Is your drinking-water safe? A rotavirus outbreak linked to water refilling stations in the Philippines, 2016


  • Nino Dacanay Rebato FETP Philippines; Department of Health, Philippines
  • Vikki Carr de los Reyes Department of Health, Philippines
  • Ma. Nemia Sucaldito Department of Health, Philippines
  • Gretchen Marin Department of Health, Philippines



Introduction: In April 2016, the Department of Health in Zamboanga Peninsula reported an increase in the number of acute gastroenteritis cases reported from Zamboanga City. An epidemiologic investigation was conducted to verify the existence of an outbreak, determine source/mode of transmission and recommend control measures.

Methods: A line list of cases was compiled from the 11 hospitals within Zamboanga City and a case-series study was conducted. Suspected cases were any persons from Zamboanga City who had three or more episodes of acute diarrhoea within 24 hours from 15 March to 29 May 2016. Confirmed cases were suspected cases with active symptoms during the investigation who had a stool sample collected with rotavirus detected. Water samples were also collected for viral detection.

Results: There were 2936 suspected cases with 22 deaths (case fatality rate: 0.75%), an age range of 8 days to 89 years (median: 2 years), with those aged less than 5 years the most affected age group (1903/2936, 65%). The majority were males (1549/2936, 53%). From the 138 active case patients included in the case-series study, the majority reported contact with a family member who had diarrhoea (89/138, 64%) and using water refilling stations as their major source of drinking-water (88/134, 64%). Of the 93 stool specimens collected, 56 (60%) were positive for rotavirus. Five samples from water refilling stations where case patients reported collecting drinking-water were all positive for rotavirus.

Discussion: Strict regulation of water refilling stations and boiling drinking-water in households were implemented, immediately controlling the outbreak. After complying with all the requirements set by the Department of Health, a water safety certificate was awarded to Zamboanga City in September 2018.

Author Biography

Nino Dacanay Rebato, FETP Philippines; Department of Health, Philippines



Population and annual growth rates for the Philippines and its regions, provinces and highly urbanized cities, Manila: National Statistics Office, 2012 (, accessed 15 Jun 2016).

Population of the Philippines. Manila: National Statistics Office, 2010 (, accessed 15 Jun 2016).

Payne DC, Wikswo M, Parashar UD. Chapter 13: Rotavirus. VPD Surveillance Manual. 2013; 5th Edition: (Chapter 13-1,, accessed 28 Apr 2016].

Gouvea V, Glass RI, Woods P, Taniquchi K, Clark HF, Forrester B, Polymerase chain reaction amplification and typing of rotavirus nucleic acid from stool specimens. J Clin Microbiol . 1990;28:276–82.( accessed 21 Feb 2017).

Manual of rotavirus detection and characterization methods, Geneva: World Health Organization, 2009 WHO/IVB/08.17. (, accessed 21 Feb 2017).

Estimated rotavirus deaths for children under 5 years of age: 2013, 215 000, Geneva: World Health Organization, 2016 (, 15 Jun 2016)

Carlos CC, Inobaya MT, Bresee JS, Lagrada ML, Olorosa AM, Kirkwood CD, The Burden of Hospitalizations and Clinic Visits for Rotavirus Disease in Children Aged <5 Years in the Philippines. Journal of Infectious Diseases. 2009;200:S174-81. (, accessed 15 Jun 2016).

Field Health Services Information System (FHSIS 2013), Manila; Department of Health, 2016 (http:///, accessed 15 Jun 2016).

Rotavirus. Atlanta; Centers for Disease Control and Prevention. 2016 (, accessed 21 Feb 2017).

Rutjes SA, Lodder WJ, Van Leeuwen AD, de Roda Husman AM. Detection of infectious rotavirus in naturally contaminated source waters for drinking water production. J Appl Microbiol. 2009 Jul;107(1):97-105. doi: 10.1111/j.1365-2672.2009.04184.x. Epub 2009 Mar 3. ( 21 Feb 2017).

Sobsey MD, Kellogg JS, De Leon Ricardo, Carol Shieh YS. Enteric Virus Detection in Water by Nucleic Acid Methods. American Water Works Association Research Foundation. 1996; (, accessed 21 Feb 2017).

Verheyen Jens, Timmen-Wego Monika, Laudien Rainer, Boussaad I, Sen S, Koc A. Detection of Adenoviruses and Rotaviruses in Drinking Water Sources Used In Rural Areas of Benin, West Africa. 2009; doi:10.1128/AEM.01807-08 ( ,accessed 21 Feb 2017)

Hopkins RS, Gaspard GB, Williams FP Jr, Karlin RJ, Cukor G, Blacklow NR

A community waterborne gastroenteritis outbreak: evidence for rotavirus as the agent. Am J Public Health. 1984 Mar; 74(3):263-5 (accessed 21 Feb 2017).

Ansari SA, Springthorpe VS, Sattar SA. Survival and vehicular spread of human rotaviruses: possible relation to seasonality of outbreaks. Rev Infect Dis. 1991 May-Jun; 13(3):448-61. ( ,accessed 21 Feb 2017).

Gratacap-Cavallier B, Genoulaz O, Brengel-Pesce K, Soule H, Innocenti-Francillard P, Bost, M. Detection of Human and Animal Rotavirus Sequences in Drinking Water. Appl Environ Microbiol. 2000 Jun; 66(6): 2690–2692. [, accessed 15 Jun 2016).



How to Cite

Rebato ND, de los Reyes VC, Sucaldito MN, Marin G. Is your drinking-water safe? A rotavirus outbreak linked to water refilling stations in the Philippines, 2016. Western Pac Surveill Response J [Internet]. 2019 Feb. 20 [cited 2023 Sep. 22];10(1). Available from:



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