Outbreak of norovirus infection among river rafters associated with packaged delicatessen meat, Grand Canyon, 2005

Mark Malek, Ezra Barzilay, Adam Kramer, Brendan Camp, Lee Ann Jaykus, Blanca Escudero-Abarca, Greg Derrick, Patricia White, Charles P Gerba, Charles Higgins, Jan Vinje, Roger Glass, Michael Lynch, Marc Alain Widdowson

Research output: Contribution to journalArticle

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Abstract

Background. Norovirus is often transmitted by infected food handlers at the point of service, whereas reports of food contamination before wholesale distribution are rare. In September 2005, we investigated reports of gastroenteritis among rafters who went on unrelated trips on the Colorado River. Methods. We surveyed all companies that launched rafting trips during the period from 14 August through 19 September 2005 to identify trips in which ≥3 rafters became ill. We conducted a case-control study. Case patients were persons who experienced diarrhea or vomiting that commenced ≤72 h after the trip launch; control subjects were persons who did not become ill ≤72 h after launch. We tested stool samples and food specimens for norovirus. We performed a traceback investigation of the suspected food vehicle and inspected the implicated processing plant. Results. Three or more rafters developed gastroenteritis during 13 (14%) of 91 trips, for a total of 137 ill persons. Of the 57 case patients who became ill ≤72 h after trip launch, 55 (96%) reported eating delicatessen meat, compared with 75 (79%) of 95 control subjects (odds ratio, 7.3; 95% confidence interval, 1.7-66.7). All delicatessen meat eaten by case patients came from 1 batch purchased from 1 processing plant and had been sliced, vacuum-packed, and frozen (temperature, -23°C) for 7-28 days. An employee sliced this batch with bare hands 1 day after recovery from gastroenteritis. Identical norovirus sequences were identified in stool specimens obtained from rafters on 3 different trips; 2 of 5 meat packages also tested positive for norovirus by reverse-transcriptase polymerase chain reaction and DNA hybridization. Conclusions. Food handlers can contaminate ready-to-eat meats with norovirus during processing. Meatprocessing practices should include specific measures to prevent contamination with enteric viruses and subsequent widespread outbreaks.

Original languageEnglish (US)
Pages (from-to)31-37
Number of pages7
JournalClinical Infectious Diseases
Volume48
Issue number1
DOIs
StatePublished - Jan 1 2009

Fingerprint

Norovirus
Rivers
Meat
Disease Outbreaks
Gastroenteritis
Food
Infection
Food Contamination
Enterovirus
Vacuum
Reverse Transcriptase Polymerase Chain Reaction
Vomiting
Case-Control Studies
Diarrhea
Hand
Eating
Odds Ratio
Confidence Intervals
Temperature
DNA

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Malek, M., Barzilay, E., Kramer, A., Camp, B., Jaykus, L. A., Escudero-Abarca, B., ... Widdowson, M. A. (2009). Outbreak of norovirus infection among river rafters associated with packaged delicatessen meat, Grand Canyon, 2005. Clinical Infectious Diseases, 48(1), 31-37. https://doi.org/10.1086/594118

Outbreak of norovirus infection among river rafters associated with packaged delicatessen meat, Grand Canyon, 2005. / Malek, Mark; Barzilay, Ezra; Kramer, Adam; Camp, Brendan; Jaykus, Lee Ann; Escudero-Abarca, Blanca; Derrick, Greg; White, Patricia; Gerba, Charles P; Higgins, Charles; Vinje, Jan; Glass, Roger; Lynch, Michael; Widdowson, Marc Alain.

In: Clinical Infectious Diseases, Vol. 48, No. 1, 01.01.2009, p. 31-37.

Research output: Contribution to journalArticle

Malek, M, Barzilay, E, Kramer, A, Camp, B, Jaykus, LA, Escudero-Abarca, B, Derrick, G, White, P, Gerba, CP, Higgins, C, Vinje, J, Glass, R, Lynch, M & Widdowson, MA 2009, 'Outbreak of norovirus infection among river rafters associated with packaged delicatessen meat, Grand Canyon, 2005', Clinical Infectious Diseases, vol. 48, no. 1, pp. 31-37. https://doi.org/10.1086/594118
Malek, Mark ; Barzilay, Ezra ; Kramer, Adam ; Camp, Brendan ; Jaykus, Lee Ann ; Escudero-Abarca, Blanca ; Derrick, Greg ; White, Patricia ; Gerba, Charles P ; Higgins, Charles ; Vinje, Jan ; Glass, Roger ; Lynch, Michael ; Widdowson, Marc Alain. / Outbreak of norovirus infection among river rafters associated with packaged delicatessen meat, Grand Canyon, 2005. In: Clinical Infectious Diseases. 2009 ; Vol. 48, No. 1. pp. 31-37.
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abstract = "Background. Norovirus is often transmitted by infected food handlers at the point of service, whereas reports of food contamination before wholesale distribution are rare. In September 2005, we investigated reports of gastroenteritis among rafters who went on unrelated trips on the Colorado River. Methods. We surveyed all companies that launched rafting trips during the period from 14 August through 19 September 2005 to identify trips in which ≥3 rafters became ill. We conducted a case-control study. Case patients were persons who experienced diarrhea or vomiting that commenced ≤72 h after the trip launch; control subjects were persons who did not become ill ≤72 h after launch. We tested stool samples and food specimens for norovirus. We performed a traceback investigation of the suspected food vehicle and inspected the implicated processing plant. Results. Three or more rafters developed gastroenteritis during 13 (14{\%}) of 91 trips, for a total of 137 ill persons. Of the 57 case patients who became ill ≤72 h after trip launch, 55 (96{\%}) reported eating delicatessen meat, compared with 75 (79{\%}) of 95 control subjects (odds ratio, 7.3; 95{\%} confidence interval, 1.7-66.7). All delicatessen meat eaten by case patients came from 1 batch purchased from 1 processing plant and had been sliced, vacuum-packed, and frozen (temperature, -23°C) for 7-28 days. An employee sliced this batch with bare hands 1 day after recovery from gastroenteritis. Identical norovirus sequences were identified in stool specimens obtained from rafters on 3 different trips; 2 of 5 meat packages also tested positive for norovirus by reverse-transcriptase polymerase chain reaction and DNA hybridization. Conclusions. Food handlers can contaminate ready-to-eat meats with norovirus during processing. Meatprocessing practices should include specific measures to prevent contamination with enteric viruses and subsequent widespread outbreaks.",
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