May 11, 2004 (CIDRAP News) – Food workers with a potentially infectious intestinal illness would be sent home under a recommendation adopted recently by a group that advises the Food and Drug Administration (FDA) on safety guidelines for the retail food industry.
The recommended provision is aimed mainly at norovirus (formerly called Norwalk virus), according to Paul Allwood, a senior environmental epidemiologist with the Minnesota Department of Health in St. Paul. Norovirus spreads easily on food and is now considered the most common cause of intestinal illness, according to the recommendation.
The current FDA Food Code says that restaurant and food service workers with intestinal symptoms generally may stay on the job but may not work with exposed food, utensils, or linens, Craig Hedberg, PhD, an associate professor of environmental and occupational health at the University of Minnesota in Minneapolis, told CIDRAP News.
The FDA Food Code is not binding but serves as a model for state and local regulations for retail food stores, restaurants, and food services. The Conference for Food Protection, a representative body of food industry officials, government regulators, academic experts, and consumers, advises the FDA on changes to the code.
Allwood, who is a member of the conference, said the conference passed the recommendation about sick employees at its biennial meeting in April. The FDA routinely adopts the conference's recommendations, and in this case the FDA itself had proposed the recommendation, he said. "I'm 99% certain this will be in the code," he predicted.
The recommendation says workers with "sudden onset" of vomiting or diarrhea should leave the premises and not return until they have been free of symptoms for 24 hours, Allwood reported. However, the requirement would not apply if there were an obvious noninfectious reason for the symptoms, such as pregnancy or an alcohol hangover, he said.
"The new recommendation is essentially targeted at the norovirus and the recognition that it's transmitted fairly efficiently by aerosol and fomites and so forth, so once there's someone [infected] in the facility it's fairly hard to control spread of the disease," Allwood said.
The Centers for Disease Control and Prevention estimates that norovirus is the leading cause of foodborne illness in the United States, according to the recommendation, a copy of which was provided by Allwood. The virus occurs in "extremely high concentrations" in the stool of infected people, and contaminated food is the virus's most common transmission vehicle, the recommendation states. It says the virus also can spread through the air as a result of vomiting.
Hedberg said there are some exceptions to the current Food Code provision that allows workers with intestinal symptoms to keep working, though not with food. The code says a worker must leave the premises if he or she is infected with Salmonella typhi (the cause of typhoid fever), Shigella species, Shiga toxin–producing Escherichia coli (E coli O157:H7), or hepatitis A, Hedberg said. Sick workers also must be sent home if they work in an operation that serves people at high risk for severe foodborne illness.
States generally base their retail food safety regulations on the FDA Food Code, though they often modify it in some respects, according to Hedberg and Allwood. For example, Minnesota's rules call for food workers with intestinal symptoms to be sent home until 48 hours after their symptoms have abated, Allwood said.
FDA information about the Food Code, with links to the code
Conference for Food Protection