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Volume 18, Number 10—October 2012

Epidemiology of Foodborne Norovirus Outbreaks, United States, 2001–2008

Aron J. HallComments to Author , Valerie G. Eisenbart, Amy Lehman Etingüe, L. Hannah Gould, Ben A. Lopman, and Umesh D. Parashar
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (A.J. Hall, V.G. Eisenbart, A. Lehman Etingüe, L.H. Gould, B.A. Lopman, U.D. Parashar); University of Illinois, Urbana, Illinois, USA (V.G. Eisenbart); and North Carolina State University, Raleigh, North Carolina, USA (A. Lehman Etingüe)

Main Article

Table 1

Estimated annual number and rate of reported illnesses associated with foodborne norovirus outbreaks by age, sex, and outcome, United States, 2001–2008

Characteristic Estimated annual outbreak-associated illnesses*
No. (%) Rate†
Age group, y


215 (2) 10.6


1,827 (18) 30.3


4,923 (48) 39.8


3,359 (33) 37.7


5,819 (56) 39.0


4,505 (44) 31.3

Health care provider visit

1,247 (12) 4.3


156 (1.5) 0.5


1 (0.01) 0.002
Total Illnesses 10,324 (100) 35.2

*Proportions of illnesses by age, sex, and outcomes among outbreaks for which such data were reported were extrapolated to all reported foodborne norovirus outbreak–associated illnesses.
†Reported rate per 1,000,000 person-years calculated by dividing the number of illnesses by the corresponding US intercensal estimate at the study period midpoint (July 2004) (23).

Main Article

  1. Scallan  E, Hoekstra  RM, Angulo  FJ, Tauxe  RV, Widdowson  M-A, Roy  SL, Foodborne illness acquired in the United States—major pathogens. Emerg Infect Dis. 2011;17:715.PubMedGoogle Scholar
  2. Batz  MB, Hoffmann  S, Morris  JG Jr. Ranking the risks: the 10 pathogen-food combinations with the greatest burden on public health: University of Florida; 2011 [cited 2012 Jul 26].
  3. Centers for Disease Control and Prevention. Surveillance for foodborne disease outbreaks—United States, 2006. MMWR Morb Mortal Wkly Rep. 2009;58:60915.PubMedGoogle Scholar
  4. Centers for Disease Control and Prevention. Surveillance for foodborne disease outbreaks—United States, 2007. MMWR Morb Mortal Wkly Rep. 2010;59:9739.PubMedGoogle Scholar
  5. Centers for Disease Control and Prevention. Surveillance for foodborne disease outbreaks—United States, 2008. MMWR Morb Mortal Wkly Rep. 2011;60:1197202.PubMedGoogle Scholar
  6. Centers for Disease Control and Prevention. Updated norovirus outbreak management and disease prevention guidelines. MMWR Recomm Rep. 2011;60(RR-3):118.PubMedGoogle Scholar
  7. Zheng  DP, Widdowson  MA, Glass  RI, Vinje  J. Molecular epidemiology of genogroup II–genotype 4 noroviruses in the United States between 1994 and 2006. J Clin Microbiol. 2010;48:16877. DOIPubMedGoogle Scholar
  8. Teunis  PF, Moe  CL, Liu  P, Miller  SE, Lindesmith  L, Baric  RS, Norwalk virus: how infectious is it? J Med Virol. 2008;80:146876. DOIPubMedGoogle Scholar
  9. Atmar  RL, Opekun  AR, Gilger  MA, Estes  MK, Crawford  SE, Neill  FH, Norwalk virus shedding after experimental human infection. Emerg Infect Dis. 2008;14:15537. DOIPubMedGoogle Scholar
  10. Aoki  Y, Suto  A, Mizuta  K, Ahiko  T, Osaka  K, Matsuzaki  Y. Duration of norovirus excretion and the longitudinal course of viral load in norovirus-infected elderly patients. J Hosp Infect. 2010;75:426. DOIPubMedGoogle Scholar
  11. Cheesbrough  JS, Barkess-Jones  L, Brown  DW. Possible prolonged environmental survival of small round structured viruses. J Hosp Infect. 1997;35:3256. DOIPubMedGoogle Scholar
  12. Seitz  SR, Leon  JS, Schwab  KJ, Lyon  GM, Dowd  M, McDaniels  M, Norovirus infectivity in humans and persistence in water. Appl Environ Microbiol. 2011;77:68848. DOIPubMedGoogle Scholar
  13. Park  GW, Barclay  L, Macinga  D, Charbonneau  D, Pettigrew  CA, Vinje  J. Comparative efficacy of seven hand sanitizers against murine norovirus, feline calicivirus and GII.4 norovirus. J Food Prot. 2010;73:22328.PubMedGoogle Scholar
  14. Park  GW, Sobsey  MD. Simultaneous comparison of murine norovirus, feline calicivirus, coliphage MS2, and GII.4 norovirus to evaluate the efficacy of sodium hypochlorite against human norovirus on a fecally soiled stainless steel surface. Foodborne Pathog Dis. 2011;8:100510. DOIPubMedGoogle Scholar
  15. Lynch  M, Painter  J, Woodruff  R, Braden  C. Surveillance for foodborne-disease outbreaks—United States, 1998–2002. MMWR Surveill Summ. 2006;55:142.PubMedGoogle Scholar
  16. Falkenhorst  G, Krusell  L, Lisby  M, Madsen  SB, Bottiger  B, Molbak  K. Imported frozen raspberries cause a series of norovirus outbreaks in Denmark, 2005. Euro Surveill. 2005;10:E050922.2.PubMedGoogle Scholar
  17. Westrell  T, Dusch  V, Ethelberg  S, Harris  J, Hjertqvist  M, Jourdan-da Silva  N, Norovirus outbreaks linked to oyster consumption in the United Kingdom, Norway, France, Sweden and Denmark, 2010. Euro Surveill. 2010;15:19524.PubMedGoogle Scholar
  18. Maalouf  H, Schaeffer  J, Parnaudeau  S, Le Pendu  J, Atmar  RL, Crawford  SE, Strain-dependent norovirus bioaccumulation in oysters. Appl Environ Microbiol. 2011;77:318996. DOIPubMedGoogle Scholar
  19. Widdowson  MA, Sulka  A, Bulens  SN, Beard  RS, Chaves  SS, Hammond  R, Norovirus and foodborne disease, United States, 1991–2000. Emerg Infect Dis. 2005;11:95102. DOIPubMedGoogle Scholar
  20. Centers for Disease Control and Prevention. Foodborne disease outbreak surveillance. September 2011 [cited 2012 Jul 13].
  21. Centers for Disease Control and Prevention. Electronic Foodborne Outbreak Reporting System: investigation of a foodborne outbreak (CDC form 52.13). November 2004 [cited 2012 Feb 22].
  22. Turcios  RM, Widdowson  MA, Sulka  AC, Mead  PS, Glass  RI. Reevaluation of epidemiological criteria for identifying outbreaks of acute gastroenteritis due to norovirus: United States, 1998–2000. Clin Infect Dis. 2006;42:9649. DOIPubMedGoogle Scholar
  23. National Center for Health Statistics. Postcensal estimates of the resident population of the United States for July 1, 2000–July 1, 2009, by year, county, age, bridged race, Hispanic origin, and sex (Vintage 2009). June 20, 2010 [cited 2011 May 11].
  24. Painter  JA, Ayers  T, Woodruff  R, Blanton  E, Perez  N, Hoekstra  RM, Recipes for foodborne outbreaks: a scheme for categorizing and grouping implicated foods. Foodborne Pathog Dis. 2009;6:125964. DOIPubMedGoogle Scholar
  25. Phillips  G, Tam  CC, Rodrigues  LC, Lopman  B. Prevalence and characteristics of asymptomatic norovirus infection in the community in England. Epidemiol Infect. 2010;138:14548. DOIPubMedGoogle Scholar
  26. Todd  EC, Greig  JD, Bartleson  CA, Michaels  BS. Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 5. Sources of contamination and pathogen excretion from infected persons. J Food Prot. 2008;71:258295.PubMedGoogle Scholar
  27. US Food and Drug Administration. Food code, 2005 [cited 2012 Jul 26].
  28. Le Guyader  FS, Atmar  RL, Le Pendu  J. Transmission of viruses through shellfish: when specific ligands come into play. Curr Opin Virol. 2012;2:10310. DOIPubMedGoogle Scholar
  29. Ethelberg  S, Lisby  M, Bottiger  B, Schultz  AC, Villif  A, Jensen  T, Outbreaks of gastroenteritis linked to lettuce, Denmark, January 2010. Euro Surveill. 2010;15:19484.PubMedGoogle Scholar
  30. Baert  L, Mattison  K, Loisy-Hamon  F, Harlow  J, Martyres  A, Lebeau  B, Review: norovirus prevalence in Belgian, Canadian and French fresh produce: a threat to human health? Int J Food Microbiol. 2011;151:2619. DOIPubMedGoogle Scholar
  31. Centers for Disease Control and Prevention. Food safety epidemiology capacity in state health departments—United States, 2010. MMWR Morb Mortal Wkly Rep. 2011;60:17014.PubMedGoogle Scholar
  32. Biggerstaff  GK, Wright  JG, Mitchell  JR. FoodCORE: foodborne diseases centers for outbreak response enhancement—improving foodborne disease outbreak response capacity in state and local health departments. In: 2012 International Conference on Emerging Infectious Diseases program and abstracts book, March 11–14, Atlanta, Georgia, USA [cited 2012 Jul 26].
  33. Centers for Disease Control and Prevention. Norovirus activity—United States, 2006–2007. MMWR Morb Mortal Wkly Rep. 2007;56:8426.PubMedGoogle Scholar
  34. Yen  C, Wikswo  ME, Lopman  BA, Vinje  J, Parashar  UD, Hall  AJ. Impact of an emergent norovirus variant in 2009 on norovirus outbreak activity in the United States. Clin Infect Dis. 2011;53:56871. DOIPubMedGoogle Scholar
  35. Lopman  BA, Hall  AJ, Curns  AT, Parashar  UD. Increasing rates of gastroenteritis hospital discharges in US adults and the contribution of norovirus, 1996–2007. Clin Infect Dis. 2011;52:46674. DOIPubMedGoogle Scholar
  36. Hall  AJ, Curns  AT, McDonald  LC, Parashar  UD, Lopman  BA. The roles of Clostridium difficile and norovirus among gastroenteritis-associated deaths in the United States, 1999–2007. Clin Infect Dis. 2012;55:21623. DOIPubMedGoogle Scholar
  37. Vega  E, Barclay  L, Gregoricus  N, Williams  K, Lee  D, Vinje  J. Novel surveillance network for norovirus gastroenteritis outbreaks, United States. Emerg Infect Dis. 2011;17:138995.PubMedGoogle Scholar
  38. Manikonda  KL, Wikswo  ME, Roberts  VA, Richardson  L, Gould  LH, Yoder  JS, The national outbreak reporting system: preliminary results of the first year of surveillance for multiple modes of transmission—United States, 2009. In: 2012 International Conference on Emerging Infectious Diseases program and abstracts book, March 11–14, Atlanta, Georgia, USA [cited 2012 Jul 26].
  39. Centers for Disease Control and Prevention. National Voluntary Environmental Assessment Information System (NVEAIS). December 2011 [cited 2012 April 3].
  40. Atmar  RL, Bernstein  DI, Harro  CD, Al-Ibrahim  MS, Chen  WH, Ferreira  J, Norovirus vaccine against experimental human Norwalk virus illness. N Engl J Med. 2011;365:217887. DOIPubMedGoogle Scholar

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