News

Category: Public Health
Posted by: swisher

Strict rules may help prevent costly outbreaks of stomach 'bug'

DELTA TOWNSHIP, MICH. -- At a Carrabba's Italian Grill here in the Lansing, Mich., area during a weekend in January, at least one employee came to work with a stomach "bug" that in turn made nearly 500 people violently ill and caused a steep drop in the restaurant's sales.

The virus that caused the outbreak among the restaurant's guests and employees was not one of the more widely known pathogens that operators lose sleep over, such as salmonella, E. coli or hepatitis A. It was a class of infectious microbes that is far more common: the norovirus.

The recent Lansing incident was a wake-up call for the 205-unit Carrabba's chain, owned by Tampa, Fla.-based Outback Steakhouse Inc. Other restaurateurs and health officials also say the increasing number of norovirus outbreaks should prompt all foodservice operators to review sanitation practices with employees and implement stricter sickleave policies.

Thought to be the culprit responsible for at least half of all gastrointestinal illness in the United States -- an estimated 23 million cases each year -- noroviruses are highly contagious and typically cause a one- to two-day bout of severe nausea, vomiting and diarrhea, as well as abdominal cramps, fever and muscle aches. In some cases victims are hospitalized.

Sometimes called the Norwalk or Norwalk-like virus, the pathogen has been linked in news reports of outbreaks on cruise ships, in nursing homes and in schools. However, the U.S. Centers for Disease Control and Prevention, or CDC, in Atlanta estimates that far more norovirus outbreaks over the past decade have been associated with restaurants, and even in other settings food handlers most often are implicated. To address the situation, the U.S. Food and Drug Administration for the first time included in its model 2005 Food Code norovirus as an illness that must be reported to employers.

Of 348 outbreaks reported to the CDC between 1996 and 2000, an estimated 39 percent were linked to restaurants, the most common setting. By contrast, cruise ships and other vacation settings accounted for only 10 percent of those outbreaks.

In 2004, the most recent year for which data are available, 251 reported outbreaks of foodborne illnesses across the country involving nearly 10,000 victims were thought to be viral. Almost all were classified as norovirus related, and 93 were norovirus outbreaks tied to restaurants, according to CDC statistics.

While foodborne illness from bacterial and other causes is declining because of better refrigeration and food-supply controls, CDC officials say norovirus outbreaks are on the rise, in part because Americans are eating in restaurants more often.

In some cases, food is contaminated at the source -- raw oysters and fresh produce are common vehicles for infection. But typically noroviruses walk in a restaurant's front door, carried either by sick employees or guests.

Health officials nationwide say the foodservice industry is ill-prepared to deal with the problem, even though a norovirus outbreak can have a devastating effect.

In the Carrabba's case, Eric Pessell, director of environmental health for the Barry-Eaton District Health Department, which includes Lansing, said the wave of illness there likely began after a sick restaurant employee vomited in the unit.

"This is happening more frequently than we as regulators know and more than the industry is aware," Pessell said.

What most operators don't realize, he said, is that vomiting can cause the norovirus to become airborne, landing on surfaces up to 15 feet away.

Commonly used restaurant sanitizers, such as quaternary ammonium chloride solutions, are ineffective against the virus. The CDC recommends a high concentration of bleach, said Pessell, who added that personnel should be trained on how to use such solutions safely.

If someone gets sick in a restaurant, operators should consider closing the restaurant immediately before gross contamination occurs, Pessell said.

In the Carrabba's case, he said, "that's the only thing, in our opinion, that would have stopped it." Carrabba's never closed the unit. The problem, said Steve Shlemon, the brand's president and chief executive, is that it typically takes 24 to 48 hours after exposure to such viruses for people to fall ill.