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Marler Blog Providing Commentary on Food Poisoning Outbreaks & Litigation

We Don’t Cover Norovirus Enough

I don’t talk about norovirus much on the pages of my blog despite the fact that norovirus is estimated to cause 23 million cases of acute gastroenteritis (commonly called the "stomach flu") in the U.S. each year, and are the leading cause of gastroenteritis. Of viruses, only the common cold is reported more often than viral gastroenteritis (norovirus).  Norovirus may cause more outbreaks of foodborne illness than all bacteria and parasites. They can cause extended outbreaks because of their high infectivity, persistence in the environment, resistance to common disinfectants, and difficulty in controlling their transmission through routine sanitary measures.  I was therefore glad to see the Orlando Sentinel’s report on "83 guests suffer norovirus outbreak at Palm Beach resort."

Florida Health officials identified the highly contagious norovirus as the cause of an outbreak that sickened at least 83 people at the Hilton Singer Island Resort. Health officials were called in after three people were hospitalized. Test results confirm that the outbreak was norovirus, a highly contagious virus that causes diarrhea, vomiting, nausea, cramps and other symptoms, officials said.

"It spreads easily and quickly," said Tim O’Connor, spokesman for the Palm Beach County Health Department. "We’ve asked (the hotel) to completely disinfect everything." The hotel shut down its kitchen Saturday, threw out food and cleaned, so health officials are unable to determine whether the virus outbreak began in the restaurant. "We didn’t know what we were looking at," said hotel manager Stan Turner. "If it is food-borne, you know that it’s this plate, this salad. But if it’s norovirus, it comes from everywhere, so that’s unnerving. "The hotel restaurant reopened after staff cleaned the entire property, Turner said. "It has been a floor-by-floor, room-by-room, surface-by-surface process," he said. "We are not resting. We are still cleaning." The hotel restaurant was cited for more than a dozen violations during a December state inspection, but the report noted there was no "immediate threat to the public."

We have taken on several hundred cases of norovirus-caused illnesses over the years.  However, showing how the virus is transmitted is hard.  Was it foodborne?  Was it an ill worker?  Ill patron?

The Missoulian newspaper also reported on the spread of norovirus in the Montana local schools:

It hits fast and hard, and can spread like the latest Britney Spears story. Its symptoms aren’t something you want to read about over breakfast.

Health officials Friday stressed the following ways to prevent norovirus infection:

1. Stay at home and away from others if you are ill, and for at least two days after you start feeling better. Food workers should stay home 72 hours.

2. Wash hands thoroughly with soap and water. “Sing happy birthday,” one expert said. “That’s about how long you should scrub.” Alcohol-based sanitizers are not effective against norovirus.

3. Clean all possibly contaminated surfaces with a chlorine bleach solution. Use 1/3 cup of bleach in 1 gallon of water for non-porous surfaces (toilets, sinks, countertops). Use 1 2/3 cups of bleach in 1 gallon of water for wooden floors and other surfaces that could absorb vomit splatters.

And, it even ruins weddings – Iowa Couple Sues Restaurant After Rehearsal Dinner Sickens Wedding Party – A central Iowa couple is suing the restaurant where they held their rehearsal dinner the night before their November 2006 wedding. A Polk County Health Department investigation concluded the man who prepared the salad served at dinner that night had stomach flu. The official cause was determined to be norovirus. A total of 71 people became sick. Restaurant owner Paul Trostel said his insurance company has settled with many of the customers who fell ill.

"I feel very terrible about this situation that happened once in 20 years," he said. "It could have happened to any restaurant, but unfortunately it happened at the Greenbriar."

  • Bill,
    As always excellent post. Norovirus is often mistaken as food poisoning … Even though it may not come directly from tainted food. I was at a wedding in Los Cabos, where half the wedding party got it. The unfortunate part is that the Mexican doctors thought it was food poisoning or Montezumas revenge … It was not until we got back to the us that we all realized it was the dreaded norovirus. Not sure if you’ve had it, but it is horrible! I’d like to see some more posts on the similarities between the virus and other foodborne illnesses and the difference in diagnosing and treating.

  • Hi Bill:
    Norovirus because of its ease in transmission is unique amongst the foodborne agents. In no other type of illness related to food is there such a wide pathway of infection. The two aspects that give NoV this trait are its very low infectious dose, as few as 10 particles and its ability to survive in the environment for long periods of time, up to 30 days. These attributes, along with resistance to common sanitizers makes stopping the spread of NoV a challenge.
    The key to NoV control is surveillance. In facilities prone to outbreaks, especially, any instance of vomiting or acute gastroenteritis should be identified and investigated. If incidence starts to climb above previously established baseline incidence further steps need to be taken such as more intensive case finding, notification of at risk populations, and monitoring of hand washing. Environmental mitigation of vomitus and fecal mater becomes critical and special techniques are needed to assure that clean up and disinfection are working.
    In a food service environment surveillance of the employees is critical. There is often a breakdown in communication in reporting in the foodservice industry and demands for labor can override the exclusion and restriction of cases. Ill employees are not the only problem, in foodservice there is evidence that asymptomatic workers cause outbreaks as well. So NoV outbreaks must be prevented by very careful and thorough hand washing and use of barriers between hands and foods.
    The challenges faced by the hospitality industry are many in NoV control. The cultural of the hospitality industry is not conducive to strict control over health and safety, and surveillance is foreign. Without these basic controls and an understanding of decontamination, outbreaks will unfortunately happen. In addition, when they do, immediate and scientific response is needed to limit cases.

  • Kathi Coston

    I was one of those who got sick at the Singer Island Hilton. Are guests intitled to any monetary compensation when vacations have been ruined by Norovirus?

  • Sue malcolm

    Are there any defining symptoms that can separate NoV from food poisoning? Also, once you’ve been sick with NoV, is it possible to get sick with it again within a month? Either through new exposure or something latent? I was very sick exactly one month ago and it was determined to be NoV, and was just violently ill again, this time the symptoms were more intense and the vomiting was more frequent. I’m not usually sick, but I work in the airline industry where I would imagine would be a breeding ground for this type of virus.

  • Wow! The numbers are pretty scary and it still puzzles me why nobody hasn’t found out yet what exactly causes norovirus. And I’m absolutely astonished about its spreading speed. It’s not just a health problem as I clearly understand from your article, it also ruins businesses. I will definitely be more suspicious next time I eat in a public place.