Sick food workers cause restaurant outbreak

Ill food service workers propagated a massive outbreak of norovirus in Michigan last year that eventually sickened 364 restaurant patrons and 32 workers. Vomiting by a line cook was thought to be a significant factor in that it contaminated the environment and possibly contributed to airborne spread of the virus to other workers and patients.

"In a norovirus outbreak, a vomiting incident is a major risk factor for norovirus illness and can double the attack rate," the Centers for Disease Control and Prevention (CDC) reported. "In this outbreak, vomiting by a line cook at the work station might have contributed to transmission. Because of the open physical layout of the restaurant, no barrier impeded airborne spread of the virus from the kitchen to the main dining area."1Foodborne transmission also might have contributed to the outbreak, as some dishes specifically prepared by the index case were linked to illness in diners. In addition, the restaurant's use of cleaning cloths soaked with a quaternary ammonium-based cleaning product likely was ineffective in disinfecting the restaurant, the CDC reported. State public health officials recommended the following measures for infection control and environmental decontamination after any vomiting incident in a food-service establishment.

First, any exposed food or single-service articles (e.g., drinking straws, takeout containers, and paper napkins) should be discarded, and all surface areas within at least a 25-foot radius of the vomiting site should be disinfected with a bleach solution.

Second, ill employees should be excluded from work for at least 72 hours after symptoms subside, and employees returning after a gastrointestinal illness should be restricted from handling kitchenware or ready-to-eat food for an additional 72 hours.

Third, because thorough disinfection might be necessary, partial or complete closure of the food establishment should be considered after a vomiting incident.

Finally, restrooms used during or after a vomiting incident should be closed immediately until they are disinfected properly with bleach solution.


1. Centers for Disease Control and Prevention. Norovirus Outbreak Associated with Ill Food-Service Workers — Michigan, January-February 2006. MMWR 2007;56:1,212-1,216. Accessed at