Norovirus on Swabs Taken from Hands Illustrate Route of Transmission: A Case Study

Authors: Boxman, Ingeborg¹; Dijkman, Remco¹; Verhoef, Linda²; Maat, Angelique³; van Dijk, Geert³; Vennema, Harry²; Koopmans, Marion²

Source: Journal of Food Protection®, Volume 72, Number 8, August 2009 , pp. 1753-1755(3)

Publisher: International Association for Food Protection

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Abstract:

Recently, environmental swabs from kitchen and bathroom surfaces have been described as an additional tool for the detection of norovirus in outbreak settings. This article describes an outbreak investigation in response to the reporting of gastroenteritis in three unrelated groups of 6, 12, and 13 adults approximately 30 h after having meals in the same restaurant. Fecal samples were collected from 13 patients and six food handlers, and environmental swabs were taken from the soap dispenser, working bench, doorknobs of cupboards, and the grip of a knife in the kitchen and in bathrooms as well as from the hands of each of three employees on the day of inspection. Clinical and environmental samples were analyzed separately in time and location for the presence of norovirus by real-time reverse transcription PCR. Structured interviews revealed that all staff members had suffered from gastroenteritis, one after the other. Norovirus RNA (GGI.6) was detected in 17 of 19 fecal samples as well as in 4 environmental samples, including a swab sample from the hands of a staff member who was preparing ready-to-eat food. Sequences obtained from clinical and environmental samples showed an identity of 100% (235 nucleotides). To our knowledge, this is the first case study to directly demonstrate the presence of norovirus RNA on a food handler's hands in an outbreak setting. This finding provides direct evidence for the feasibility of transmission of norovirus by a food handler to food. Education of food handlers on the infectivity of norovirus and updating of hygienic codes are strongly recommended.

Document Type: Research article

Affiliations: 1: Food and Consumer Product Safety Authority, P.O. Box 202, 7200 AE, Zutphen, The Netherlands 2: Laboratory for Infectious Diseases and Screening, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands 3: Municipal Health Service West-Brabant, P.O. Box 3369, 4800 DJ Breda, The Netherlands

Publication date: 2009-08-01

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First published in 1937, the Journal of Food Protection^®, is a refereed monthly publication. Each issue contains scientific research and authoritative review articles reporting on a variety of topics in food science pertaining to food safety and quality. The Journal is internationally recognized as the leading publication in the field of food microbiology with a readership exceeding 11,000 scientists from 70 countries. The Journal of Food Protection^® is indexed in Index Medicus, Current Contents, BIOSIS, PubMed, Medline, and many others.

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Norovirus on Swabs Taken from Hands Illustrate Route of Transmission: A Case Study

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