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The Food Service Industry Can Help Prevent Norovirus Outbreaks

Patrick Boshell
June 17, 2014

norovirus food industryMost norovirus outbreaks from contaminated  food occur in food service settings, according to a Vital Signs report by the Centers for Disease Control and Prevention. Infected food  workers are frequently the source of these outbreaks, often by touching  ready-to-eat foods served in restaurants with their bare hands. The food  service industry can help prevent norovirus outbreaks by enforcing food safety  practices, such as making sure workers always practice good hand hygiene on the  job and stay home when they are sick.  


Norovirus  often gets a lot of attention for outbreaks on cruise ships, but those account  for only about 1 percent of all reported norovirus outbreaks. Norovirus is  highly contagious and can spread anywhere people gather  or food is served, making people sick with vomiting and diarrhea. About 20  million people get sick from norovirus each year; most get infected by having  close contact with other infected people or by eating contaminated food.


“Norovirus  outbreaks from contaminated food in restaurants are far too common.” said CDC  Director Tom Frieden, M.D., M.P.H.  “All who prepare food, especially the  food service industry, can do more to create a work environment that promotes  food safety and ensures that workers adhere to food safety laws and regulations  that are already in place.”



The Vital  Signs report provides key recommendations to help the food service industry prevent norovirus outbreaks from contaminated food. The recommendations, which  underscore provisions in the Food and Drug Administration model Food Code ( and CDC guidelines (, include:


  • Making sure  food service workers practice proper hand washing and use  utensils and single-use disposable gloves to avoid touching ready-to-eat foods with bare hands,
  • Certifying  kitchen managers and training food service workers in food safety practices,  and 
  • Establishing  policies that require food service workers to stay home when sick with vomiting  and diarrhea and for at least 48 hours after symptoms stop.


“It is vital  that food service workers stay home if they are sick; otherwise, they risk  contaminating food that many people will eat,” said Aron Hall, D.V.M.,  M.S.P.H., of CDC’s Division of Viral Diseases.   However, 1 in 5 food service workers have reported working at least once  in the previous year while sick with vomiting or diarrhea. Fear of job loss and  not wanting to leave coworkers short-staffed were cited as significant factors  in their decision. “Businesses can consider using measures that would encourage  sick workers to stay home, such as paid sick leave and a staffing plan that  includes on-call workers,” said Hall.


 Infographic: Norovirus Questions and Answers.

Entire infographic Adobe PDF file


CDC analyzed norovirus outbreak data  reported by state, local, and territorial health departments from 2009 to 2012  through CDC’s National Outbreak Reporting System (NORS). Over the four years,  health departments reported 1,008 norovirus outbreaks from contaminated food,  most of which occurred in food service settings such as restaurants and  catering or banquet facilities. 


Factors contributing  to food contamination were  reported in 520 of the outbreaks, with an infected food worker implicated in  364 (70 percent) of them. Of these outbreaks, 196 (54 percent) involved food  workers touching ready-to-eat foods with their bare hands. Ready-to-eat foods  are foods that are ready to be served without additional preparation, such as  washed raw fruits and vegetables for salads or sandwiches, baked goods, or  items that have already been cooked.


CDC’s  analysis also looked at which foods were commonly implicated in norovirus  outbreaks. Of 324 outbreaks with a specific food item implicated, more than 90  percent were contaminated during final preparation (such as making a sandwich  with raw and already cooked ingredients) and 75 percent were foods eaten raw.  Leafy vegetables, fruits, and mollusks, such as oysters, were the most common  single food categories implicated in these outbreaks.


The report  also highlights the key role health departments play in investigating and  reporting norovirus outbreaks. Outbreak reporting rates varied greatly among  states, likely illustrating differences in surveillance efforts rather than  variation in norovirus disease incidence. “There is a continued need to build  the capacity of health departments to more thoroughly investigate and report  outbreaks to NORS,” said Hall. 


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About NORS


CDC launched  NORS in 2009 to collect information on outbreaks of foodborne, waterborne, and  enteric diseases that spread from person-to-person, animals, environmental  surfaces, and other or unknown ways. Public health agencies can report all  outbreaks of gastroenteritis, including norovirus illness, through this  web-based system. This information is used to determine where norovirus  outbreaks commonly occur, how the virus is spread, and specific food or water  sources involved. In turn, this helps identify the best ways to prevent and  control norovirus illnesses and outbreaks.


For more  information about norovirus, please visit Additional information on preventing foodborne diseases is available at www.foodsafety.govExternal Web Site Icon


Vital Signs is a CDC report that appears on the first Tuesday of the  month as part of the CDC journal Morbidity and Mortality Weekly Report, or MMWR. The report provides the latest data and information on  key health indicators. These are cancer prevention, obesity, tobacco use, motor  vehicle passenger safety, prescription drug overdose, HIV/AIDS, alcohol use,  health care-associated infections, cardiovascular health, teen pregnancy, food  safety and developmental disabilities.


As published by the Centers of Disease Control and Prevention (CDC)

Tuesday, June 3, 2014, 1:00 p.m. ET

Contact: CDC Media Relations
(404) 639-3286

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