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. 2019 May;24(18):1800511.
doi: 10.2807/1560-7917.ES.2019.24.18.1800511.

Challenges of investigating a large food-borne norovirus outbreak across all branches of a restaurant group in the United Kingdom, October 2016

Mari Morgan  1   2   3 , Vicky Watts  3   4   5 , David Allen  6   7   8 , Daniele Curtis  9 , Amir Kirolos  10 , Neil Macdonald  9 , Ellie Maslen  11 , Deb Morgan  12 , Ayoub Saei  13 , James Sedgwick  9 , Janet Stevenson  10 , Deborah Turbitt  14 , Roberto Vivancos  5 , Catriona Waugh  10 , Chris Williams  1 , Valerie Decraene  5
Affiliations

Challenges of investigating a large food-borne norovirus outbreak across all branches of a restaurant group in the United Kingdom, October 2016

Mari Morgan et al. Euro Surveill. 2019 May.

Abstract

During October and November 2016, over 1,000 customers and staff reported gastroenteritis after eating at all 23 branches of a restaurant group in the United Kingdom. The outbreak coincided with a new menu launch and norovirus was identified as the causative agent. We conducted four retrospective cohort studies; one among all restaurant staff and three in customers at four branches. We investigated the dishes consumed, reviewed recipes, interviewed chefs and inspected restaurants to identify common ingredients and preparation methods for implicated dishes. Investigations were complicated by three public health agencies concurrently conducting multiple analytical studies, the complex menu with many shared constituent ingredients and the high media attention. The likely source was a contaminated batch of a nationally distributed ingredient, but analytical studies were unable to implicate a single ingredient. The most likely vehicle was a new chipotle chilli product imported from outside the European Union, that was used uncooked in the implicated dishes. This outbreak exemplifies the possibility of rapid spread of infectious agents within a restaurant supply chain, following introduction of a contaminated ingredient. It underlines the importance of appropriate risk assessments and control measures being in place, particularly for new ingredients and ready-to-eat foods.

Keywords: United Kingdom; food-borne infections; norovirus; outbreak; ready-to-eat products; restaurant chains.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Date range of gastrointestinal illness reported by staff and customers of a restaurant groupa, investigation of a norovirus outbreak in a restaurant group, United Kingdom, 2016
Figure 2
Figure 2
Cases of gastrointestinal illness among all restaurant staff of a restaurant group by early and late onset, staff cohort study in norovirus outbreak in a restaurant group, United Kingdom, 2016 (n = 125)
Figure 3
Figure 3
Summary of ingredient composition of menu items associated with gastrointestinal illness in customer and staff cohort studies, investigation of norovirus outbreak in a restaurant group, United Kingdom, 2016
See this image and copyright information in PMC

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