Gastroenteritis in Norwegian primary care - Time trends and a large waterborne outbreak

Gastroenteritis is a common term for acute infection of the gastrointestinal tract and includes several conditions and specific infections. Gastroenteritis has to a great extent caused disease and death in humans through our history. Even the very foundation of epidemiology can be traced back to John Snow's work on identifying drinking water as source of the cholera epidemic in London in 1854. Gastroenteritis still occurs frequently in the community, but most people in our part of the world experience self-limiting symptoms and therefore only a small proportion seek the health care services. Of those seeking medical attention, only a few submit stool samples for microbiological diagnostics, and only those who are diagnosed with a notifiable microbe are included in the statistics of the notification systems of infectious diseases. The clinical features of gastroenteritis vary from asymptomatic cases to fatal disease, but diarrhea is common in cases who develop symptoms. The clinical features in the individual gastroenteritis patient can give a hint as to whether there is a viral or bacterial cause. Correspondingly, using existing knowledge about seasonal variation and the epidemiology of the specific infections may give an indication of probable microbiological cause in gastroenteritis patients at group level. This is useful knowledge because laboratory verified diagnoses are rare. Our study of consultations for gastroenteritis in Norwegian primary care during a 10-year period shows a contact pattern similar to what characterizes viral gastroenteritis: Most consultations took place in the winter and children and young adults dominated among the patients. The findings contribute to increased knowledge of the normal situation regarding gastroenteritis patients’ use of health care services. Since antibiotics became widely available in the years following World War II, antibiotic treatment has been central to the treatment of many infectious diseases. Gastroenteritis has been an exception, both because most are viral ...