title: A quantitative exposure model simulating human norovirus transmission during preparation of deli sandwiches.
abstract: Human noroviruses (HuNoVs) are a major cause of food borne gastroenteritis worldwide. They are often transmitted via infected and shedding food handlers manipulating foods such as deli sandwiches. The presented study aimed to simulate HuNoV transmission during the preparation of deli sandwiches in a sandwich bar. A quantitative exposure model was developed by combining the GoldSim® and @Risk® software packages. Input data were collected from scientific literature and from a two week observational study performed at two sandwich bars. The model included three food handlers working during a three hour shift on a shared working surface where deli sandwiches are prepared. The model consisted of three components. The first component simulated the preparation of the deli sandwiches and contained the HuNoV reservoirs, locations within the model allowing the accumulation of NoV and the working of intervention measures. The second component covered the contamination sources being (1) the initial HuNoV contaminated lettuce used on the sandwiches and (2) HuNoV originating from a shedding food handler. The third component included four possible intervention measures to reduce HuNoV transmission: hand and surface disinfection during preparation of the sandwiches, hand gloving and hand washing after a restroom visit. A single HuNoV shedding food handler could cause mean levels of 43±18, 81±37 and 18±7 HuNoV particles present on the deli sandwiches, hands and working surfaces, respectively. Introduction of contaminated lettuce as the only source of HuNoV resulted in the presence of 6.4±0.8 and 4.3±0.4 HuNoV on the food and hand reservoirs. The inclusion of hand and surface disinfection and hand gloving as a single intervention measure was not effective in the model as only marginal reductions of HuNoV levels were noticeable in the different reservoirs. High compliance of hand washing after a restroom visit did reduce HuNoV presence substantially on all reservoirs. The model showed that good handling practices such as washing hands after a restroom visit, hand gloving, hand disinfection and surface disinfection in deli sandwich bars were an effective way to prevent HuNoV contamination of the prepared foods, but it also demonstrated that further research is needed to ensure a better assessment of the risk of HuNoV transmission during preparation of foods.
authors.affiliation: Ghent University, Faculty of Bioscience Engineering, Department of Food Safety and Food Quality, Laboratory of Food Microbiology and Food Preservation, Coupure Links 653, 9000 Ghent, Belgium; Flemish Government, Institute for Agricultural and Fisheries Research, Technology and Food Sciences Unit, Brusselsesteenweg 370, 9090 Melle, Belgium.
authors.forename: Ambroos
authors.initials: A
authors.lastname: Stals
authors.affiliation: Ghent University, Faculty of Bioscience Engineering, Department of Food Safety and Food Quality, Laboratory of Food Microbiology and Food Preservation, Coupure Links 653, 9000 Ghent, Belgium. Electronic address: Liesbeth.Jacxsens@ugent.be.
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Jacxsens
authors.affiliation: Ghent University, Faculty of Bioscience Engineering, Department of Food Safety and Food Quality, Laboratory of Food Microbiology and Food Preservation, Coupure Links 653, 9000 Ghent, Belgium.
authors.forename: Leen
authors.initials: L
authors.lastname: Baert
authors.affiliation: Flemish Government, Institute for Agricultural and Fisheries Research, Technology and Food Sciences Unit, Brusselsesteenweg 370, 9090 Melle, Belgium.
authors.forename: Els
authors.initials: E
authors.lastname: Van Coillie
authors.affiliation: Ghent University, Faculty of Bioscience Engineering, Department of Food Safety and Food Quality, Laboratory of Food Microbiology and Food Preservation, Coupure Links 653, 9000 Ghent, Belgium.
authors.forename: Mieke
authors.initials: M
authors.lastname: Uyttendaele
mesh_terms: D017250:Caliciviridae Infections / Q000517:prevention & control / Q000635:transmission*; D004203:Disinfection / Q000592:standards; D005511:Food Handling / Q000592:standards*; D005759:Gastroenteritis / Q000517:prevention & control; D006801:Humans; D018545:Lactuca / Q000821:virology; D008962:Models, Theoretical; D029322:Norovirus / Q000502:physiology*
keywords: Food preparation; Norovirus; QMRA; Quantitative exposure model; Transmission