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Volume 11, Number 1—January 2005

Research

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 3

Role of different foods and foodhandlers in outbreaks of gastroenteritis of noroviral, bacterial, and unknown cause, United States, 1998–2000*

Cause of outbreak
p value†
Norovirus no. (%) Bacteria no. (%) Unknown no. (%)
Total outbreaks with data on implicated food 76 124 408
Implicated food
Salad 20 (26) 20 (16) 73 (18) NS
Sandwich 10 (13) 0 24 (6) < 0.05‡
Produce/fruit 13 (17) 4 (3) 15 (4) < 0.001
Meat dish 8 (11) 50 (40) 139 (34) < 0.001
Fish dish 4 (5) 9 (7) 19 (5) NS
Bakery product 5 (7) 2 (2) 15 (4) NS
Oysters 2 (3) 2 (2) 12 (3) NS
Other various§
14 (18)
37 (30)
111 (27)
ND
Total outbreaks with data on investigation of foodhandler 94 102 564
Foodhandler implicated
Yes 45 (48) 20 (20) 51 (9) < 0.001
No 49 (52) 82 (80) 513 (91)

* ND, not done; NS, not significant.
†Chi-square test: p value refers to comparison of norovirus (NoV) outbreaks with both bacteria and unknown outbreaks separately.
‡p < 0.001 when comparing NoV outbreaks with bacterial outbreaks.
§No difference noted for dairy products (3%–5%), cold meats (2%–4%), egg dishes (0%–1%), beverages (1%–4%), or ice (0%–1%).

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.

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