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Epidemiology of Foodborne Norovirus Outbreaks - United States, 2009-2015.
Food Saf (Tokyo). 2018 Jun; 6(2):58-66.FS

Abstract

Noroviruses are the leading cause of acute gastroenteritis and foodborne disease in the United States (U.S.). About 1 in 5 reported norovirus outbreaks are spread through foodborne transmission, presenting opportunities for prevention. We describe the epidemiology of U.S. foodborne norovirus outbreaks reported to national surveillance systems, including differences between genotypes. Foodborne outbreaks that occurred during August 2009-July 2015 with norovirus reported as a single confirmed etiology to the National Outbreak Reporting System (NORS) were matched with outbreaks reported to CaliciNet, a U.S. laboratory norovirus outbreak surveillance network. We analyzed these matched outbreaks stratified by genotype for epidemiologic characteristics, including setting, size and duration, health outcomes of case-patients, implicated food, and outbreak contributing factors. Four hundred ninety-three confirmed foodborne norovirus outbreaks were reported in both NORS and CaliciNet. The most common norovirus genotypes reported were GII.4 (52%), GII.6 (9%), and GI.3 (8%). Compared to non-GII.4 outbreaks, GII.4 outbreaks had higher hospitalization rates (12.8 vs. 4.8 per 1,000 cases, P < 0.01). While contaminated foods were identified and reported in only 35% of outbreaks, molluscan shellfish (4% overall) were more often implicated in non-GII.4 outbreaks than in GII.4 outbreaks (7% vs. 1%, P = 0.04). Of the 240 outbreaks reporting at least one contributing factor, food workers were implicated as the source of contamination in 182 (76%), with no difference between GII.4 and non-GII.4 (73% vs 79%, P = 0.3). Foodborne norovirus outbreaks are frequently reported in the U.S., most of which are caused by GII.4 noroviruses. Viruses of this genotype are associated with higher rates of hospitalization; non-GII.4 noroviruses are more frequently associated with contaminated molluscan shellfish. These surveillance data highlight the diversity of noroviruses causing foodborne disease and can help guide appropriate food safety interventions, including worker hygiene, improved food handling and preparation, and further development of norovirus vaccines.

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Authors+Show Affiliations

Marsh Z
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
Shah MP
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Wikswo ME
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Barclay L
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Kisselburgh H
Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. Atlanta Research and Education Foundation, Atlanta, GA, USA.
Kambhampati A
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. IHRC, Inc., Atlanta, GA, USA.
Cannon JL
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. CDC Foundation, Atlanta, GA, USA.
Parashar UD
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Vinjé J
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Hall AJ
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32231948

Citation

Marsh, Zachary, et al. "Epidemiology of Foodborne Norovirus Outbreaks - United States, 2009-2015." Food Safety (Tokyo, Japan), vol. 6, no. 2, 2018, pp. 58-66.
Marsh Z, Shah MP, Wikswo ME, et al. Epidemiology of Foodborne Norovirus Outbreaks - United States, 2009-2015. Food Saf (Tokyo). 2018;6(2):58-66.
Marsh, Z., Shah, M. P., Wikswo, M. E., Barclay, L., Kisselburgh, H., Kambhampati, A., Cannon, J. L., Parashar, U. D., Vinjé, J., & Hall, A. J. (2018). Epidemiology of Foodborne Norovirus Outbreaks - United States, 2009-2015. Food Safety (Tokyo, Japan), 6(2), 58-66. https://doi.org/10.14252/foodsafetyfscj.2017028
Marsh Z, et al. Epidemiology of Foodborne Norovirus Outbreaks - United States, 2009-2015. Food Saf (Tokyo). 2018;6(2):58-66. PubMed PMID: 32231948.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Epidemiology of Foodborne Norovirus Outbreaks - United States, 2009-2015. AU - Marsh,Zachary, AU - Shah,Minesh P, AU - Wikswo,Mary E, AU - Barclay,Leslie, AU - Kisselburgh,Hannah, AU - Kambhampati,Anita, AU - Cannon,Jennifer L, AU - Parashar,Umesh D, AU - Vinjé,Jan, AU - Hall,Aron J, Y1 - 2018/05/25/ PY - 2017/11/15/received PY - 2018/03/26/accepted PY - 2020/4/2/entrez PY - 2018/5/25/pubmed PY - 2018/5/25/medline KW - food KW - genotypes KW - norovirus KW - outbreaks KW - surveillance SP - 58 EP - 66 JF - Food safety (Tokyo, Japan) JO - Food Saf (Tokyo) VL - 6 IS - 2 N2 - Noroviruses are the leading cause of acute gastroenteritis and foodborne disease in the United States (U.S.). About 1 in 5 reported norovirus outbreaks are spread through foodborne transmission, presenting opportunities for prevention. We describe the epidemiology of U.S. foodborne norovirus outbreaks reported to national surveillance systems, including differences between genotypes. Foodborne outbreaks that occurred during August 2009-July 2015 with norovirus reported as a single confirmed etiology to the National Outbreak Reporting System (NORS) were matched with outbreaks reported to CaliciNet, a U.S. laboratory norovirus outbreak surveillance network. We analyzed these matched outbreaks stratified by genotype for epidemiologic characteristics, including setting, size and duration, health outcomes of case-patients, implicated food, and outbreak contributing factors. Four hundred ninety-three confirmed foodborne norovirus outbreaks were reported in both NORS and CaliciNet. The most common norovirus genotypes reported were GII.4 (52%), GII.6 (9%), and GI.3 (8%). Compared to non-GII.4 outbreaks, GII.4 outbreaks had higher hospitalization rates (12.8 vs. 4.8 per 1,000 cases, P < 0.01). While contaminated foods were identified and reported in only 35% of outbreaks, molluscan shellfish (4% overall) were more often implicated in non-GII.4 outbreaks than in GII.4 outbreaks (7% vs. 1%, P = 0.04). Of the 240 outbreaks reporting at least one contributing factor, food workers were implicated as the source of contamination in 182 (76%), with no difference between GII.4 and non-GII.4 (73% vs 79%, P = 0.3). Foodborne norovirus outbreaks are frequently reported in the U.S., most of which are caused by GII.4 noroviruses. Viruses of this genotype are associated with higher rates of hospitalization; non-GII.4 noroviruses are more frequently associated with contaminated molluscan shellfish. These surveillance data highlight the diversity of noroviruses causing foodborne disease and can help guide appropriate food safety interventions, including worker hygiene, improved food handling and preparation, and further development of norovirus vaccines. SN - 2187-8404 UR - https://www.unboundmedicine.com/medline/citation/32231948/Epidemiology_of_Foodborne_Norovirus_Outbreaks___United_States_2009_2015_ DB - PRIME DP - Unbound Medicine ER -