1 NOROVIRUS A Food Production Perspective Tom Ford Vice President, Food Safety Ecolab November 2012 Photo courtesy: Dr. B.V.V. Prasad, Baylor College of Medicine
Settings of Confirmed Norovirus Outbreaks, US, 2010-2011 (n=1518) Party & Event 6% School 4% Hospital 4% Cruise Ship 4% 2 Restaurant 8% Other & Unknown 15% Long-term Care Facility 59% Source: A. Hall, CDC Preliminary Data, 2012
Mode of Transmission in Norovirus Outbreaks, 20 States, 2009 (N=613) 3 90.00 80.00 78.00 70.00 60.00 50.00 40.00 30.00 20.00 15.00 10.00 0.00 7.00 0.20 0.10 Source: A. Hall, CDC, 2012
4 How is Norovirus Transmitted? USA 2000-2004 Nursing homes, retirement centers, hospitals Restaurant and catered events Vacation settings & cruise Schools and day-care centers % of Outbreaks Foodborne Person to Person Waterborne Other 4 62 0 34 83 3 0 14 5 43 5 46 22 44 6 28 Other 14 28 25 33 TOTAL 30 35 5 30 Source: Blanton et al. 2006. J Inf. Dis.:193:413-21.
5 How is Norovirus Transmitted? % of Outbreaks England & Wales 1992-2000 Foodborne Person to Person Other/ unknown Food outlet 67 22 11 Hospital 1 95 4 Residential facilities 5 91 4 School 6 89 6 Hotel 29 64 7 Other 34 58 8 TOTAL 10 85 5 Source: Lopman et al, Emerg Infect Dis. 2003 Jan www.cdc.gov/ncidod/eid/vol9no1/020175.htm
6 What is the Source of Norovirus? y Feces or vomit of an infected person y Spreads : Directly from person to person Through unwashed hands Via ingestion of contaminated food or water Through contact with contaminated surfaces y An infected person may be contagious for 2 weeks after recovery
7 How is Norovirus Inactivated? y Difficult to inactivate Persists in chlorinated drinking water y Persists in the environment Survives freezing and refrigeration Requires very high temperature to inactivate Survives in acidic environments y Norovirus should be a concern at production facilities Source: Doultree, et. al. 1999. J. Hosp. Infection 41:51-57
8 Regulatory Status y Human norovirus cannot be cultured in the laboratory, making regulatory classifications complicated y Hard Surface Disinfectants US EPA accepts feline calicivirus as a norovirus surrogate for disinfectant claims. In 2011, CDC suggested use of multiple surrogate viruses to assess norovirus disinfectant efficacy. Academic and industry study remains in development. y Hand Care Products Cannot list claims against norovirus in the US because viral claims are not currently recognized by the FDA (FDA Tentative Final Monograph for Healthcare Antiseptic Drug Products). In Canada and certain European countries, norovirus hand antiseptics may be cleared based on norovirus surrogate testing data.
9 Risk Reduction Plan y Review current cleaning and hygiene plan. y Have a hygiene plan in place. Hands should be washed frequently y Do not permit infected workers to prepare food: While they have symptoms For at least 3 days after recovery y Discard food that may have been contaminated by an ill person.
10 Tips for Being Prepared y Have appropriate spill kits and other products on hand. y Have personal protective equipment (PPE) on hand. y Audit your products and procedures. y Post handwashing signage and procedures.
Risk Reduction and Remediation Considerations y procedures organized into three levels of action: LEVEL GREEN: Standard procedures maintaining hygiene when norovirus poses no direct threat LEVEL YELLOW: Risk reduction a heightened defensive response to an outbreak in your area/industry LEVEL RED: Remediation a focused response to an outbreak in your facility, designed to break the chain of infection or illness INCIDENT CLEAN-UP How to clean an incident of vomitus or stool contamination 11
12 Summary y Norovirus is highly infectious and resistant y Concerns would be : identification and exclusion of infected workers- and taking subsequent action regarding risk to food Hand Hygiene program is a key component An effective sanitation program utilizing appropriate products