[editor note: Lisa Atkinson, a member of the BHTS team jumps in this month to give us the norovirus lowdown]
Until I moved to the USA, the term “stomach flu” was relatively unknown to me. In the UK, if we suffer from symptoms including vomiting and diarrhea, we usually tell colleagues, friends or family that we are suffering from a “dodgy tummy,” an “upset belly” or “the runs” and we are rarely asked for any more details.
In Baltimore this winter, many friends and relatives have fallen ill where I have heard the term stomach flu used more that I would like – not because the name is inaccurate – but because the symptoms, while rarely critical, are certainly not fun.
So, if is not flu (which is a respiratory disease), what is the illness which normally causes vomiting, diarrhea, nausea and abdominal cramps, and often muscle aches, low-grade fever, and headaches if you are particularly unlucky? Well, it is usually viral gastroenteritis. The name of the culprit is Norovirus. This virus is prevalent around the world, and thought to cause up to 50 percent of foodborne illnesses in the United States.
Most of the students in my ServSafe classes have never heard of norovirus. While it is much more common than E. Coli and salmonella, norovirus does not usually hospitalize unless the person is very young, immune compromised or elderly. Often, infected people do not visit the doctor, so we do not know the true number of infections.
According to the Centers for Disease Control (CDC), “Foods that are commonly involved in outbreaks of norovirus illness are leafy greens (such as lettuce), fresh fruits, and shellfish (such as oysters). But, any food that is served raw or handled after being cooked can become contaminated.
So, what preventative measures can you take if you work in a foodservice establishment? Proper hand-washing is always the best way to prevent the spread of viruses, and in addition to that, ready-to-eat foods should always be handled by a food handler wearing single use gloves that are changed regularly and when soiled.
In one outbreak in the UK in 1998, 90 percent of diners eating at the tables adjacent to a lady who vomited, consequently contracted the virus, so always clean up vomit quickly and clean and sanitize the affected area with a chlorine based sanitizer. Keep sick employees away from work, and ensure they know it is their duty to inform you if they have vomited or had multiple episodes of diarrhea in the last 24 hours. The virus can actually be shed in the stool for more than two weeks after the conclusion of symptoms. For this reason, and because norovirus can be transmitted through airborne particles as well as through food and food contact surfaces, infected food-handlers should not prepare food while experiencing symptoms, and if norovirus is confirmed, it should be reported to the local regulatory authority.
A friend visited today with her toddler. Her visit was cut short when the toddler vomited all over her and my parent’s living room. We cleaned up as best we could, and when found out that there were three more vomiting episodes once the little girl returned home, I promptly swept through the house, acting as I would if this had happened in a restaurant: I cleaned and sanitized all dishes, utensils and contact surfaces – including door handles – with a chlorine bleach solution (quaternary ammonium compound sanitizers are not always effective against norovirus). I also discarded the platter of cookies that we had been enjoying, along with my own daughter’s juice box. My friend should keep her daughter away from others until she has been symptom-free for 24 hours, in order to decrease the risk of spreading an infection. In addition, after contact with vomit and feces (dirty nappies here) proper hand-washing with warm water and soap should be conducted, since an alcohol based hand-sanitizer is not always capable of destroying the virus.
If you think it can’t happen to you, take a look at the number one rated restaurant in the world Noma in Denmark. Recently the restaurant was the recipient of ugly publicity as 63 diners of 435 during five days in February developed cases of norovirus. Noma’s director Peter Kreiner issued a statement acknowledging it had spread from a “non-sympton” showing employee. In any case the story had a life of longer than a week … and the restaurant was forced to suffer monetarily but probably more so from damage to its reputation and slow response time before it closed the kitchen, deep cleaned and sanitized and destroyed all perishable foods. What I was doing in this home after a sick child visited, they should have been doing in their kitchen … this is real.