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.
Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Parashar
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Dow
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Fankhauser
C D
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Humphrey
J
J
Miller
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T
Ando
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Williams
C R
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Eddy
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Noel
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Ingram
J S
JS
Bresee
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Monroe
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Glass
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