Charlotte restaurant server diagnosed with hepatitis A

When I was a PhD student I volunteered as a dishwasher in a restaurant as part of my food safety-related research. I saw lots of things, but the two things I remember most is that I was often asked to work with a server to do some salad plating; and I had to listen to a lot of Pink Floyd.

There was some Tom Petty, and The Clash, but a lot of Pink Floyd.

Servers, while not traditionally thought as food handlers, are often involved with scooping beverage ice, putting silverware together and sometimes, as I experienced, salad preparation.mondo_446339a

And when a server is confirmed ill with hepatitis A, even if they are superstars at handwashing, a whole lot of business hurt happens. Stuff like public health clinics and loss of confidence.

According to WCNC, a server at a Charlotte-area restaurant, Dogwood Southern Table and Bar, has the virus and may have exposed patrons in early February.

Health officials say the worker did not prepare food, but was responsible for polishing silverware and severing food. Monday afternoon, the Health Department offered a walk-in clinic for free vaccination.

One customer who received the vaccination, who did not want to be identified, said she was surprised by the news.

“I’m very concerned because I have small kids at home and so I worry about not just myself, but my family, and so it’s unfortunate.”

So far about 20 people have been vaccinated. 

How to avoid norovirus: don’t watch people barf, or hold their hair back

You can earn some credibility holding back a woman’s hair while she vomits; you can lose credibility when a 2-year-old vomits all over the car seat, and then while attempting to clean it up, you vomit in response, like in Stand By Me (see below).

I’ve done both.

Researchers from the U.S. Centers for Disease Control investigated a 2009 outbreak on a cruise ship and concluded infected passengers were significantly more likely to have an ill cabin mate, and to have resided or dined on the deck level where a vomiting incident had occurred during boarding.

That’s right: someone barfed while passengers were boarding the ship and just watching and trying to contain that little bit of throw-up that just happened in your mouth was a statistically significant risk factor.

Questionnaires about when people did or did not seek medical care, hygiene practices, and possible norovirus exposure were placed in every cabin after the outbreak began. The ship had 1,842 passengers on board, and 83 percent returned the questionnaires. Of the 15 percent of respondents who met the case definition for acute gastroenteritis, only 60 percent had sought medical care on the ship.

Less than 1 per cent of the crew reported illness, and their low attack rate may have been due to the few crew members who had direct contact with passengers. This included separate sleeping and dining areas and alternate passages for boarding and exiting the ship.

"Cruise line personnel should discourage ill passengers from boarding their ships," according to study author Mary Wikswo, MPH, of the Centers for Disease Control and Prevention. "Once on board, passengers and crew who become ill should report to the ship’s medical center as soon as possible. These quick actions are crucial in preventing the introduction and spread of norovirus on cruise ships and allow ship personnel to take immediate steps to prevent the spread of illness."

What I conclude, based on this and other studies, including our own, is that telling people to wash their hands has almost no effect — and that the best way to control the spread of norovirus – on cruise ships, in restaurants, in schools – is to break the infection cycle because these noroviruses are crazy infective: stay home, isolate yourself, tie your hair in a bun, and barf away.

Riding in carts with meat

Several years ago, a young girl in Ottawa contracted E. coli O157 after licking the moisture off a package of hamburger on a particularly hot day. The risks of having young children near potentially contaminated food in a shopping cart has been well recognized. And now confirmed.

Researchers at CDC and elsewhere report in the current Journal of Food Protection that kids can be exposed to raw meat and poultry products while riding in shopping carts. Parents, pay attention.

Prevalence of, and factors associated with, this risk factor for Salmonella and campylobacter infection in children younger than 3 years***
Journal of Food Protection®, Volume 73, Number 6, pp. 1097-1100(4)
Patrick, Mary E.; Mahon, Barbara E.; Zansky, Shelley M.; Hurd, Sharon3; Scallan, Elaine
Riding in a shopping cart next to raw meat or poultry is a risk factor for Salmonella and Campylobacter infections in infants. To describe the frequency of, and factors associated with, this behavior, we surveyed parents of children aged younger than 3 years in Foodborne Disease Active Surveillance Network sites. We defined exposure as answering yes to one of a series of questions asking if packages of raw meat or poultry were near a child in a shopping cart, or if a child was in the cart basket at the same time as was raw meat or poultry. Among 1,273 respondents, 767 (60%) reported that their children visited a grocery store in the past week and rode in shopping carts. Among these children, 103 (13%) were exposed to raw products. Children who rode in the baskets were more likely to be exposed than were those who rode only in the seats (odds ratio [OR], 17.8; 95% confidence interval [CI], 11.0 to 28.9). In a multivariate model, riding in the basket (OR, 15.5; 95% CI, 9.2 to 26.1), income less than $55,000 (OR, 1.8; 95% CI, 1.0 to 3.1), and Hispanic ethnicity (OR, 2.3; 95% CI, 1.2 to 4.5) were associated with exposure. Our study shows that children can be exposed to raw meat and poultry products while riding in shopping carts. Parents should separate children from raw products and place children in the seats rather than in the baskets of the cart. Retailer use of leak-proof packaging, customer placement of product in a plastic bag and on the rack underneath the cart, use of hand sanitizers and wipes, and consumer education may also be helpful.