ATLANTA, June 3 (UPI) -- About 20 million people get sick from norovirus -- referred to incorrectly as "stomach flu" -- each year, mostly from eating in restaurants, catering or banquet facilities.
"Norovirus outbreaks from contaminated food in restaurants are far too common," Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, said in a statement.
"All who prepare food, especially the food service industry can do more to create a work environment that promotes food safety and ensures that workers adhere to food safety laws and regulations that are already in place."
Norovirus is extremely contagious, with an estimated infectious dose as low as 18 viral particles -- the amount on the head of a pin could sicken more than 1,000 people.
The CDC's Vital Signs report used data from the National Outbreak Reporting System. From 2009 to 2012 health departments reported 1,008 norovirus outbreaks to the National Outbreak Reporting System.
In about half of the outbreaks, factors contributing to food contamination were reported and an infected food worker was implicated in 70 percent of them. In these outbreaks, food workers infected with norovirus contaminated food often by touching ready-to-eat foods -- washed raw fruit and vegetables for salads or sandwiches, baked goods, or cooked items -- served in restaurants with their bare hands.
Sixty-four percent of the food outbreaks were traced to contaminated food in restaurants, 17 percent from catering or banquet facilities, 13 percent were from other causes than contaminated food, 4 percent were from private residences, 1 percent from healthcare facilities and 1 percent from schools and daycare facilities.
One-in-5 food service workers reported working at least once in the previous year while sick with vomiting or diarrhea because they feared for their job and didn't want to leave coworkers short-staffed, the report said.
The Vital Signs report provides recommendations to help the food service industry prevent norovirus using provisions in the existing Food and Drug Administration model Food Code, which included:
-- Making sure food service workers practice proper hand washing and use utensils and single-use disposable gloves to avoid touching ready-to-eat foods with bare hands, -- Certifying kitchen managers and training food service workers in food safety practices. -- Establishing policies that require food service workers to stay home when sick with vomiting and diarrhea and for at least 48 hours after symptoms stop by providing paid sick leave and having a staffing plan that includes on-call workers.