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Problem/condition: State and local public health departments report hundreds of foodborne illness outbreaks each year to CDC and are primarily responsible for investigations of these outbreaks. Typically, investigations involve epidemiology, laboratory, and environmental health components. Health departments voluntarily report epidemiologic and laboratory data from their foodborne illness outbreak investigations to CDC through the Foodborne Disease Outbreak Surveillance System (FDOSS); however, minimal environmental health data from outbreak investigations are reported to FDOSS., Period Covered: 2014-2016., Description of System: In 2014, CDC launched the National Environmental Assessment Reporting System (NEARS) to complement FDOSS surveillance and to use these data to enhance prevention efforts. State and local health departments voluntarily report data from their foodborne illness outbreak investigations of retail food establishments. These data include characteristics of foodborne illness outbreaks (e.g., agent), characteristics of establishments with outbreaks (e.g., number of meals served daily), food safety policies and practices of these establishments (e.g., glove use policies), and characteristics of outbreak investigations (e.g., timeliness of investigation activities). NEARS is the only available data source that includes characteristics of retail establishments with foodborne illness outbreaks., Results: During 2014-2016, a total of 16 state and local public health departments reported data to NEARS on 404 foodborne illness outbreaks at retail establishments. The majority of outbreaks with a suspected or confirmed agent were caused by norovirus (61.1%). The majority of outbreaks with identified contributing factors had at least one factor associated with food contamination by a worker who was ill or infectious (58.6%). Almost half (47.4%) of establishments with outbreaks had a written policy excluding ill workers from handling food or working. Approximately one third (27.7%) had a written disposable glove use policy. Paid sick leave was available for at least one worker in 38.3% of establishments. For most establishments with outbreaks (68.7%), environmental health investigators initiated their component of the investigation soon after learning about the outbreak (i.e., the same day) and completed their component in one or two visits to the establishment (75.0%). However, in certain instances, contacting the establishment and completing the environmental health component of the investigation occurred much later (>8 days)., Interpretation: Most outbreaks reported to NEARS were caused by norovirus, and contamination of food by workers who were ill or infectious contributed to more than half of outbreaks with contributing factors; these findings are consistent with findings from other national outbreak data sets and highlight the role of workers in foodborne illness outbreaks. The relative lack of written policies for ill workers and glove use and paid sick leave for workers in establishments with outbreaks indicates gaps in food safety practices that might have a role in outbreak prevention. The environmental health component of the investigation for most outbreaks was initiated quickly, yet the longer initiation timeframe for certain outbreaks suggests the need for improvement., Public Health Action: Retail establishments can reduce viral foodborne illness outbreaks by protecting food from contamination through proper hand hygiene and excluding workers who are ill or infectious from working. NEARS data can help prioritize training and interventions for state and local food safety programs and the retail food establishment industry by identifying gaps in food safety policies and practices and types of establishments vulnerable to outbreaks. Improvement of certain outbreak investigation practices (e.g., delayed initiation of environmental health investigations) can accelerate identification of the agent and implementation of interventions. Future analysis comparing establishments with and without outbreaks will contribute knowledge about how establishments' characteristics and food safety policies and practices relate to foodborne illness outbreaks and provide information to develop effective prevention approaches., Competing Interests: No conflicts of interest were reported.

Background: Norovirus is often transmitted by infected food handlers at the point of service, whereas reports of food contamination before wholesale distribution are rare. In September 2005, we investigated reports of gastroenteritis among rafters who went on unrelated trips on the Colorado River., Methods: We surveyed all companies that launched rafting trips during the period from 14 August through 19 September 2005 to identify trips in which > or =3 rafters became ill. We conducted a case-control study. Case patients were persons who experienced diarrhea or vomiting that commenced < or =72 h after the trip launch; control subjects were persons who did not become ill < or =72 h after launch. We tested stool samples and food specimens for norovirus. We performed a traceback investigation of the suspected food vehicle and inspected the implicated processing plant., Results: Three or more rafters developed gastroenteritis during 13 (14%) of 91 trips, for a total of 137 ill persons. Of the 57 case patients who became ill < or =72 h after trip launch, 55 (96%) reported eating delicatessen meat, compared with 75 (79%) of 95 control subjects (odds ratio, 7.3; 95% confidence interval, 1.7-66.7). All delicatessen meat eaten by case patients came from 1 batch purchased from 1 processing plant and had been sliced, vacuum-packed, and frozen (temperature, -23 degrees C) for 7-28 days. An employee sliced this batch with bare hands 1 day after recovery from gastroenteritis. Identical norovirus sequences were identified in stool specimens obtained from rafters on 3 different trips; 2 of 5 meat packages also tested positive for norovirus by reverse-transcriptase polymerase chain reaction and DNA hybridization., Conclusions: Food handlers can contaminate ready-to-eat meats with norovirus during processing. Meat-processing practices should include specific measures to prevent contamination with enteric viruses and subsequent widespread outbreaks.

An outbreak of suspected norovirus gastroenteritis among three consecutive groups of houseboaters on a large recreational lake in Arizona was investigated to assess the role of fomite contamination, and to provide recommendations for prevention of future outbreaks. Interior boat surfaces were sampled for norovirus using transport swabs. Onboard toilet reservoirs were swabbed as a surrogate for stool samples from ill participants, since none were available, and onboard potable water supplies were sampled for norovirus. All samples were analyzed using RT-PCR with primers specific for human norovirus. Widespread fomite contamination was documented in the houseboats; 83% (5/6) of bathroom surface samples, 40% (2/5) of kitchen surface samples, and 100% (3/3) of doorknob samples were positive for the presence of norovirus. Samples of onboard potable water supplies were all negative. One of the participants on the first boating trip arrived already displaying symptoms of gastrointestinal illness prior to boarding the boat. This investigation demonstrates the potential role of widespread fomite contamination in outbreaks in confined spaces. To prevent or minimize future outbreaks in confined spaces, the adoption of practices such as surface disinfection and the utilization of methods to identify and exclude those with gastroenteritis from trips or activities in confined spaces, where others may become infected, are recommended.

The article discusses the top contributing factors for the outbreaks in restaurants, according to the U.S. Centers for Disease Control and Prevention's National Environmental Assessment Reporting System. Topics mentioned include how state and local food regulatory programs can identify contributing factors, the three types of contributing factors, and an environmental assessment training screenshot of an interview with food workers.

Environmental health specialists often perform environmental assessments (EAs) when a suspected or confirmed foodborne illness outbreak is linked to a food establishment. Information from EAs helps officials determine the cause of the outbreak and develop strategies to prevent future outbreaks; however, EAs are not always conducted. To determine facilitators and barriers to conducting EAs, we analyzed openended responses reported to the National Environmental Assessment Reporting System about these assessments. We found that EAs were conducted most often when illness was identified, a jurisdiction had a policy to investigate illnesses, and there were resources for such a response. EAs were not conducted in instances such as limited resources, insufficient training, uncooperative facility personnel, or if the establishment fell outside of health department jurisdiction. Identifying the facilitators and barriers to conducting EAs can enable health departments to develop strategies that improve their ability to conduct EAs. [ABSTRACT FROM AUTHOR]