Individually Quick Frozen raspberries imported from China were the source of 615 confirmed cases of Norovirus in Quebec between March and July of this year, and of 15 cases in Minnesota in August of 2016.

The Quebec outbreak encompassed clients and staff of seven seniors’ residences, two daycare centers and one hotel conference in four separate administrative regions of the province, according to a spokesperson for Quebec’s Ministry of Health and Social Services.

Confirmed cases were documented in Mauricie at six seniors’ residences, Laurentides at a hotel conference, Chaudieres-Appalaches at a daycare center, and Capitale-Nationale at a daycare center and a seniors’ residence.

Of the 615 outbreak victims, 141 were employees of at least two different seniors’ residences, and four were employees at one of the affected daycare centers. Citing privacy concerns, the health ministry declined to provide any further breakdown of the data by gender, age or geographic location. However, extrapolation of the venue data provided by the provincial health agency suggests that approximately 250 of the outbreak victims were seniors, and 33 were children.

In Minnesota
The Minnesota outbreak was linked to ice cream manufactured by Sebastian Joe’s, a Minneapolis-based company, according to a spokesperson from the Minnesota Department of Health. The ice cream was supplied to multiple venues within the Minneapolis-St. Paul area.

Raspberry chocolate chip flavor ice cream consumed at two Sebastian Joe’s venues, one private gathering, and one Twin Cities area restaurant was identified as the source. Of the 15 confirmed cases, 10 were female. One person was hospitalized.

The ice cream contained frozen raspberries imported from China. Analyses conducted by the Food and Drug Administration confirmed the presence of norovirus matching the case specimens in samples of the raspberries.

Product recalls
The Canadian Food Inspection Agency issued a total of 14 recall notices related to the implicated raspberries — the first on June 20 and the last on Aug. 21. Eleven of the notices were disseminated only to the food industry, with no public warning released.

only the recall notices dated Aug. 11, 16 and 21 were released to the public. They alluded to the existence of “… reported illnesses associated with the consumption…” of the recalled products.

From June 23 to Aug. 14 Quebec’s Ministry of Agriculture, Fisheries and Food issued a series of six public alerts and product recalls, which included numerous bakery products manufactured with the individually quick frozen (IQF) raspberries. Each of those alerts warned of “many” illnesses associated with the consumption of products containing IQF raspberries.

The U.S. Food and Drug Administration carried out analytical sampling and laboratory analysis when advised of the Minnesota outbreak, according to a spokesperson from FDA. As a result of the FDA investigation, the agency added IQF raspberries from Taian Runko Industry International Trade Co. Ltd. to the import alert 99-35 requiring “Detention Without Physical Examination.” The “Red List” status was effective May 2, and has not been changed.

Sebastian Joe’s initiated a product withdrawal as a result of the 2016 Minnesota outbreak.

Public health alerts
The Public Health Agency of Canada never issued a public health alert in conjunction with the norovirus outbreak linked to the IQF raspberries. A spokesperson for health agency said the agency’s silence was due to the outbreak having been confined to a single province.

The provincial health department responsible for investigating the 5-month outbreak, did not issue any news releases or public health alerts either. According to a provincial spokesperson, food recalls are the responsibility of the ministry of agriculture and the federal food inspection agency. The spokesperson added that health ministry worked with those agencies on the investigation.

The first public notice of the Quebec outbreak was contained in a public warning and recall notice issued by the agriculture ministry on June 23. The Canadian Food inspection Agency (CFIA) did not post a similar warning with its recall notices until Aug. 11.

The Minnesota Department of Health website did not post any alerts regarding the norovirus-related ice cream recall in that state.

Timeline
August 4-14, 2016: Norovirus illnesses associated with consumption of raspberry chocolate chip ice cream at four Minneapolis-St. Paul area venues.

March-May 2017: Three separate outbreak clusters involving six seniors’ residences, all of which were serviced by a single central kitchen.

May 2, 2017: Individually Quick Frozen (IQF) red raspberries from Taian Runko Industry International Trade Co. Ltd. (Taian, Shandong CHINA) is added to the FDA’s “Red List” one the import alert 99-35, citing norovirus GII contamination.

May 31, 2017: CFIA is notified by Quebec authorities that norovirus outbreak clusters are linked to raspberries, and it initiates a food safety investigation.

June 2017: Two additional outbreak clusters occur, one at a daycare center and the other at a hotel.

June 20, 2017: CFIA issues first product recall notice for IQF raspberries imported from China.

June 23, 2017: Quebec’s health ministry issues first Consumer alert and recall notice for IQF raspberries and some products containing the raspberries, reporting for the first time the existence of “many” illnesses associated with consumption of IQF raspberries.

July 2017: Two additional outbreak clusters are reported, one at a daycare center and the other at a seniors’ residence.

Canadian, U.S. outbreaks unrelated
The Minnesota and Quebec outbreaks occurred more than six months apart and appear to have been independent of each other. Taian Runko, the company identified by FDA during its analytical sampling, was not involved in the Quebec outbreak, according to CFIA.

Consumer information
Norovirus is the leading cause of outbreaks from contaminated food in the United States, according to the Centers for Disease Control and Prevention, accounting for approximately 50 percent of all food-related illnesses.

Symptoms of norovirus infection include nausea, vomiting, diarrhea and stomach pain. The symptoms usually develop within 12-24 hours after exposure to the virus and last one to three days.

Most cases of norovirus are self-limiting, and do not present a long-term health risk. Nevertheless, seniors and children are at heightened risk of severe dehydration if infected with the virus.

Most cases of norovirus illness in the population at large are shrugged off as “stomach flu.” Victims are usually not seen by doctors, and the infections go unreported.

A national survey carried out in the United Kingdom in 2011 determined that only 1 in every 23 people with norovirus consulted a physician. only one case was reported to national surveillance for every 12.7 patients. Overall, for every 288 cases of norovirus occurring in the general population, only one was reported to national surveillance authorities.