FOOD WORKERS OFTEN PASS ON NOROVIRUS

I just checked this blog and found that I had 33 posts dealing with Norovirus. Many of them have well over a thousand hits. The most popular ones are those which deal with Norovirus on cruise ships. That is a very common place for large outbreaks caused by this nasty virus. But sizeable Norovirus outbreaks have also occurred in restaurants, nursing homes, catered receptions and, in schools, where they have been occurring a lot recently in the U.S.

Why these places? True the virus is highly contagious. But there is another reason - these are all places where food is prepared by food service workers. Low income food service workers, with no health insurance, often turn up for work when they are ill so that they don't lose the wages they need to live on. In fact, if they have been ill with this virus, they should actually stay home for at least two days after they feel fine, because they could still be contagious. But of course, they don't. Can you blame them?

It estimated that at least 21 million people in the U.S. get sick from Norovirus every year, and some 70,000 or so are sick enough to end up in hospital. Those who die are often already ill or are older people who become very badly dehydrated. That is why I have often warned seniors not to eat at salad bars, which are a common place for the virus to hide out.

TSF

CRUISING MAY BE NO CARNIVAL IF YOU GET FOOD POISONING

I noticed that there have been a lot of views lately of my post of 25 February of last year, titled "Is Cruise Ship Food Safe to Eat?" People must be planning cruises this time of year. That is, if they still want to take the risk after the Carnival Cruises disaster in Italy a few days ago. But if you do - remember, running aground is not the only risk on the trip. There's also food poisoning.

In case you need convincing about the health risks on cruise ships, read the second comment on this post - much abbreviated here: "Just returned from my third cruise in about 3 years. Both my daughter and I got sick........ I feel like death warmed over. I wouldn't wish this on my worst enemy!..." It sounds like a bad case of Norovirus - the most common cause of food poisoning, which frequently crops up on cruise ships. It can really ruin your vacation.

There are actually three post on the topic of cruise ship food on this blog, and you should particularly read the second on the list if cruising is on your agenda:

"Why are Cruise Ships Risky Places to Eat" - 26 February 2011

"How to Avoid Getting Sick on a Cruise Ship" - 25 February 2011

"Is Cruise Ship Food Safe to Eat?" 25 February 2011

And choose your cruise ship carefully to make sure it has not had recent outbreaks by checking the CDC "green sheet" (information on the posts).

To your good health,

TSF
Updated on Jan. 16

WHY ARE CRUISE SHIPS RISKY PLACES TO EAT?

Alright, I still haven't really explained in recent blogs why cruise ships are among the riskiest places to eat. Mea culpa. So here goes.

Not every food borne illness originates on board a cruise ship. Some of the foods purchased for the cruise already carry contaminants (as was believed to be the case with contaminated shrimp served at the embarkation buffet on board one recent cruise). But the studies I have looked at suggest that most get into the food on board the vessel. Often people - crew or passengers - are involved in the spread of illness.

Here are some reasons:

• The mass preparation of food which is usually more prone to contamination ( whether done for catered events, nursing homes, schools, restaurants, conferences or cruise ships).

• The confined area and non-stop socializing among passengers, leading to close contact between people. This means that a crew member handling food can contaminate it, with several passengers (and maybe crew) becoming ill, and then these sick people will pass it on to others (as often happens in the case of Norovirus-caused illness), or, even contaminate more food (if crew members are involved, as they usually seem to be).

• The popularity of buffet service (often with passengers serving themselves): buffets are known to be especially risky type of food for a number of reasons (see future blog).

Investigation of on-board outbreaks has sometimes traced them back to just one ill crew member, which, by the end of the cruise, resulted in over a hundred, or several hundred, illnesses. The original carrier of an illness may also have been a passenger who came on board while ill (not wanting to miss a pre-paid cruise). He or she may then have passed it on to a crew member (cleaning up the mess) and from there to other crew members, including kitchen staff, and on to food and more passengers and crew.

Norovirus - the most common cause of gastrointestinal illness on board - is so very easy to pass on. Just a few viruses on a table surface, a fork or a lettuce leaf will do it. It is also extremely difficult to deep sanitize an infected ship if Norovirus is involved. I have looked at numerous cases in CDC records where the same ship was involved in repeated outbreaks in spite of all the efforts made.

TSF

HOW TO AVOID GETTING SICK ON A CRUISE

In the last blog, I talked about food borne illness on cruise ships. But, as one of my readers said,
"So, what's your advice?" Good point.

I am not going to advise you not to go on a cruise (much as
I personally hate them, though I love the sea, sailing, and love travelling on cargo ships). If it gives you pleasure, go ahead. But if you want to stay healthy and enjoy the trip, I suggest that you:

1) Check out the ship's outbreak record and inspection scores before you buy your ticket. The CDC's "green sheet" which is a "Summary of Sanitation Inspections of International Cruise Ships" and records from its inspection program are the best sources (available on: http://wwwn.cdc.gov/InspectionQueryTool/InspectionSearch.aspx. If there has been an outbreak on the cruise before yours, or, on several recent cruises, don't book on that ship. But two words of caution - the inspection scores are not completely up to date, and some ships score 100 or just below, and still have outbreaks - as in the case of the Royal Caribbean Ship "Radiance of the Seas" this year.

2) Try not to eat at the buffets, which are known to be the riskiest places, or, at least be in line first, which could reduce some of your food contamination risk.

3) Don't eat any on-shore catered food (It has been found to account for about the third of the foodborne illnesses on cruises - or, maybe just gets blamed). Buy your own - carefully - instead.

4)Try to avoid the shrimp and other seafood served on board, which often seems to be the source of illness.

5)Be on your best hygiene behavior throughout the cruise, so you don't catch Norovirus from someone else who may have got it from their food - or, pass it on if you yourself have it. Surveys comparing passengers who became ill with those who did not have found that hand washing made the difference.

TSF

IS CRUISE SHIP FOOD SAFE TO EAT?

No, eating too much and putting on weight is not what you should worry most about on that cruise you are about to take. Worry instead about gastrointestinal illness, often originating in those mountains of food served.

But look on the bright side: if you do come down with a really bad bout of vomiting and diarrhea, you may even lose weight. Mind you, there is that unfortunate downside: I guess you wouldn't enjoy the cruise all that much if you spent half of it doubled over the "lu" throwing up, instead of sunning on deck, going to all those shows and playing bingo.

The statistics show that cruises are one of the most dangerous places to eat. And things are not improving in spite of special programs such as the US one operated by the Centers for Disease Control (CDC) which inspect ships entering US ports for cleanliness (including of the food), employee hygiene, and collects statistics on the number of illnesses that have occurred on that trip.

I dug up CDC statistics on cruise-ship-based outbreaks of gastrointestinal illness. Let me tell you now, the news is not good. In the year 1999, only one outbreak was recorded on a cruise ship. 2000 and 2001 were pretty good too, with 5 and 4 outbreaks respectively. But during the last 9 years (2002 through 2010) there has been an average of 21.3 outbreaks in the cruise ships entering US ports, with all the major cruise lines involved, from the most expensive to the cheapest. In 2006 there were 33, and in 2004, 32. Some of these were repeats, in the sense that the same ship would have repeated problems, one cruise after another (more on this in another blog). This year - 2011 - is not off to a great start either, with a Celebrity Cruises ship (Celebrity Solstice) and a Royal Caribbean cruise ship (Radiance of the Seas) having outbreaks in January or early February.

And don't think it is just a case of a couple of people becoming ill and you won't be one of them. I haven't finished analyzing all the data yet, but the outbreaks I have looked at so far, show between 3% and 25% of passengers affected (plus a good number of the crew), and of course, as usual, these statistics are likely to be an underestimation, as not everyone who becomes will go to see the ship's doctor.

With a few exceptions, the cause of the illnesses has been Norovirus, which is sometimes called "the cruise ship virus." It is very, very contagious, and the most common way to catch it is from food, although it can be passed from one passenger to another and one crew member to another either directly or indirectly (e.g. through vomit spattered around). Usual symptoms are vomiting and diarrhea, and sometimes also a low-grade fever and headache - not exactly what you want on that long-anticipated cruise that you paid so much for and usually only lasts a few days anyway.

TSF