title: An outbreak of norovirus GI-6 infection following a wedding in North West England.
abstract: In August 2015 a gastroenteritis outbreak occurred following a wedding. An outbreak investigation was undertaken and a cohort study was conducted using an online survey. Of 140 guests, 134 received the survey and 113 responded (84·3% response rate). Seventy respondents met the case definition of vomiting and/or diarrhoea within 72 h of the wedding (61·9% attack rate). Fifteen exposures were associated with illness; on stratification, all were confounded by the ham hock starter. Multivariable analysis showed a significant association with exposure to ham hock (risk ratio 6·62, 95% confidence interval 2·19-20·03). Eight guests and two catering staff submitted stool samples. All tested positive for norovirus GI-6 infection, including a food handler who had vomiting less than 48 h before the wedding. A single genotype was detected among all samples, suggesting a single source of contamination. The transmission pattern suggested point-source exposure. The most plausible cause of the outbreak was transmission from an infected food handler via contaminated food. This highlights the importance of appropriate exclusions for symptomatic food handlers. Additionally, the food handler's stool sample was submitted 7 days after symptom resolution. The potential for extended viral excretion, and the extremely low infective dose of norovirus, may mean that current exclusion guidelines are not of sufficient duration.
authors.affiliation: Health Protection Team,Public Health England,North West,UK.
authors.forename: K C
authors.initials: KC
authors.lastname: Smith
authors.affiliation: Field Epidemiology Service,National Infections Service,Public Health England,Liverpool,UK.
authors.forename: T
authors.initials: T
authors.lastname: Inns
authors.affiliation: Field Epidemiology Service,National Infections Service,Public Health England,Liverpool,UK.
authors.forename: V
authors.initials: V
authors.lastname: Decraene
authors.affiliation: Food Water and Environmental Microbiology Laboratory,Public Health England,Preston,UK.
authors.forename: A
authors.initials: A
authors.lastname: Fox
authors.affiliation: NIHR Health Protection Research Unit in Gastrointestinal Infections,UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Allen
authors.affiliation: Health Protection Team,Public Health England,North West,UK.
authors.forename: A
authors.initials: A
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D018562:Disease Transmission, Infectious; D004739:England / Q000453:epidemiology; D005243:Feces / Q000821:virology; D005260:Female; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000821:virology; D005759:Gastroenteritis / Q000453:epidemiology* / Q000821:virology; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D029322:Norovirus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Caliciviruses; Norwalk agent and related viruses; gastrointestinal infections; outbreaks