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A blog by your local public health experts

 

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Norovirus Suspected at El Toro Restaurant in University Place

Photo of Communications Manager Edie Jeffers
by Edie Jeffers01/10/2018 12:21 p.m.
Updated: 02/06/2018

Update

Jan. 18, 2018, 3:30 p.m.

Norovirus is highly contagious and more common during cold weather months. The recent El Toro outbreaks were a timely reminder that the virus can affect many people.

As of today, the Health Department has a total of 542 cases—520 from the Tacoma location and 22 suspect cases from the University Place location. We have a lab confirmation of norovirus from the Tacoma location.

Because of the large drop in case reporting, this is our last regular update.

To explain more about the outbreaks and norovirus in general, we talked to Environmental Health Supervisor Christina Sherman from our food & community safety program.

You identified about 540 sick people from this outbreak. Is that number of cases normal?

Outbreaks can last a few days, a few weeks, or a few months. This a large number of cases for us, but we know cases of norovirus typically go unreported. And likely, the high number reflects secondary cases—people who became ill from eating at the restaurant, then went home and infected family members. It’s highly contagious. People will get norovirus an average of five times in their lives and not necessarily realize what it is—and they will probably not report it to the health department.

Norovirus outbreaks typically have greater numbers of cases than other types of outbreaks because of the low number of virus particles needed to cause infection and the rapid person-to-person transmission. This outbreak had much higher numbers than usual because:

  • The exposure period lasted eight days before we received notification people were sick.
  • We shared more about this outbreak than others in the past. Media coverage and our own public outreach through our blog and social media expanded awareness of the outbreak and how to report foodborne illness. More people became aware their symptoms might be norovirus, and they contacted us. 

Other restaurants have had outbreaks. Why did the Health Department share so much information about this one? 

Last summer, we started the practice of listing on our website when we close a food service establishment for 24 hours because of food safety violations or other health threats. We also looked for other ways to be more transparent with public health information.

Our new website provides features like blogging to update the public on important issues like a foodborne illness outbreak—and to update the status in real time. It’s another tool in our public information toolbox that also promotes more public engagement with the information we share. Moving forward, we will use our blog to share information during incidents like this—as well as plenty of good news public health stories.

Would a restaurant rating system have prevented or lessened the outbreak?

While we don’t currently use a restaurant grading system, we are considering one as a method to make it simple for consumers to understand the food safety performance of food establishments. Any grading system will build on improvements we’ve already made, such as posts of restaurant closure information online and signs on food establishments we temporarily close.

It’s difficult to say what effect a grading system would have had during this outbreak. The grades would have been based on inspections, which are snapshots of an establishment’s performance on that particular day. Our inspectors can only cite food safety violations they observe during a particular inspection.

In the case of the El Toro Restaurants, both received 65 critical points—not a passing score—during their last routine inspections, but they passed their follow up inspections. (See the two-year inspection history for the Tacoma El Toro and University Place El Toro.) On the other hand, many restaurants can pass their inspections then go on to have a foodborne illness outbreak. Conditions that lead to an outbreak—for example, food workers handling ready to eat food with their bare hands—might not be present during the inspection.

If norovirus can live on surfaces for up to two weeks, what good is it to clean and sanitize?

The virus’ ability to live on surfaces is exactly why cleaning and sanitizing are so important. To sanitize hard surfaces, a bleach and water solution is the most common and practical way to kill and remove the virus. Cloth and other surfaces require heat and steam to disinfect them. Learn more about cleaning and sanitizing for norovirus.

How can you determine norovirus as the source of illness if you don’t test for it?

We often are not able to confirm norovirus with a lab test during the early phase of an outbreak. We follow the Centers for Disease Control and Prevention recommendation to use the Kaplan Criteria to identify norovirus outbreaks. We consider the symptoms of the virus (nausea, vomiting, stomach cramping, diarrhea, fever, and headache), and when people start showing those symptoms. As an outbreak continues, we sometimes get laboratory confirmation of the illness, as we did in this recent outbreak.

How can someone spread norovirus while not showing symptoms? 

People exposed to norovirus but not showing symptoms can spread it during the incubation phase. That means they are spreading the virus for one to two days before they themselves become sick. That is why it is so important for everyone to wash their hands often. For food workers, it is especially important not to touch ready to eat foods with their bare hands.

How do you pinpoint the source of a norovirus outbreak—or any foodborne illness?

We rely on people who have become sick to report their illness to us. For an outbreak at a food establishment, we look for two or more reports:

  • From different households.
  • With meals at the same food establishment during the same time period.
  • Common incubation times and symptoms.

We match these criteria to what we know about different foodborne pathogens. In this case, they matched norovirus and the restaurants were the only thing all the sick people had in common. Then we investigate if any employees were sick, what tasks they performed, and what foods the sick people ate.

Food workers should always stay home when they’re sick. What if they can’t miss work without facing financial hardship?

On Jan. 1, the state’s new Paid Sick Leave Law took effect. The law requires employers provide their employees with paid time off to take care of their health. Learn more about paid sick leave on the Labor and Industries website.

Because norovirus and the flu are in circulation, we want everyone to take preventative steps to stay healthy and keep those around you from getting sick. Wash your hands often, cover your coughs and sneezes, and stay home if you’re sick. Learn more about norovirusthe flu, and handwashing.

 Image of a dating profile for norovirus with food safety information about how not to get the virus.

Last September we introduced our GermDate dating profiles. We used humor to educate the public about foodborne illness for Food Safety Month. Norovirus was among them. Check out the profile to see how to avoid this nasty bug and learn more on our norovirus page.

Update

Jan. 11, 2018, 2:11 p.m.

The Health Department allowed the University Place El Toro Restaurant to reopen this morning after a thorough cleaning and sanitizing. This follows a suspected norovirus outbreak that made 10-15 people sick. We don’t yet have an exact number because we have not interviewed all the people who have made illness reports. We continue to receive additional illness reports.

We have confirmed norovirus as the cause of illnesses at the El Toro Restaurant in Tacoma’s Westgate neighborhood. We received a positive test result from a private laboratory today for a customer who ate there between Dec. 31 and Jan. 8. Currently 391 cases are connected to the Tacoma location.

About the investigation

The Health Department is working with El Toro to identify the most likely source of norovirus. Through interviews with restaurant staff and customers who got sick, we look for food they handled or ate and areas of contact they have in common.

We know two staff members at the Tacoma location worked while ill during the time customers there dined and later got sick. It’s still unclear if the outbreaks at the two locations are connected. Because of the nature of norovirus outbreaks, we may never know the exact affected items that caused illness. We know all the cases have dining at the El Toro Restaurants in common.

Each restaurant makes everything in-house. They make their own salsa from scratch.

For restaurant closures of this type, we always schedule an educational visit where all employees, management, and owners review food safety practices and procedures. We also follow up with an inspection after the educational visit.

We investigate every foodborne illness complaint. If you believe you ate at a food establishment and got sick, contact the Health Department at food@tpchd.org, report online at www.tpchd.org/reportfoodborneillness, or call (253) 798-4712.

Update 

Jan. 10, 2018, 2:58 p.m.

The Health Department has more reports of ill customers from the suspected norovirus outbreaks at two El Toro restaurants. We have received reports of 232 ill customers at the Tacoma location and four at the one in University Place. We continue to receive more reports and interview more customers.

If you ate at El Toro Restaurant and became ill, contact the Health Department at food@tpchd.org, report online at www.tpchd.org/reportfoodborneillness, or call (253) 798-4712.

Jan. 10, 2018, 12:21 p.m.

Tacoma-Pierce County Health Department is working with El Toro Restaurant on a second suspected norovirus outbreak. Today, the Health Department closed the restaurant’s University Place location, 3820 Bridgeport Way W., for at least 24 hours or until thoroughly cleaned and sanitized.

We received two reports on Jan. 8 from customers in separate households who say they got ill after dining at the University Place location. Each report has multiple cases. We are still confirming the total and gathering information about new cases.

The customers got sick after they ate at El Toro’s University Place restaurant on Jan. 6. They experienced symptoms, which include vomiting and diarrhea, 24-36 hours after eating. Their symptoms lasted one to two days. We suspect norovirus to be the pathogen based on the symptoms.

It’s unclear if this outbreak is connected to our ongoing norovirus investigation at El Toro’s Tacoma restaurant in the Westgate neighborhood, 5716 N. 26th St.

“Someone exposed to norovirus can spread it 24 hours before showing symptoms,” said Katie Lott, food safety program manager. “That’s why preventing bare hand contact with food is so important,” Lott said.

Ill employees can return to work at a food establishment 48 hours after they become well.

“Food establishments benefit when sick food workers stay home: They don’t lose business and don’t jeopardize the health of their customers,” said Lott. “With Washington’s new paid sick leave law, food workers don’t have to be penalized financially for taking care of their health.” Learn more about paid sick leave on the Labor and Industries website.

In a recent editorial, the News Tribune supported the new sick leave law. The newspaper quoted research that said the law may benefit public health, in part, because of a “connection between paid sick leave and overall better population health, including fewer infectious outbreaks."

Norovirus:

  • Is highly contagious.
  • Causes explosive diarrhea and violent vomiting, often at the same time.
  • Is the same virus often related to cruise ship outbreaks.

Cleaning for norovirus

Clean vomit or diarrhea accidents immediately.

Step 1. Remove vomit or poop.

  • Pick up the chunks with paper towels or other disposable material.
  • Soak up liquids with absorbent materials. Use kitty litter or dry oatmeal for carpeted areas.
  • Double bag and discard.
  • Do not use a vacuum cleaner.

Step 2. Sanitize.

  • Disinfect hard surfaces using 1 2/3 cups of household bleach per gallon of water. Allow for 1 minute of contact time.
  • Sanitize all handles and knobs in your house with the bleach solution.
  • Linens (including clothing, towels, napkins): Wash separately in hot water and dry on high.
  • Steam clean carpets using the highest setting for heat.
  • Avoid cross-contamination (use separate sanitation cloths for bathroom and other surfaces).
  • Clean and disinfect all containers used (e.g., buckets).

Handwashing

Wash hands often with soap and warm water for at least 20 seconds. Especially after cleaning, restroom use and before eating.

If you ate at El Toro Restaurant and became ill, contact the Health Department at food@tpchd.org, report online at www.tpchd.org/reportfoodborneillness, or call (253) 798-4712.

Learn more about norovirus at www.tpchd.org/norovirus. Sign up for restaurant closures at www.tpchd.org/notify.

  1. Updated: 02/06/2018
  2. Updated: 02/05/2018
  3. Updated: 01/19/2018
  4. Updated: 01/18/2018
  5. Updated: 01/16/2018
  6. Updated: 01/11/2018
Photo of Communications Manager Edie Jeffers

by Edie Jeffers

Communications & Community Relations Manager