Reality research: Norovirus in restaurant bathrooms

Long-time friend and friend of the barfblog.com, Don Schaffner, a professor of microbiology at Rutgers University (right, sort of as shown) writes:

More than seven years ago I had the good fortune to be contacted by my colleague, Dr. Lee-Ann Jaykus (below, left, exactly as shown).

She asked if I wanted to be involved in what was at the time going to be a remarkable endeavor. She was going to lead a team of scientists competing to earn a $25 million grant from the USDA focused on understanding Norovirus.

Norovirus causes more foodborne disease than any other microorganism. Because it is often self-limiting, and seldom fatal, it gets a little attention. It’s also a remarkably difficult organism to study. One of the reasons it has been difficult to study is that there had no way to culture the organism outside it’s human host. This meant that anyone wanting to do research with the organism had to have a supply of frozen poop containing the virus.

One of the goals of the ambitious project lead by Dr. Jaykus was to finally crack the code which would allow scientists to culture the virus in the laboratory. Spoiler alert, we got the grant. We were all excited to learn recently that thanks in large measure to the USDA Grant, that riddle has been solved.

This USDA Grant also allowed a number of other research projects too numerous to recount here, but I do want to tell the story of one.

Early on in our efforts on the ground, my colleague, Angie Fraser reached out and asked if I wanted to be part of an extensive survey of restaurant bathroom for Norovirus. I was delighted to say yes, and we began

I have to express my sincere appreciation to Cortney Leone whom led the project. She had the unenviable task of having to oversee researchers in three U.S. states, charged with collection of the data for this project. I also owe huge debt of gratitude to my graduate student Hannah Bolinger who led our data collection efforts in New Jersey.  Thanks also to the NJ team of graduate students, undergraduate students and significant others who visited public bathrooms around the state (Louis Huang, Pierce Gaynor, Sarah Hossain, Sneha Sreekumar, Jenny Todd-Searle, and Arthur Todd-Searle).

(Schaffner, this isn’t an Academy Award acceptance speech, on with it — dp.)

Because we wanted to ensure that our data were representative, we collected data from nine different counties in New Jersey. This turned out to be a lot harder than you might think. New Jersey is a home rule state.

This means that public health operates at the municipal level, with minimal oversight from the state. Our first task was to compile lists of food service establishment from the three regions of New Jersey.

This was easy to do in less densely populated regions, where the municipal entity was the county. We could simply contact the county, and through appropriate freedom of information act paperwork, obtain a list of all of the restaurants in the county. This was far more difficult in the densely settled parts of the state, where obtaining a list require contacting each and every municipality in the county, and filling out each municipalities’ different paperwork, in some cases mailing a paper check to cover photocopying costs, and then eventually taking the information we received back, and putting it into a standardized database. All of this was required before we could even begin to collect the first piece of data.

Thanks to Hanna’s outstanding work, we were eventually able to produce a robust enough database that we could proceed with data collection. Hannah lead a team of students that visited restrooms in and around New Jersey. This was harder than it sounded, as often the information provided by the  municipalities was out of date, and the students arrived at a location, only to learn that the restaurant was closed, or the location was incorrect.

Eventually, the teams in all three states had collected enough swabs and sent the samples back to CDC for analysis.

The end result of all this work was published in the Journal of Food Protection. Although our goal was to visit 750 commercial food establishments, we actually visited 751 establishments, in which 1,044 bathrooms and 4,163 surfaces were swabbed.  Four swab samples were collected from each bathroom: (i) the underside of the toilet seat where it connects to the toilet bowl, (ii) the flush handle of the toilet, (iii) the inner door handle of the stall door or, when there was no stall door, the inner door handle of the outer door, and (iv) the hot water knob of the sink faucet.

In the end 61 (1.5%) of 4,163 swabs were presumptively positive for human norovirus, and 9 of these were confirmed by sequencing.  This is similar to what others have found.

Almost half (30) of positive swabs were found on the underside of the toilet seat. About 20% were found on the toilet flush handle (13) and the inner handle of the stall or outer door (11). Only 11% (7) of positive swabs were found on the sink faucet handle.  Our results suggest that areas further away from the toilet are less likely to harbor norovirus contamination; toilet surfaces (especially the underside of the seat) would be closest to vomiting and diarrheal events during which high numbers of norovirus particles could be shed.

Chain restaurants had significantly more positive samples than non-chains (p = 0.0273). Unisex bathrooms had significantly more positive samples than female bathrooms (p = 0.0163).  Bathrooms with bar soap had significantly more positive samples than liquid soap bathroom (p = 0.0056) and foam soap bathrooms (p = 0.0147), but note that only 3 bathrooms out of 751 actually used bar soap. Bathrooms containing a trash can attached to the paper towel dispenser had significantly more positive samples than bathrooms with a free-standing trash can (p = 0.0004).

Although[the NoroCORE grant recently ended,I know there will be continued publications coming for many years, several of which will come from my lab, that will serve to further advance our understanding of Norovirus, and the means by which it can be controlled.

Prevalence of Human Noroviruses in Commercial Food Establishment Bathrooms

CORTNEY M. LEONE, MUTHU DHARMASENA, CHAOYI TANG, ERIN DiCAPRIO, YUANMEI MA, ELBASHIR ARAUD, HANNAH BOLINGER, KITWADEE RUPPROM, THOMAS YEARGIN, JIANRONG LI, DONALD SCHAFFNER, XIUPING JIANG, JULIA SHARP, JAN VINJÉ, and ANGELA FRASER (2018) Prevalence of Human Noroviruses in Commercial Food Establishment Bathrooms. Journal of Food Protection: May 2018, Vol. 81, No. 5, pp. 719-728.

https://doi.org/10.4315/0362-028X.JFP-17-419

http://jfoodprotection.org/doi/abs/10.4315/0362-028X.JFP-17-419?code=fopr-site

Although transmission of human norovirus in food establishments is commonly attributed to consumption of contaminated food, transmission via contaminated environmental surfaces, such as those in bathrooms, may also play a role. Our aim was to determine the prevalence of human norovirus on bathroom surfaces in commercial food establishments in New Jersey, Ohio, and South Carolina under nonoutbreak conditions and to determine characteristics associated with the presence of human norovirus. Food establishments (751) were randomly selected from nine counties in each state. Four surfaces (underside of toilet seat, flush handle of toilet, inner door handle of stall or outer door, and sink faucet handle) were swabbed in male and female bathrooms using premoistened macrofoam swabs. A checklist was used to collect information about the characteristics, materials, and mechanisms of objects in bathrooms. In total, 61 (1.5%) of 4,163 swabs tested were presumptively positive for human norovirus, 9 of which were confirmed by sequencing. Some factors associated with the presence of human norovirus included being from South Carolina (odd ratio [OR], 2.4; 95% confidence interval [CI], 1.2 to 4.9; P < 0.05) or New Jersey (OR, 1.7; 95% CI, 0.9 to 3.3; 0.05 < P < 0.10), being a chain establishment (OR, 1.9; 95% CI, 1.1 to 3.3; P < 0.05), being a unisex bathroom (versus male: OR, 2.0; 95% CI, 0.9 to 4.1; 0.05 < P < 0.10; versus female: OR, 2.6; 95% CI, 1.2 to 5.7; P < 0.05), having a touchless outer door handle (OR, 3.3; 95% CI, 0.79 to 13.63; 0.05 < P < 0.10), and having an automatic flush toilet (OR, 2.5, 95% CI, 1.1 to 5.3; 0.05 < P < 0.10). Our findings confirm that the presence of human norovirus on bathroom surfaces in commercial food establishments under nonoutbreak conditions is a rare event. Therefore, routine environmental monitoring for human norovirus contamination during nonoutbreak periods is not an efficient method of monitoring norovirus infection risk.

Get a stool sample it may improve your food safety knowledge in Vietnam

Consumption of fast food and street food is increasingly common among Vietnamese, particularly in large cities. The high daily demand for these convenient food services, together with a poor management system, has raised concerns about food hygiene and safety (FHS). This study aimed to examine the FHS knowledge and practices of food processors and sellers in food facilities in Hanoi, Vietnam, and to identify their associated factors.

A cross-sectional study was conducted with 1,760 food processors and sellers in restaurants, fast food stores, food stalls, and street vendors in Hanoi in 2015. We assessed each participant’s FHS knowledge using a self-report questionnaire and their FHS practices using a checklist. Tobit regression was used to determine potential factors associated with FHS knowledge and practices, including demographics, training experience, and frequency of health examination.

Overall, we observed a lack of FHS knowledge among respondents across three domains, including standard requirements for food facilities (18%), food processing procedures (29%), and food poisoning prevention (11%). Only 25.9 and 38.1% of participants used caps and masks, respectively, and 12.8% of food processors reported direct hand contact with food. After adjusting for socioeconomic characteristics, these factors significantly predicted increased FHS knowledge and practice scores: (i) working at restaurants and food stalls, (ii) having FHS training, (iii) having had a physical examination, and (iv) having taken a stool test within the last year.

These findings highlight the need of continuous training to improve FHS knowledge and practices among food processors and food sellers. Moreover, regular monitoring of food facilities, combined with medical examination of their staff, should be performed to ensure food safety.

Evaluating food safety knowledge and practices of food processors and seller working in food facilities in Hanoi, Vietnam, April 2018

Journal of Food Protection, vol 81, no 4

BACH XUAN TRAN,1,2 HOA THI DO,3 LUONG THANH NGUYEN,1 VICTORIA BOGGIANO,4 HUONG THI LE,1 XUAN THANH THI LE,1 NGOC BAO TRINH,1 KHANH NAM DO,1 CUONG TAT NGUYEN,5* THANH TRUNG NGUYEN,5 ANH KIM DANG,1 HUE THI MAI,1 LONG HOANG NGUYEN,6 SELENA THAN,5 and CARL A. LATKIN2

https://doi.org/10.4315/0362-028X.JFP-17-161

Fancy food ain’t safe food: Possible Salmonella infections at popular Brisbane eatery

Holly Hales of the Daily Mail reports a popular Vietnamese restaurant in Brisbane‘s trendy West-End has been accused of disregarding food safety laws after it was searched by health inspectors.   

It come after eight diners were left with a bad taste in their mouth after claiming a visit to the restaurant gave them food poisoning.

Trang Restaurant has previously found fame being named Brisbane’s best Vietnamese food but the new allegations claim defrosting raw chicken found underneath a sink was allegedly among discoveries made by inspectors during a visit to the premises.

Despite the allegations of contempt for food safety laws, Trang has retained a largely satisfied customer-base

The allegations come as council health inspectors filed a complaint in the Brisbane’s Magistrate’s Court accusing the eatery of skimping on food safety laws.

The Courier Mail also reports complaints filed in late February included sightings of infected food, which was found throughout the restaurant. 

It is thought the raid was catalysed by eight diners allegedly contracting salmonella after eating at the restaurant between February and March this year. 

Natural green tofu and noodle products recalled in Ireland due to rodent

When shit gets in the tofu.

The Food Safety Authority of Ireland reports all of the below listed products supplied or manufactured by Natural Green Limited, Stadium Business Park, Ballycoolin, Dublin are subject to recall due to rodent infestation at the supply site in Ireland. A Closure Order, under the FSAI Act 1998, was served by the HSE on the food business operator of the Stadium Business Park site.

Celebrity chefs suck: UK Masterchef winner’s Mexican restraint chain Wahaca loses almost £5 Million after outbreak of noro hit staff and customers forced nine branches to close

This Is Money reports Mexican restaurant chain Wahaca has plunged into a £4.7m loss, blaming a norovirus outbreak which forced it to close nine restaurants.

The chain, which was founded by 2005 MasterChef winner Thomasina Miers, said sinking into the red was partly due to one-off costs of £700,000, which sent profits down from £600,000 a year earlier. Around 160 customers and a quarter of Wahaca’s staff were taken ill in October 2016 after it was hit by an ‘unprecedented’ outbreak of Norovirus.  

In all 18 of the 25 restaurants were hit and 11 including Canary Wharf, Covent Garden, Oxford Circus, Soho and White City, all in London, had to close. 

Wahaca co-founder Mark Selby later admitted it ‘changed the way they did business’.

He said July last year: ‘We’ve had to make some tough calls with our suppliers. We’ve had to say, we have to have absolute visibility or we can’t work with you.
At one stage we thought we were going to have to close every restaurant for four weeks,’ says Selby. ‘During that time sales plummeted 45 per cent, but if I’d had to close all sites, I don’t see how we would have survived.’ 

Selby got together with Thomasina Miers, the 2005 winner of the BBC’s MasterChef series, and together they opened the first Wahaca in Covent Garden in 2007.

Another worry for the chain is immigration post-Brexit. Only a quarter of Wahaca’s 1,200 staff are British. 

Selby said: ‘[We] opened in Chichester and found it really hard to find staff to work there, even in management.’  

Inquest told Irish woman died due to Salmonella after Communion function

On May 18, 2017, the first cases of food poisoning were reported to health types in Dublin and soon linked to a northern Dublin food business that had supplied food to numerous family parties the weekend of May 13 and 14, 2017.

25/05/17 Members of the ‘Sloggers to Joggers’ fitness group jog behind the hearse pictured after the funeral of Sandra O’Brien St. Finian’s Church, River Valley, Swords this morning. Sandra Murphy O’Brien, in her 50s, died after she became ill after a Communion celebration at a north Dublin pub….Picture Colin Keegan, Collins Dublin.

“A Closure Order was served on the food business on Friday 19th May.”

The statement came a week after Sandra O’Brien, who was in her 50s, died from suspected food poisoning at a First Communion party.

The statement continues: “The HSE is aware of more than 50 people (including 4 children) ill from a number of separate groups of family parties supplied by a North Dublin food business on Saturday 13th May and Sunday 14th May.

“To date five people were admitted to hospital and 16 of those ill have been confirmed as Salmonella.”

Now, an inquest has heard the woman died from Salmonella.

Investigations by two separate authorities are ongoing into the salmonella outbreak, the inquest heard.

The Health Service Executive’s Environmental Health Office and the Food Safety Authority of Ireland are preparing files on the incident.

Reports will be filed by both authorities to the Director of Public Prosecution once investigations are complete.

The catering company, Flanreil Food Services, who provided the food served on the day of the First Communion function was represented at the inquest by solicitor Elaine Byrne.

Inspector Oliver Woods applied for a six-month adjournment of the inquest to allow for investigations to continue and the coroner adjourned the inquest until 8 November, 2018.

17 sick in 7 states with E. coli O157:H7: Source not yet identified

CDC, several states, the U.S. Food and Drug Administration, and the U.S. Department of Agriculture’s Food Safety and Inspection Service are investigating a multistate outbreak of Shiga toxin-producing E. coli O157:H7 infections. The investigation is still ongoing and a specific food item, grocery store, or restaurant chain has not been identified as the source of infections. CDC is not recommending that consumers avoid any particular food at this time. Restaurants and retailers are not advised to avoid serving or selling any particular food. CDC will provide more information as it becomes available.

As of April 9, 2018, 17 people infected with the outbreak strain of E. coli O157:H7 have been reported from 7 states. A list of the states and the number of cases in each can be found on the Case Count Map page. Illnesses started on dates ranging from March 22, 2018 to March 31, 2018. Ill people range in age from 12 to 84 years, with a median age of 41. Among ill people, 65% are female. Six ill people have been hospitalized, including one person who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.

Rats, Ireland and babies

A crèche in Co Louth has been ordered to close after food safety inspectors discovered a rodent infestation in a pre-school room, baby room and nappy changing area.

The Food Safety Authority of Ireland (FSAI) has reported that six closure orders and one prohibition order were served on food businesses during the month of March for breaches of food safety legislation.

Among them was Aladdins’ Cave Montessori School and Crèche, Stoney Lane, Ardee, Co Louth. Also in Co Louth, a closure orders were served on Panda House, a take away at 43 Barrack Street in Dundalk.

Hab Foods, trading as Haji Baba, a wholesaler, was ordered to close a black container unit adjacent to its main building in the Cherry Orchard Industrial Estate, Ballyfermot, Dublin 10.

It was also served with a prohibition order and ordered to withdraw all minced lamb, diced beef, diced lamb and diced skinned chicken being supplied from the premises.

FSAI chief executive Dr Pamela Byrne said food business operators in Ireland “should fully understand that it is their legal responsibility to ensure they are maintaining a high standard of food safety throughout their food business. … Non-compliance by food businesses will not be tolerated and all breaches of food safety legislation will be dealt with to the full extent of the law.”

UK health officials finger C. perfringens as source of over 60 illnesses at pub

Those 60-plus diners that got sick at the Old Farmhouse pub on Mother’s Day in Somerset, UK, were stricken with Clostridium perfringens.

PHE South West Consultant in Health Protection Dr Bayad Nozad said: “C. perfringens live normally in the human and animal intestine and in the environment.

“The illness is usually caused by eating food contaminated with large numbers of C. perfringens bacteria that produce enough toxin in the intestines to cause illness.”

The Old Farmhouse, owned by brewery chain Hall and Woodhouse, temporarily closed its kitchen while investigations were underway.

Samples were then taken in order to identify the cause of the sickness outbreak.

Dr Nozad said: “It is good news that the majority of affected individuals appear to have recovered quickly.

“Our advice for anyone else affected is to drink plenty of water to avoid dehydration.

“We are currently working with Environmental Health Officers from North Somerset Council to ensure that the venue have appropriate precautions and procedures in place.”

North Somerset Council environmental health officers have say the venue is now operating under their guidance.

First it was 5, now 19 sick in E. coli outbreak linked to Edmonton restaurant

The number of people sickened with E. coli after eating at a southeast Edmonton restaurant has climbed to 19, including two who have developed symptoms serious enough to be admitted to hospital, Alberta Health Services said Thursday.

That’s a jump of 13 cases from a week ago, when the health authority announced the discovery of the first cluster of infections among people who ate at Mama Nita’s Binalot restaurant.

Keith Gerein of the Edmonton Journal reports it’s believed at least some of those new cases are among restaurant staff.

Patrons were infected with E. coli O157:H7, which can produce diarrhea that may be bloody.

Public health officials are warning anyone who has dined at Mama Nita’s since March 15 to see a doctor if they have symptoms, and mention they may have been exposed to E. coli.

A spokesperson for the restaurant could not be reached for comment.

Here’s a comment: Use a fucking thermometer.