According to the CDC, most norovirus outbreaks from contaminated food occur in food service settings, according to a report by the Centers for Disease Control and Prevention. Infected food workers are frequently the source of these outbreaks, often by touching ready-to-eat foods served in restaurants with their bare hands. The food service industry can help prevent norovirus outbreaks by enforcing food safety practices, such as making sure workers always practice good hand hygiene on the job and stay home when they are sick.

Norovirus often gets a lot of attention for outbreaks on cruise ships, but those account for only about 1 percent of all reported norovirus outbreaks. Norovirus is highly contagious and can spread anywhere people gather or food is served, making people sick with vomiting and diarrhea. About 20 million people get sick from norovirus each year; most get infected by having close contact with other infected people or by eating contaminated food.

The Vital Signs report provides key recommendations to help the food service industry prevent norovirus outbreaks from contaminated food. The recommendations, which underscore provisions in the Food and Drug Administration model Food Code (http://www.fda.gov/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/default.htm) and CDC guidelines (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6003a1.htm), include:

• Making sure food service workers practice proper hand washing and use utensils and single-use disposable gloves to avoid touching ready-to-eat foods with bare hands,
• Certifying kitchen managers and training food service workers in food safety practices, and
• Establishing policies that require food service workers to stay home when sick with vomiting and diarrhea and for at least 48 hours after symptoms stop.

CDC analyzed norovirus outbreak data reported by state, local, and territorial health departments from 2009 to 2012 through CDC’s National Outbreak Reporting System (NORS). Over the four years, health departments reported 1,008 norovirus outbreaks from contaminated food, most of which occurred in food service settings such as restaurants and catering or banquet facilities.

Factors contributing to food contamination were reported in 520 of the outbreaks, with an infected food worker implicated in 364 (70 percent) of them. Of these outbreaks, 196 (54 percent) involved food workers touching ready-to-eat foods with their bare hands. Ready-to-eat foods are foods that are ready to be served without additional preparation, such as washed raw fruits and vegetables for salads or sandwiches, baked goods, or items that have already been cooked.