Food Poisoning Lawyer & Attorney : Marler Clark : Food Poison Blog

Natalie Angier, wrote about noroviruses in yesterday's New York Times.  Her family had a run-in with a norovirus after New Year's Eve, and she did some research into norovuiruses.  Part of what she found is this:

Its sour suite of symptoms is often referred to as “stomach flu,” but norovirus infection is distinct from the flu, which is caused by the influenza virus and targets not the gut but the lungs.

Well, not that distinct. Noroviruses, flu viruses, the rhino and corona viruses that cause the common cold, the herpes virus that causes the cold sore, all are active players in the wheezing ambient pleurisy of January.

According to About-Norwalk.com, a website about norovirus, the Centers for Disease Control and Prevention (CDC) estimates that noroviruses cause 23 million cases of acute gastroenteritis annually, making noroviruses the leading cause of gastroenteritis in the United States.  Of viruses, only the common cold is reported more often than viral gastroenteritis (norovirus).  Transmission occurs either person-to-person or through contamination of food or water. Foodborne norovirus transmission can occur when food is contaminated by an infected food handler; noroviruses are recognized as causing over half of all foodborne illness outbreaks.

In comparison to bacterial sources of foodborne illness such as E. coli, Salmonella, and Campylobacter, norovirus causes a relatively short illness.  Angier addresses this fact in her article with a quote from Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases:

“Our bodies spontaneously recover from viruses more so than overwhelming bacterial infections,” said [Fauci. “Viral infections have shaped the nature of the human immune system, and we have adapted to mount a very effective response against most of the viruses that we confront.” Vaccines accentuate this facility, he added, which is why vaccination programs have been most successful in preventing viral diseases.

The Centers for Disease Control and Prevention makes the following recommendations regarding preventing the spread of norovirus:

• Frequently wash your hands, especially after toilet visits and changing diapers and before eating or preparing food.

• Carefully wash fruits and vegetables, and steam oysters before eating them.
  
• Thoroughly clean and disinfect contaminated surfaces immediately after an episode of illness by using a bleach-based household cleaner.
  
• Immediately remove and wash clothing or linens that may be contaminated with virus after an episode of illness (use hot water and soap).
  
• Flush or discard any vomitus and/or stool in the toilet and make sure that the surrounding area is kept clean.

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The CDC's Morbidity and Mortality Weekly Report (MMWR) includes a report titled, "Norovirus Outbreak Associated with Ill Food-Service Workers --- Michigan, January--February 2006" this week.  In it, we learn that:

• On January 30, 2006, the Barry-Eaton District Health Department (BEDHD) in Michigan was notified of gastrointestinal illness in several members of two dining parties after a meal at an Eaton County restaurant on January 28.
  
• BEDHD began an investigation to identify the source and agent of infection
• Norovirus genogroup I (GI) was detected in stool specimens submitted by multiple patrons and employees.
  
• Several food-service workers had been ill during January 19--February 3, 2006, and that a line cook had vomited in the restaurant on January 28, possibly increasing environmental contamination and transmission of virus.
  
• At least 364 restaurant patrons became ill with norovirus during the outbreak. 
  

Norovirus is easily spread in restaurant settings.  This week's food safety infosheet from the International Food Safety Network (iFSN) focuses on norovirus, the symptoms of norovirus illness, and its source - poop.

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The LA Daily News reported that at least two LA-area restaurants have been identified as the source of norovirus outbreaks recently.  The Buca di Beppo restaurant located in the Valencia Town Center and the Marie Callender's restaurant located near Magic Mountain - both in Los Angeles County - were the source of food poisoning outbreaks that caused symptoms of vomiting, diarrhea, nausea, fever, and dehydration.  According to the Daily News, one employee who worked at both restaurants could have been the source of disease transmission. 

Ironically, this week's MMWR, published by the Centers for Disease Control and Prevention, contains a report on norovirus outbreaks at Michigan restaurants in early 2006.  An editorial note in the MMWR contains the following:

Norovirus can be transmitted person-to-person (via the fecal-oral route) and spread through contaminated airborne droplets, food, water, environmental surfaces, and fomites (3). In the outbreak described in this report, at least 364 restaurant patrons became ill with gastroenteritis after dining at a restaurant where employees had reported to work while ill. In a norovirus outbreak, a vomiting incident is a major risk factor for norovirus illness and can double the attack rate (4). In this outbreak, vomiting by a line cook at the work station might have contributed to transmission. Because of the open physical layout of the restaurant, no barrier impeded airborne spread of the virus from the kitchen to the main dining area. Attack rates increased after this incident, and among employees who worked on January 28, a higher percentage of line cooks became ill compared with servers. In addition, other environmental contamination probably contributed to transmission. Low-level transmission was occurring in the week before January 28; seven patrons who dined at the restaurant during January 21--27 met the case definition. During January 21--February 3, exposure to virus likely occurred by contact with contaminated surfaces and objects.

Norovirus, as seen here, is particularly easy to spread and is frequently spread through modes of transmission other than food.

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At least 1,000 people were exposed to what is believed to be Norovirus at a Santa Cruz, California, hotel.  Santa Cruz County Public Health (SCCPH) has identified at least 80 people who were sickened as part of the outbreak.  SCCPH chief of public health Bob Kennedy commented on the outbreak that, "We strongly suspect it's the Norovirus, but we hope to have lab results back by Monday."

KTVU.com reported:

About 1,000 people may have been exposed at a Santa Cruz area hotel, which Kennedy declined to name, between Nov. 9 and Thursday. Public health is attempting to contact each person who may have been exposed, including hotel staff and guests.

Hotel workers are being monitored for symptoms and if they display signs of illness will be sent home until they are symptom free for 24 hours. The health department is also reviewing food-handling practices with workers and has supervised a thorough cleansing of the kitchen, bathrooms and dining areas.

Anyone who suspects they are suffering from the illness should contact their physician.

The Contra-Costa Times revealed the name of the hotel associated with the outbreak in an article published yesterday:

County health officials gave the restaurant [at Sanderlings resort] the OK to reopen around 8:45 p.m. Friday with the following conditions:

Facility and equipment cleaning and disinfection supervised and approved by Public Heath Department staff was completed.

Sanderlings' 71 staff members had been interviewed by the county.

The employees received food handling education.

Sanderlings management will screen employees returning to work for illness and they will not be allowed to work if they feel sick at all. The management will also keep a log on this screening, which the Public Health Department can inspect on an unannounced basis.

Usual symptoms of Norovirus infection include nausea, vomiting, diarrhea, and abdominal pain. Headache and low-grade fever may also accompany this disease. The disease is usually mild and brief. It will develop 24 to 48 hours after contaminated food or water is ingested and lasts for 24 to 60 hours. People infected with Norwalk Virus usually recover in 2 to 3 days without serious or long-term health effects.

A 1999 study suggests that Norovirus may cause more outbreaks of food-borne illness than all bacteria and parasites. It is estimated that nearly 65% of nonbacterial gastroenteritis in the United States is attributable to Noroviruses. Approximately 181,000 cases occur annually, with no known associated deaths.

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