title: An outbreak of norovirus gastroenteritis associated with wedding cakes.
abstract: We sought to determine the source of a norovirus outbreak among attendees of 46 weddings taking place during a single weekend. Norovirus-compatible illness was experienced by 332 (39%) of wedding guests surveyed; the outbreak affected up to 2700 persons. Illness was associated with eating wedding cake provided by a bakery common to the weddings (adjusted RR 4.5, P<0.001). A cake requiring direct hand contact during its preparation accounted for the majority of illness. At least two bakery employees experienced norovirus-compatible illness during the week preceding the weddings. Identical sequence types of norovirus were detected in stool specimens submitted by two wedding guests, a wedding hall employee, and one of the ill bakery employees. It is likely that one or more food workers at the bakery contaminated the wedding cakes through direct and indirect contact. These findings reinforce the necessity of proper food-handling practices and of policies that discourage food handlers from working while ill.
authors.affiliation: Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: D S
authors.initials: DS
authors.lastname: Friedman
authors.forename: D
authors.initials: D
authors.lastname: Heisey-Grove
authors.forename: F
authors.initials: F
authors.lastname: Argyros
authors.forename: E
authors.initials: E
authors.lastname: Berl
authors.forename: J
authors.initials: J
authors.lastname: Nsubuga
authors.forename: T
authors.initials: T
authors.lastname: Stiles
authors.forename: J
authors.initials: J
authors.lastname: Fontana
authors.forename: R S
authors.initials: RS
authors.lastname: Beard
authors.forename: S
authors.initials: S
authors.lastname: Monroe
authors.forename: M E
authors.initials: ME
authors.lastname: McGrath
authors.forename: H
authors.initials: H
authors.lastname: Sutherby
authors.forename: R C
authors.initials: RC
authors.lastname: Dicker
authors.forename: A
authors.initials: A
authors.lastname: DeMaria
authors.forename: B T
authors.initials: BT
authors.lastname: Matyas
mesh_terms: D004196:Disease Outbreaks; D005506:Food Contamination; D005516:Food Microbiology; D005759:Gastroenteritis / Q000453:epidemiology* / Q000821:virology; D006920:Hygiene / Q000592:standards; D029322:Norovirus / Q000302:isolation & purification*; D012499:Sanitation / Q000592:standards