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Foodborne and Food-Handler Norovirus Outbreaks: A Systematic Review

Lookup NU author(s): Dr Marie McIntyreORCiD, Professor Sarah O'Brien



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© Joanne L. Hardstaff et al. 2018; Published by Mary Ann Liebert, Inc. 2018.Norovirus (NoV) is the commonest cause of gastrointestinal disease in the United Kingdom and in many developed countries, causing diarrhea and vomiting in millions of cases worldwide annually. Transmission is most often mediated from person to person. NoV infection has, however, additionally been associated with the consumption of food, either through the consumption of food contaminated at source such as seafood, berries, and salad, or as a consequence of the foodstuff being contaminated in some way by a food handler during processing or serving. A systematic review of outbreaks attributed to NoV between January 2003 and July 2017 was conducted to assess the contribution of food handlers to the burden of NoV, and to identify foods commonly associated with NoV outbreaks. A total of 3021 articles were screened, of which 27 met the definition of confirmed foodborne outbreaks and 47 met the criteria for definite food-handler NoV outbreaks. Of all food types, shellfish were implicated in the greatest number of definite foodborne outbreaks. Food handlers contributed to definite food-handler outbreaks involving a diverse range of foodstuffs and in a wide variety of settings, including weddings and military establishments. More genotypes of NoV were found in people who were ill than in samples from food and food handlers. The potential for both food products and food handlers to contribute to the burden of NoV infection is demonstrated conclusively.

Publication metadata

Author(s): Hardstaff JL, Clough HE, Lutje V, McIntyre KM, Harris JP, Garner P, O'Brien SJ

Publication type: Review

Publication status: Published

Journal: Foodborne Pathogens and Disease

Year: 2018

Volume: 15

Issue: 10

Pages: 589-597

Print publication date: 01/10/2018

Online publication date: 15/08/2018

Acceptance date: 02/04/2016

ISSN (print): 1535-3141

ISSN (electronic): 1556-7125

Publisher: Mary Ann Liebert Inc.


DOI: 10.1089/fpd.2018.2452

PubMed id: 30109958