title: Epidemiology of foodborne norovirus outbreaks, United States, 2001-2008.
abstract: Noroviruses are the leading cause of foodborne illness in the United States. To better guide interventions, we analyzed 2,922 foodborne disease outbreaks for which norovirus was the suspected or confirmed cause, which had been reported to the Foodborne Disease Outbreak Surveillance System of the Centers for Disease Control and Prevention during 2001-2008. On average, 365 foodborne norovirus outbreaks were reported annually, resulting in an estimated 10,324 illnesses, 1,247 health care provider visits, 156 hospitalizations, and 1 death. In 364 outbreaks attributed to a single commodity, leafy vegetables (33%), fruits/nuts (16%), and mollusks (13%) were implicated most commonly. Infected food handlers were the source of 53% of outbreaks and may have contributed to 82% of outbreaks. Most foods were likely contaminated during preparation and service, except for mollusks, and occasionally, produce was contaminated during production and processing. Interventions to reduce the frequency of foodborne norovirus outbreaks should focus on food workers and production of produce and shellfish.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. ajhall@cdc.gov
authors.forename: Aron J
authors.initials: AJ
authors.lastname: Hall
authors.forename: Valerie G
authors.initials: VG
authors.lastname: Eisenbart
authors.forename: Amy Lehman
authors.initials: AL
authors.lastname: Etingüe
authors.forename: L Hannah
authors.initials: LH
authors.lastname: Gould
authors.forename: Ben A
authors.initials: BA
authors.lastname: Lopman
authors.forename: Umesh D
authors.initials: UD
authors.lastname: Parashar
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000821:virology; D002487:Centers for Disease Control and Prevention, U.S.; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D005506:Food Contamination; D005511:Food Handling / Q000379:methods; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000209:etiology / Q000821:virology*; D005638:Fruit / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008974:Mollusca / Q000821:virology; D029322:Norovirus / Q000302:isolation & purification*; D011159:Population Surveillance / Q000379:methods; D012758:Shellfish / Q000821:virology; D014481:United States / Q000453:epidemiology; D014675:Vegetables / Q000821:virology; D055815:Young Adult