![[ Visit Client Website ]](images/banner.jpg)
BACKGROUND: On December 18, 2013, the Kansas Department of Agriculture (KDA) notified the Kansas Department of Health and Environment (KDHE) of an illness complaint that six persons consumed food from a Jimmy John’s restaurant in Kansas on December 12 and five subsequently developed gastrointestinal illnesses. KDHE notified the Finney County Health Department (FCHD) and initiated an outbreak investigation.
METHODS: A retrospective case-control study was conducted to determine if illness was associated with a specific food. A case was defined as diarrhea or vomiting in a person who ate food from Jimmy John’s from December 10-24, 2013. KDHE was provided contact information including email addresses for patrons who paid by credit card. FCHD conducted telephone interviews, and an online questionnaire was publically distributed by FCHD and through local press and social media. Conditional logistic regression was performed to assess food exposures that were significantly associated with illness. Stool specimens were collected from eight persons and submitted to Kansas Health and Environmental Laboratories. KDA conducted environmental assessments on December 18 and December 24. A Hazards Analysis and Critical Control Point inspection was conducted on January 29, 2014.
RESULTS: Questionnaires were completed by 402 persons; 296 reported illness and 216 met the outbreak case definition. In bivariate analysis, lettuce, tomato, and hot peppers were associated with illness. Tomato and hot peppers remained significant in the logistic regression model. During the initial inspection, the manager reported several employees had been ill; this was not confirmed during employee interviews. Cooling and cold holding violations were noted. Due to ongoing transmission of norovirus the facility closed on December 24 and norovirus clean-up was conducted using guidelines developed by the Iowa Department of Inspections and Appeals and adopted by KDA. Three stool specimens tested positive for norovirus genogroup II.
CONCLUSIONS: This outbreak of norovirus was associated with consuming tomatoes and hot peppers from Jimmy John’s from December 10-24, 2013. Investigators hypothesize that food became contaminated during preparation and service. Receiving e-mail addresses for patrons greatly enhanced our ability to conduct an online survey and case-control study. Employee interviews were of limited value; initial information about employee illnesses during the environmental assessment was more reliable. After additional cases were identified, the norovirus clean-up protocol at the restaurant was implemented and no additional illnesses were reported. These guidelines were successful in stopping norovirus transmission and will be used in future outbreaks.