An outbreak of viral gastroenteritis associated with consumption of sandwiches: implications for the control of transmission by food handlers.
Although food handlers are often implicated as the source of infection in outbreaks of food-borne viral gastroenteritis, little is known about the timing of infectivity in relation to illness. We investigated a gastroenteritis outbreak among employees of a manufacturing company and found an association (RR = 14.1, 95% CI = 2.0-97.3) between disease and eating sandwiches prepared by 6 food handlers, 1 of whom reported gastroenteritis which had subsided 4 days earlier. Norwalk-like viruses were detected by electron microscopy or reverse transcriptase-polymerase chain reaction (RT-PCR) in stool specimens from several company employees, the sick food handler whose specimen was obtained 10 days after resolution of illness, and an asymptomatic food handler. All RT-PCR product sequences were identical, suggesting a common source of infection. These data support observations from recent volunteer studies that current recommendations to exclude food handlers from work for 48-72 h after recovery from illness may not always prevent transmission of Norwalk-like viruses because virus can be shed up to 10 days after illness or while exhibiting no symptoms.
Parashar
U D
UD
Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Dow
L
L
Fankhauser
R L
RL
Humphrey
C D
CD
Miller
J
J
Ando
T
T
Williams
K S
KS
Eddy
C R
CR
Noel
J S
JS
Ingram
T
T
Bresee
J S
JS
Monroe
S S
SS
Glass
R I
RI
D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D004196:Disease Outbreaks; D005511:Food Handling; D005516:Food Microbiology; D005759:Gastroenteritis / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D009663:Norwalk virus / Q000302:isolation & purification*; D020133:Reverse Transcriptase Polymerase Chain Reaction