Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 11, Number 1—January 2005

Norovirus and Foodborne Disease, United States, 1991–2000

Marc-Alain Widdowson*Comments to Author , Alana Sulka*, Sandra N. Bulens*†, R. Suzanne Beard*, Sandra S. Chaves†‡, Roberta Hammond§, Ellen D.P. Salehi¶, Ellen Swanson#, Jessica Totaro**, Ray Woron††, Paul S. Mead*, Joseph S. Bresee*, Stephan S. Monroe*, and Roger I. Glass*
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Atlanta Research and Education Foundation, Atlanta, Georgia, USA; ‡Department of Human Resources, Atlanta, Georgia, USA; §Bureau of Community Environmental Health, Tallahassee, Florida, USA; ¶Ohio Department of Health, Columbus, Ohio, USA; #Department of Health, Minneapolis, Minnesota, USA; **Maryland Department of Health and Mental Hygiene, Baltimore, Maryland, USA; ††New York State Department of Health, Troy, New York, USA

Main Article

Table 5

Estimates of the role of norovirus (NoV) in foodborne outbreaks of gastroenteritis*

Place (reference) Years of data No. of foodborne outbreaks Method used to attribute to NoV % of foodborne outbreaks attributable to NoV
United Kingdom (31) 1995–1996 341 Electron microscopy 6
Sweden (30) 1998–1999 85 RT-PCR 6
Sweden (29) 1994–1998 92 Electron microscopy 72
New Zealand† 2000–2002 383 RT-PCR 12
The Netherlands‡ 2002 59 RT-PCR 27
United States (6) 1982–1989 1049 Epidemiologic criteria 33
United States (8) 1981–1998 295 RT-PCR and epidemiologic criteria 41
United States§ 2000 600 RT-PCR and extrapolation 50

*RT-PCR; reverse transcription–polymerase chain reaction.
†N. Boxall, pers. comm.
‡Y. van Duynhoven, pers. comm.
§Current study.

Main Article

  1. Mead  PS, Slutsker  L, Dietz  V, Slutsker  L, Dietz  V, McCagi  LF, Food-related illness and death in the United States. Emerg Infect Dis. 1999;5:60725. DOIPubMedGoogle Scholar
  2. Bell  BP, Goldoft  M, Griffin  PM, Davis  MA, Gordon  DC, Tarr  PI, A multistate outbreak of Escherichia coli O157:H7-associated bloody diarrhea and hemolytic uremic syndrome from hamburgers. The Washington experience. JAMA. 1994;272:134953. DOIPubMedGoogle Scholar
  3. Michino  H, Araki  K, Minami  S, Takaya  S, Sakai  N, Miyazaki  M, Massive outbreak of Escherichia coli O157:H7 infection in schoolchildren in Sakai City, Japan, associated with consumption of white radish sprouts. Am J Epidemiol. 1999;150:78796.PubMedGoogle Scholar
  4. Lin  FY, Morris  JG Jr, Trump  D, Tilghman  D, Wood  PK, Jackman  N, Investigation of an outbreak of Salmonella enteritidis gastroenteritis associated with consumption of eggs in a restaurant chain in Maryland. Am J Epidemiol. 1988;128:83944.PubMedGoogle Scholar
  5. Olsen  SJ, MacKinnon  LC, Goulding  JS, Bean  NH, Slutsker  L. Surveillance for foodborne-disease outbreaks—United States, 1993–1997. MMWR CDC Surveill Summ. 2000;49(No.SS-1):164.PubMedGoogle Scholar
  6. Hall  JA, Goulding  JS, Bean  NH, Tauxe  RV, Hedberg  CW. Epidemiologic profiling: evaluating foodborne outbreaks for which no pathogen was isolated by routine laboratory testing: United States, 1982–9. Epidemiol Infect. 2001;127:3817. DOIPubMedGoogle Scholar
  7. Bresee  JS, Widdowson  M-A, Monroe  SS, Glass  RI. Foodborne viral gastroenteritis: challenges and opportunities. Clin Infect Dis. 2002;35:74853. DOIPubMedGoogle Scholar
  8. Deneen  VC, Hunt  JM, Paule  CR, James  OI, Johnson  RG, Raymond  MJ, The impact of foodborne calicivirus disease: the Minnesota experience. J Infect Dis. 2000;181(Suppl 2):S2813. DOIPubMedGoogle Scholar
  9. Hedberg  CW, Osterholm  MT. Outbreaks of food-borne and waterborne viral gastroenteritis. Clin Microbiol Rev. 1993;6:199210.PubMedGoogle Scholar
  10. Kaplan  JE, Feldman  R, Campbell  DS, Lookabaugh  C, Gary  GW. The frequency of a Norwalk-like pattern of illness in outbreaks of acute gastroenteritis. Am J Public Health. 1982;72:132932. DOIPubMedGoogle Scholar
  11. Greenberg  HB, Valdesuso  J, Yolken  RH, Gangarosa  E, Gary  W, Wyatt  RG, Role of Norwalk virus in outbreaks of nonbacterial gastroenteritis. J Infect Dis. 1979;139:5648. DOIPubMedGoogle Scholar
  12. Monroe  SS, Glass  RI, Noah  N, Flewett  TH, Caul  EO, Ashton  CI, Electron microscopic reporting of gastrointestinal viruses in the United Kingdom, 1985–87. J Med Virol. 1991;33:1938. DOIPubMedGoogle Scholar
  13. Gary  GW Jr, Kaplan  JE, Stine  SE, Anderson  LJ. Detection of Norwalk virus antibodies and antigen with a biotin-avidin immunoassay. J Clin Microbiol. 1985;22:2748.PubMedGoogle Scholar
  14. Kaplan  JE, Gary  GW, Baron  RC, Singh  N, Schonberger  LB, Feldman  R, Epidemiology of Norwalk gastroenteritis and the role of Norwalk virus in outbreaks of acute nonbacterial gastroenteritis. Ann Intern Med. 1982;96:75661.PubMedGoogle Scholar
  15. Jones  TF, Gerber  DE. Perceived etiology of foodborne illness among public health personnel. Emerg Infect Dis. 2001;7:9045. DOIPubMedGoogle Scholar
  16. Jiang  X, Wang  J, Graham  DY, Estes  MK. Detection of Norwalk virus in stool by polymerase chain reaction. J Clin Microbiol. 1992;30:252934.PubMedGoogle Scholar
  17. Moe  CL, Gentsch  J, Ando  T, Grohmann  G, Monroe  SS, Jiang  X, Application of PCR to detect Norwalk virus in fecal specimens from outbreaks of gastroenteritis. J Clin Microbiol. 1994;32:6428.PubMedGoogle Scholar
  18. Fankhauser  RL, Monroe  SS, Noel  JS, Ando  TA, Glass  RI. Epidemiologic and molecular trends of Norwalk-like viruses associated with outbreaks of gastroenteritis in the United States. J Infect Dis. 2002;186:17. DOIPubMedGoogle Scholar
  19. Centers for Disease Control and Prevention. Guide to confirming the diagnosis in foodborne diseases. [cited 2004 Feb 1].Available from
  20. Daniels  NA, Bergmire-Sweat  DA, Schwab  KJ, Hendricks  KA, Reddy  S, Rowe  SM, A foodborne outbreak of gastroenteritis associated with Norwalk-like viruses: first molecular traceback to deli sandwiches contaminated during preparation. J Infect Dis. 2000;181:146770. DOIPubMedGoogle Scholar
  21. Ponka  A, Maunula  L, von Bonsdorff  CH, Lyytikainene  O. Outbreak of calicivirus gastroenteritis associated with eating frozen raspberries. Eurosurveillance. 1999;4:669.PubMedGoogle Scholar
  22. Kuritsky  JN, Osterholm  MT, Greenberg  HB, Korlath  JA, Godes  JR, Hedberg  CW, Norwalk gastroenteritis: a community outbreak associated with bakery product consumption. Ann Intern Med. 1984;100:51921.PubMedGoogle Scholar
  23. Dowell  SF, Groves  C, Kirkland  KB, Cicirello  HG, Ando  T, Jin  Q, A multistate outbreak of oyster-associated gastroenteritis: implications for interstate tracing of contaminated shellfish. J Infect Dis. 1995;171:1497503. DOIPubMedGoogle Scholar
  24. Kohn  MA, Farley  TA, Ando  T, Curtis  M, Wilson  SA, Jin  Q, An outbreak of Norwalk virus gastroenteritis associated with eating raw oysters: implications for maintaining safe oyster beds. JAMA. 1995;273:46671. DOIPubMedGoogle Scholar
  25. Berg  DE, Kohn  MA, Farley  TA, McFarland  LM. Multi-state outbreaks of acute gastroenteritis traced to fecal-contaminated oysters harvested in Louisiana. J Infect Dis. 2000;181(Suppl 2):S3816. DOIPubMedGoogle Scholar
  26. Parashar  UD, Dow  L, Fankhauser  RL, Humphrey  CD, Miller  J, Ando  T, An outbreak of viral gastroenteritis associated with consumption of sandwiches: implications for the control of transmission by food handlers. Epidemiol Infect. 1998;121:61521. DOIPubMedGoogle Scholar
  27. Gaulin  CD, Ramsay  D, Cardinal  P, D’Halevyn  M-A. Epidemie de gastro-enterite d'origine virale associee a la consommation de framboises importees. Can J Public Health. 1999;90:3740.PubMedGoogle Scholar
  28. Dentinger  CM, Bower  WA, Nainan  OV, Cotter  SM, Myers  G, Dubusky  LM, An outbreak of hepatitis A associated with green onions. J Infect Dis. 2001;183:12736. DOIPubMedGoogle Scholar
  29. Hedlund  KO. Rubilar-Abreu, Svensson L. Epidemiology of calicivirus infections in Sweden, 1994–1998. J Infect Dis. 2000;181(Suppl 2):S27580. DOIPubMedGoogle Scholar
  30. Lindqvist  R, Andersson  Y, Lindback  J, Wegscheider  M, Eriksson  Y, Tidestrom  L, A one-year study of foodborne illnesses in the municipality of Uppsala, Sweden. Emerg Infect Dis. 2001;7:58892. DOIPubMedGoogle Scholar
  31. Evans  HS, Madden  P, Douglas  C, Adak  GK, O’Brien  SJ, Djuretic  T, General outbreaks of infectious intestinal disease in England and Wales: 1995 and 1996. Commun Dis Public Health. 1998;1:16571.PubMedGoogle Scholar
  32. Lopman  BA, Adak  GK, Reacher  MH, Brown  DW. Two epidemiologic patterns of norovirus outbreaks: surveillance in England and Wales, 1992–2000. Emerg Infect Dis. 2003;9:717.PubMedGoogle Scholar
  33. Green  KY, Chanock  RM, Kapikian  AZ. Human caliciviruses. In: Knipe DM, Howley PM, editors. Fields virology. Vol 1. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 841–74.
  34. Koopmans  M, Vennema  H, Heersma  H, van Strien  E, van Duynhoven  Y, Brown  D, Early identification of common-source foodborne virus outbreaks in Europe. Emerg Infect Dis. 2003;9:113642.PubMedGoogle Scholar
  35. Widdowson  MA, Cramer  EH, Hadley  L, Bresee  JS, Beard  RS, Bulens  SN, Outbreaks of acute gastroenteritis on cruise ships and on land: identification of a predominant circulating strain of norovirus—United States, 2002. J Infect Dis. 2004;190:2736. DOIPubMedGoogle Scholar

Main Article

1Efforts in 1998 to improve outbreak reporting resulted in more outbreaks being retrospectively attributed to this period. The current figures for 1993 to 1997 are 65 (2%) of 3,257 outbreaks attributable to NoV and 67% of unknown etiology.

Page created: April 14, 2011
Page updated: April 14, 2011
Page reviewed: April 14, 2011
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.