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness. +Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected. +Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis. +Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans. +","What is the source that started the event? +","{'answer_start': [411], 'text': ['water supply for the ski resort was contaminated with human sewage.']}" +17,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +The source of the outbreak was a drinking water supply contaminated by human sewage. +The water supply for the ski resort was contaminated with human sewage. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified. +A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006. +Symptoms included nausea, vomiting, or diarrhea. +The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness. +Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected. +Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis. +Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans. +","How was the event first detected? +","{'answer_start': [496], 'text': ['public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort.']}" +13,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +The source of the outbreak was a drinking water supply contaminated by human sewage. +The water supply for the ski resort was contaminated with human sewage. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified. +A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006. +Symptoms included nausea, vomiting, or diarrhea. +The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness. +Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected. +Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis. +Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans. +","How many people were ill? +","{'answer_start': [642], 'text': ['218 cases ']}" +13,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +The source of the outbreak was a drinking water supply contaminated by human sewage. +The water supply for the ski resort was contaminated with human sewage. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified. +A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006. +Symptoms included nausea, vomiting, or diarrhea. +The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness. +Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected. +Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis. +Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans. +","What are the pathogens? +","{'answer_start': [855], 'text': [' norovirus (NoV)']}" +30,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +The source of the outbreak was a drinking water supply contaminated by human sewage. +The water supply for the ski resort was contaminated with human sewage. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified. +A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006. +Symptoms included nausea, vomiting, or diarrhea. +The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness. +Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected. +Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis. +Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans. +","What is the concentration of the contaminant after analysis? +","{'answer_start': [1231], 'text': ['E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml)']}" +32,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +The source of the outbreak was a drinking water supply contaminated by human sewage. +The water supply for the ski resort was contaminated with human sewage. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified. +A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006. +Symptoms included nausea, vomiting, or diarrhea. +The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness. +Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected. +Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis. +Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans. +","What are the symptoms? +","{'answer_start': [1131], 'text': ['nausea, vomiting, or diarrhea']}" +13,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +The source of the outbreak was a drinking water supply contaminated by human sewage. +The water supply for the ski resort was contaminated with human sewage. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified. +A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006. +Symptoms included nausea, vomiting, or diarrhea. +The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness. +Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected. +Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis. +Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans. +","What is the event? +","{'answer_start': [1546], 'text': ['an outbreak of acute gastroenteritis']}" +33,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +The source of the outbreak was a drinking water supply contaminated by human sewage. +The water supply for the ski resort was contaminated with human sewage. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified. +A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006. +Symptoms included nausea, vomiting, or diarrhea. +The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness. +Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected. +Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis. +Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans. +","What are the initial steps of investigation? +","{'answer_start': [1852], 'text': ['a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7)']}" +28,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +The source of the outbreak was a drinking water supply contaminated by human sewage. +The water supply for the ski resort was contaminated with human sewage. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified. +A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006. +Symptoms included nausea, vomiting, or diarrhea. +The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness. +Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected. +Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis. +Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans. +","What are the first steps of mitigation? +","{'answer_start': [2292], 'text': ['work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities.']}" +20,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +The source of the outbreak was a drinking water supply contaminated by human sewage. +The water supply for the ski resort was contaminated with human sewage. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified. +A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006. +Symptoms included nausea, vomiting, or diarrhea. +The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness. +Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected. +Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis. +Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans. +","What type of samples were examined? +","{'answer_start': [2670], 'text': ['fecal samples ']}" +19,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +The source of the outbreak was a drinking water supply contaminated by human sewage. +The water supply for the ski resort was contaminated with human sewage. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified. +A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006. +Symptoms included nausea, vomiting, or diarrhea. +The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness. +Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected. +Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis. +Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans. +",What was the outbreak investigation?,"{'answer_start': [1999], 'text': ['Information was sought from the ski resort management about the design and management of the water supply and the sewerage system.']}" +11,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +The source of the outbreak was a drinking water supply contaminated by human sewage. +The water supply for the ski resort was contaminated with human sewage. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified. +A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006. +Symptoms included nausea, vomiting, or diarrhea. +The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness. +Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected. +Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis. +Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans. +","What measures were taken to prevent the event? +","{'answer_start': [2833], 'text': ['reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans.']}" +21,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +The source of the outbreak was a drinking water supply contaminated by human sewage. +The water supply for the ski resort was contaminated with human sewage. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified. +A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006. +Symptoms included nausea, vomiting, or diarrhea. +The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness. +Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected. +Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis. +Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans. +",What is the source of contamination?,"{'answer_start': [353], 'text': ['a drinking water supply contaminated by human sewage']}" +9,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +The source of the outbreak was a drinking water supply contaminated by human sewage. +The water supply for the ski resort was contaminated with human sewage. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified. +A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006. +Symptoms included nausea, vomiting, or diarrhea. +The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness. +Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected. +Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis. +Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans. +",What were the associated pathogens of concern?,"{'answer_start': [894], 'text': [' rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases)']}" +15,Contamination Question Answering,"In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +The source of the outbreak was a drinking water supply contaminated by human sewage. +The water supply for the ski resort was contaminated with human sewage. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A total of 218 cases were identified (115 ski resort staff and 103 visitors) in this outbreak. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +In addition, cases of rotavirus (one case), cryptosporidium (four cases), and campylobacter (two cases) were also identified. +A case was dened as a resort staff member or visitor who developed diarrhea or vomiting on or after 21 July 2006. +Symptoms included nausea, vomiting, or diarrhea. +The water samples taken on 27 July 2006 showed significant levels of E. coli (range, 7.4 to 220 per 100 ml) and total coliforms (range, 72 to 1,100 per 100 ml) from the four points along the water supply, including the lake, storage tanks, and the main building, which housed the restaurants, and child care and health care services. +In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. +On 27 July 2006, public health authorities were informed about a possible outbreak of gastroenteritis among staff and visitors at a popular ski resort. +A retrospective cohort investigation using a standardized questionnaire and analysis based on Epi Info v 3.3.2 (7) was conducted among ski resort staff to investigate the source of illness. +Information was sought from the ski resort management about the design and management of the water supply and the sewerage system. The restaurant, child care, and health care facilities were also inspected. +Comprehensive control measures were implemented starting 27 July 2006; these included work restrictions for sick staff, hand hygiene signage for staff and visitors, emergency chlorination of the water supply, and comprehensive environmental cleaning of the resorts facilities. +Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). +Following notification of the outbreak, fecal samples were collected from 31 staff, visitors, and apartment dwellers with recent symptoms of acute gastroenteritis. +Government agencies in New Zealand are reviewing their approach to water supply management with a particular focus on improved training for supply managers and the development of risk management plans. +",What was the outbreak?,"{'answer_start': [1731], 'text': ['outbreak of gastroenteritis']}" +18,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +","What was the age of the affected population? +","{'answer_start': [5376], 'text': ['elderly persons']}" +6,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +",What did the local authorities investigate?,"{'answer_start': [3655], 'text': ['use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements.']}" +30,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +",What were the first steps of investigation?,"{'answer_start': [3426], 'text': ['model the distribution system']}" +16,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +",How many people were deceased?,"{'answer_start': [1196], 'text': ['four deaths']}" +15,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +",How many deaths?,"{'answer_start': [815], 'text': ['4 deaths']}" +27,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +","What is the initial cause of the event? +","{'answer_start': [200], 'text': ['43 water meter replacements and 2 line breaks']}" +8,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +","What is the location of the event? +","{'answer_start': [48], 'text': ['Ozark hills']}" +12,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +",What pathogen was connected to the outbreak?,"{'answer_start': [2422], 'text': ['E. coli 0157:H7']}" +34,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +","What is the source that started the event? +","{'answer_start': [452], 'text': ['groundwater supply']}" +21,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +","How was the event first detected? +","{'answer_start': [631], 'text': ['residents and visitors to the community of Cabool']}" +28,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +","How many people were ill? +","{'answer_start': [860], 'text': ['243 documented cases']}" +25,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +","How many people were hospitalized? +","{'answer_start': [825], 'text': ['32 hospitalizations']}" +7,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +","How many people died? +","{'answer_start': [739], 'text': ['four deaths']}" +25,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +","What are the pathogens? +","{'answer_start': [2153], 'text': [' Escherichia Coli serotype 0157:H7']}" +12,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +","What are the symptoms? +","{'answer_start': [2710], 'text': ['bloody diarrhea']}" +5,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +","What is the event? +","{'answer_start': [2746], 'text': ['outbreak of gastrointestinal illness']}" +29,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +","What are the initial steps of investigation? +","{'answer_start': [3240], 'text': ['review data, conduct a sanitary survey and collect additional water samples']}" +16,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +","What is the duration of the event? +","{'answer_start': [4219], 'text': ['4 weeks after the main impact of the outbreak had subsided']}" +32,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +","From when until when the event happened +","{'answer_start': [3980], 'text': ['15 December 1989-20 January 1990']}" +30,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +","What are the first steps of mitigation? +","{'answer_start': [4521], 'text': ['household survey']}" +13,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +","What did they do to mitigate the event? +","{'answer_start': [4908], 'text': ['chlorination program ']}" +29,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +","What type of samples were examined? +","{'answer_start': [4976], 'text': ['Special water samples of 200 ml volume ']}" +21,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +",What was the outbreak investigation?,"{'answer_start': [3510], 'text': ['inspection of the drinking water supply system and operating practice']}" +18,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +","For which pathogens did they test for in the samples? +","{'answer_start': [5260], 'text': ['total coliform bacteria ']}" +24,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +",How many people were affected?,"{'answer_start': [1157], 'text': ['243 cases']}" +8,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +",What did the authorities do to mitigate the event?,"{'answer_start': [4760], 'text': ['boil water order']}" +20,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +",What is the source of contamination?,"{'answer_start': [344], 'text': ['public water supply.']}" +25,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +",How many cases were there?,"{'answer_start': [700], 'text': ['243 cases']}" +33,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +",What were the associated pathogens of concern?,"{'answer_start': [2278], 'text': ['Escherichia Coli serotype 0157:H7']}" +19,Contamination Question Answering,"Cabool, Mo. (population 2090) is located in the Ozark hills, near the border with Arkansas. +Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. +Illness was restricted to people using public water supply. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +The pathogenic agent, Escherichia Coli serotype 0157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control +Escherichia Coli serotype 0157:H7 was found in the feces of some infected individuals. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +This was the second reported waterborne occurrence of E. Coli 0157:H7. +This time in a community with an outbreak of 243 cases of bloody diarrhea and 4 deaths. +An outbreak of gastrointestinal illness attributed to E. coli 0157:H7 occurred in a groundwater supply that had been historically characterized as being of excellent quality and not in need of disinfection. +At the invitation of the CDC (U.S. Public Health Service), the Missouri State Health Department and the Missouri Department of Natural Resources, staff members of the U.S. Environmental Protection Agency (EPA), Drinking Water Research Division (Cincinnati, Ohio) went to Cabool to review data, conduct a sanitary survey and collect additional water samples to be sent to the EPA Research Center in Cincinnati for further study. +In addition, attempts were made to model the distribution system for movement of water through the system. +A general inspection of the drinking water supply system and operating practice was also conducted. +This investigation provided the first opportunity to use a distribution system model to study the pattern of illness occurrences in relation to normal water movement patterns in the distribution system, develop descriptions in water flow caused by line breaks and map the diffusion of a pathogenic agent through either line breaks or meter replacements. +During the period 15 December 1989-20 January 1990, residents and visitors to the community of Cabool, Mo., experienced 243 cases of diarrhea (85 bloody) and four deaths (Swerdlow et al., 1992). +Since this investigation of the water system was conducted 4 weeks after the main impact of the outbreak had subsided, the strategy for investigating the possible involvement of water supply focused on the study of long term monitoring data from the groundwater supply (aquifer and distribution quality). +The Centers for Disease Control (CDC) conducted a household survey from which they concluded that persons living inside the city (on the municipal water) were 18.2 times more likely to develop bloody diarrhea than for persons living outside the city using private well water. +After a boil water order was issued (5 January 1990) in the city of Cabool, the number of new cases rapidly declined. +The city authorities implemented a chlorination program for the community water supply on 12 January. +Special water samples of 200 ml volume were collected on 14 and 15 February 1990 from the distribution network in addition to sample collections at the two operating wells (well Nos 5 and 6) for analyses at the EPA Research Center, Cincinnati. +These water samples were analyzed for total coliform bacteria by the membrane filter method using m-Endo LES agar and m-T7 agar. +In the Cabool outbreak, elderly persons were more likely to become ill and the four deaths were among elderly citizens. +",How many people were dead?,"{'answer_start': [1313], 'text': ['4 deaths']}" +7,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +",What symptoms did the people had?,"{'answer_start': [3154], 'text': ['diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%).']}" +20,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +",What symptoms were developed?,"{'answer_start': [2764], 'text': ['diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea']}" +18,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +",What caused the event?,"{'answer_start': [1000], 'text': ['heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network.']}" +17,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +",With what symptoms they were presented?,"{'answer_start': [2628], 'text': ['diarrhoea or vomiting']}" +5,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +",When was the outbreak first reported?,"{'answer_start': [139], 'text': ['6 June 2019']}" +20,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +",What caused the outbreak?,"{'answer_start': [775], 'text': ['contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period.']}" +14,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +",What symptoms did people report?,"{'answer_start': [2994], 'text': [' diarrhoea, stomach pain and fever']}" +23,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +",What did the local authorities investigate?,"{'answer_start': [3625], 'text': ['collected data on in-person and telephone consultations']}" +7,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +",What were the first steps of investigation?,"{'answer_start': [3493], 'text': ['Whole genome sequencing on human and environmental isolates was performed.']}" +22,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +","What is the initial cause of the event? +","{'answer_start': [487], 'text': ['Contamination through cracks in the reservoir most probably occurred during heavy rainfall']}" +13,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +","What is the date of the event? +","{'answer_start': [3], 'text': ['6 June 2019']}" +32,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +","What is the location of the event? +","{'answer_start': [115], 'text': ['Asky']}" +23,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +","What is the source that started the event? +","{'answer_start': [1666], 'text': ['drinking water']}" +18,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +","How was the event first detected? +","{'answer_start': [1754], 'text': ['Medical Officer in Asky reported an outbreak of gastroenteritis']}" +14,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +","How many people were ill? +","{'answer_start': [1917], 'text': ['50 cases']}" +7,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +","How many people were hospitalized? +","{'answer_start': [1972], 'text': ['10 people']}" +8,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +","What is the attack rate? +","{'answer_start': [2180], 'text': ['20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas.']}" +14,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +","What are the symptoms? +","{'answer_start': [2339], 'text': ['fever, abdominal pain and diarrhoea']}" +24,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +","What are the initial steps of investigation? +","{'answer_start': [3394], 'text': ['pilot interviews, a telephone survey and an SMS-based cohort study of residents']}" +24,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +","What is the duration of the event? +","{'answer_start': [4277], 'text': [' between 1 and 19 June 2019']}" +9,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +","What type of samples were examined? +","{'answer_start': [4350], 'text': ['Campylobacter isolates']}" +5,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +",What was the outbreak investigation?,"{'answer_start': [4036], 'text': ['standardized 19-page trawling questionnaire']}" +7,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +","For which pathogens did they test for in the samples? +","{'answer_start': [4602], 'text': ['faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens']}" +13,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +","What was the age of the affected people? +","{'answer_start': [4923], 'text': ['34 years']}" +16,Contamination Question Answering,"On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butcher- ing, preparation and consumption of poultry [4-6]. +Contamination through cracks in the reservoir most probably occurred during heavy rainfall. +While we were unable to conclusively determine how the reservoir became contaminated, the diversity of data sources used to investigate this outbreak support the hypothesis that environmental contamination through cracks in Reservoir X most likely occurred during heavy rain- fall following a long dry period. +Campylobacter has frequently been identified as the cause of waterborne outbreaks, often associated with heavy rainfall and intrusion of contaminated surface water either into source water or into the distribution network. +A reservoir in a water supply sys- tem was suspected as the source of the outbreak because of the acute onset and geographical distri- bution of cases. +In Norway, outbreaks of campylobacteriosis have been associated with consumption of untreated or contaminated drinking water, unpasteurised milk, mutton, contact with farm animals and with butchering, preparation and consumption of poultry [4-6]. +Staff of the OPHS noted that many patients presenting with gastroenteritis had home addresses near each other, which led to a suspicion that drinking water could be the source of the outbreak. +On the evening of 6 June 2019, the Medical Officer in Asky reported an outbreak of gastroenteritis to the NIPH. +On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Asky. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +The overall attack rate was 20% for the childcare centres in affected areas and 2% for the childcare centres in unaffected areas. +In a 24 h period, 10 people had been hospitalized with fever, abdominal pain and diarrhoea, and ca 30 individuals had sought medical attention from out- of-hours primary healthcare services (OPHS). +For the childcare centre survey, a case was defined as any person absent from the childcare centre (child or employee) because of the symptoms diarrhoea or vomiting between 28 May and 7 June. +We defined a case as a person with gastroenteritis (defined as having symptoms of (i) diarrhoea only or (ii) vomiting and at least one of the following: abdominal distention, fever, stomach pain or nausea, with duration of illness of more than 24 h), with symptom onset between 1 and 19 June 2019. +They reported diarrhoea, stomach pain and fever with onset on 4 June (n = 1) or 5 June (n = 4). +A total of 1,829 persons reported at least one of the fol- lowing symptoms: diarrhoea (n = 1,626; 89%), abdominal pain (n = 1,347; 74%), headache (n = 959; 52%), nausea (n = 935; 51%), fever (n = 868, 48%), abdominal distention (n = 639; 35%), vomiting (n = 286; 16%) and bloody stool (n = 113; 6%). +We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. +Whole genome sequencing on human and environmental isolates was performed. +In order to determine the extent of the outbreak, we collected data on in-person and telephone consultations with the International Classification of Primary Care (ICPC-2) codes for diarrhoea (D11), gastrointestinal infection (D70) and gastroenteritis (D73) that occurred at the OPHS and general practitioners (GP) offices in Asky between 3 June and 15 June. +Several of the initial cases with confirmed Campylobacter infections were interviewed using a standardized 19-page trawling questionnaire in order to exclude possible exposures other than drinking water. +A case was defined as a person in a household served by Water Supply System A (WSS- A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. +The primary diagnostic laboratory sent Campylobacter isolates from patients to the National Reference Laboratory for Enteropathogenic Bacteria (NRL) for confirmation and genotyping. +According to the routine sampling and analysis plan for WSS-A, water samples are collected and tested for faecal indicator bacteria: weekly for Escherichia coli and coliform bacteria and for heterotrophic plate count, and monthly for intestinal enterococci and Clostridium perfringens, according to standard methods described in the national drinking water legislation [21]. +Mean age of the included household members was 34 years (range: 0 to 93 years) and 50% were female. +",What is the source of contamination?,"{'answer_start': [1121], 'text': ['reservoir in a water supply sys- tem']}"