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Open Access Highly Accessed Research article

Foodborne norovirus outbreak: the role of an asymptomatic food handler

Irene Barrabeig1, Ariadna Rovira1, Javier Buesa2, Rosa Bartolomé3, Rosa Pintó4, Hortènsia Prellezo5 and Àngela Domínguez67*

Author Affiliations

1 Epidemiological Surveillance Unit of Costa Ponent. Directorate of Public Health. Department of Health, Autonomous Government of Catalonia, Barcelona, Spain

2 Department of Microbiology. University of Valencia, Spain

3 Department of Microbiology. Vall d'Hebron University Hospital. Barcelona, Spain

4 Enteric Virus Laboratory. University of Barcelona, Spain

5 Health Protection Agency. Department of Health, Barcelona, Spain

6 Department of Public Health, School of Medicine, University of Barcelona, Spain

7 CIBER Epidemiología y Salud Pública (CIBERESP), Instituto Carlos III. Madrid, Spain

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BMC Infectious Diseases 2010, 10:269  doi:10.1186/1471-2334-10-269

Published: 15 September 2010

Abstract

Background

In July 2005 an outbreak of acute gastroenteritis occurred on a residential summer camp in the province of Barcelona (northeast of Spain). Forty-four people were affected among residents and employees. All of them had in common a meal at lunch time on 13 July (paella, round of beef and fruit). The aim of this study was to investigate a foodborne norovirus outbreak that occurred in the residential summer camp and in which the implication of a food handler was demonstrated by laboratory tests.

Methods

A retrospective cohort study was designed. Personal or telephone interview was carried out to collect demographic, clinical and microbiological data of the exposed people, as well as food consumption in the suspected lunch. Food handlers of the mentioned summer camp were interviewed.

Ten stool samples were requested from symptomatic exposed residents and the three food handlers that prepared the suspected food. Stools were tested for bacteries and noroviruses. Norovirus was detected using RT-PCR and sequence analysis.

Attack rate, relative risks (RR) and its 95% confidence intervals (CI) were calculated to assess the association between food consumption and disease.

Results

The global attack rate of the outbreak was 55%. The main symptoms were abdominal pain (90%), nausea (85%), vomiting (70%) and diarrhoea (42.5%). The disease remitted in 24-48 hours. Norovirus was detected in seven faecal samples, one of them was from an asymptomatic food handler who had not eaten the suspected food (round of beef), but cooked and served the lunch. Analysis of the two suspected foods isolated no pathogenic bacteria and detected no viruses. Molecular analysis showed that the viral strain was the same in ill patients and in the asymptomatic food handler (genotype GII.2 Melksham-like).

Conclusions

In outbreaks of foodborne disease, the search for viruses in affected patients and all food handlers, even in those that are asymptomatic, is essential. Health education of food handlers with respect to hand washing should be promoted.