In Jan. 2009, the beginnings of the world’s largest known restaurant-based norovirus outbreak began to take hold in Heston Blumenthal’s fancy pants Fat Duck restaurant.

A new report in Epidemiology and Infection reiterates much of what was known at the time and summarized in a subsequent U.K. Health Protection Agency report, but still hammers home the point that a series of errors can culminate in a lot of people barfing.

About 591 in this outbreak.

The report doesn’t mention The Fat Duck by name, but rather, states the restaurant “uses an approach based on the principles of molecular gastronomy, prepares and serves unusual dishes using what it describes as innovative methods.”

Nice dig.

“The complex nature of food preparation in this particular restaurant, with extensive handling of foods, requires excellent food management systems to ensure safety. Two of the 22 food samples taken from the restaurant were contaminated with E. coli and Enterobacteriaceae, reported to be an indicator of a breakdown in food hygiene practices.”

Ouch.

This was after the restaurant failed to notify public health types as dozens of complaints poured into the restaurant, hired its own food safety consultant, did a deep clean, and then temporarily closed.

The figure (bottom) is particularly instructive.

Once the health types got involved, they started testing some staff and ill diners; even late in the outbreak, six of 63 staff members tested positive for norovirus (44 were tested).

“Diners were infected with multiple norovirus strains belonging to genogroups I and II, a pattern characteristic of molluscan shellfish-associated outbreaks. The ongoing risk from dining at the restaurant may have been due to persistent contamination of the oyster supply alone or in combination with further spread via infected food handlers or the restaurant environment. Delayed notification of the outbreak to public health authorities may have contributed to outbreak size and duration.”

Norovirus in raw shellfish, especially oysters, is nothing new. But the amplification of risk by a series of dumb assumptions (we can contain this) and omissions (don’t tell anyone) is staggering.

“The size and duration of this outbreak exceed any other commercial restaurant-associated norovirus outbreaks in the published literature. It is hoped that lessons learned from this outbreak will help to inform future action by restaurateurs especially in early notification to public health authorities once an outbreak is suspected.”