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Norovirus season is underway, and it's likely to be severe, according to a norovirus expert at GOJO Industries. After experiencing a lull during the first two years of the pandemic, norovirus cases came surging back in the first quarter of 2022, with outbreaks peaking at over 100 per week in late February, according to data from the Centers for Disease Control and Prevention.¹

"Several elements are coming together that suggest we may soon see a surge in norovirus cases – similar to what we've seen with other viruses like RSV and flu," said Chip Manuel, Ph.D., Food Safety Science Advisor, GOJO Industries. "It's not a coincidence that U.S. norovirus cases dropped to historic lows in 2020 and 2021, then came surging back as Americans began dropping their pandemic precautions this past spring. People are fatigued by social distancing, isolation, and masking, but it is important to remember that everyday practices like hand and surface hygiene help to control norovirus and many other infectious diseases."

"Everyone needs to remember that norovirus is a highly contagious virus that spreads via person to person and by coming into contact with contaminated surfaces or food – it only takes a few virus particles to make someone sick, and a sick person sheds billions of particles of the virus in their vomit and feces," continued Dr. Manuel. "Part of the reason why it's the #1 cause of foodborne illness in the U.S. is also that it can survive on surfaces for weeks. So even if COVID-19 goes away tomorrow, surface and hand hygiene remain a critical piece to foodborne illness prevention, particularly norovirus – and particularly for foodservice establishments where one sick worker can spread norovirus throughout an establishment, including through the food they touch."

"In 2022, the U.S. saw the largest number of norovirus outbreaks in more than 10 years, even though the 2021-2022 norovirus season peaked late (late February vs. early January)," ¹ said Hal King, Ph.D., Managing Partner, Active Food Safety and Founder/CEO, Public Health Innovations. "In 2023, we can expect even more norovirus infections will be circulating in our communities, and many of these infected persons will likely be workers and customers entering restaurants. The best means to reduce the risk of transmission of norovirus in restaurants is to continue to screen employees for wellness (with a focus on all foodborne disease signs and symptoms), continue disinfection of high-touch surfaces in the restaurant (especially the restroom areas), and ensure proper hand hygiene and glove use before, during, and after food preparation."

With Technomic, a foodservice industry research and analytics company, predicting a further return of diners to on-premise dining in 2023, it's essential that establishments are prepared to protect their customers from potential foodborne illness outbreaks.

Foodservice establishments can prepare now with these action steps:

• Keep sick employees home. 70 percent of norovirus outbreaks are caused by infected foodservice workers,² so preventing employees from coming to work sick with norovirus is an important step in preventing outbreaks in foodservice establishments.³ Adopting sick leave policies and employee wellness screens will reduce the risk of a facility causing a foodborne illness outbreak. Employees that come to work sick spread the virus to foods, surfaces, customers, and other employees.
• Practice frequent proper hand hygiene and minimize bare-hand contact with food. Inadequate hand hygiene and bare-hand contact with foods are the most frequently encountered contributing factors to norovirus outbreaks.⁴ Ensure bare-hand contact with foods is minimized by emphasizing proper glove use. More frequent handwashing, providing handwash stations, and providing alcohol-based hand sanitizers for when soap and water are not available, are all examples of best practices related to hand hygiene.
• Disinfect high-touch surfaces regularly. Establishments should continue to disinfect high-touch surfaces since they have a direct carryover to controlling foodborne illnesses, especially norovirus. Examples include frequent disinfection of restroom door handles, handwash sink faucet handles, and restroom stall latches.
• Clean before you sanitize. Proper surface sanitizing requires the surface to be cleaned first to remove all food debris, fats, oils, and other soils. In fact, the U.S. Food Code requires that all food-contact surfaces must be cleaned before the sanitizing step.⁵ This ensures that the sanitizer solution will remain effective, as these soils can interfere with the sanitizer's effectiveness.
• Ditch the "rag and bucket" practice. Using a red bucket of sanitizing solution and a reusable cloth is a common way to sanitize tables in a restaurant. But research shows that reusable cloths can easily become breeding grounds for foodborne disease-causing bacteria⁶ – then spread pathogens to many surfaces throughout an establishment. There is much room for error with reusable wiping cloths as there are many factors that staff need to get just right with the practice: the sanitizer solution must be monitored throughout the day so it maintains a required concentration level and be changed out when the solution appears dirty, plus the cloths must be stored in the solution, laundered daily, and not used for multiple tasks. Switching to applying a food-contact sanitizer by spray bottle or a disposable wipe can reduce some of the risks associated with reusable cloths.
• Select an effective surface product with low toxicity that works quickly. By using ready-to-use products with short contact times (e.g., a minute or less for organisms of interest), compliance with enhanced disinfection protocols will increase, which helps reduce the risk of an outbreak within a facility – plus it saves your staff valuable time. The U.S. Environmental Protection Agency (EPA) categorizes products from I (highly toxic) to IV (very low toxicity.) If possible, select products rated as category IV to limit your staff and guests' exposure to harsh fumes. Higher toxicity products also have precautionary statements like "Caution," which may require handwashing after use and personal protective equipment, such as gloves, gowns, and eye protection during use.

"Norovirus outbreaks are costly, they put the health of customers and employees at risk, can significantly damage a restaurant's reputation, and with labor shortages, operators likely can't afford to have employees out sick," Dr. Manuel said. "A robust food safety plan is a restaurant's insurance policy. Cases typically peak in January or February, so there is time for establishments to act now and prepare."

Globally, norovirus sickens nearly 700 million each year and costs an estimated $64 billion a year, primarily through productivity loss, according to a 2016 study. ⁷

To learn more about how important formulation is when it comes to product performance against norovirus, read this Q&A from North Carolina State University about new research.

For more resources to prevent foodborne illness from spreading at your establishment, visit the Food Safety Learning Center on GOJO.com/Foodservice

1. Centers for Disease Control and Prevention, "Reporting and Surveillance for Norovirus: NoroSTAT." https://www.cdc.gov/norovirus/reporting/norostat/index.html Accessed Dec. 12, 2022.
2. Centers for Disease Control and Prevention, "Preventing Norovirus Outbreaks." https://www.cdc.gov/vitalsigns/norovirus/index.html Accessed Nov. 22, 2022.
3. Duret, S., et al. Quantitative risk assessment of norovirus transmission in food establishments: evaluating the impact of intervention strategies and food employee behavior on the risk associated with norovirus in foods. Risk Analysis, 37(11), 2080-2106, 2017.
4. Brown, L. G., et al. Outbreak characteristics associated with identification of contributing factors to foodborne illness outbreaks. Epidemiology and infection, 145(11), 2254–2262, 2017. https://doi.org/10.1017/S0950268817001406
5. U.S. Food & Drug Administration, "Food Code 2017." https://www.fda.gov/food/guidanceregulation/retailfoodprotection/foodcode/ucm595139.htm Accessed Nov. 22, 2022.
6. Scott, E. and Bloomfield, S. 1990. Investigations of the effectiveness of detergent washing, drying and chemical disinfection on contamination of cleaning cloths. J. Appl. Bacteriol. 68: 279-283.
7. Bartsch SM, Lopman BA, Ozawa S, Hall AJ, Lee BY (2016) Global Economic Burden of Norovirus Gastroenteritis. PLoS ONE 11(4): e0151219. https://doi.org/10.1371/journal.pone.0151219

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EDITOR'S NOTE: Chip Manuel, Ph.D., is available for media interviews, including throughout the season as norovirus outbreaks occur by contacting Kelly Ward-Smith at News@GOJO.com. He holds a BS, MS, and Ph.D. degrees in Food Science and his area of research expertise is in food virology, specifically control of norovirus in food settings. Read his bio and blog posts