Norovirus Outbreak PreventionTulare County Environmental Health

Health & Human Services

Nilsa Gonzalez, REHS IV

What is Norovirus ?

• Norovirus is a small virus that is highly contagious.• Norovirus infection is the most common cause of

gastroenteritis outbreaks. Although some people call this the "stomach flu," norovirus is not related to the influenza virus.

• According to statistics from the CDC, there are 21 million cases of norovirus infection annually in the U.S., of which one-quarter are related to food-borne outbreaks.

Why is the Norovirus a big deal?

• Noroviruses are a public health problem.• They are highly contagious .• People with Norovirus illness shed billions of virus particles in

their stool and vomit, but it only takes a very small amount of them (< 100 particles) to make someone sick.

• They spread easily and quickly, especially in closed places like day cares centers, schools, nursing homes and cruise ships.

• They are hard to get rid of because they:• Stay on objects and surfaces and still infect people after days or

weeks • Survive both freezing and heating (up to 140 degrees F) and even

some disinfectants.

Signs & Symptoms

• Acute Gastroenteritis (inflammation of the stomach and intestines)• Diarrhea, vomiting, nausea, stomach pain• Fever, body aches, fatigue• If you have norovirus illness, you can feel extremely ill and

throw up or have diarrhea many times a day. This can lead to dehydration, especially in young children, older adults, and people with other illnesses.

• Most people with norovirus illness get better within 1-3 days.

Transmission

• Anyone can get infected with norovirus and get sick. Also, you can get sick many times in your life.

• Norovirus can be found in your stool even before you start feeling sick. The virus can stay in your stool for 2 weeks or more after you feel better.

• You are most contagious when you are sick with norovirus illness, and during the first 3 days after you recover from the norovirus illness.

How is the virus spread?

• People with norovirus illness shed billions of virus particles in their stool and vomit.

• People can get infected by :• Eating food or drinking liquids contaminated with norovirus• Touching surfaces or objects that have norovirus on them

then putting fingers in mouth.• Having direct contact with someone infected• Caring for, sharing food, drinks or eating utensils with an

infected person.

Food Handlers

• Food handlers, such as those in restaurants, can spread norovirus to others when they are ill.• They can easily contaminate the food and drinks that they

touch• People who consume these foods or drinks can get infected

and sick, leading to an outbreak.• According to the CDC, about 50% of all outbreaks of food-

related illness are caused by norovirus. In many of these cases, sick food handlers were involved in spreading the virus.(FBI Outbreak study 2006-2010)

Common Foods

• Foods commonly involved in norovirus outbreak include:• Raw or undercooked foods, such as leafy greens, fresh fruits, or

shellfish.• Any food served raw or handled after being cooked can get

contaminated with the norovirus.• Fresh produce may be handled at several different points , including

harvesting, processing, and preparing, before it is eaten.• Water used to irrigate the crops can cause norovirus contamination,

which will persist on raw food.• Raw or undercooked shellfish like oysters, can be problematic when

they are harvested from contaminated waters.• Ready to eat foods, like sandwiches and salads.

Prevention in the Food Industry

• First, focus on the food handler• Infected food handlers are the source of approximately 50%

of foodborne norovirus outbreaks in California.• Most outbreaks are caused by food in restaurants

contaminated during preparation .• Food handlers should:• Always practice good hygiene• Avoid touching food with bare hands • Stay out of the kitchen and not handle or prepare food when

they are sick – STAY HOME WHEN SICK

Proper Hand washing

• Most critical part of personal

cleanliness

• Should follow any act of

potential contamination

5 Tips to Prevent a Food Borne Illness Outbreak

• First, always wash your hands carefully with soap and water after using the restroom and before eating, preparing, or handling food.

• Second, wash all fruits and vegetables thoroughly.• Third, do not handle or prepare food for others when you

are sick and for at least 2-3 days after you recover.• Fourth, clean and disinfect contaminated surfaces after

vomiting or experiencing diarrhea.• Finally, wash any soiled laundry thoroughly after

throwing up or having diarrhea.

Employee Health, Cal Code, section 11349

• It is the intent of the legislature to reduce the likelihood of foodborne disease transmission by preventing any food employee who is suffering from symptoms of acute gastrointestinal illness or a known communicable disease from engaging of the handling of food.

Local Health Officer

• When the Local Health Officer is notified of an illness that can be transmitted by food in a food facility, the Health Officer will notify the Local Enforcement Agency and we will notify the person in charge at the food facility.

• The Local Health Officer will take appropriate action with the immediate Restriction or Exclusion of any employee from the affected food facility, the immediate closing of the food facility or a medical evaluation of an employee.

Owner Responsibility, section 113949.2

• The owner shall instruct all food employees regarding the relationship between personal hygiene and food safety, including the association of hand contact, personal habits and behaviors , and food employee health to foodborne illness.

• The owner shall also require the food employee to report the diagnosis of any of the 7 infectious agents or if a food employee has a lesion or wound that is open or draining.

Responsibility of the Food Employee

• The food employee shall report to the person in charge if he/she has been diagnosed with any of the 7 infectious agents or any lesions or wounds that are open or draining.

• The food employee must also comply with the Exclusions or Restrictions issued by the Local Health Officer

Outbreak Occurs

• A Norovirus outbreak has occurred , the employees have been identified and Excluded from the food facility.

• Now we need decontaminate the food facility .

Decontaminating Surfaces

• A chlorine bleach solution with a concentration of 1000-5000 ppm (5-25 tablespoons of household bleach [5.25%] per gallon of water)

• All surfaces must be properly sanitized from the back of the facility to the front, top to bottom. Every door knob, handle and horizontal surface.

For more information see EPA’s Registered Antimicrobial Products Effective against Norovirus. www.epa.gov

Things to Remember

• If you work with food when you have the norovirus illness, you can spread the virus. You can easily contaminate food and drinks that you touch.

• People who consume contaminated food or drinks can become infected with norovirus and become sick. This can cause an outbreak.

• About 50% of all outbreaks of food-related illness are caused by norovirus. In many of these cases, sick food handlers were involved in spreading the virus.

Any Questions ?

Nilsa Gonzalez REHSSupervising Environmental Health Specialist

Tulare County Environmental Health, (559) 624-7400

Norovirus causes about 20 million gastroenteritis cases each year in the United States. There is no vaccine to prevent infection and no drug to treat it. Wash your hands often and follow the simple tips to stay healthy.