Today in norovirus news

Winter vomiting virus, noro, Norwalk, whatever you want to call it, is all the rage right now. There are so many outbreaks it’s hardly new and novel.

Today, two schools in Denver shut due to an outbreak. And one in Florida.10849902_719581291471357_3442145704847569295_n1-300x3001-300x300-1

A hotel in Ireland also closed for to control the virus through cleaning and disinfection after residents, staff and guests came down with gastrointestinal illness symptoms. Sounds like a memorable wedding.


Seek and ye shall find: Shiga-toxin producing E. coli sources of most USDA outbreaks

The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) works closely with federal, state, and local public health partners to investigate foodborne illness outbreaks associated with its regulated products.

regulators-younggunmountupTo provide insight into outbreaks associated with meat and poultry, outbreaks reported to FSIS during fiscal years 2007 through 2012 were evaluated.

Outbreaks were classified according to the strength of evidence linking them to an FSIS-regulated product and by their epidemiological, etiological, and vehicle characteristics. Differences in outbreak characteristics between the period 2007 through 2009 and the period 2010 through 2012 were assessed using a chi-square test or Mann-Whitney U test.

Of the 163 reported outbreaks eligible for analysis, 89 (55%) were identified as possibly linked to FSIS-regulated products and 74 (45%) were definitively linked to FSIS-regulated products. Overall, these outbreaks were associated with 4,132 illnesses, 772 hospitalizations, and 19 deaths.

Shiga toxin–producing Escherichia coli was associated with the greatest proportion of reported outbreaks (55%), followed by Salmonella enterica (34%) and Listeria monocytogenes (7%). Meat and poultry products commercially sold as raw were linked to 125 (77%) outbreaks, and of these, 105 (80%) involved beef. Over the study period, the number of reported outbreaks definitively linked to FSIS-regulated products (P = 0.03) declined, while the proportion of culture-confirmed cases (P = 0.0001) increased.

Our findings provide insight into the characteristics of outbreaks associated with meat and poultry products.

Foodborne outbreaks reported to the U.S. Food Safety and Inspection Service, fiscal years 2007 through 2012

Journal of Food Protection, Number 3, March 2016, Pages 442-447, DOI:

Robertson, A. Green, L. Allen, T. Ihry, P. White, W. S. Chen, A. Douris, and J. Levine

UPI gets into the Buzzfeed list business: Notable E. coli outbreaks in U.S. fast food restaurants

Most of the U.S. mainstream food safety news coming through Google Alerts over the last week has been recycled and Chipotle-related.

Much of the focus has been on the business with the same questions are being asked by many journos: Will the fast casual Mexican restaurant rebound? What will happen to their stocks? When can we eat there again? Sorta lost in the media are the stories of the folks who went to grab a lunch and ended up ill. The folks that couldn’t go to work, missed life events and may have a long recovery. The affected have been digested down to a list of numbers.Jimmy-Johns-Gourmet-sandwiches

UPI gets into the food safety list business and revisits stigma-creating events over the past 30+ years, here are some highlights:

McDonald’s (1982)
Nearly 50 people in Oregon and Michigan fell ill after eating burgers at McDonald’s. The confirmed outbreak was the first time E. coli O157:H7 was linked to food poisoning, but wouldn’t be the last time ground beef would be recalled for outbreaks of the dangerous pathogen, including Topps Meat Co. recalling nearly 22 million pounds in 2007 and Con Agra Foods pulling nearly 20 million pounds of ground beef in 2002.

Jack-in-the-Box (1993)
The 1993 Jack-in-the-Box outbreak occurred when more than 500 people became infected after eating undercooked beef patties associated with 73 restaurants in Washington, Idaho, California, and Nevada. Four children died and hundreds of customers were left with permanent injuries, including kidney damage, resulting in numerous lawsuits.

Kentucky Fried Chicken (1999)
In July of 1999, public health officials confirmed four Cincinnati-area Kentucky Fried Chickens were to blame for an outbreak of E. coli that led to 18 illnesses and at least 11 hospitalizations. Investigators identified poorly prepared coleslaw as the source of the contamination.

Sizzler (2000)
Two Sizzler restaurants in Wisconsin were responsible for 64 confirmed cases of E. coli and dozens of hospitalizations. Four patients developed hemolytic uremic syndrome, or HUS, a serious illness that can result in kidney failure. One child died. Officials linked the contamination back to watermelon, which was cross-contaminated with raw meat products. Eight years later, the family of the 3-year-old girl who died from exposure at a Sizzler restaurant reached a $13.5 million settlement with the company’s meat supplier.

Taco Bell (multiple)
In December, 2006, 71 illnesses linked to Taco Bell were reported to the CDC from five states: New Jersey, New York, Pennsylvania, Delaware, and South Carolina. Investigations indicated shredded lettuce was the likely source of the outbreak. Two years later, all Taco Bell restaurants in Philadelphia were temporarily closed and green onions removed from all 5,800 of its U.S. restaurants after tests indicated they were to blame for an E. coli outbreak that sickened at least five dozen people in New Jersey, New York and Pennsylvania.

Jimmy John’s (multiple)
In 2013, the Colorado Department of Public Health and Environment identified nine cases of E.coli O157:H7 in the Denver area linked to the consumption of Jimmy John’s sandwiches containing cucumbers imported from Mexico. This wasn’t the first time Jimmy John’s, based in Champaign, Ill., has been linked to an outbreak. Since 2008, the sandwich chain has been cited for serving contaminated sprouts at least five times.

FiveThirtyEight analyzes Chipotle’s norovirus outbreak

I’ve been a fan of Nate Silver’s for a few years. It’s one of a handful of sites that I read daily. Today the numbers nerds tackled the Chipotle norovirus outbreak comparing it to other fast food outbreaks using CDC’s databases. Turns out this outbreak is unique for its size and location – at a fast food setting.Screen Shot 2015-12-10 at 10.17.38 PM

Just under 3 percent of the food-related norovirus outbreaks that the Centers for Disease Control and Prevention tracked from 2009 to 20141sickened 80 or more people. Only 1.3 percent of outbreaks sickened 140 or more people. Half of all outbreaks sickened 11 or fewer people.

It’s not just the size of the outbreak that’s unusual — it’s where it happened. Although norovirus is the most common cause of food-related illnesses nationwide (about 50 percent of outbreaks), it’s not the most common cause of illnesses at fast-food outlets like Chipotle. Since 2009, when the CDC began tracking where outbreaks occurred, fast-food restaurants have been much more likely to give their patrons salmonella than norovirus (28 percent of illnesses at fast-food chains were linked to norovirus, while 43 percent were linked to salmonella). Sit-down restaurants have the opposite risk profile (45 percent of illnesses linked to norovirus, 25 percent to salmonella).

And here’s some more context from CDC on where norovirus outbreaks happen.

Screen Shot 2015-12-10 at 10.13.16 PM



Ciders and juices can cause illnesses; here’s a big list

Every fall since 2010 there’s been at least one juice or cider related outbreak in North America. Some beverages were pasteurized, many weren’t. CiderPic1Right now there are two outbreaks linked to unpasteurized ciders in California and Illinois.

Here’s a list of all the ones we’ve been able to find (going back to 1924) – 84 outbreaks leading to over 3500 illnesses.

Click here to download the entire list.

Screen Shot 2015-11-05 at 3.18.55 PM


Surveillance for waterborne disease outbreaks associated with drinking water – United States, 2011-2012

The U.S. Centers for Disease Control reports in Morbidity and Mortality Weekly that advances in water management and sanitation have substantially reduced waterborne disease in the United States, although outbreaks continue to occur (1). Public health agencies in the U.S. states and territories* report information on waterborne disease outbreaks to the CDC Waterborne Disease and Outbreak Surveillance System (

water.wellFor 2011–2012, 32 drinking water–associated outbreaks were reported, accounting for at least 431 cases of illness, 102 hospitalizations, and 14 deaths. Legionella was responsible for 66% of outbreaks and 26% of illnesses, and viruses and non-Legionella bacteria together accounted for 16% of outbreaks and 53% of illnesses. The two most commonly identified deficiencies† leading to drinking water–associated outbreaks were Legionella in building plumbing§ systems (66%) and untreated groundwater (13%). Continued vigilance by public health, regulatory, and industry professionals to identify and correct deficiencies associated with building plumbing systems and groundwater systems could prevent most reported outbreaks and illnesses associated with drinking water systems.

This report provides information on drinking water–associated¶ waterborne disease outbreaks in which the first illness occurred in 2011 or 2012** (, and summarizes outbreaks reported to the Waterborne Disease and Outbreak Surveillance System through the electronic National Outbreak Reporting System ( as of October 30, 2014. For an event to be defined as a waterborne disease outbreak, two or more persons must be linked epidemiologically by time, location of water exposure, and case illness characteristics; and the epidemiologic evidence must implicate water as the probable source of illness. Data submitted for each outbreak include 1) the number of cases, hospitalizations, and deaths; 2) the etiologic agent (confirmed or suspected); 3) the implicated water system; 4) contributing factors in the outbreak; and 5) the setting of exposure.

Karlyn D. Beer, PhD1,2; Julia W. Gargano, PhD2; Virginia A. Roberts, MSPH2; Vincent R. Hill, PhD2; Laurel E. Garrison, MPH3; Preeta K. Kutty, MD3; Elizabeth D. Hilborn, DVM4; Timothy J. Wade, PhD4; Kathleen E. Fullerton, MPH2; Jonathan S. Yoder, MPH, MSW2

Norovirus confirmed in PA university outbreak

There’s a lot of norovirus on campuses this time of year. A bunch of Virginia colleges dealt with the pathogen a couple of weeks ago, and it looks like N.C. State did too. According to, the virus caused over 150 illnesses at East Stroudsburg University in Pennsylvania.

The vomiting, diarrhea and stomach pain that affected 154 students at East Stroudsburg University last week was the result of a highly contagious virus, the state Health Department said Thursday.

The Department of Health has determined that there is now enough accumulated evidence to say the recent ESU outbreak is due to norovirus,” department spokesman Wes Culp said.

The illnesses swept through the campus so fast that doctors and medical staffs could not identify its cause with certainty, though doctors did suspect norovirus. The outbreak affected 2.5 percent of ESU students.

Here are some campus-specific food safety infosheets. Click on the pics to download.

Careful with the guac: emergence of salsa and guacamole as frequent vehicles of foodborne disease outbreaks in the US 1973–2008

American researchers report fresh salsa and guacamole often contain diced raw produce, are often made in large batches, and are often poorly refrigerated, which may make them prone to contamination that can cause foodborne illness.

The safety of salsa and guacamole is increasingly important as these foods gain popularity. Since 1973, local, state, and territorial health departments guacamole2have voluntarily reported foodborne disease outbreaks to the Centers for Disease Control and Prevention’s Foodborne Disease Outbreak Surveillance System (FDOSS) using a standard reporting form. FDOSS used paper-based reporting for 1973–1997 and switched to electronic reporting for 1998–2008.

We reviewed all reports of outbreaks during 1973–2008 in which salsa or guacamole was reported as a vehicle. We found 136 outbreaks in which salsa or guacamole was reported as a possible vehicle, which resulted in 5,658 illnesses.

Of these 136 salsa- or guacamole-associated (SGA) outbreaks additional possible food vehicles were reported for 33 (24%) outbreaks. There were no SGA outbreaks reported before 1984.

Among reported outbreaks, most were caused by norovirus (24%), nontyphoidal Salmonella (19%), and Shigella (7%). Eighty-four percent of outbreaks were caused by foods prepared in restaurants or delis; of these, OLYMPUS DIGITAL CAMERA19% reported ill foodworkers, and 29% reported improper storage as possible contributing factors.

Among all foodborne disease outbreaks with a reported food vehicle during 1984–1997, 26 (0.9%) of 2,966 outbreaks were SGA, and during 1998–2008, 110 (1.4%) of 7,738 outbreaks were SGA. The number of reported foodborne disease outbreaks attributable to salsa or guacamole increased in the United States from 1984 to 2008, especially in later years, and especially in restaurants.

Fresh salsa and guacamole require careful preparation and storage. Focused prevention strategies should reduce the risk of illness and ensure that these foods are enjoyed safely.

Foodborne Pathogens and Disease. April 2013, 10(4): 316-322

Magdalena E. Kendall, Rajal K. Mody, Barbara E. Mahon, Michael P. Doyle, Karen M. Herman, and Robert V. Tauxe

Nosestretcher alert: small farms produce safest food?

Are small farms incompatible with food safety rules?

Deborah Stockton, executive director of the National Independent Consumers and Farmers Association (NICFA), said today,

"Small farms produce the safest food available, without regulation. … Just like family farms brought us out of the Great Depression, they can bring us out of the food safety problem and this recession, if they are allowed to thrive.”

Sounds like someone is compensating for inadequacy issues and responding with exaggeration, like a 50-year-old in a Miata rag-top.

The idea that food grown and consumed locally is somehow safer than other food, either because it contacts fewer hands or any outbreaks would be contained, is the product of wishful thinking.?

Maybe the majority of foodborne outbreaks come from large farms because the vast majority of food and meals is consumed from food produced on large farms. To accurately compare local and other food, a database would have to somehow be constructed so that a comparison of illnesses on a per capita meal or even ingredient basis could be made.

NICFA is gonna lobby Washington, D.C. types and then hold a local foods feast for Congress tomorrow night. I hope no one gets sick – faith-based food safety is a lousy approach.

From the mine is bigger than yours file: How much does foodborne illness cost?

At the start of pretty much every talk I’ve given in the past 3 years I have a slide about the societal cost and estimated burden of foodborne illness. I somewhat robotically spout out these two statistics:

– About 1-in 3 to 1-in-4 individuals will acquire illnesses from food each year
– The societal burden of these illnesses is estimated to be $1.4 trillion

The statistics I use come from a variety of sources including USDA Economic Research Service, WHO, CDC, Canadian health officials and Australian public health.

Today I woke up to a press release from the Produce Safety Coalition, the Make our Food Safe Coalition and the Pew Charitable Trust that cited a “landmark  study” estimating the cost of foodborne illness to be $152 billion annually.

From the report:
There are a number of ways to estimate the economic impact of foodborne illness. This report uses an FDA cost-estimate approach: health-related costs are the sum of medical costs (physician services, pharmaceuticals, and hospital costs) and losses to quality of life (lost life expectancy, pain and suffering, and functional disability).

Hardly landmark, unless you mean this estimate represents  a reduction of almost a factor of 10 in estimated costs since 2007 (I don’t think that was what was intended). Tanya Roberts published a paper in 2007 estimating the cost of foodborne illness from a willingness-to-pay (WTP) standpoint at $1.4 trillion. According to Roberts, WTP is endorsed in the literature as the valuation method most consistent with economic theory and her calculation included all seventy-six million cases of acute food-borne illness. Previous estimates examined only a few specific pathogens.

Sure, the numbers matter when it comes to prioritizing the need to address or fund food safety work. Whether it’s $6 billion, $152 billion, $1.4 trillion or $2,500-$8,000 per case (pathogen dependant) it’s a huge number. But it’s also very abstract.

The statistics are nice, but they really don’t grab foodhandlers’ attention. More compelling is where the real cost of foodborne illness is born: with the individuals and in the families of those who have been affected by it. Billions and trillions are fodder for discussions with politicians and boards of directors. Where the real food safety work occurs, both positive and negative, is on the farm, in the restaurant kitchen, supermarket deli and homes. And the numbers don’t really matter there, what resonates is that foodborne illness sucks.

What matters so much more to individual food handlers who protect public health in the US are the stories of real people being affected by food they trusted would not make them ill.

The disconnect between statistics and stories is why I follow up the burden slide with more impactful tales of outbreaks that happen weekly.  Like those who have affected real people including Mason Jones and Stephanie Smith both of whom were severely affected by E. coli O157. Tragically, Mason died at only 5 years of age and Stephanie, who is now 23, will probably never walk again.  The numbers, while nice, don’t really do these stories justice.