Schmid D, Stüger H P, Lederer I, Pichler A-M, Kainz-Arnfelser G, Schreier E, Allerberger F
Austrian Agency for Health and Food Safety, Waehringerstr. 25a, 1095 Vienna, Austria.
Infection. 2007 Jun;35(4):232-9. doi: 10.1007/s15010-007-6327-1. Epub 2007 Jul 23.
Norovirus is increasingly being recognized as a leading cause of foodborne disease. Nevertheless, well documented foodborne outbreaks due to norovirus are rarely found in the literature.
A retrospective cohort study was conducted for identifying the source of a gastroenteritis outbreak. A total of 325 persons were identified as the at risk group.
The overall attack rate was 56% (182/325). Of the four working days of possible foodborne exposure to norovirus (Monday till Thursday), Wednesday (risk ratio [RR]: 18.82; 95%CI 11.82-29.96) and Thursday (RR 2.14; 95%CI 1.65-2.79) turned out to be the most likely days on which infections with norovirus occurred. The day-by-day food specific cohort analyses yielded consumption of salad on Wednesday (adjusted RR 2.82; 95%CI 1.0-7.94) to be associated with highest risk of illness. The most likely source of food contamination is a kitchen assistant having prepared salad manually. She fell ill with symptoms of gastroenteritis on Wednesday during the early working hours and continued working. Human stool samples obtained from five out of six outbreak cases, including the sick kitchen assistant, were RT-PCR positive for norovirus genotype GGII.7 (Leeds-like).
This foodborne norovirus outbreak underlines the drastic consequences of neglecting the rules of basic kitchen hygiene. Food handlers working despite manifest diarrhea or vomiting--often in fear of job loss--are a common cause of foodborne norovirus outbreaks.
诺如病毒越来越被认为是食源性疾病的主要病因。然而，文献中很少能找到有充分记录的由诺如病毒引起的食源性疾病暴发。
进行了一项回顾性队列研究以确定一次胃肠炎暴发的源头。共有325人被确定为风险人群。
总体发病率为56%（182/325）。在可能通过食物接触诺如病毒的四个工作日（周一至周四）中，周三（风险比[RR]：18.82；95%置信区间11.82 - 29.96）和周四（RR 2.14；95%置信区间1.65 - 2.79）被证明是最有可能感染诺如病毒的日子。按天进行的食物特异性队列分析表明，周三食用沙拉（调整后RR 2.82；95%置信区间1.0 - 7.94）与患病风险最高相关。最有可能的食物污染源头是一名手工制作沙拉的厨房帮工。她在周三工作开始时出现胃肠炎症状，但仍继续工作。从包括患病厨房帮工在内的六例暴发病例中的五例采集的人类粪便样本，经逆转录聚合酶链反应检测诺如病毒基因型GGII.7（利兹样）呈阳性。
这次食源性诺如病毒暴发凸显了忽视基本厨房卫生规则的严重后果。食品处理人员在出现明显腹泻或呕吐症状时仍继续工作——通常是出于对失业的恐惧——是食源性诺如病毒暴发的常见原因。
