Listeria outbreak from caramel apples has killed four; 23 sick

Four people have died from a Listeria outbreak linked to prepackaged caramel apples, according to the U.S. Centers for Disease Control and Prevention.

0b1d2d18d5851e7b175ba98f98488433At least 28 people in 10 states have become sick due to the bacterial infection. Twenty-six have been hospitalized. Five of the patients have died, although one death was not linked to Listeria.

Nine of the illnesses were linked to pregnancy, affecting either a pregnant woman or a newborn. The outbreak also has been linked to three cases of invasive meningitis — a dangerous inflammation of the lining of the brain or spinal cord — in healthy children ages 5 to 15.

More than 80% of patients said they ate commercially produced, prepackaged caramel apples before becoming sick, according to the CDC. There is no link to home-made caramel apples or fresh produce. Health officials are working to try to identify a specific brand or type of caramel apple.

For now, however, the CDC advises people to avoid all prepackaged caramel apples.

CDC is collaborating with public health officials in several states and with the U.S. Food and Drug Administration (FDA) to investigate an outbreak of Listeria monocytogenes infections (listeriosis) linked to commercially produced, prepackaged caramel apples. Listeria can cause a serious, life-threatening illness.

The information CDC has at this time indicates that commercially produced, prepackaged caramel apples may be contaminated with Listeria and may be causing this outbreak.

Out of an abundance of caution, CDC recommends that U.S. consumers do not eat any commercially produced, prepackaged caramel apples, including plain caramel apples as well as those containing nuts, sprinkles, chocolate, or other toppings, until more specific guidance can be provided.

Although caramel apples are often a fall seasonal product, contaminated commercially produced, prepackaged caramel apples may still be for sale at grocery stores and other retailers nationwide or may be in consumers’ homes.

This investigation is rapidly evolving. New information will be provided as it becomes available.

As of December 18, 2014, a total of 28 people infected with the outbreak strains of Listeria monocytogenes have been reported from 10 states.

26 ill people have been hospitalized. Among the 26 people hospitalized, five deaths have been reported. Listeriosis contributed to at least four of these deaths.

Nine illnesses were pregnancy-related (occurred in a pregnant woman or her newborn infant).

Three invasive illnesses (meningitis) were among otherwise healthy children aged 5–15 years.

To date, 15 (83%) of the 18 ill people interviewed reported eating commercially produced, prepackaged caramel apples before becoming ill.

At this time, no illnesses related to this outbreak have been linked to apples that are not caramel-coated and not prepackaged or to caramel candy.

Investigators are working quickly to determine specific brands or types of commercially produced, prepackaged caramel apples that may be linked to illnesses and to identify the source of contamination.

This investigation is rapidly evolving, and new information will be provided as it becomes available.

87 now sick with Salmonella from sprouts

The U.S. Centers for Disease Control and Prevention reports:

  • As of December 2, 2014, a total of 87 people infected with the outbreak strains of Salmonella Enteritidis have been reported from 11 states.

      amy.sprouts.guelph.05   Twenty-seven percent of ill persons have been hospitalized. No deaths have been reported.  

  • CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory conducted antibiotic resistance testing on Salmonella Enteritidis isolates collected from three ill persons infected with the outbreak strains.

         All three isolates were susceptible to all antibiotics tested on the NARMS panel.

  • Collaborative investigation efforts of state, local, and federal public health and regulatory agencies indicate that bean sprouts produced by Wonton Foods, Inc. are the likely source of this outbreak.

         In interviews, 42 (78%) of 54 ill persons reported eating bean sprouts or menu items containing bean sprouts in the week before becoming ill.

  • Wonton Foods, Inc. continues to cooperate with state and federal public health and agriculture officials.
  • On November 21, 2014, Wonton Foods, Inc. agreed to destroy any remaining products while they conducted thorough cleaning and sanitization and implemented other Salmonella control measures. On November 24, the firm completed cleaning and sanitization and restarted production of bean sprouts. The firm resumed shipment on November 29, 2014

         Contaminated bean sprouts produced by Wonton Foods, Inc. are likely no longer available for purchase or consumption given the maximum 12-day shelf life of mung bean sprouts.

  • CDC recommends that consumers, restaurants, and other retailers always practice food safety for sprouts.

         Children, older adults, pregnant women, and persons with weakened immune systems should avoid eating raw sprouts of any kind (including alfalfa, clover, radish, and mung bean sprouts).

         Cook sprouts thoroughly to reduce the risk of illness. Cooking sprouts thoroughly kills any harmful bacteria.

  • This investigation is ongoing, and CDC will update the public when more information becomes available.

344 now sickened says CDC: Multistate outbreak of human Salmonella infections linked to live poultry in backyard flocks

  • As of September 23, 2014, a total of 344 persons infected with the outbreak strains of Salmonella Infantis, Salmonella Newport, or Salmonella Hadar have been reported from 42 states and Puerto Rico.
  • campy.chicken31% of ill persons have been hospitalized, and no deaths have been reported.
  • Epidemiologic, laboratory, and traceback findings have linked this outbreak of human Salmonella infections to contact with chicks, ducklings, and other live poultry from Mt. Healthy Hatcheries in Ohio.
  • 78% of ill people reported contact with live poultry in the week before their illness began.
  • Findings of multiple traceback investigations of live baby poultry from homes of ill persons have identified Mt. Healthy Hatcheries in Ohio as the source of chicks and ducklings. This is the same mail-order hatchery that has been associated with multiple outbreaks of Salmonella infections linked to live poultry in past years, including in 2012 and 2013.
  • CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory conducted antibiotic resistance testing on Salmonella isolates collected from 11 ill persons infected with the outbreak strains of Salmonella Infantis or Newport. Of the 11 isolates tested:
  • Two (18%) were drug resistant (defined as resistance to one or more antibiotics).
  • Nine (82%) were pansusceptible (susceptible to all antibiotics tested).
  • Mail-order hatcheries, agricultural feed stores, and others that sell or display chicks, ducklings, and other live poultry should provide health-related information to owners and potential purchasers of these birds prior to selling them. This should include information about the risk of acquiring a Salmonella infection from contact with live poultry.
  • Read the advice to mail-order hatcheries and feed stores and others that sell or display live poultry.
  • Consumers who own live poultry should take steps to protect themselves:
  • Always wash your hands thoroughly with soap and water right after touching live poultry or anything in the area where these birds live and roam.
  • Do not let live poultry inside the house.

Not cute with 300 sick from Salmonella linked to live poultry in backyard flocks

The U.S. Centers for Disease Control and Prevention reports that as of August 5, 2014, a total of 300 persons infected with the outbreak strains of Salmonella Infantis, Salmonella Newport, or Salmonella Hadar in 42 states and Puerto Rico, up from 251 in late June.

OLYMPUS DIGITAL CAMERA• 31% of ill persons have been hospitalized, and no deaths have been reported.

  • Epidemiologic, laboratory, and traceback findings have linked this outbreak of human Salmonella infections to contact with chicks, ducklings, and other live poultry from Mt. Healthy Hatcheries in Ohio.

• 80% of ill people reported contact with live poultry in the week before their illness began.

  • Findings of multiple traceback investigations of live baby poultry from homes of ill persons have identified Mt. Healthy Hatcheries in Ohio as the source of chicks and ducklings. This is the same mail-order hatchery that has been associated with multiple outbreaks of Salmonella infections linked to live poultry in past years, including in 2012 and 2013.
  • CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory conducted antibiotic resistance testing on Salmonella isolates collected from 11 ill persons infected with the outbreak strains of Salmonella Infantis or Newport. Of the 11 isolates tested:

• Two (18%) were drug resistant (defined as resistance to one or more antibiotics).

• Mail-order hatcheries, agricultural feed stores, and others that sell or display chicks, ducklings, and other live poultry should provide health-related information to owners and potential purchasers of these birds prior to selling them. This should include information about the risk of acquiring a Salmonella infection from contact with live poultry.

◦  Read the advice to mail-order hatcheries and feed stores and others that sell or display live poultry.

◦  Consumers who own live poultry should take steps to protect themselves such as handwashing and no live poultry inside the house.

Is it really foodborne illness? Is it? Factors contributing to decline in foodborne disease outbreak reports, United States

The number of foodborne disease outbreaks reported in the United States declined substantially in 2009, when the surveillance system transitioned from reporting only foodborne disease outbreaks to reporting all enteric disease outbreaks. A 2013 survey found that some outbreaks that would have been previously reported as foodborne are now reported as having other transmission modes.

deniro.taxi.driver.jun.14Since 1973, the Centers for Disease Control and Prevention (CDC) has collected data on foodborne disease outbreaks submitted by all states, the District of Columbia, and US territories through the Foodborne Disease Outbreak Surveillance System. In 2009, existing foodborne and waterborne disease outbreak surveillance systems were transitioned to an enhanced reporting platform, the National Outbreak Reporting System (NORS), which also collects reports of enteric disease outbreaks transmitted through person-to-person contact, contact with animals, environmental contamination, and indeterminate means (1). A new electronic reporting form and data entry interface were also introduced. In 2009, the number of reported foodborne disease outbreaks declined 32% compared with the mean of the preceding 5 years (2); the number also remained below the pre-2009 average during 2010–2012 (2,3). The decline was largely observed among outbreaks attributed to norovirus, which can be transmitted through many routes: in comparison, the number of outbreaks attributed to Salmonella spp., which is usually transmitted through food, remained relatively constant (1,2).

We considered 3 possible reasons for the decline in the number of reported foodborne disease outbreaks: 1) classification of some outbreaks that previously would have been reported as foodborne as caused by another modeof transmission; 2) technical issues associated with the introduction of the new system; and 3) staffing and resource limitations related to the influenza A(H1N1)pdm09 virus pandemic. Clarification of how these factors might have affected reporting would provide accurate conclusions about trends in foodborne disease outbreaks. In 2013, we conducted a survey to identify possible reasons for the decline in the number of foodborne disease outbreak reports that started in 2009.

In January 2013, we conducted a voluntary, anonymous, internet-based survey of public health officials who are responsible for entering foodborne disease outbreak data into NORS at US state and territory health departments. The survey contained 33 questions in multiple choice, rating scale, or text formats. The questions asked about reporting procedures that might influence data quality and completeness, challenges and practices when determining the mode of transmission for each outbreak, the usability of the online reporting interface, and resource limitations.

UnknownOf the 133 public health officials in 56 jurisdictions who received the link to the survey, 50 (38%) from 39 (70%) jurisdictions completed the survey in whole or in part. The denominator varied for different questions because of nonresponse and exclusion of responses when “don’t know” was selected. Also, some respondents had not used the previous reporting system. Most respondents (36/43, 84%) assigned a high priority to entering foodborne disease outbreak data, rating outbreak reporting as 4 or 5 on a scale of 1 to 5, where 1 indicated low priority and 5 high priority. Similarly, 38/47 (81%) of respondents reported that 90%–100% of foodborne disease outbreaks investigated in their health departments were entered into NORS; 5/47 (11%) reported entering <50% of outbreaks.

The survey included 1 question to determine whether respondents had experienced difficulties identifying the primary mode of transmission for some outbreaks and 1 question to understand which modes of transmission they found difficult to distinguish from foodborne transmission. Many respondents (35/47, 74%) reported sometimes having difficulties in determining an outbreak’s primary mode of transmission. More than half (26/47, 55%) of respondents reported that, since 2009, they had used the newly established category of indeterminate/other/unknown to report an outbreak for which the mode of transmission was not clear. Twenty (80%) of 25 respondents reported that they had experienced difficulty distinguishing between foodborne and person-to-person transmission. In comparison, determining whether an outbreak was caused by transmission of the infectious agent through food or by animal contact was a problem for only 6 of 21 (29%) respondents. Respondents who reported difficulty distinguishing between foodborne and another mode of transmission were asked if they would have reported the outbreak as foodborne to the previous reporting system (before 2009). Most respondents indicated that an outbreak was very likely or likely to have been reported to the previous system as a foodborne disease outbreak if there was a problem determining whether an outbreak was caused by foodborne or person-to-person transmission (15/20 respondents, 75%); by foodborne or environmental contamination (8/11 respondents, 73%); or if a specific mode of transmission could not be determined with confidence (13/19 respondents, 68%).

imagesRegarding usability of the NORS reporting interface, most respondents (36/37, 97%) reported that usability of the new interface was the same as or better than that of the previous system. Most respondents (26/31, 84%), reported that technical issues with the NORS system did not prevent them from entering outbreak reports; only 2 respondents reported that >10% of outbreaks were not entered because of technical issues. When asked if their health departments experienced decreased resources available to work on foodborne disease outbreaks in 2009 while dealing with influenza A(H1N1)pdm09 virus, 19 (57%) of 35 respondents reported decreased resources for foodborne disease outbreak investigations; 14 (44%) of 32 respondents reported decreased resources for outbreak detection (e.g., laboratory capacity); and 14 (38%) of 37 respondents reported decreased resources for outbreak data entry and reporting.

Clarifying the factors that affect foodborne disease outbreak surveillance enables accurate interpretion of observed changes over time. The findings of this survey suggest that the large decline in the number of foodborne disease outbreaks reported in 2009 was likely a combined result of the following: 1) a surveillance artifact, in that some outbreaks previously reported as foodborne are now attributed to other modes of transmission; and 2) limited availability of resources to detect, investigate, and report foodborne disease outbreaks during the influenza A(H1N1)pdm09 pandemic. The total number of outbreaks reported increased after 2009 but remained below pre-2009 numbers, which suggests that the effect of the surveillance artifact is persistent and that outbreaks are now being more accurately categorized by mode of transmission. Although we hypothesized that technical issues with the new reporting interface might have affected reporting, this explanation appears less likely.

Limitations of the survey included the length of time between the transition to NORS and the survey, which meant that some survey participants who are current NORS users had not used the previous reporting system or worked on foodborne disease outbreaks in 2009. This limitation explains the low number of responses to survey questions that required knowledge of practices before 2009. Also, the overall response rate for the survey was low. Possible explanations include staffing and resource limitations, but the survey was voluntary and anonymous, and no follow-up efforts were made to determine reasons for the low response rate. In addition, because some jurisdictions have >1 reporting administrator, personnel in some jurisdictions may have compiled a single response. On the other hand, the experiences of some health departments that did not compile responses might have been overrepresented. Further, the survey was not designed to measure the proportion of reported outbreaks affected by the introduction of NORS. Other potential reasons for the decline in the number of reported foodborne disease outbreaks, such as resource limitations and loss of public health positions resulting from budget cuts during the recession (4), were not explored.

In summary, the results of this survey provide unique insights into the decline in the number of foodborne outbreak reports submitted in 2009 and thereafter. NORS provides more comprehensive surveillance of outbreaks and a better understanding of the epidemiology of pathogens with multiple transmission pathways (1). These findings may be useful to improve guidance and training for outbreak reporting, particularly in reporting of the mode of transmission when multiple pathways exist for a pathogen.

At the time of the survey, Dr Imanishi was an Epidemic Intelligence Service Officer with the Division of Foodborne, Waterborne, and Environmental Diseases of the National Center for Emerging and Zoonotic Infectious Diseases, CDC. Her research interests include epidemiology and control of foodborne diseases and zoonoses.

Centers for Disease Control and Prevention, Emerging Infectious Diseases, Volume 20, Number 9, September 2014, DOI: 10.3201/eid2009.140044

Maho Imanishi, Karunya Manikonda, Bhavini P. Murthy, and L. Hannah Gould

125 now sick in multi-state Cyclospora investigation

The Center for Infectious Disease Research and Policy is reporting that U.S. federal health officials have joined with officials in 13 states to investigate a spike in Cyclospora illnesses, with 125 confirmed or probable cases reported and no specific food item implicated so far.

love.boat.cyclosporaTexas health officials have been investigating a recent surge of infections, and an outbreak investigation is underway in Maine, with Massachusetts also probing an increase in lab-confirmed cyclosporiasis cases, the CDC said in an e-mail to CIDRAP News. As of today, it said, those 3 states, 10 others, and New York City have reported cases. The other states are Connecticut, Florida, Georgia, Illinois, Maryland, Montana, New Jersey, New York, Oregon, and Tennessee.

News of a multistate increase in Cyclospora illnesses follows the recent launch of the investigation in Texas. Over the last months the Texas Department of State Health Services (TDSHS) has learned of 61 cases around the state, which prompted a recent alert to Texas healthcare providers. No common source has been identified.

CDC: Antibiotic resistance in foodborne germs is an ongoing threat

In a report that is sure to be interpreted by the political lenses of various groups, the U.S. Centers for Disease Control and Prevention reports that in 2012 that multi-drug resistant Salmonella decreased during the past 10 years and resistance to two important groups of drugs – cephalosporins and fluoroquinolones – remained low in 2012. However, in Salmonella typhi, the germ that causes typhoid fever, resistance to quinolone drugs increased to 68 percent in 2012, raising concerns that one of the common treatments for typhoid fever may not work in many cases.

chickenpurseAbout 1 in 5 Salmonella Heidelberg infections was resistant to ceftriaxone, a cephalapsorin drug. This is the same Salmonella serotype that has been linked to recent outbreaks associated with poultry. Ceftriaxone resistance is a problem because it makes severe Salmonella infections harder to treat, especially in children.

The data are part of the latest report of the National Antimicrobial Resistance Monitoring System (NARMS), a tri-agency surveillance system that has tracked antibiotic resistance in humans (CDC), retail meats (Food and Drug Administration), and food animals (U.S. Department of Agriculture) since 1996.  The report from CDC NARMS compares resistance levels in human samples in 2012 to a baseline period of 2003-2007. 

“Our latest data show some progress in reducing resistance among some germs that make people sick but unfortunately we’re also seeing greater resistance in some pathogens, like certain types of Salmonella,” said Robert Tauxe, M.D., M.P.H, deputy director of CDC’s Division of Foodborne, Waterborne, and Environmental Diseases. “Infections with antibiotic-resistant germs are often more severe. These data will help doctors prescribe treatments that work and to help CDC and our public health partners identify and stop outbreaks caused by resistant germs faster and protect people’s health.”

Among the other findings in the 2012 report:

*Campylobacter resistance to ciprofloxacin remained at 25 percent, despite FDA’s 2005 withdrawal of its approval for the use of enrofloxacin in poultry. Ciprofloxacin and enrofloxacin are both in the fluoroquinolone class of drugs.

*Shigella resistance to ciprofloxacin (2 percent) and azithromycin (4 percent) is growing. However, no Shigella strains were resistant to both drugs.

*Although fluoroquinolone resistance remained low in 2012, Salmonella enteritidis – the most common Salmonella type – accounted for 50 percent of infections resistant to the fluoroquinolone drug nalidixic acid, which is used in laboratory testing for resistance. Resistance to nalidixic acid relates to decreased susceptibility to ciprofloxacin, a widely used fluoroquinolone drug. Other work shows that many of the nalidixic acid resistant Salmonella enteritidis infections are acquired during travel abroad.

The full 2012 NARMS report is available on the CDC website at www.cdc.gov/narms/reports/annual-human-isolates-report-2012.html. For more information about NARMS,  visit www.cdc.gov/narms.

In Australia, researchers from the Australian National University’s Research School of Biology tested more than 90 packages of chicken bought from several Canberra retailers for the presence of E. coli. 

chicken.south.parkProfessor of microbial population biology and evolution, David Gordon, said almost 200 samples were found to contain E. coli and of those, about two-thirds were discovered to be antibiotic-resistant.

Just four strains of E. coli were found to be resistant to antibiotics known as fluoroquinolone, which were not used by Australia’s poultry industry, he said. 

Professor Gordon said the E. coli strains researchers found were rare in the samples. 

He said it was unlikely the strains of fluoroquinolone-resistent E. coli were in the chicken before slaughtering, and the “most logical, although not necessarily true, explanation for their presence in poultry is post-processing contamination.”

An ACT Health spokeswoman said although the directorate had not seen the study, the presence of resistant bacteria in chicken meat highlighted the importance of good food handling and preparation when eating chicken, including thorough cooking and cleaning of food-preparation surfaces. 

“This is important to prevent bacterial food-borne illness regardless of whether bacteria are resistant to an antibiotic,” she said. 

An Australian Pesticides and Veterinary Medicines Authority spokeswoman said the authority was responsible for the assessment and registration of veterinary medicines, including antibiotics, in Australia.

She said fluoroquinolones have never been registered for use in food-producing animals in Australia.

“State and territory governments are responsible for controlling the use of pesticides and veterinary medicines beyond the point of retail sale,” she said.

‘Safety’s our greatest priority’ Restaurant association don’t take too kindly to CDC norovirus report

The U.S. Centers for Disease Control and Prevention (CDC) issued a Vital Signs report this week stating that most norovirus outbreaks from contaminated food occur in food service settings.

The report prompted the National Restaurant Association, the leading business association for the restaurant industry, to release the following statement: “For the restaurant and foodservice industry, there is no greater priority than food safety and our customers’ and employees’ well-being,” said Scott DeFife, executive vice president for policy and government affairs, National Restaurant Association.

norovirus-2“The National Restaurant Association and foodservice operators take food safety very seriously. In its report, the CDC notes the demonstrated success of training and certification of kitchen managers in preventing norovirus outbreaks, which we support and encourage. Through the National Restaurant Association’s ServSafe food preparation training program, over 5.6 million foodservice workers across the U.S. have been trained in the safe handling and serving of food. The program provides specific recommendations on ways to prevent norovirus, including proper hand washing and exclusion of sick employees.

“The National Restaurant Association supports the FDA Food Code, which also details these prevention measures, and we believe more states should move to fully adopt the FDA Food Code.

“In addition, the National Restaurant Association played an active and constructive role in developing the Council to Improve Foodborne Outbreak Response (CIFOR) guidelines, released last year in partnership with state, local and federal public health officials and other industry stakeholders.

“We agree with many of CDC’s suggestions as to what can be done. However, we believe that some of the language is misleading and that norovirus is not common in the industry, as the report claims. The report shows that the overwhelming majority of norovirus outbreaks during the studied time period were non-foodborne. Restaurants serve 130 million meals each day, and while any instance is serious, there are very few instances of norovirus contamination.” 

New US CDC data on foodborne disease outbreaks

Outbreaks provide important insights into how germs spread, which food and germ combinations cause illnesses, and how to prevent infections. Public health and industry use outbreak data to create information on prevention, education, and policy.

foodborne-disease-data_d250pxCDC has a long history of summarizing outbreak reports from local and state health departments. CDC collects outbreak data and makes it available to the public. Tracking and reporting outbreak data is the first step towards prevention.

Highlights of New Reports:

CDC published two new reports for 2011 and 2012. The data from these reports help show the human impact of foodborne disease outbreaks.

Number and Causes of Outbreaks

*1,632 foodborne disease outbreaks, 29,112 illnesses, 1,750 hospitalizations, and 68 deaths

*793 outbreaks caused by a single, confirmed pathogen

*Most common causes of outbreaks:

*Norovirus: 41% of reported outbreaks

*Salmonella: 25% of reported outbreaks

Number and Causes of Outbreak-Related Illnesses

*18,880 (65%) outbreak-related illnesses caused by a single, confirmed pathogen

*1,501 (8%) resulted in hospitalization

*Most common causes of outbreak-related illnesses:

*Norovirus: 46% of outbreak-related illnesses

Salmonella: 34% of outbreak-related illnesses

Setting of Outbreaks

Among the outbreaks with a single known food preparation setting, foods were prepared most- commonly at or by:

*Restaurants, specifically sit-down dining style restaurants: 60% of outbreaks,

*Caterers or banquet facilities: 13% of outbreaks

*Homes: 13% of outbreaks

Germs and Foods

*Pathogens and foods responsible for the most outbreak-related illnesses, hospitalizations, and deaths in 2012:

*Illnesses

*Salmonella in fruits (446 illnesses)

*Salmonella in fish (425 illnesses)

Salmonella in chicken (345 illnesses)

*Hospitalizations

*Salmonella in chicken (109 hospitalizations)

*Salmonella in fruits (55 hospitalizations)

*Salmonella in fish (55 hospitalizations)

*Deaths

*Listeria in dairy (5 deaths)

*Campylobacter in chicken (4 deaths)

*Among the 192 outbreaks attributed to a food composed of ingredients from a single food category, the categories most often implicated:

*Fish (16%)

*Vegetable row crops (12%)

*Dairy (10%, nearly all unpasteurized)

Campylobacter Outbreaks on the Rise since 2009

The number of outbreaks caused by Campylobacter increased from 15 outbreaks in 2009 to 25 in 2010, 30 in 2011, and 37 in 2012. During 2011 and 2012, 37 outbreaks were linked to foods; unpasteurized (raw) milk was responsible for the largest number of outbreaks.

CDC: Norovirus outbreaks most often linked to infected food handlers

In 1929 Dr. John Zahorsky wrote about children developing sporadic cases of vomiting, supplemented by watery diarrhea each year between November and May – and over 30 years of clinical practice, he coined the term winter vomiting sickness. According to a 1950 Time Magazine article, Dr. Zahorsky was a pediatrician working extolling the virtues of good sanitation during birth and infant care – one of the fathers of disease prevention.m63e0603a1f1
In 1968, one of these winter vomiting sickness outbreaks occurred in an elementary school in Norwalk, OH. Teachers and students were both affected, with 32% of the primary cases spreading illness to others in their families and homes. After a collaborative investigation with researchers from NIH and Walter-Reed Army medical center a causative agent was found in the feces of the ill — a 27nm sized virus particle. Zahorsky’s illnesses then took on the name Norwalk. Since then, the name has morphed to Norwalk and Norwalk-like viruses, which begat noroviruses.
Often linked to cruise ships in popular culture, noro really is linked much more often to food handlers in food service. According to fellow NoroCORE collaborator Aron Hall and colleagues in this week’s MMWR, noroviruses are the leading cause of reported foodborne disease outbreaks nationally and most often linked to restaurants – with contamination occurring from infected food workers.
 
During 2009–2012, a total of 4,318 norovirus outbreaks were reported to NORS (the national outbreak reporting system -ben) , resulting in 161,253 illnesses, 2,512 hospitalizations, and 304 deaths. Foodborne transmission was the primary mode reported in 1,008 (23%) norovirus outbreaks, representing 48% of the 2,098 foodborne outbreaks reported with a single suspected or confirmed cause during the 4-year study period. Other primary transmission modes reported among the 4,318 norovirus outbreaks included person-to-person (2,976 [69%]), environmental (15 [0.35%]), waterborne (11 [0.26%]), and unknown transmission mode (308 [7%]). In 158 (16%) of foodborne norovirus outbreaks, secondary transmission through one of these other modes was reported. Norovirus outbreaks were most common in winter, with 2,394 (55%) occurring during December–February (Figure 1). Among foodborne norovirus outbreaks, 398 (39%) occurred during December–February, compared with 1,996 (60%) of nonfoodborne norovirus outbreaks.
 
Outbreak data (above, exactly as shown) demonstrates that winter vomiting virus is a fitting moniker.