Reported behavior, knowledge and awareness toward the potential for norovirus transmission by food handlers in Dutch catering companies and institutional settings in relation to the prevalence of norovirus

Norovirus (NoV) in ready to eat food has recently been defined as one of the virus-food commodity combinations with greatest public health concern. The role of food handlers therein has well been recognized. The aim of this study was to identify gaps in food handlers' education and to investigate possible associations between reported behavior, knowledge and awareness of NoV, and environmental presence of NoV. For this, face-to-face interviews were conducted using structured questionnaires in 1023 catering companies (i.e. restaurants mainly), 101 non-hospital health care centers, 52 hospital central kitchens and in 102 hospital in-patient units. In addition, three surface swabs were taken at each setting. Multivariate logistic regression was performed on data restricted to NoV high season months only, in which NoV was present in 21/374 (6%) catering companies and 37/233 (16%) institutional settings (p<0.01). The two independent determinants of presence of NoV on environmental surfaces identified were being situated in an institutional setting and having an attitude to continue food handling while sick with vomiting complaints. Several gaps in education and training were identified, demonstrating that knowledge on NoV was low, although awareness of NoV was significantly higher among food handlers in institutional settings than in catering companies. This is the first time questionnaires and environmental testing have been combined in the same study to identify issues of improvement. Training on all important aspects of NoV according to the recently developed Codex Alimentarius guidelines to control viruses in food is strongly recommended.

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