Abstract
Norovirus (NoV) is the commonest cause of gastrointestinal disease in the United Kingdom and in many developed countries, causing diarrhea and vomiting in millions of cases worldwide annually. Transmission is most often mediated from person to person. NoV infection has, however, additionally been associated with the consumption of food, either through the consumption of food contaminated at source such as seafood, berries, and salad, or as a consequence of the foodstuff being contaminated in some way by a food handler during processing or serving. A systematic review of outbreaks attributed to NoV between January 2003 and July 2017 was conducted to assess the contribution of food handlers to the burden of NoV, and to identify foods commonly associated with NoV outbreaks. A total of 3021 articles were screened, of which 27 met the definition of confirmed foodborne outbreaks and 47 met the criteria for definite food-handler NoV outbreaks. Of all food types, shellfish were implicated in the greatest number of definite foodborne outbreaks. Food handlers contributed to definite food-handler outbreaks involving a diverse range of foodstuffs and in a wide variety of settings, including weddings and military establishments. More genotypes of NoV were found in people who were ill than in samples from food and food handlers. The potential for both food products and food handlers to contribute to the burden of NoV infection is demonstrated conclusively.
Highlights
Norovirus (NoV) is the leading cause of acute gastroenteritis worldwide (Scallan et al, 2011; Tam et al, 2012; Al-Thani et al, 2013) and leads to sudden onset vomiting and diarrhea
Shellfish were implicated in the greatest number of definite foodborne outbreaks
Twenty-seven articles met the criteria for inclusion as NoV -definite foodborne outbreaks document 36 separate incidents
Summary
Norovirus (NoV) is the leading cause of acute gastroenteritis worldwide (Scallan et al, 2011; Tam et al, 2012; Al-Thani et al, 2013) and leads to sudden onset vomiting and diarrhea. Symptoms usually last for 2 to 4 days (Graham et al, 1994; Rockx et al, 2002; Lopman et al, 2004) in healthy adults (Murata et al, 2007). Symptom duration can be longer in hospitalized patients (Lopman et al, 2004; Murata et al, 2007; O’Ryan et al, 2010). Asymptomatic individuals tend to shed NoV in smaller amounts than symptomatic individuals (Bernstein et al, 2015). Viral shedding can occur for 3–14 h before symptom onset (Atmar et al, 2008). Newborn infants can shed virus longer than healthy adults (Atmar et al, 2008). NoV has experimentally survived on surfaces for extended periods of time, enabling long periods of potential exposure (Lamhoujeb et al, 2009; Liu et al, 2009)
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