Twin Trees Too, a popular Syracuse, New York restaurant, will be undergoing a serious cleaning over the next 18 hours, as the number of customers with norovirus is now up to 70.

The health department says there’s no evidence the bug is still being spread, but as a precaution, the restaurant is voluntarily closing for the first half of the day on Wednesday so Serve-Pro can come in and do a thorough cleaning.

The Onondaga County Health Department suspects the norovirus – or stomach bug – was spread in the restaurant sometime around the last weekend of February and was likely caused by sick employees preparing food.

While the restaurant is well known for its pies, it may have been some other foods that were contaminated.

"The investigation is still pending, but we do think that it’s more likely to be related to a salad or antipasto than to the pizza at this time,” said Onondaga County Health Commissioner, Dr. Cynthia Morrow.

Ben had a dream.

“I was at a Chick-Fil-A by myself, sat down at a table next to a family (bunch of boys, mom and dad). One of the kids, probably a 6-year-old, threw up on my back and it splattered all over the floor, table and seats.

“Staff came out to clean it up – but I didn't leave to go clean myself up, I just stood there watching, taking pictures with my phone and asking them what kind of sanitizer they were using, whether it was a different concentration that what they would normally use, and how far from the puke they were going to clean and sanitize.”

I won’t get into the Freudian or Jungian or Bromancian aspects of Ben sharing his dream with me via e-mail (and Amy and Schaffner); it’s how we roll. But Ben’s dream is grounded in the reality of stories we see daily, where people barf and a bunch of others get sick with norovirus.

Researchers from the Netherlands and Germany report in the current Eurosurveillance about a norovirus outbreak triggered by copper intoxication on a coach trip from the Netherlands to Germany.

From the abstract:

Overall, 30 of 40 people (including drivers and crew) developed nausea, vomiting and/or diarrhoea, 11 of them on the first day of the trip. The incidence epidemic curve showed a first peak on Day 1 and a second on Day 4. Nine passengers were hospitalised with gastrointestinal symptoms. Norovirus was found in stool samples from two patients, but the infection could not explain the first peak in the epidemic curve only a few hours after departure. Interviews with the passengers and an inspection of the coach and its water supply implicated the water used for coffee and tea as the potential source.

Microbiological investigations of the water were negative, but chemical analysis showed a toxic concentration of copper. Blood copper levels as well as renal and liver function were determined in 28 of the 32 passengers who had been exposed to the water. One passenger who did not have gastrointestinal symptoms had an elevated copper level of 25.9 µmol/L, without loss of liver or renal function. It is likely that the spread of norovirus was enhanced because of vomiting of one of the passengers due to copper intoxication.

The complete paper is available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20104.

In response to Ben’s e-mail this morning, I asked if he could get paid to do anything else, and that maybe he needs a change.

He replied, “Don't want to change a thing. In related news, I don't really have any other skills.”

Two foodborne illness outbreaks in Granville, Ohio during the past two weeks have been blamed on norovirus.

Test results from an Ohio Department of Health laboratory found Norovirus in samples from both an outbreak resulting from a catered Feb. 12 event at Bryn Du Mansion and from a separate incident among students at Denison University.

Licking County Health Commissioner Joe Ebel told the Newark Advocate in an interview an investigation will be conducted into whether or not the two incidents could be related.

 Ebel said Tuesday that 41 of 78 people who attended the Bryn Du event, put on by the Columbus Museum of Art, experienced a gastrointestinal illness. He said most of those attending were from Franklin County, but one test sample returned from the lab involved a Licking County resident.



In Thursday’s health department announcement, Ebel said 36 Denison students and two staff members were affected by the outbreak there, which occurred gradually over about the past 10 days. 

“Usually in a school setting like that, once it gets started it’s hard to get stopped." Dr. Charles J. Marty, medical director for Denison University Health Services, said in an emailed statement Thursday that DU community members have been advised to report any illness however slight, wash hands often and avoid sharing food or beverages.

There are lots of food safety myths floating around like color is a good indicator of safe temperatures or the 3-second rule. One that popped up last week in a class I was guest lecturing in: freezing food kills things. I think this comes from some old parasite-reducing practices (fish especially) but someone asked specifically about shellfish - and whether freezing things like oysters, shrimp or clams does anything. Depends on the target pathogen, the risks with oysters specifically are viral (Noro or Hep A). So freezing might do something for the worms, but it's not going to do much of anything to reduce viruses.

In this week's Morbidity and Mortality Weekly Report (still my favorite publication title) investigators discuss a Washington State outbreak associated with frozen raw oysters.

Some highlights:

On October 19, 2011, Public Health – Seattle & King County was contacted regarding a woman who had experienced acute gastroenteritis after dining at a local restaurant with friends. Staff members interviewed the diners and confirmed that three of the seven in the party had consumed a raw oyster dish. Within 18–36 hours after consumption, the three had onsets of aches, nausea, and nonbloody diarrhea lasting 24–48 hours. One ill diner also reported vomiting. The four diners who had not eaten the raw oysters did not become ill.

An inspection of a walk-in freezer at the restaurant revealed eight 3-pound bags of frozen raw oysters, which the restaurant indicated had been an ingredient of the dish consumed by the ill diners. The oysters had been imported from South Korea by company A and shipped to a local vendor, which sold them to the restaurant. All eight bags were sent to the Food and Drug Administration's Gulf Coast Seafood Laboratory for norovirus testing and characterization by real-time reverse transcription–polymerase chain reaction (rRT-PCR).

A stool specimen from one of two ill diners collected 17 days after symptom onset tested positive for norovirus; sequence analysis identified GI.1 and GII.17 strains. Sequence analysis of the oysters identified a GII.3 strain. Because oysters can harbor multiple norovirus strains that are unequally amplified by rRT-PCR, discordance between stool specimens and food samples in shellfish-associated norovirus outbreaks is common and does not rule out an association. On November 4, 2011, company A recalled its frozen raw oysters.

The frozen oysters implicated in this outbreak were distributed internationally and had a 2-year shelf-life.
Such contamination has potential for exposing persons widely dispersed in space and time, making cases difficult to identify or link through traditional complaint-based surveillance