Risk factors for winter outbreak of acute diarrhoea in France

BMJ 1998;317:145 ( 11 July )

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Risk factors for winter outbreak of acute diarrhoea in France

Winter outbreaks of diarrhoea occur in United Kingdom too

Authors did not rule out shellfish as a factor

Authors' reply

Winter outbreaks of diarrhoea occur in United Kingdom too

The first 150 words of the full text of this article appear below.

EDITOR $---$ Letrilliart et al conclude that the winter epidemic of diarrhoea in France in 1995-6 was not associated with consumptionof tap water or shellfish, that person to person spread was implicated,and that the epidemic was of viral aetiology.¹ Despite considerable reservations about the validity of their evidence we agree thatthe epidemic may have been largely attributable to viral diarrhoea.

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Winter outbreaks of viral diarrhoea associated with shellfish have been described in the United Kingdom,² but the Frenchstudy's failure to show an association may have been because ofthe methods used. Infection with small round structured virus,the most frequently identified cause of foodborne viral gastroenteritis,induces short term immunity,³ which could produce perverseeffects in a study of this design $---$ for example, people who eatoysters frequently might be differentially immune owing to higherexposure to risk inducing an apparent protective effect for frequentconsumption. Separate . . . [Full text of this article]

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