Incidence Of Outbreaks Research Articles

Hyperspectral Determination of Fluorescence Wavebands for Multispectral Imaging Detection of Multiple Animal Fecal Species Contaminations on Romaine Lettuce

Consumption of fresh produce has been linked to multiple outbreaks of serious foodborne illnesses over the past two decades, and the popularity growth of ready-to-eat fruit and vegetable products may be related to the increased incidence of produce-related outbreaks. Because the sources of the pathogenic microorganisms most frequently involved in these outbreaks, E. coli O157: H7 and Salmonella, have been attributed primarily to animal fecal matter, research examining routes of fecal contamination and developing methods to prevent them have been areas of recent emphasis. This investigation used non-destructive hyperspectral fluorescence imaging to evaluate relatively simple spectral classification algorithms—using single wavebands or two-band ratios—for detecting animal feces contamination on leafy greens. In particular, this study sought to detect and discriminate between feces contamination from four animal species on romaine lettuce leaves. Single fluorescence wavebands found to be effective for discriminating feces from dairy cattle, pig, chicken, and sheep were F641 nm, F505 nm, F633 nm, and F645 nm, respectively. A two-band ratio in the range of F664 ± 4 nm/F694 ± 2 nm was shown to have a detection accuracy of over 93% for undiluted feces and 1:20 and 1:50 fecal dilutions for three of the four fecal species. The spectral bands identified in this hyperspectral imaging study can be implemented for use in a relatively simple portable hand-held imaging device for on-site safety evaluation of produce in the field.

Disinfection of Ultrasound Transducers Using Non-Sterile Tissue Paper in Some Low-Cost Private Ultrasound Centres in Nigeria – Implications for Nosocomial Infection Management

Background/Aims: The incidence of disease outbreaks in clinical settings arising from ultrasound examinations is well documented, and is a source of worry. The ultrasound transducers and the coupling gel are potential sources of these infections since they come in direct contact with the patient’s skin. In this study, we examine the efficacy of the widespread practice of the use of plain non-sterile tissue paper in some low-cost private ultrasound centres in our locality as a method of disinfecting ultrasound transducers after each use. Its potential impact on nosocomial infection management in clinical practice is also examined. Methods: Swab samples from convex ultrasound transducers before and after transabdominal scanning of three consecutive patients were obtained from 10 different ultrasound centres in urban and rural areas of Enugu state. Ultrasound coupling gel samples were equally obtained, and all samples cultured for bacteria growth which was quantified in colony-forming units per ml (CFU/ml) and reported in 1000/ml. Paired sampled t-test was used to check for significance in a reduction in a bacterial load before and after the transducer was cleaned. Results: Nine different bacterial strains were isolated. Staphylococcus aureus and Klebsiella spp had the highest percentage of occurrence in all centres. Significant bacteria growth was recorded in the morning before the examination, and plain tissue paper significantly reduced the bacteria load in the ultrasound transducer. Conclusion: Even though disinfecting ultrasound transducers with non-sterile plain tissue paper alone is statistically effective and has the potential to minimize nosocomial infection, it is however not clinically effective and hence not advised.

Disinfection of Ultrasound Transducers Using Non-Sterile Tissue Paper in Some Low-Cost Private Ultrasound Centres in Nigeria – Implications for Nosocomial Infection Management

Background/Aims: The incidence of disease outbreaks in clinical settings arising from ultrasound examinations is well documented, and is a source of worry. The ultrasound transducers and the coupling gel are potential sources of these infections since they come in direct contact with the patient’s skin. In this study, we examine the efficacy of the widespread practice of the use of plain non-sterile tissue paper in some low-cost private ultrasound centres in our locality as a method of disinfecting ultrasound transducers after each use. Its potential impact on nosocomial infection management in clinical practice is also examined. Methods: Swab samples from convex ultrasound transducers before and after transabdominal scanning of three consecutive patients were obtained from 10 different ultrasound centres in urban and rural areas of Enugu state. Ultrasound coupling gel samples were equally obtained, and all samples cultured for bacteria growth which was quantified in colony-forming units per ml (CFU/ml) and reported in 1000/ml. Paired sampled t-test was used to check for significance in a reduction in the bacterial load before and after the transducer was cleaned. Results: Nine different bacterial strains were isolated. Staphylococcus aureus and Klebsiella spp had the highest percentage of occurrence in all centres. Significant bacteria growth was recorded in the morning before the examination, and plain tissue paper significantly reduced the bacteria load in the ultrasound transducer. Conclusion: Even though disinfecting ultrasound transducers with non-sterile plain tissue paper alone is statistically effective and has the potential to minimize nosocomial infection, it is however not clinically effective and hence not advised.

Bridging Crop Diversity and Market Development in the Northeast Grain Renaissance

The local food movement has grown significantly over the past several years, producing and marketing fresh fruits and vegetables, and meat and dairy. Recently there has been a push in the Northeastern U.S. to grow small grains, primarily high-protein wheat varieties for baking bread and for malting barley for brewing and distilling, for local and regional markets. University researchers, nonprofit organizations, and government institutions are supporting this advance in the regional food system by working with farmers to increase production of these crops and develop markets for their sale. This paper argues that these farming systems, starting with the early stages of field crop production work, should include diverse crop rotations that will provide farmers with multiple revenue streams, improve soil quality, and reduce the incidence and severity of pest outbreaks. Consumers in the existing and developing regional grain market will benefit from increased availability of fresh, flavorful, and healthy grains, beans, and oilseeds. The paper draws connections between the farming, research, and market-development communities that are working toward improved farm biodiversity.

Multiple introductions of reassorted highly pathogenic avian influenza viruses (H5N8) clade 2.3.4.4b causing outbreaks in wild birds and poultry in Egypt

Recently, an increased incidence of outbreaks of highly pathogenic avian influenza (HPAI) H5N8 in poultry linked to infected migratory birds has been reported from different European, Asian and African countries.In Egypt, incursion of HPAI H5N8 virus of clade 2.3.4.4b has been recently registered. Full genomic characterization of 3 virus isolates from wild birds and poultry (backyard and commercial farm sectors) showed high nucleotide similarity among the HA, NA, M, and NS gene segments of the three Egyptian HPAI H5N8 viruses, indicating that they are descendants of a common ancestral virus. However, the analyzed Egyptian H5N8 viruses revealed distinct genotypes involving different origins of the PB2, PB1, PA and/or NP segments. In genotype-1 represented by strain A/common-coot/Egypt/CA285/2016 the PB2 and NP segments showed closest relationship to H5N6 and H6N2 viruses, recently detected in Italy. The second is replacement of PB1 and NP genes A novel reassortant, represented by strain A/duck/Egypt/SS19/2017, showed an exchange of PB1 and NP genes which might have originated from H6N8 or H1N1 and H6N2 viruses. Finally, replacement of PA and NP genes characterized strain A/duck/Egypt/F446/2017. Bayesian phylogeographic analyses revealed that Egyptian H5N8 viruses are highly likely derived from Russian 2016 HPAI H5N8 virus (A/great_crested_grebe/Uvs-Nuur_Lake/341/2016 (H5N8)) and the reassortment likely occurred before incursion to Egypt.

The use of ambient humidity conditions to improve influenza forecast.

Laboratory and epidemiological evidence indicate that ambient humidity modulates the survival and transmission of influenza. Here we explore whether the inclusion of humidity forcing in mathematical models describing influenza transmission improves the accuracy of forecasts generated with those models. We generate retrospective forecasts for 95 cities over 10 seasons in the United States and assess both forecast accuracy and error. Overall, we find that humidity forcing improves forecast performance (at 1–4 lead weeks, 3.8% more peak week and 4.4% more peak intensity forecasts are accurate than with no forcing) and that forecasts generated using daily climatological humidity forcing generally outperform forecasts that utilize daily observed humidity forcing (4.4% and 2.6% respectively). These findings hold for predictions of outbreak peak intensity, peak timing, and incidence over 2- and 4-week horizons. The results indicate that use of climatological humidity forcing is warranted for current operational influenza forecast.

Temporal and spatial distribution of lumpy skin disease outbreaks in Ethiopia in the period 2000 to 2015

BackgroundLumpy skin disease (LSD) is an infectious viral disease of cattle caused by a virus of the genus Capripoxvirus. LSD was reported for the first time in Ethiopia in 1981 and subsequently became endemic. This time series study was undertaken with the aims of identifying the spatial and temporal distribution of LSD outbreaks and to forecast the future pattern of LSD outbreaks in Ethiopia.ResultsA total of 3811 LSD outbreaks were reported in Ethiopia between 2000 and 2015. In this period, LSD was reported at least once in 82% of the districts (n = 683), 88% of the administrative zones (n = 77), and all of the regional states or city administrations (n = 9 and n = 2) in the country. The average incidence of LSD outbreaks at district level was 5.58 per 16 years (0.35 year−1). The incidence differed between areas, being the lowest in hot dry lowlands and highest in warm moist highland. The occurrence of LSD outbreaks was found to be seasonal. LSD outbreaks generally have a peak in October and a low in May. The trend of LSD outbreaks indicates a slight, but statistically significant increase over the study period. The monthly precipitation pattern is the reverse of LSD outbreak pattern and they are negatively but non-significantly correlated at lag 0 (r = −0.05, p = 0.49, Spearman rank correlation) but the correlation becomes positive and significant when the series are lagged by 1 to 6 months, being the highest at lag 3 (r = 0.55, p < 0.001). The forecast for the period 2016–2018 revealed that the highest number of LSD outbreaks will occur in October for all the 3 years and the lowest in April for the year 2016 and in May for 2017 and 2018.ConclusionLSD occurred in all major parts of the country. Outbreaks were high at the end of the long rainy season. Understanding temporal and spatial patterns of LSD and forecasting future occurrences are useful for indicating periods when particular attention should be paid to prevent and control the disease.

The effect of environmental parameters on the incidence of Shigella outbreaks in Yazd province, Iran

Abstract Climate changes have a profound effect on human health, especially when infectious diseases are concerned. Variable factors including temperature, precipitation, and relative humidity directly influence the magnitude and frequency of water-borne pathogen transfers. In this study, we determined the long-term temporal trends and seasonal patterns of shigellosis and evaluated the effects of demographic and climatic factors on its incidence in Yazd province, Iran, during 2012 through 2015. The incidence of shigellosis was highest among patients in the age group of 6–20 years and peaked in every summer of the years studied, especially during August. Furthermore, there was a significant association between climatic variables (such as monthly temperature, humidity, and atmospheric dust) and the incidence of shigellosis. However, contrary to expectations, rainfall did not affect incidence of the disease. The transmission of Shigella to humans is a complex ecological process. Socio-economic factors and lifestyle behaviours need to be addressed in future studies.

Fine-temporal forecasting of outbreak probability and severity: Ross River virus in Western Australia.

Health warnings of mosquito-borne disease risk require forecasts that are accurate at fine-temporal resolutions (weekly scales); however, most forecasting is coarse (monthly). We use environmental and Ross River virus (RRV) surveillance to predict weekly outbreak probabilities and incidence spanning tropical, semi-arid, and Mediterranean regions of Western Australia (1991-2014). Hurdle and linear models were used to predict outbreak probabilities and incidence respectively, using time-lagged environmental variables. Forecast accuracy was assessed by model fit and cross-validation. Residual RRV notification data were also examined against mitigation expenditure for one site, Mandurah 2007-2014. Models were predictive of RRV activity, except at one site (Capel). Minimum temperature was an important predictor of RRV outbreaks and incidence at all predicted sites. Precipitation was more likely to cause outbreaks and greater incidence among tropical and semi-arid sites. While variable, mitigation expenditure coincided positively with increased RRV incidence (r 2 = 0·21). Our research demonstrates capacity to accurately predict mosquito-borne disease outbreaks and incidence at fine-temporal resolutions. We apply our findings, developing a user-friendly tool enabling managers to easily adopt this research to forecast region-specific RRV outbreaks and incidence. Approaches here may be of value to fine-scale forecasting of RRV in other areas of Australia, and other mosquito-borne diseases.

Evaluation of different methods for DNA extraction from human burnt bones and the generation of genetic profiles for identification.

Bone exposure to heat in the presence of moisture breaks the phosphodiester bonds of the backbone, leaving sheared DNA in bone cells. This also limits the possibility of generating a complete profile of the victim. With the increasing incidence of fire outbreaks over the past few years, a paradigm shift to establish identity has been observed, from morphological identification of victims to STR profiling. For this study, 10 bone samples were taken from burnt human bodies that were recovered from different fire outbreak scenes. The DNA from these burnt human tissues was isolated using four different extraction methods: the organic extraction method, the total demineralisation method, the Qiagen kit method, and the Chelex extraction method. STR profiles of victims were generated on a genetic analyser using an AmpFlSTR Identifiler® Plus Kit and analysed on Gene Mapper ID-X. DNA isolated from bones using the total demineralisation extraction method and organic extraction method was of the highest quality due to the efficient removal of inhibitors. DNA obtained using these two methods successfully generated the STR profiles of the victims. The quality of isolated DNA obtained through the Qiagen kit was comparatively low, but STR profiles of the victims were successfully generated. The Chelex kit failed to extract good quality DNA of high quantity from the burnt bones, encountering inhibition in all samples at varying degrees. This study concludes that total demineralisation and the Qiagen kit are sophisticated and reliable methods to obtain a good yield of DNA from burnt human bones, which can be used for the identification of victims.

Economic factors influencing zoonotic disease dynamics: demand for poultry meat and seasonal transmission of avian influenza in Vietnam

While climate is often presented as a key factor influencing the seasonality of diseases, the importance of anthropogenic factors is less commonly evaluated. Using a combination of methods – wavelet analysis, economic analysis, statistical and disease transmission modelling – we aimed to explore the influence of climatic and economic factors on the seasonality of H5N1 Highly Pathogenic Avian Influenza in the domestic poultry population of Vietnam. We found that while climatic variables are associated with seasonal variation in the incidence of avian influenza outbreaks in the North of the country, this is not the case in the Centre and the South. In contrast, temporal patterns of H5N1 incidence are similar across these 3 regions: periods of high H5N1 incidence coincide with Lunar New Year festival, occurring in January-February, in the 3 climatic regions for 5 out of the 8 study years. Yet, daily poultry meat consumption drastically increases during Lunar New Year festival throughout the country. To meet this rise in demand, poultry production and trade are expected to peak around the festival period, promoting viral spread, which we demonstrated using a stochastic disease transmission model. This study illustrates the way in which economic factors may influence the dynamics of livestock pathogens.

Awareness, concern and willingness to adopt biosecure behaviours: public perceptions of invasive tree pests and pathogens in the UK

The growing incidence of invasive tree pest and disease outbreaks is recognised as an increasing threat to ecosystem services and human wellbeing. Linked to global trade, human movement and climate change, a number of outbreaks have attracted high public and media attention. However, there is surprisingly little evidence characterising the nature of public attentiveness to these events, nor how publics might respond to evolving outbreaks and the management actions taken. This paper presents findings from an online questionnaire involving 1334 respondents nationally-representative of the British public to assess awareness, concern and willingness to adopt biosecure behaviours. Despite revealing low levels of awareness and knowledge, the results indicate that the British public is concerned about the health of trees, forests and woodlands and is moderately willing to adopt biosecure behaviours. A key finding is that membership of environmental organisations and strong place identity are likely to engender higher awareness and levels of concern about tree pests and diseases. Further, those who visit woodlands regularly are likely to be more aware than non-visitors, and gardeners are more likely to be concerned than non-gardeners. Women, older respondents, those with strong place identity and dependence, members of environmental organisations, woodland visitors and gardeners were most likely to express a willingness to adopt biosecure behaviours. A comparison with findings from a survey conducted by the authors 3 years previously shows a decline over time in awareness, concern and willingness.

Societal impact of dengue outbreaks: Stakeholder perceptions and related implications. A qualitative study in Brazil, 2015.

BackgroundThe growing burden of dengue in many countries worldwide and the difficulty of preventing outbreaks have increased the urgency to identify alternative public health management strategies and effective approaches to control and prevent dengue outbreaks. The objectives of this study were to understand the impact of dengue outbreak on different stakeholders in Brazil, to explore their perceptions of approaches used by governmental authorities to control and prevent dengue outbreaks and to define the challenges and implications of preventing future outbreaks.MethodsIn 2015, a qualitative study was conducted in two urban states in Brazil: São Paulo, which was experiencing an outbreak in 2015, and Rio de Janeiro, which experienced outbreaks in 2011 and 2012. Face-to-face interviews using a semi-structured questionnaire were conducted with nine different categories of stakeholders: health workers (physicians, nurses), hospital administrators, municipal government representatives, community members and leaders, school administrators, business leaders and vector control managers. Interviews were focused on the following areas: impact of the dengue outbreak, perceptions of control measures implemented by governmental authorities during outbreaks and challenges in preventing future dengue outbreaks.ResultsA total of 40 stakeholders were included in the study. Health workers and community members reported longer waiting times at hospitals due to the increased number of patients receiving care for dengue-related symptoms. Health workers and hospital administrators reported that there were no major interruptions in access to care. Overall financial impact of dengue outbreaks on households was greatest for low-income families. Despite prevention and control campaigns implemented between outbreak periods, various stakeholders reported that dengue prevention and control efforts performed by municipal authorities remained insufficient, suggesting that efforts should be reinforced and better coordinated by governmental authorities, particularly during outbreak periods.ConclusionThe study shows that a dengue outbreak has a multisectorial impact in the medical, societal, economic and political sectors. The study provides useful insights and knowledge in different stakeholder populations that could guide local authorities and government officials in planning, designing and initiating public health programs. Research focused on a better understanding of how communities and political authorities respond to dengue outbreaks is a necessary component for designing and implementing plans to decrease the incidence and impact of dengue outbreaks in Brazil.

Framing Childhood Vaccination in the United States: Getting Past Polarization in the Public Discourse

Vaccination rates in some areas of the United States are decreasing. Decreases are slight but significant: the incidence of vaccine preventible disease outbreaks has risen. Vaccination is, once aga...

Known Predators of Crown-of-Thorns Starfish (Acanthaster spp.) and Their Role in Mitigating, If Not Preventing, Population Outbreaks

Predatory release has long been considered a potential contributor to population outbreaks of crown-of-thorns starfish (CoTS; Acanthaster spp.). This has initiated extensive searches for potentially important predators that can consume large numbers of CoTS at high rates, which are also vulnerable to over-fishing or reef degradation. Herein, we review reported predators of CoTS and assess the potential for these organisms to exert significant mortality, and thereby prevent and/or moderate CoTS outbreaks. In all, 80 species of coral reef organisms (including fishes, and motile and sessile invertebrates) are reported to predate on CoTS gametes (three species), larvae (17 species), juveniles (15 species), adults (18 species) and/or opportunistically feed on injured (10 species) or moribund (42 species) individuals within reef habitats. It is clear however, that predation on early life-history stages has been understudied, and there are likely to be many more species of reef fishes and/or sessile invertebrates that readily consume CoTS gametes and/or larvae. Given the number and diversity of coral reef species that consume Acanthaster spp., most of which (e.g., Arothron pufferfishes) are not explicitly targeted by reef-based fisheries, links between overfishing and CoTS outbreaks remain equivocal. There is also no single species that appears to have a disproportionate role in regulating CoTS populations. Rather, the collective consumption of CoTS by multiple different species and at different life-history stages is likely to suppress the local abundance of CoTS, and thereby mediate the severity of outbreaks. It is possible therefore, that general degradation of reef ecosystems and corresponding declines in biodiversity and productivity, may contribute to increasing incidence or severity of outbreaks of Acanthaster spp. However, it seems unlikely that predatory release in and of itself could account for initial onset of CoTS outbreaks. In conclusion, reducing anthropogenic stressors that reduce the abundance and/or diversity of potential predatory species represents a “no regrets” management strategy, but will need to be used in conjunction with other management strategies to prevent, or reduce the occurrence, of CoTS outbreaks.

Aflatoxins: A Global Concern for Food Safety, Human Health and Their Management.

The aflatoxin producing fungi, Aspergillus spp., are widely spread in nature and have severely contaminated food supplies of humans and animals, resulting in health hazards and even death. Therefore, there is great demand for aflatoxins research to develop suitable methods for their quantification, precise detection and control to ensure the safety of consumers’ health. Here, the chemistry and biosynthesis process of the mycotoxins is discussed in brief along with their occurrence, and the health hazards to humans and livestock. This review focuses on resources, production, detection and control measures of aflatoxins to ensure food and feed safety. The review is informative for health-conscious consumers and research experts in the fields. Furthermore, providing knowledge on aflatoxins toxicity will help in ensure food safety and meet the future demands of the increasing population by decreasing the incidence of outbreaks due to aflatoxins.

Two-Phase Hospital-Associated Outbreak of Mycobacterium abscessus: Investigation and Mitigation.

Nontuberculous mycobacteria (NTM) commonly colonize municipal water supplies and cause healthcare-associated outbreaks. We investigated a biphasic outbreak of Mycobacterium abscessus at a tertiary care hospital. Case patients had recent hospital exposure and laboratory-confirmed colonization or infection with M. abscessus from January 2013 through December 2015. We conducted a multidisciplinary epidemiologic, field, and laboratory investigation. The incidence rate of M. abscessus increased from 0.7 cases per 10000 patient-days during the baseline period (January 2013-July 2013) to 3.0 cases per 10000 patient-days during phase 1 of the outbreak (August 2013-May 2014) (incidence rate ratio, 4.6 [95% confidence interval, 2.3-8.8]; P < .001). Thirty-six of 71 (51%) phase 1 cases were lung transplant patients with positive respiratory cultures. We eliminated tap water exposure to the aerodigestive tract among high-risk patients, and the incidence rate decreased to baseline. Twelve of 24 (50%) phase 2 (December 2014-June 2015) cases occurred in cardiac surgery patients with invasive infections. Phase 2 resolved after we implemented an intensified disinfection protocol and used sterile water for heater-cooler units of cardiopulmonary bypass machines. Molecular fingerprinting of clinical isolates identified 2 clonal strains of M. abscessus; 1 clone was isolated from water sources at a new hospital addition. We made several water engineering interventions to improve water flow and increase disinfectant levels. We investigated and mitigated a 2-phase clonal outbreak of M. abscessus linked to hospital tap water. Healthcare facilities with endemic NTM should consider similar tap water avoidance and engineering strategies to decrease risk of NTM infection.

Innovative sandwich assay with dual optical and SERS sensing mechanisms for bacterial detection

The increased incidence of food pathogen outbreaks placed a new emphasis on the requirement of a rapid, sensitive, and reliable detection method for pathogens in food samples.

Incidence of Hospital Norovirus Outbreaks and Infections Using 2 Surveillance Methods in Sweden.

OBJECTIVE To evaluate 2 different methods of surveillance and to estimate the incidence of norovirus (NoV) outbreaks in hospitals. DESIGN Prospective observational study. SETTING All 194 hospital wards in southern Sweden during 2 winter seasons (2010-2012). METHODS Clinical surveillance based on outbreak reports of 2 or more clinical cases, with symptom onset within 5 days, was compared with laboratory surveillance based on positive NoV results among inpatients. At least 2 NoV positive patients sampled within 5 days at a ward defined a cluster. Outbreak reports including at least 1 NoV positive case and clusters including at least 1 NoV positive patient with 5 or more days from ward admission to sampling were defined as NoV outbreaks. RESULTS During the study periods 135 NoV outbreaks were identified; 74 were identified by both clinical and laboratory surveillance, 18 were identified only by outbreak reports, and 43 were identified only by laboratory surveillance. The outbreak incidence was 1.0 (95% CI, 0.8-1.2) and 0.5 (95% CI, 0.3-0.6) per 1,000 admissions for the 2 different seasons, respectively. To correctly identify NoV outbreaks, the sensitivity and positive predictive value of the clinical surveillance were 68% and 88% and of the laboratory surveillance were 86% and 81%, respectively. CONCLUSION The addition of laboratory surveillance significantly improves outbreak surveillance and provides a more complete estimate of NoV outbreaks in hospitals. Laboratory surveillance can be recommended for evaluation of clinical surveillance. Infect Control Hosp Epidemiol 2016;1-7.

A State-by-State Assessment of Food Service Regulations for Prevention of Norovirus Outbreaks

Noroviruses are the leading cause of foodborne disease in the United States. Foodborne transmission of norovirus is often associated with contamination of food during preparation by an infected food worker. The U.S. Food and Drug Administration's Food Code provides model food safety regulations for preventing transmission of foodborne disease in restaurants; however, adoption of specific provisions is at the discretion of state and local governments. We analyzed the food service regulations of all 50 states and the District of Columbia (i.e., 51 states) to describe differences in adoption of norovirus-related Food Code provisions into state food service regulations. We then assessed potential correlations between adoption of these regulations and characteristics of foodborne norovirus outbreaks reported to the National Outbreak Reporting System from 2009 through 2014. Of the 51 states assessed, all (100%) required food workers to wash their hands, and 39 (76%) prohibited bare-hand contact with ready-to-eat food. Thirty states (59%) required exclusion of staff with vomiting and diarrhea until 24 h after cessation of symptoms. Provisions requiring a certified food protection manager (CFPM) and a response plan for contamination events (i.e., vomiting) were least commonly adopted; 26 states (51%) required a CFPM, and 8 (16%) required a response plan. Although not statistically significant, states that adopted the provisions prohibiting bare-hand contact (0.45 versus 0.74, P =0.07), requiring a CFPM (0.38 versus 0.75, P =0.09), and excluding ill staff for ≥24 h after symptom resolution (0.44 versus 0.73, P =0.24) each reported fewer foodborne norovirus outbreaks per million person-years than did those states without these provisions. Adoption and compliance with federal recommended food service regulations may decrease the incidence of foodborne norovirus outbreaks.