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American Journal of Epidemiology Vol. 126, No. 3: 516-525
Copyright © 1987 by The Johns Hopkins University School of Hygiene and Public Health

research-article

SNOW MOUNTAIN AGENT GASTROENTERITIS FROM CLAMS

BENEDICT I. TRUMAN1,, H. PAUL MADORE2, MARILYN A. MENEGUS3, JOEL L. NITZKIN4 and RAPHAEL DOLIN2

1Division of Field Services, Epidemiology Program Office, Centers for Disease Control Atlanta, GA, and Bureau of Communicable Disease Control, New York State Department of Health Albany, NY.
2Infectious Disease Unit, Department of Medicine, University of Rochester School of Medicine and Dentistry/Strong Memorial Hospital Medical Center Rochester, NY.
3Department of Microbiology, University of Rochester School of Medicine and Dentistry Rochester, NY.
4Monroe County Department of Health Rochester, NY.

Reprint requests to Dr. Benedict I. Truman, Bureau of Communicable Disease Control, New York State Department of Health, Corning Tower, Room 668, Empire State Plaza, Albany, NY 12237.

Truman, B. I. (New York State Dept. of Health, Albany, NY 12237), H. P. Madore, M. A. Menegus, J. L. Nitzkin, and R. Dolin. Snow Mountain agent gastroenteritis from clams. Am J Epidemiol 1987;126:516–25.

A 1983 investigation of two clambake-related gastroenteritis outbreaks in Rochester, New York, showed that 84 (43%) of 196 persons interviewed had an acute illness characterized by watery diarrhea, vomiting, and abdominal cramps. None of the ill persons were hospitalized or had complications. Illness was associated with eating raw (p = 0.002) or baked (p < 0.01) hard-shell clams, with the risk of illness increasing with the total number of clams consumed (p < 0.01). The median incubation period and duration of illness were 36 and 44 hours, respectively. Stool samples obtained 2–4 days after onset of illness were negative for commonly recognized bacterial and viral pathogens. However, of 31 persons whose stools were tested, the stool of only one ill person was positive by enzyme-linked immunosorbent assay for the Snow Mountain agent, one of the Norwalk-like viruses. Paired serum specimens from six (67%) of nine ill and two (29%) of seven well persons showed a fourfold or greater rise in antibody titer to Snow Mountain agent. Persons who ate clams were more likely to seroconvert to Snow Mountain agent (eight of 12) than were those who did not eat clams (zero of four) (p = 0.04). The clams were harvested off the coast of southern Massachusetts in late October, when harvest waters were documented to be contaminated by untreated municipal sewage. This report describes the first documented outbreak of shellfish-associated gastroententis attributed to Snow Mountain agent of which we are aware.

clams; gastroenteritis; Norwalk agent; viral diseases


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