Hotel Marshfield: Not a John Irving novel but familiar storyline with dozens sick from noro

On 4/19/2016, the Wood County Health Department (WCHD) notified the Wisconsin Division of Public Health (DPH), Communicable Diseases Epidemiology Section (CDES) of two ill individuals who had both attended a company (Company A) banquet event at the Hotel Marshfield in Marshfield, WI on 4/16/16.

hotel-new-hampshireOnset of gastrointestinal symptoms in these individuals began early morning 4/18/2016. Appetizers, snacks, and entrees served during the event were prepared by Hotel Marshfield staff. Cupcakes were purchased from Bakery A, and cookies were provided by Company B. Leftover entrees from the banquet were boxed up immediately after the event and donated to Organization A (12 boxed meals total) where some were eaten by staff and residents of that organization.

Upon recognition of a suspected outbreak, Organization A was asked by WCHD to hold the leftover food in their refrigerator and not serve it to anyone. WCHD collected a list of food and drink items served at the banquet from both the Hotel Marshfield manager and the Employee Relations Officer for Company A. CDES began creation of an investigation questionnaire, as well as an online survey to collect food and hotel exposure information from attendees. WCHD began dissemination of stool kits to ill banquet attendees and Hotel Marshfield employees to submit for laboratory testing.

This investigation identified a foodborne outbreak of norovirus gastroenteritis associated with consuming food from a banquet event held at the Hotel Marshfield banquet facility in Marshfield, WI on 4/16/2016. The causative agent was Norovirus genogroup II.17B (Kawasaki). Confirmed and probable cases were identified among banquet attendees and employees of Hotel Marshfield.

Based on the epidemiologic, laboratory, and environmental evidence gathered during this outbreak, improper food handling by a Hotel Marshfield employee who was infected with norovirus is the most likely cause of this outbreak. Because specific food items were identified that were associated with higher risk of illness and all of these items were served on the same plate, this suggests the ill employee was a chef rather than a server or bartender. The challenge of being short-staffed in the banquet kitchen on the day of the banquet may have contributed to a breakdown in hand hygiene or glove use.

The pattern of illness onset dates and times in the epidemic curve supports the conclusion that exposure to the virus occurred at the same time among banquet attendees and hotel staff. This means that the virus was not introduced to the hotel by an ill banquet attendee. Although one banquet attendee reported becoming ill during the event, the epidemic curve indicates a point source exposure consistent with a foodborne outbreak, rather than the pattern of illnesses typically seen with person-to-person transmission from an ill attendee. Since ill attendees do not come in contact with kitchen staff, outbreaks where both food workers and attendees are ill at the same time generally indicate the food worker was the source, rather than a victim.

Additionally, the same strain of norovirus, norovirus GII.17B (Kawasaki) was isolated from both food workers and banquet attendees. The Kawasaki strain is a rare strain of norovirus only recently introduced to the United States in the last five years.7 In Wisconsin, it tends to be associated with foodborne outbreak settings rather than person-to-person transmission in the community; during 2015- 2016, 62.5% of the outbreaks caused by the Kawasaki strain in Wisconsin were foodborne.8 The rarity of the strain, its recovery from both employees (including Chef A) and attendees, and the fact that the same strain was identified in all norovirus positive specimens support the conclusion the illnesses were all acquired from a single source.

norovirus-qmraChef A reported illness onset at 1:45am on the night of the banquet (4/16/16) while the majority of other illnesses began in the evening of the next day. The length of Chef A’s incubation period (time between exposure and start of symptoms) was 7.75 hours, which is shorter than the range of 10‐50 hours observed during volunteer studies of norovirus infection where exact time of exposure is known,9,10 as well as the median incubation period length of 32.5 hours observed in this outbreak. Assuming the onset date and time of Chef A’s illness was accurately reported, this indicates Chef A was likely exposed to the virus 1-2 days prior to the banquet (not at the same time as banquet attendees and other staff). Although Chef A’s symptoms did not begin until after the banquet was over, shedding of norovirus in the stool of infected asymptomatic individuals has been documented11 and it was likely Chef A was shedding virus at the time he/she was preparing and plating the food for the banquet. Additionally, carriage and shedding of norovirus has been documented in individuals who never develop symptoms.12 It is also possible that an unidentified asymptomatic shedding employee could have served as a source of contamination during food prep, or that an ill employee did not accurately disclose his/her illness status and onset date/time.

While Front of House staff were involved in adding croutons to salads, none of these items were statistically associated with illness. Only items that were prepared and finished in the kitchen were statistically associated with illness, increasing the likelihood the contamination event occurred during banquet meal preparation. If a banquet server was the source, we would expect to see no statistically significant association with a specific food item because all types of entrée plates would be handled by the ill individual.

Results of the case-control study showed that individuals who consumed the New York strip steak (served with a red wine reduction), buttery garlic chive mashed potatoes, and glazed carrots were more than two times more likely to become ill than those who did not. These three items were plated together on the same plate. A significant statistical association with illness existed for each item individually and for all three items combined. No other food or beverage items were statistically associated with illness. The fact that all food items with a significant association with illness were cooked items (except the chopped parsley garnish and honey glaze) suggests that contamination occurred after the items were cooked. Foodborne norovirus outbreaks commonly involve food items that are handled and served raw, such as salads and fruit. The only raw ingredients on the steak plates reported by the establishment were chopped fresh parsley used as garnish and the honey squeezed onto the carrots after reheating. Since the chef stated that the same parsley was used as garnish for all three entrees, if the parsley was contaminated at its source (in the field), we would expect to see no statistically significant food item, since all entrees would have contained the same parsley. However, the fact that only the steak plate was statistically associated with illness suggests contamination by food worker during kitchen prep is more likely than contamination in the field. Contamination could have been introduced if parsley was chopped while wearing gloves, but then added to the steak plates by an ungloved hand. Alternatively, the parsley may have only been added to the steak plates. Also, contamination could have also been introduced if the honey squeeze bottle or bottle nozzle was contaminated with norovirus.

Although no additional illnesses were reported among attendees of subsequent banquets, one secondary case occurred in an employee, suggesting person-to-person transmission or transmission from contact with contaminated environmental surfaces also occurred among staff the day after the banquet. Chef A continued to work the next couple days while symptomatic with diarrhea and could have contaminated surfaces or transferred the virus via contact, serving as the source of infection for the secondary case identified among staff. Hotel employees with primary cases who became ill but did not consume banquet food may have been exposed to contaminated food during serving, table clearing, or cleaning, or to contaminated surfaces such as tables in kitchen prep areas, sinks, bathrooms, or door handles.

Several contributing factors were identified during this outbreak investigation, and multiple violations of Wisconsin Food Code which could contribute to the likelihood of an outbreak occurring were observed during the on-site assessments conducted by WCHD sanitarians. Bare-handed contact of ready-to-eat food items by food workers was observed multiple times during the same visit, suggesting that bare- handed contact occurs frequently during routine food prep activities at the facility. The facility did not have any formal written employee illness, hand washing, or glove use policies. Review of the employees’ work schedules in conjunction with their illness onset and resolution dates indicated that Chef A worked preparing food for more banquets at the facility while symptomatic with diarrhea, which violates Wisconsin Food Code. Additionally, hotel employee restrooms did not have functioning fans and are located near (approx. 15ft) food preparation areas. While the case-control study results point to contamination of specific food items as the source of illness during this outbreak, the close proximity of the employee bathrooms to prep areas could contribute to kitchen contamination and future outbreaks.

RECOMMENDATIONS

According to the CDC, while there is no vaccine to prevent norovirus infection, illness can be prevented through proper hand hygiene; washing fruits and vegetables and cooking seafood thoroughly before consuming; avoiding food preparation and caring for others when sick; cleansing and disinfecting contaminated surfaces; and carefully washing laundry.

Individuals who work in the food service industry should be aware of practices that can prevent the spread of noroviruses:

  • not preparing food for others when sick and for at least 48 hours after symptoms stop,
  • practicing proper hand hygiene,
  • rinsing fruits and vegetables and cooking shellfish,
  • regularly cleaning and sanitizing kitchen utensils, counters, and surfaces, and
  • carefully washing table linens, napkins, and other laundry.

It is particularly important for food establishment employees to inform their manager when they are ill and to not work while sick with gastroenteritis and for at least 48 hours following recovery. Complying with this recommendation means that employees need to be both aware of it and have the motivation and responsibility to comply with it.

The following recommendations were developed for Hotel Marshfield following the assessment conducted on 4/20 and 4/21/2016:

  • Review internal procedures regarding employee illness, glove use, and hand washing to ensure they are consistent with standard food safety regulations, and create written policies outlining these procedures.
  • Review and update sick leave policy for management and employees.
  • All personnel, including management, should undergo comprehensive food handling training that includes at a minimum: personal hygiene, proper use of disposable gloves, and employee illness policies to ensure complete understanding.

Consider installing negative pressure ceiling fans in employee restrooms to minimize movement of aerosolized particles into the kitchen, or, discontinue use of the employee restrooms in the kitchen area.

As a result of these recommendations, the hotel has reviewed their procedures for reporting illness, glove use, and hand washing with all staff. The sick leave policy has been reviewed with all staff, and the fact that all staff that earn paid time off (sick leave) has been reinforced. The WCHD conducted an onsite food safety training at Hotel Marshfield that discussed personal hygiene, glove use, and employee illness, as well as other risk factors for foodborne illness. The information provided during the training presentation and via brochures has been incorporated into the hotel’s employee training program.

The employee restroom fans were verified operational (low-flow, constant-on fans) and the employee restroom doors have had spring hinges installed to self-close and keep closed. Ready-to-use spray bottles of bleach solution have been added as an additional option for sanitizing in the kitchen.

Norovirus Outbreak Associated with a Banquet at Hotel Marshfield

4.nov.16

Wood County Health Department ,  Wisconsin Division of Public Health Bureau of Communicable Diseases

https://assets.documentcloud.org/documents/3190897/Final-Investigation-Report-Wood-Hotel-Marshfield.pdf

Chipotle top cheeses make a lot of dough

According to Motley Fool, top execs at Chipotle made more money than lots of other food CEOs.

Even after their compensations were cut in half last year, its co-CEOs Steve Ells and Monty Moran earned nearly $14 million each.

Ells’ and Moran’s compensation packages are particularly egregious in the wake of its food safety crisis, which began last year with an E. coli outbreak at a number of its restaurants in the Pacific Northwest.ells-moran

To a certain extent, it’s to be expected that a company like Chipotle would have something like this happen at some point in its corporate existence. After all, it’s happened at virtually every other major food company in the United States, be it fast food chains such as McDonalds, Taco Bell, or Jack in the Box or grocery stores such as Wal-Mart, Whole Foods, or Costco.

But what’s important to appreciate is that Chipotle left itself especially vulnerable to food borne illness outbreaks. As Austin Carr points out in an incredibly detailed review of Chiptole’s crisis for Fast Company magazine, while the chain served the equivalent of the population of Philadelphia on a daily basis prior to outbreaks, it had only four people assigned to its quality assurance team, tasked with tracking the quality of ingredients sourced from suppliers.

Over 100 ill with noro at USC

Norovirus kind of sucks, unless you are a virologist. The perfect human pathogen (a term coined by my NoroCORE colleague and all-around good guy, Aron Hall) is shed at a crazy high rate of virus particles per gram of vomit or feces and sticks around in the environment for a long time. So outbreaks tend to persist and hit college campuses where lots of people live and eat together.

Like USC, where, according to LAist, a lot of students are sick.la-sp-usc-recruiting-update-20141021

The Los Angeles County Department of Public Health has confirmed that they are currently investigating a norovirus outbreak at the University of Southern California. A representative from the Department of Public Health told LAist that 103 cases have been reported since October 26, which is when the university reached out to the department about the situation. 

The university has asked students to remain home from classes or social events until they’ve been symptom free for at least 24 hours, according to a post on the USC Engemann Student Health Center website. This isn’t the first time the student body has been struck down by the virus—in 2008 hundreds of cases were reported in 2008, and there were a number of outbreaks around the L.A. area last year, as well.

Brae Surgeoner, Doug and I had a paper published in the Journal of Environmental Health about some research we conducted in the Winter of 2006. The study came about because a whole bunch of kids in the University of Guelph’s residence system started puking from an apparent norovirus outbreak. There were lots of handwashing signs up and we wanted to know whether they changed hygiene behavior (especially if kids were using the tools available when entering the cafeteria). Turns out that students weren’t doing as good of a job at hand hygiene as they reported to us.

Food safety fairytales: With over 400 sick, Wahaca says ‘we have never had such an unprecedented incident’

Mark Selby and Thomasina Miers, the co-founders of Brit-Mex restaurant chain, Wahaca, write that last week a number of our staff and customers were struck down by what is suspected to be the winter vomiting bug, norovirus.

wahacaWe assessed each case and when it became clear they were not isolated incidents, we got in touch with relevant officials at Public Health England and Environmental Health Offices. In tandem with that, we took our own precautionary measures – voluntarily closing affected restaurants, carrying out anti-viral deep cleaning at all of our restaurants, whether affected or not, and ensuring that any staff member who had reported illness remained off site until their symptoms had ceased for at least 48 hours.

Our amazing teams have worked tirelessly to ensure that we have done everything within our power to limit any risk to our customers and team members, and the situation remains under control and we continue to work with all local authorities to monitor this closely.

The majority of our restaurants are open and we hope to reopen the 4 remaining sites, on a case by case basis, as soon as we feel we are ready to do so.

We are incredibly sorry that people have been unwell. In the 9 years since we first opened Wahaca we have never had such an unprecedented incident, and we are doing everything we can to get to the bottom of how this may have happened.

And monkeys may fly out of my butt.

Winning food awards isn’t the same as not serving poop.

waynesworld-monkeys

About 400 sick: Vomit bug hits hundreds of UK Wahaca staff and customers, forcing it to shut nine restaurants

And this is why MasterChef sucks.

Hundreds of staff and diners at UK Mexican restaurant chain Wahaca have been struck down with suspected norovirus.

wahaca_carousel_1Public health chiefs tonight confirmed they had launched a national probe into the outbreak.

In total, 205 workers and 160 customers have fallen ill in vomiting bug cases linked to the popular restaurant chain.

Wahaca was founded by Thomasina Miers, who won MasterChef in 2005. It has 25 venues across the UK.

Nine of its restaurants across the UK were voluntarily shut down in the wake of the outbreak. Five have since reopened.

One of the restaurants affected was the chain’s branch in Canary Wharf, East London.

One diner struck down after visiting the venue said: “It was horrendous. I felt terrible. It took three days for me to recover.

“A friend I went with was ill on the Tube, they didn’t manage to make it home, it came on that quickly.”

A message to customers on the official website for the Canary Wharf restaurant today said: “We’re really sorry but due to unforeseen circumstances, we’ve had to close today.

“We hope to be open up again soon (and continue making money while you barf), please keep an eye here for updates.”

Public Health England has confirmed to the Daily Mirror that it had launched a major probe into the outbreak.

Food Safety Talk 111: The Meat Spot

Food Safety Talk, a bi-weekly podcast for food safety nerds, by food safety nerds. The podcast is hosted by Ben Chapman and barfblog contributor Don Schaffner, Extension Specialist in Food Science and Professor at Rutgers University. Every two weeks or so, Ben and Don get together virtually and talk for about an hour.slide-image-1

They talk about what’s on their minds or in the news regarding food safety, and popular culture. They strive to be relevant, funny and informative — sometimes they succeed. You can download the audio recordings right from the website, or subscribe using iTunes.

Episode 111 can be found here and on iTunes.

Show notes so you can follow along at home:

NAACP members sue California hotel over ‘humiliating’ norovirus outbreak

NAACP members are suing an international hotel chain over a norovirus outbreak that sickened 127 people — everyone who ate the salmon — at the NAACP’s annual California conference at the upscale Hotel Sofitel in Redwood City in 2014.

Civil rights attorney John Burris listens as Alice A. Huffman, President of the California  NAACP, talks about her experience with the staff at the Hotel Sofitel at the law offices of John Burris in Oakland Calif., on Tuesday, Oct. 25, 2016. Civil rights attorney John Burris announces the filing of a lawsuit against Sofitel Corporation on behalf of 127 NAACP members including Alice Huffman. (Laura A. Oda/Bay Area News Group)

Civil rights attorney John Burris listens as Alice A. Huffman, President of the California NAACP, talks about her experience with the staff at the Hotel Sofitel at the law offices of John Burris in Oakland Calif., on Tuesday, Oct. 25, 2016. Civil rights attorney John Burris announces the filing of a lawsuit against Sofitel Corporation on behalf of 127 NAACP members including Alice Huffman. (Laura A. Oda/Bay Area News Group)

Civil rights attorney John Burris, one of the conference attendees who didn’t eat the fish, filed the lawsuit on Tuesday, on the two-year anniversary of the Oct. 25, 2014 gala of around 300 black dignitaries, community leaders and youth. Attendants described brunch the next morning as a “humiliating” “horror scene” with NAACP members age 5 to 80 getting violently ill in the hotel lobby while hotel staff ignored them and provided no aid.

A spokesperson for Sofitel Corporation could not be reached for comment on Tuesday.

California NAACP President and conference organizer Alice Huffman said the members were treated “like dogs” by hotel staff.

“I get very sad when I think about what happened to our people and then I get very annoyed at the hotel and the indifference that they showed us,” said Huffman, who said she had enough problems with the hotel before the conference to make her wonder if race was an issue.

Former Oakland Mayor Elihu Harris, who said he was in a coma for two days after being struck by the virus, was among more than three dozen attendees who were hospitalized.

Global norovirus pandemic emergence: maybe it’s in the polymerase

The perfect human pathogen has fantastic fitness because of lots of things: small hearty virus particles, millions of particles shed per gram of feces/vomit; induces projectile vomiting and according to new research in mSphere, fa_polymerase_figure4maybe the lack of fidelity in norovirus polymerase increases transmission between hosts.

Viruses are awesome.

Norovirus Polymerase Fidelity Contributes to Viral Transmission In Vivo 

oct.16

mSphere

1(5):e00279-16

A. Arias, L. Thorne, E. Ghurburrun, D. Bailey and I. Goodfellow

Intrahost genetic diversity and replication error rates are intricately linked to RNA virus pathogenesis, with alterations in viral polymerase fidelity typically leading to attenuation during infections in vivo. We have previously shown that norovirus intrahost genetic diversity also influences viral pathogenesis using the murine norovirus model, as increasing viral mutation frequency using a mutagenic nucleoside resulted in clearance of a persistent infection in mice. Given the role of replication fidelity and genetic diversity in pathogenesis, we have now investigated whether polymerase fidelity can also impact virus transmission between susceptible hosts. We have identified a high-fidelity norovirus RNA-dependent RNA polymerase mutant (I391L) which displays delayed replication kinetics in vivo but not in cell culture. The I391L polymerase mutant also exhibited lower transmission rates between susceptible hosts than the wild-type virus and, most notably, another replication defective mutant that has wild-type levels of polymerase fidelity. These results provide the first experimental evidence that norovirus polymerase fidelity contributes to virus transmission between hosts and that maintaining diversity is important for the establishment of infection. This work supports the hypothesis that the reduced polymerase fidelity of the pandemic GII.4 human norovirus isolates may contribute to their global dominance.

IMPORTANCE Virus replication fidelity and hence the intrahost genetic diversity of viral populations are known to be intricately linked to viral pathogenesis and tropism as well as to immune and antiviral escape during infection. In this study, we investigated whether changes in replication fidelity can impact the ability of a virus to transmit between susceptible hosts by the use of a mouse model for norovirus. We show that a variant encoding a high-fidelity polymerase is transmitted less efficiently between mice than the wild-type strain. This constitutes the first experimental demonstration that the polymerase fidelity of viruses can impact transmission of infection in their natural hosts. These results provide further insight into potential reasons for the global emergence of pandemic human noroviruses that display alterations in the replication fidelity of their polymerases compared to nonpandemic strains.

Norovirus sucks; here’s what it does to the body

It’s the perfect human pathogen.

A 2015 CDC report on noro burden by Ben Lopeman describes the virus as “ubiquitous, associated with 18% (95% CI: 17-20%) of diarrheal disease globally, with similar proportions of disease in high- middle- and low- income settings. Norovirus is estimated to cause approxi­mately 200,000 deaths annually worldwide, with 70,000 or more among children in developing countries.”10849902_719581291471357_3442145704847569295_n1-300x3001-300x300

Express describes what happens when the virus infects.

The viral particles hit the stomach first, but it is only when they travel into the small intestine that the virus begins to multiply.

It enters the cells lining the intestine, making copies of itself and then the cells die, release more virus particles, and the process is repeated.

The immune system recognises that cells are ‘dying’ and as an immune response, antibodies travel to the small intestine and deactivate the virus. Experts say this is when the body will start to feel the effects of the virus – such as fever and nausea.

The virus causes the gut to become inflamed or irritated – which leads to vomiting and watery diarrhoea. This, medics say, is the body’s way of fighting the infection and trying to clear it from the body.

 

OysterFest in Wellfleet MA to go on, without raw oysters, after 75 ill with noro

I’ve eaten exactly one raw oyster ever.

It was at a reception for a food safety meeting in New Zealand.

I picked up the shell, dumped the contents (salt water and a slimy shellfish meat) into my mouth, getting about 50% of it on my shirt. I spent the rest of the night smelling like the beach.raw_oyster

I didn’t get noro from the bivalve experience. According to capecod.com 75 folks around Cape Cod, MA are ill with norovirus after eating raw oysters harvested in a month that ends in ‘r.’

The state has closed all shellfish beds in Wellfleet Harbor following an outbreak of suspected norovirus believed to be linked to shellfish from that area.

It comes just two days before the Wellfleet OysterFest, which attracts tens-of-thousands of people to the Outer Cape.

An official from the festival said the event will go on planned, but without any raw shellfish.

The Massachusetts Department of Public Health issued the ban Thursday afternoon after receiving reports of approximately 75 suspect cases of norovirus over the past two days.

A statement from the DPH said they were all primarily associated with eating raw shellfish at weddings and restaurants in the Outer Cape area.

All shellfish harvesters in the area and Town of Wellfleet officials have been notified about the closure.

All affected shellfish that was harvested on or after September 26 has been recalled and ordered not to be used.