title: A State-by-State Assessment of Food Service Regulations for Prevention of Norovirus Outbreaks.
abstract: Noroviruses are the leading cause of foodborne disease in the United States. Foodborne transmission of norovirus is often associated with contamination of food during preparation by an infected food worker. The U.S. Food and Drug Administration's Food Code provides model food safety regulations for preventing transmission of foodborne disease in restaurants; however, adoption of specific provisions is at the discretion of state and local governments. We analyzed the food service regulations of all 50 states and the District of Columbia (i.e., 51 states) to describe differences in adoption of norovirus-related Food Code provisions into state food service regulations. We then assessed potential correlations between adoption of these regulations and characteristics of foodborne norovirus outbreaks reported to the National Outbreak Reporting System from 2009 through 2014. Of the 51 states assessed, all (100%) required food workers to wash their hands, and 39 (76%) prohibited bare-hand contact with ready-to-eat food. Thirty states (59%) required exclusion of staff with vomiting and diarrhea until 24 h after cessation of symptoms. Provisions requiring a certified food protection manager (CFPM) and a response plan for contamination events (i.e., vomiting) were least commonly adopted; 26 states (51%) required a CFPM, and 8 (16%) required a response plan. Although not statistically significant, states that adopted the provisions prohibiting bare-hand contact (0.45 versus 0.74, P =0.07), requiring a CFPM (0.38 versus 0.75, P =0.09), and excluding ill staff for ≥24 h after symptom resolution (0.44 versus 0.73, P =0.24) each reported fewer foodborne norovirus outbreaks per million person-years than did those states without these provisions. Adoption and compliance with federal recommended food service regulations may decrease the incidence of foodborne norovirus outbreaks.
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333.|Oak Ridge Institute for Science and Education, Oak Ridge 37830, Tennessee, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Kambhampati
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333.|Oak Ridge Institute for Science and Education, Oak Ridge 37830, Tennessee, USA.
authors.forename: Kayoko
authors.initials: K
authors.lastname: Shioda
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333.
authors.forename: L Hannah
authors.initials: LH
authors.lastname: Gould
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333.
authors.forename: Donald
authors.initials: D
authors.lastname: Sharp
authors.affiliation: National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30333.
authors.forename: Laura G
authors.initials: LG
authors.lastname: Brown
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333.
authors.forename: Umesh D
authors.initials: UD
authors.lastname: Parashar
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333.
authors.forename: Aron J
authors.initials: AJ
authors.lastname: Hall
mesh_terms: D017250:Caliciviridae Infections / Q000821:virology*; D004196:Disease Outbreaks; D004219:District of Columbia; D005506:Food Contamination; D005517:Foodborne Diseases / Q000517:prevention & control; D005759:Gastroenteritis / Q000453:epidemiology; D006801:Humans; D029322:Norovirus; D014481:United States
keywords: Food service; Norovirus; Prevention; Regulation; Retail food code