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If you have never been directly affected by a foodborne illness, you might know someone who was not so lucky. The Centers for Disease Control and Prevention (CDC) estimates that 48 million people in the United States each year become sick from a foodborne illness. Since only a small percentage of illnesses are diagnosed and reported, the CDC periodically uses surveillance systems and surveys to help estimate which foodborne pathogens are causing the most illnesses. These tracking systems have identified 31 pathogens known to cause foodborne illnesses. Out of 31 pathogens, norovirus was identified as the leading cause of vomiting and diarrhea and is considered the number one cause of foodborne illnesses in the United States. This is why strict employee health policies and consistent food safety practices must be implemented in food service establishments to prevent an outbreak.
What is norovirus?
Norovirus, often called the stomach flu, has no biological association with influenza viruses. The infection is caused by small, single-stranded RNA viruses that are easily spread through person-to-person contact and contaminated food, water or surfaces. Once ingested, these pathogens cause inflammation of the stomach and intestines, triggering acute onset of:
- Vomiting.
- Non-bloody diarrhea.
- Nausea.
- Stomach pain.
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A low-grade fever and headache can also occur. Symptoms typically begin between 12-48 hours after eating food or drink contaminated with the virus. Most people fully recover in 1-3 days; however, those with compromised or underdeveloped immune systems, such as the elderly and the very young, may experience longer recovery times of 4-6 days.
What is the cause for concern?
Norovirus is a cause for concern because it only takes a small amount of the virus to make someone sick. According to the CDC’s Updated Norovirus Management and Disease Prevention Guidelines, as many as 100 billion virus particles have been found in one gram of an infected person’s stool, and only 18 virus particles are needed to make someone sick. This explains how the virus can spread so easily between people. Norovirus is also difficult to control and eliminate because the virus:
- can be shed in stool for as long as five days after infection.
- can be detected in stool for up to four weeks following infection.
- can survive a wide range of temperatures.
- can survive on surfaces for weeks.
Common outbreak settings
Norovirus outbreaks can happen at any time of the year but occur more often during the winter months between November and April. It spreads quickly, especially in confined spaces. The most commonly reported outbreak settings are:
- Healthcare facilities such as nursing homes and hospitals.
- Restaurants.
- Banquet halls.
- Schools and childcare centers.
- Cruise ships.
Infected food handlers can easily contaminate food, beverages and surfaces they touch. Leafy greens, fresh fruits, and shellfish are foods that are commonly involved in outbreaks. However, any food served raw, handled after cooking or contaminated before delivery could also be involved.
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Prevention is the best defense against norovirus due to its resiliency. Both staff and customers can be protected by diligently using prevention practices outlined in the NC Food Code and the CDC guidelines:
- Maintain high standards for employee health.
- Inform the local health authority of an employee experiencing reportable symptoms/illnesses.
- Exclude sick workers for at least 48 hours after symptoms stop.
- Implement routine health checks.
- Practice proper hand washing. Hand sanitizers should only be used after proper hand washing.
- Use utensils and single-use disposable gloves to prevent bare-hand contact with ready-to-eat foods.
- Wash fruits and vegetables thoroughly before preparing and serving them.
- Cook shellfish such as oysters to at least 145°F or above.
- Regularly clean and sanitize kitchen surfaces and frequently touched objects using chlorine-based products or a sanitizer approved by the EPA for use against norovirus.
- Provide a written Vomit & Diarrhea Clean-up Plan (español) for employees to use during vomit/diarrhea incidents.
- Provide norovirus prevention training for food workers:
Norovirus Fact Sheet for Food Workers - English
Norovirus Fact Sheet for Food Workers - español
For more information, visit the CDC’s Norovirus website.
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