{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T22:44:35Z","timestamp":1777934675800,"version":"3.51.4"},"reference-count":27,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2024,4,13]],"date-time":"2024-04-13T00:00:00Z","timestamp":1712966400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>From April 1 to May 31, 2022, Grand Canyon National Park received increased acute gastroenteritis reports. Pooled portable toilet specimens identified norovirus genogroups I and II. We sought to determine outbreak transmission contributors and individual risk factors while rafting or backpacking in the park.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Grand Canyon rafters and backpackers were surveyed online from June 13\u2013July 8, 2022, and a Cox proportional hazards model was used to identify predictors associated with illness and adjusted for potential confounding factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 762 surveys, 119 cases and 505 well persons submitted complete survey data. Illness among rafters was associated with interaction with ill persons during the trip (adjusted hazard ratio [adjHR]\u2009=\u20093.4 [95%CI 2.3\u20135.0]) and lack of any hand hygiene (1.2 [0.7\u20131.9]) or use of only sanitizer or water (1.6 [1.04\u20132.6]) before snacks. Younger rafters had higher illness rates compared to those \u226560 y (1.5 [1.2\u20131.8] for ages 40\u201359 and 2.2 [1.4\u20133.5] for ages &lt;40 y).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Person-to-person transmission likely accounted for the widespread outbreak. Future outbreak mitigation efforts on river trips could focus on symptom screening before the trip starts, prompt separation of ill and well passengers, strict adherence to hand hygiene with soap and water, minimizing social interactions among rafting groups, and widespread outbreak notices and education to all park users.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10806032241245093","type":"journal-article","created":{"date-parts":[[2024,4,13]],"date-time":"2024-04-13T05:08:20Z","timestamp":1712984900000},"page":"173-182","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Acute Gastroenteritis Outbreak Among Colorado River Rafters and Backpackers in the Grand Canyon, 2022"],"prefix":"10.1177","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7382-6119","authenticated-orcid":false,"given":"Shanna","family":"Miko","sequence":"first","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, GA, USA"},{"name":"Epidemic Intelligence Service, Atlanta, GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Calderwood","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, GA, USA"},{"name":"Cherokee Nation Assurance, Atlanta, GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ariella P.","family":"Dale","sequence":"additional","affiliation":[{"name":"Epidemic Intelligence Service, Atlanta, GA, USA"},{"name":"Arizona Department of Health Services, Phoenix, AZ, USA"},{"name":"Maricopa County Department of Public Health, Maricopa, AZ, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronan F.","family":"King","sequence":"additional","affiliation":[{"name":"National Park Service \u2013 Office of Public Health, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew B.","family":"Maurer","sequence":"additional","affiliation":[{"name":"Coconino County Health and Human Services, Coconino County, Flagstaff, AZ, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria A.","family":"Said","sequence":"additional","affiliation":[{"name":"National Park Service \u2013 Office of Public Health, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marette","family":"Gebhardt","sequence":"additional","affiliation":[{"name":"Coconino County Health and Human Services, Coconino County, Flagstaff, AZ, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurie P.","family":"Dyer","sequence":"additional","affiliation":[{"name":"National Park Service, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy","family":"Maurer","sequence":"additional","affiliation":[{"name":"Coconino County Health and Human Services, Coconino County, Flagstaff, AZ, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary E.","family":"Wikswo","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara A.","family":"Mirza","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,4,13]]},"reference":[{"key":"bibr1-10806032241245093","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00075-14"},{"key":"bibr2-10806032241245093","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa438"},{"key":"bibr3-10806032241245093","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss6412a1"},{"key":"bibr4-10806032241245093","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7138a3"},{"key":"bibr5-10806032241245093","doi-asserted-by":"publisher","DOI":"10.1111\/1469-0691.12674"},{"key":"bibr6-10806032241245093","unstructured":"National Park Service. 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