A large foodborne outbreak of norovirus in diners at a restaurant in England between January and February 2009

Abstract

SUMMARYAn outbreak of gastroenteritis affected at least 240 persons who had eaten at a gourmet restaurant over a period of 7 weeks in 2009 in England. Epidemiological, microbiological, and environmental studies were conducted. The case-control study demonstrated increased risk of illness in those who ate from a special ‘tasting menu’ and in particular an oyster, passion fruit jelly and lavender dish (odds ratio 7·0, 95% confidence interval 1·1–45·2). Ten diners and six staff members had laboratory-confirmed norovirus infection. Diners were infected with multiple norovirus strains belonging to genogroups I and II, a pattern characteristic of molluscan shellfish-associated outbreaks. The ongoing risk from dining at the restaurant may have been due to persistent contamination of the oyster supply alone or in combination with further spread via infected food handlers or the restaurant environment. Delayed notification of the outbreak to public health authorities may have contributed to outbreak size and duration.

Environmental Transmission of Human Noroviruses in Shellfish Waters

“…The literature contains abundant case and outbreak reports of NoV infection associated with the consumption of bivalve shellfish (20,21,22,23,24). Such outbreaks continue to occur on a regular basis worldwide (23,24,25) with potentially very significant associated economic costs.…”

“…Such outbreaks continue to occur on a regular basis worldwide (23,24,25) with potentially very significant associated economic costs. Batz et al estimated that the annual cost of illness attributed to seafood contamination with NoV in the United States would be $184 million (26).…”

Mapping Broadly Reactive Norovirus Genogroup I and II Monoclonal Antibodies

“…In the United States, NoVs cause 19 to 21 million cases each year (4,5). NoV outbreaks have been identified in children (6), the elderly (7), military personnel (8,9), immunocompromised individuals (10), restaurant patrons (11,12), travelers to developing countries (13,14), passengers of cruise ships (15), residents of health care facilities such as nursing homes (16,17) and hospitals (18), and other populations housed in close quarters (19). The increasing incidence of NoV infections emphasizes the need to quickly detect and identify the causative agent, because early diagnosis of NoV infection can be crucial in the effective control of outbreaks and can decrease the secondary attack rate (20).…”

Inactivation Kinetics and Mechanism of a Human Norovirus Surrogate on Stainless Steel Coupons via Chlorine Dioxide Gas

“…Environmental and food contact surfaces are one of the most common routes for human NoV transmission (4,7,(28)(29)(30)(31)(32). FDAand EPA-approved sanitizers, however, are not effective for the inactivation and removal of human NoV from contact surfaces.…”

“…Human NoV transmission occurs primarily through the fecal-oral route, either via person-to-person contact or contaminated food, water, fomites, and environmental surfaces (4,5), and airborne transmission of viral particles may also be possible due to aerosolized vomitus or fecal material (6). Human NoV is highly contagious, with an infectious dose as low as 10 particles, and outbreaks often occur in confined settings, including restaurants, coach buses, hotels, nursing homes, hospitals, and cruise ships (7)(8)(9)(10)(11). Although human NoV causes significant health and emotional burdens, research on human NoV has been hampered due to the lack of an in vitro cell culture method and a small animal model (12).…”