{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T02:40:23Z","timestamp":1755225623306,"version":"3.43.0"},"reference-count":19,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Mil Health"],"accepted":{"date-parts":[[2019,6,18]]},"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Norovirus outbreaks frequently occur in communities and institutional settings acquiring a particular significance in armed forces where prompt reporting is critical. Here we describe the epidemiological, clinical and laboratorial investigation of a multicentre gastroenteritis outbreak that was detected simultaneously in three Portuguese army units with a common food supplier, Lisbon region, between 5 and 6 December 2017.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Questionnaires were distributed to all soldiers stationed in the three affected army units, and stool specimens were collected from soldiers with acute gastrointestinal illness. Stool specimens were tested for common enteropathogenic bacteria by standard methods and screened for a panel of enteric viruses using a multiplex real-time PCR assay. Food samples were also collected for microbiological analysis. Positive stool specimens for norovirus were further genotyped.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The three simultaneous acute gastroenteritis outbreaks affected a 31 (3.5%) soldiers from a total of 874 stationed at the three units and lasted for 2 days. No secondary cases were reported. Stool specimens (N=11) were negative for all studied enteropathogenic agents but tested positive for norovirus. The recombinant norovirus GII.P16-GII.4 Sydney was identified in all positive samples with 100% identity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The results are suggestive of a common source of infection plausibly related to the food supplying chain. Although centralisation of food supplying in the army has economic advantages, it may contribute to the multifocal occurrence of outbreaks. A rapid intervention is key in the mitigation of outbreak consequences and in reducing secondary transmission.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jramc-2019-001242","type":"journal-article","created":{"date-parts":[[2019,7,5]],"date-time":"2019-07-05T07:49:00Z","timestamp":1562312940000},"page":"40-43","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Simultaneous norovirus outbreak in three Portuguese army bases in the Lisbon region, December 2017"],"prefix":"10.1136","volume":"167","author":[{"given":"Ant\u00f3nio","family":"Lopes-Jo\u00e3o","sequence":"first","affiliation":[{"name":"Laborat\u00f3rio de Bromatologia e Defesa Biol\u00f3gica do Ex\u00e9rcito (LBDB), Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8769-8103","authenticated-orcid":false,"given":"J R","family":"Mesquita","sequence":"additional","affiliation":[{"name":"Departamento de Cl\u00ednicas Veterin\u00e1rias, Instituto de Ci\u00eancias Biom\u00e9dicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal"},{"name":"Epidemiology Research Unit (EPIUnit), Instituto de Sa\u00fade P\u00fablica da Universidade do Porto, Porto, Portugal"}]},{"given":"R","family":"de Sousa","sequence":"additional","affiliation":[{"name":"Departamento de Doen\u00e7as Infecciosas Lisboa, Portugal, Laborat\u00f3rio Nacional de Refer\u00eancia para as Infe\u00e7\u00f5es Gastrointestinais, Instituto Nacional de Sa\u00fade Dr. Ricardo Jorge, Lisboa, Portugal"}]},{"given":"M","family":"Oleastro","sequence":"additional","affiliation":[{"name":"Departamento de Doen\u00e7as Infecciosas Lisboa, Portugal, Laborat\u00f3rio Nacional de Refer\u00eancia para as Infe\u00e7\u00f5es Gastrointestinais, Instituto Nacional de Sa\u00fade Dr. Ricardo Jorge, Lisboa, Portugal"}]},{"given":"C","family":"Penha-Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Bromatologia e Defesa Biol\u00f3gica do Ex\u00e9rcito (LBDB), Lisboa, Portugal"}]},{"given":"M S J","family":"Nascimento","sequence":"additional","affiliation":[{"name":"Epidemiology Research Unit (EPIUnit), Instituto de Sa\u00fade P\u00fablica da Universidade do Porto, Porto, Portugal"},{"name":"Departamento de Ci\u00eancias Biol\u00f3gicas, Laborat\u00f3rio de Microbiologia, Faculdade de Farm\u00e1cia da Universidade do Porto (FFUP), Porto, Portugal"}]}],"member":"239","published-online":{"date-parts":[[2019,7,4]]},"reference":[{"key":"2025081308152442000_167.1.40.1","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-156-04-10"},{"key":"2025081308152442000_167.1.40.2","first-page":"20","article-title":"Incidence of gastrointestinal infections among U.S. active component service members stationed in the U.S. compared to U.S. civilians, 2012-2014","volume":"24","author":"Hill","year":"2017","journal-title":"MSMR"},{"key":"2025081308152442000_167.1.40.3","first-page":"8","article-title":"Surveillance for norovirus and enteric bacterial pathogens as etiologies of acute gastroenteritis at U.S. military recruit training centers, 2011-2016","volume":"25","author":"Brooks","year":"2018","journal-title":"MSMR"},{"key":"2025081308152442000_167.1.40.4","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0035791"},{"key":"2025081308152442000_167.1.40.5","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.jcv.2015.05.008","article-title":"Multiple enteropathogenic viruses in a gastroenteritis outbreak in a military exercise of the Portuguese Army","volume":"68","author":"Lopes-Jo\u00e3o","year":"2015","journal-title":"J Clin Virol"},{"key":"2025081308152442000_167.1.40.6","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1002\/jmv.24704","article-title":"Acute gastroenteritis outbreak associated to norovirus GI.9 in a Portuguese army base","volume":"89","author":"Lopes-Jo\u00e3o","year":"2017","journal-title":"J Med Virol"},{"key":"2025081308152442000_167.1.40.7","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-2018-000991"},{"key":"2025081308152442000_167.1.40.8","doi-asserted-by":"publisher","DOI":"10.3201\/eid0602.009918"},{"key":"2025081308152442000_167.1.40.9","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.3201\/eid1110.050298","article-title":"Gastroenteritis outbreak in British troops, Iraq","volume":"11","author":"Bailey","year":"2005","journal-title":"Emerg Infect Dis"},{"key":"2025081308152442000_167.1.40.10","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-004-4002-3"},{"key":"2025081308152442000_167.1.40.11","doi-asserted-by":"crossref","unstructured":"Wadl M , Scherer K , Nielsen S , et al . 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