An outbreak of foodborne norovirus gastroenteritis linked to a restaurant in Melbourne, Australia, 2014

• Main Authors: Shaun P. Coutts, Kaye Sturge, Karin Lalor, John A. Marshall, Leesa D. Bruggink, Nela Subasinghe, Marion Easton
• Format: Article
• Language: English
• Published: World Health Organization Regional Office for the Western Pacific 2017-05-01
• Series: Western Pacific Surveillance and Response
• Subjects: norovirus; gastroenteritis; outbreak; foodborne; food handler; case-control study
• Online Access: http://ojs.wpro.who.int/ojs/index.php/wpsar/article/view/536/756
• ISSN: 2094-7321; 2094-7313

Introduction: In May 2014 an outbreak of norovirus occurred among patrons of a restaurant in Melbourne, Australia. Investigations were conducted to identify the infectious agent, mode of transmission and source of illness, and to implement controls to prevent further transmission. Methods: A retrospective case-control study was conducted to test the hypothesis that food served at the restaurant between 9 and 15 May 2014 was the vehicle for infection. A structured questionnaire was used to collect demographic, illness and food exposure data from study participants. To ascertain whether any food handlers had experienced gastroenteritis symptoms and were a possible source of infection, investigators contacted and interviewed staff who had worked at the restaurant between 9 and 16 May 2014. Results: Forty-six cases (including 16 laboratory-confirmed cases of norovirus) and 49 controls were interviewed and enrolled in the study. Results of the analysis revealed a statistically significant association with illness and consumption of grain salad (OR: 21.6, 95% CI: 1.8–252.7, p = 0.015) and beetroot dip (OR: 22.4, 95% CI: 1.9–267.0, p = 0.014). An interviewed staff member who reported an onset of acute gastrointestinal illness on 12 May 2014 had prepared salads on the day of onset and the previous two days. Discussion: The outbreak was likely caused by person-to-food-to-person transmission. The outbreak emphasizes the importance of the exclusion of symptomatic food handlers and strict hand hygiene practices in the food service industry to prevent contamination of ready-to-eat foods and the kitchen environment.