Lawsuit filed in norovirus-linked fatality

Foodborne norovirus is linked to around 5.5 million illnesses a year and costs the U.S. around $3 billion annually. Fortunately most of the cases result in a couple of days of really bad vomiting or diarrhea – but usually not deaths (an estimated 150 annually).

According to Oregon Live, a 2013 norovirus outbreak at Maggie’s Buns may have resulted in a unique and tragic outcome: 43-year-old Kevin Weeks’ died a week after exposure to the pathogen.Screen Shot 2015-03-17 at 12.53.52 PM

The wife of a 43-year-old man who died after allegedly eating food contaminated with the norovirus has filed a $2.9 million lawsuit against a popular Forest Grove restaurant.

Stacey Weeks faults Maggie’s Buns for catering a meal that she believes was tainted with the norovirus. Her husband, Kevin Weeks, was a spokesman for the Oregon Department of Forestry and ate the food at the work event on Friday, March 15, 2013.

Public health investigators said 15 other people fell ill by the following Saturday, but most were feeling better by Monday. Weeks, however, died the following Tuesday — four days after dining at the gathering.

Investigators determined that most of those who were sickened ate watermelon, cantaloupe, pineapple or strawberries from a fruit tray. But investigators said in March 2013 that they didn’t know how the virus ended up there.

The virus is spread directly among people through contact or through contaminated food, water or surfaces. It’s highly contagious, but doesn’t usually kill.

Shortly after Weeks died, deputy state medical examiner Dr. Clifford Nelson said Weeks was exposed to the norovirus at the event, but it appeared that Weeks had health problems that caused his death. Nelson said, however, that he was awaiting some test results before he could draw a final conclusion.

The burden of foodborne illness: it’s kind of a big deal

Last week I gave a guest lecture to an undergraduate nutrition class at UNC-Chapel Hill on the burden of foodborne illness as sort of an introduction to how and why folks like small farmers, school garden managers, cafeteria staff address food safety.

In a lot of my talks I get looks of bewilderment when I throw up the details from Elaine Scallan (and lots of her colleagues) papers on the burden of foodborne illness. Same with when I show economic estimates from friend of barfblog and all-around-good-guy-with-hipster-glasses Mike Batz (and colleagues). Foodborne illness, is kind of a big deal (at least to us food safety nerds).

I’m collaborating with Matt Shipman, public information officer at NC State University and curator of The Abstract, on a set of food safety-related posts from other NCSU folks as we roll toward WHO’s World Health Day – which is focused this year on food safety.

Here’s the first post:21d2f2194e7eb6925dac5a428cc518d4398b850316887505b740e8bd0e8ffdd2

Food safety poses a global health problem. According to the World Health Organization, contaminated food can cause more than 200 diseases – and food- and water-borne diseases that cause diarrhea are estimated to kill two million people each year worldwide.

And food safety is not just someone else’s problem.

“Foodborne illnesses are a significant problem in the United States, with massive impacts on public health and the economy,” says Ben Chapman, a food safety expert and researcher at NC State. And the numbers back Chapman up.

According to a 2012 report from researchers at the Emerging Pathogens Institute, Resources For the Future, and the U.S. Department of Agriculture’s Economic Research Service, foodborne illness is estimated to cost the U.S. more than $14 billion annually. (The estimate takes into account factors such as medical costs and productivity losses.)

And a 2011 report from the U.S. Centers for Disease Control and Prevention (CDC) reported an estimated 9.4 million episodes of foodborne illness each year in the U.S. from known pathogens. An additional 38.4 million cases are estimated to come from unspecified or unknown pathogens. In total, foodborne illnesses are thought to contribute to 48 million illnesses annually – resulting in more than 128,000 hospitalizations and 3,000 deaths.

It is, in short, a big deal.

So what are these foodborne illnesses? And how much damage does each of them cause?

In advance of World Health Day, we wanted to explain a handful of the relevant pathogens implicated in foodborne illness.

Campylobacter: Campylobacteris a genus of bacteria, many of which can cause an illness called campylobacteriosis in humans, with symptoms including diarrhea and abdominal pain. People can contract campylobacteriosis from undercooked chicken, from cross-contamination via raw chicken, or from drinking unpasteurized milk.

According to the 2012 paper, campylobacteriosis affects 845,000 people annually in the U.S., costing the nation an estimated $1.747 billion every year and leading to 8,463 hospitalizations.

Listeria monocytogenes: This is a bacterium that causes listeriosis, which is characterized by fever, muscle aches, and sometimes by gastrointestinal problems, such as diarrhea. Listeriosis can be contracted from an incredibly broad range of foods.

According to the 2012 study, listeriosis costs the U.S. $2.577 billion annually, despite the fact that there are only 1,591 illnesses per year. But 1,455 of those illnesses require hospitalization – and 255 result in death.

Norovirus: Noroviruses are the most common cause of foodborne illness in the U.S., affecting an estimated 19-21 million people each year. Symptoms range from vomiting and diarrhea to fever and headache. Transmission comes from ingesting infected feces or vomit particles – for example, by touching a contaminated surface and then touching food or touching your mouth.

According to the 2012 study, noroviruses cost the U.S. $2 billion per year, with more than 14,000 hospitalizations and approximately 150 deaths annually. NC State is a leader in norovirus research, and home to NoroCORE – the Norovirus Collaborative for Outreach, Research, and Education. NoroCORE pulls together norovirus research from 18 institutions, with funding from the U.S. Department of Agriculture.

Salmonella enterica: This is one species of the pathogen that has myriad of subspecies and types – more than 1,400 of which are known to cause human illness. Infection with Salmonella species causes salmonellosis, with symptoms including diarrhea, fever, and cramping. Salmonellosis can be contracted from a variety of sources, ranging from poultry to peanut butter to mangoes.

According to the 2012 study, the subspecies within S. entericaalone costs the U.S. $3.3 billion each year, causing more than one million hospitalizations and almost 400 deaths annually.

What are researchers doing about this?

The four pathogens listed above are just a few of the rogue’s gallery of bacteria and viruses that can cause foodborne illness. But researchers are constantly learning more about these health risks.

“New technology and new research on pathogens, practices and prevention are improving our ability to identify and address foodborne illness,” Chapman says. “The field is really opening up. It’s an exciting time to be involved in food safety research.”

Between now and April 7, we’re planning to publish a series of posts on various aspects of food safety – what we know, what we don’t know, and what we’re working on. We also hope to offer insights to help folks lower the risk of contracting foodborne illnesses. We hope you’ll learn something new.

Note: you can find all of our posts related to food safety here.

Citations:

Batz, Michael B., Sandra Hoffmann, and J. Glenn Morris, Jr. “Ranking the Disease Burden of 14 Pathogens in Food Sources in the United States Using Attribution Data from Outbreak Investigations and Expert Elicitation” Journal of Food Protection, Vol. 75, No. 7, 2012, Pages 1278–1291. doi:10.4315/0362-028X.JFP-11-418

Scallan, Elaine, et al. “Foodborne Illness Acquired in the United States—Major Pathogens” Emerg Infect Dis, Vol. 17, No. 1, 2011. doi:10.3201/eid1701.P11101

How long will I barf with norovirus? Survey says, 44 hours

Norovirus infections—sometimes known as the stomach flu—typically last for the same amount of time, independent of age or the type of norovirus a person is infected with, according to a recent study by the University of Georgia College of Public Health, Emory University and the Centers for Disease Control and Prevention in the journal Epidemiology and Infection.

norovirusSymptoms from a norovirus infection last about two days, a finding that is constant between infected individuals, as well as environmental settings. The incubation period-or time until symptoms start-is also a consistent 1.5 days from time of infection. These findings differ from the authors’ expectations.

“I would have expected there to be a difference in something like a hospital setting or a difference depending on age groups,” said Andreas Handel, an assistant professor of epidemiology. “But when we analyzed the data, we didn’t see much of a difference.”

One caveat noted by the authors is that the data they analyzed was reported on the level of individual outbreaks, not individual patients. Future studies looking at individual patients are required to further test the findings.

The journal article on “Association of host, agent and environment characteristics and the duration of incubation and symptomatic periods of norovirus gastroenteritis” is available at http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9456829

Over 240 students in Taiwan ill with Norovirus

There’s a lot of Norovirus going around Taiwan resulting in hotel closures, waivers and according to the Want China Times, the latest group hit by the vomit-inducing pathogen are students on graduation trips.

About 140 students and teachers out of a 285-person group from New Taipei Municipal An Kang High School reported diarrhea and vomiting during their trip to southern Taiwan, according to the CDC.10849902_719581291471357_3442145704847569295_n1-300x300

The symptoms appeared after the group ate breakfast at their hotel in the scenic Kenting area on Thursday morning and again after eating dinner at another restaurant on Thursday night, the agency said.

The patients were sent to numerous hospitals and most of them have been discharged, the agency said.

Likewise, 100 students from Ming Hu Elementary School in Taipei have reported vomiting during their trip to Chiayi county since Thursday morning.

The CDC said it is investigating if any staff members of the hotels and restaurants the group visited have contracted the disease.

In China, visitors to resort have to sign Norovirus waiver

Hundreds of Taiwanese visitors to Taichung’s Hoya Resort Hotel in Wuling have signed an affidavit that they are staying at the resort at their own risk in the midst of an outbreak of norovirus GII.17, a genotype common in certain African nations, reports China Times.

Hoya-Resort-Hotel-Wuling--300x199Over 300 visitors to Hoya Resort Hotel Wuling are still coming for the long holiday weekend.

The outbreak over the Lunar New Year holiday of the norovirus, which causes the rapid onset of vomiting and diarrhea, has affected the health of over 200 visitors and employees at the resort. The virus is transmitted through the fecal-oral route, primarily through contaminated food or water.

After the outbreak began, Hoya Resort Hotel Wuling closed for two days. Visitors wishing to continue their stay were given the option of signing the affidavit absolving the hotel from all responsibility should they contract the virus. In addition, the resort will not provide them with food.

The resort is reportedly fully booked for the coming Feb. 28 weekend. The cherry blossoms in the area which bloom briefly as spring nears are a major visitor attraction.

CDC probing strain of Taiwan Norovirus

Whether last week’s norovirus outbreak in Taichung’s Hoya Resort Hotel Wuling (武陵富野渡假村) was caused by norovirus GII.17 — a genotype common in certain African nations — has not been determined, the Centers for Disease Control (CDC) said yesterday.

norovirusThe agency made the remarks after a norovirus outbreak at the hotel over the Lunar New Year holiday affected more than 200 guests and employees.

Norovirus infections cause rapid onset of vomiting and diarrhea. The virus is transmitted through the fecal-oral route, primarily via contaminated food or water.

CDC Deputy Director-General Chuang Jen-hsiang (莊人祥) said there are many genotypes of norovirus and that local cases last year were caused mostly by GII.4 and GII.6 strains.

“GII.17 genotype was first detected in Taiwan in October 2013, before disappearing shortly later. However, it re-emerged in the nation late last year and has since been the most predominant genotype circulating in the country,” Chuang said.

Chuang said the world’s knowledge about the GII.17 strain’s pathogenicity and level of communicability is still limited, except that it caused a cluster of infections in Africa and Brazil in 2005 and 2006 respectively, and affected a few individuals in the US and Japan in recent years.

15 sick: Norovirus strikes in NZ play area affects 15

At least 15 people have become ill after contracting a virus from the children’s play area of a Tauranga ten pin bowling venue.

tumblr_inline_mk7cmgis031qz4rgpToi Te Ora – Public Health Service medical officer of health Dr Jim Miller said, in a written statement, the service had been notified of cases of norovirus gastroenteritis in at least nine preschool and primary aged children and six adults earlier this month.

He confirmed those affected had picked up the bug from the children’s play area of a Tauranga ten pin bowling venue.

Mr Miller said the virus would most likely have been spread through person-to-person contact after exposure to an ill person.

Toi Te Ora investigated the outbreak and had since given the bowling alley advice on dealing with diarrhoea and vomiting episodes on the premises and effective cleaning, he said.

A request for further information, including the name of the bowling alley, and if any victims had been hospitalised was not answered by the time the Bay of Plenty Times went to print.

120 sick: Tourists at Taiwan afflicted by possible norovirus

About 120 tourists in a central Taiwan tourist spot known for its cherry blossoms reported a diarrhea and vomiting outbreak Monday, which health officials said could be a result of norovirus infection.

Hoya Resort Hotel WulingBoth tourists and staff of the Hoya Resort Hotel Wuling in the Wuling Farm reported norovirus symptoms such as diarrhea, vomiting and fever, according to the Taichung City Health Bureau.

The hotel has been ordered to stop providing food to guests, the bureau said, adding that it has taken samples to test for the virus.

The hotel said that five of its workers had taken sick leave prior to the outbreak.

Celebrity Cruises Equinox has an outbreak; pathogen unconfirmed

According to CDC’s Vessel Sanitation Program, the Celebrity Equinox has a bunch of ill folks on it and it will be back in port tomorrow for public health specialists to investigate.

Voyage Dates: February 13 – February 23, 2015

Number of passengers who have reported being ill during the voyage out of total number of passengers onboard: 95 of 2896 (3.28%)Unknown-9

Number of crew who have reported being ill during the voyage out of total number of crew onboard: 7 of 1209 (0.58%)

Predominant symptoms: vomiting, diarrhea

Causative agent: unknown

Actions: In response to the outbreak, Celebrity Cruises and the crew aboard the ship reported the following actions:

– Increasing cleaning and disinfection procedures according to their outbreak prevention and response plan,

– Making announcements to notify onboard passengers and crew of the outbreak, encourage case reporting, and encourage good hand hygiene,

vomit-cruise1-226x300– Collecting stool specimens from passenger and crew gastrointestinal illness cases for testing by CDC,

– Making twice daily reports of gastrointestinal illness cases to the VSP,

– Sending corporate management public health, hotel, housekeeping team to assist the onboard management with infection control response plan,

– Is consulting with CDC on plans for their comprehensive sanitation procedures in Fort Lauderdale, FL on February 23, 2015, including:

– providing additional cleaning crew to complete a thorough public and accommodation super-sanitization cleaning and disinfection,

– planning staged disembarkation for active cases to limit the opportunity of illness transmission to well guests, and

– planning for sanitation of terminal and transport infection control procedures.

Three CDC Vessel Sanitation Program environmental health officers and one epidemiologist will board the ship in Port Everglades (Fort Lauderdale) on February 23, 2015 to conduct an environmental health assessment and evaluate the outbreak and response activities. Specimens are being collected and will be tested by CDC to determine the causative agent for this outbreak. 

Norovirus confirmed in PA university outbreak

There’s a lot of norovirus on campuses this time of year. A bunch of Virginia colleges dealt with the pathogen a couple of weeks ago, and it looks like N.C. State did too. According to mcall.com, the virus caused over 150 illnesses at East Stroudsburg University in Pennsylvania.

The vomiting, diarrhea and stomach pain that affected 154 students at East Stroudsburg University last week was the result of a highly contagious virus, the state Health Department said Thursday.

The Department of Health has determined that there is now enough accumulated evidence to say the recent ESU outbreak is due to norovirus,” department spokesman Wes Culp said.

The illnesses swept through the campus so fast that doctors and medical staffs could not identify its cause with certainty, though doctors did suspect norovirus. The outbreak affected 2.5 percent of ESU students.

Here are some campus-specific food safety infosheets. Click on the pics to download.