Norovirus foodborne outbreak in an agritourism: causes, development and legal consequences

• Published in: European journal of public health Vol. 30; no. Supplement_5
• Main Authors: Masciarelli, M, Di Giovanni, P, Cedrone, F, D’Addezio, M, Di Martino, G, Meo, F, Ranalli, E, Saraullo, V, Scampoli, P, Staniscia, T
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.09.2020
• Subjects: Agritourism; Appeals; Biological properties; Biological samples; Childrens health; Contamination; Customers; Faucets; Feces; Food; Food contamination; Food contamination & poisoning; Food handling; Food safety; Food sanitation; Food service; Foodborne diseases; Gastroenteritis; Gastrointestinal diseases; Handlers; Hazard analysis critical control point; Hygiene; Illnesses; Imprisonment; Inspection; Litigation; Norovirus; Outbreaks; Prevention; Public health; Rectum; Tourism; Waterborne diseases
• ISSN: 1101-1262; 1464-360X
• DOI: 10.1093/eurpub/ckaa166.250

Background Norovirus is the main causative agent of viral acute gastroenteritis. It is easily transmitted and frequently causes foodborne and waterborne outbreaks. The Food Hygiene Service of ASL 2 Abruzzo received notification of gastrointestinal illness in 33 customers who attended a lunch at an agritourism on 28 July 2019. Methods The investigation started immediately. The event was reported to the Judicial Authority and food preparation was suspended. Stool specimens and rectal swabs were collected from 18 guests and 2 food handlers and tested. A questionnaire survey was given to the customers. During the inspection, the Food Hygiene Service sampled some food leftover and water from faucets. Furthermore, it found an incomplete HACCP manual. Results The 31 cases of gastrointestinal illness occurred within 12-72 hours and didn't need hospitalization. Among the affected subjects,18 were men (58.1%) with a median age of 51 years. All the biological samples collected from the subjects were positive for Norovirus GII, as revealed by Real Time-PCR. The two food handlers resulted positive for Norovirus GII, but they were asymptomatic. They were tested up to 3 weeks after the outbreak and their feces remained positive. Water and food samples resulted negative, except for raw ham's outer surface, that resulted positive for Norovirus GII. The contamination probably occurred during food preparation. Discussion This outbreak was related to food cross-contamination by infected food handlers, likely caused by a failure in application of both personal and food hygiene measures prescribed in HACCP plan. Food preparation restarted on 12 September 2019, but infected food handlers were dismissed until they were positive. The Judicial Authority will file a lawsuit against the food operator business that could lead to imprisonment or fines. Key messages Norovirus outbreaks are recognized as a public health concern causing a high number of cases and serious health consequences in children and the elderly. HACCP manual must be customized for each food business and integrally applied by food handlers in order to attain a higher standard of food safety for prevention of foodborne illness.