On May 17, 2014 the Hawaii Department of Health (HDOH) learned of an outbreak of gastrointestinal illnesses among Royal Hawaiian Hotel guests and restaurant patrons. People who had attended a wedding dinner reception held on May 15 at the Azure Restaurant, a guest food establishment at the hotel, had reported symptoms to the hotel general manager. The HDOH initiated an outbreak investigation.
A total of 114 individuals reported symptoms of diarrhea and vomiting in a 24 hour period. Ill persons identified a wide variety of food exposures; individual parties consumed different food items that were prepared and served on different days. Thus, no one food item or employee was identified as the source of the infections. The only common factor was that ill persons had consumed food that had been prepared by the kitchen at the Royal Hawaiian. Illness onset dates ranged from May 14 to May 26, 2014. Ten stool specimens were submitted to the HDOH State Laboratories Division (SLD). Of these, 6 were positive for norovirus, genotype GI.3B. One additional specimen was reported as norovirus positive by a private clinical laboratory.
There are a total of three guest food establishments at the Royal Hawaiian. All three share one common kitchen/prep area and staff. Employee meals are prepared by the same common kitchen and served at an employee cafeteria. Seventeen employees reported having a gastrointestinal illness during the outbreak period. One ill employee reported an episode of diarrhea in the employee restroom at work on May 14 prior to dinner service. A second employee reportedly vomited into a kitchen area trash can on May 15. The last employee illness was on May 20.
The hotel conducted environmental sanitation beginning on May 16. The HDOH Sanitation Branch inspected the hotel kitchen on May 19 and observed violations of sanitizing procedures and cold holding temperatures. A follow-up inspection on May 21 verified correction of these violations. Due to additional reports of illness on May 24, the Sanitation Branch conducted a re-inspection of the kitchen on May 25 and directly supervised the discarding of prepared food items, sanitation of food preparation areas, and thorough facility cleaning from May 25 through May 28. The Azure Restaurant was closed during this period.
The HDOH concluded there was a confirmed norovirus outbreak associated with consuming foods prepared by the Royal Hawaiian Hotel. Seven cases of confirmed norovirus and 107 probable cases meeting the clinical definition of norovirus were identified. Citing the shared onset date (May 14) for guests and employees, the HDOH did not determine how the virus was introduced in the hotel. However, the HDOH did note that illness among food handling personnel and coincident environmental contamination were likely contributing factors which served to propagate the infection among hotel guests and employees.