886 infection control & hospital epidemiology july 2017, vol. 38, no. 7


oysters, shellfish, fruits, and vegetables, especially when they are consumed raw without heating. Recently, another norovirus outbreak associated with consumption of green sea- weed that was eaten unheated with vinegar seasoning was reported in South Korean schools.8 However, outbreaks due to shredded, dried, laver seaweed processed for long-term pre- servation are unprecedented. As such, the current events provide several implications for preventing future norovirus outbreaks. First, even in a packaged food product that has undergone


heat-treatment, norovirus contamination can occur if it is handled by an infected person’s bare hands during the man- ufacturing process. Although no regulations currently govern whether food manufacturers use gloves throughout the entire manufacturing process in Japan, more attention should be given to the risks of contamination. A previous report showed that the contaminated hands of food handlers could transfer infective norovirus even during gloving,9 so effective hand hygiene including handwashing with soap and water should be emphasized by food manufacturers. In addition, the integrated and streamlined school-lunch


provision system is highly vulnerable to norovirus outbreaks. An appropriate decentralized provision system should be explored, weighing the risks and costs prudently. In the modern society where highly connected distribution routes are well established, a single contaminated product can cause multiple outbreaks in geographically disparate places. The responsible local authorities should share infection informa- tion promptly and widely across geographic borders. Finally, a comprehensive surveillance system including dried processed foods should be established to detect the source of such pathogens as early as possible to avoid further spread of the virus. Notably, an Italian study using a polymerase-chain reac- tion identification technique revealed the presence of norovirus in semidried tomatoes deemed “ready to eat.”10 In the past, packaged dried foods may have been overlooked as the source of pathogens. In norovirus outbreaks, we should remember to consider this surprising source of infection.


acknowledgments


Financial support: No financial support was provided relevant to this article. Potential conflicts of interest: All authors report no conflicts of interest rele- vant to this article.


Eiji Kusumi, MD;1


Tetsuya Tanimoto, MD;1 Kazutaka Hosoda, MD;1


Masaharu Tsubokura, MD, PhD;1 Tamae Hamaki, MD;1


transmission. However, prevention of norovirus infection is often challenging due to several factors: low infectious dose, prolonged survival on dry inanimate surfaces, resistance to commonly used disinfectants, long infectious period, and prolonged shedding.5–7 Common foods that can cause norovirus infection include


Kenzo Takahashi, MD, PhD;1,2 Masahiro Kami, MD, PhD1,3


Affiliation: 1. Navitas Clinic, Tokyo, Japan; 2. Teikyo University Graduate


School of Public Health, Tokyo, Japan; 3. Medical Governance Research Institute, Tokyo, Japan. Address correspondence to Tetsuya Tanimoto, MD, Navitas Clinic, Shibasaki-cho 3-1-1, Tachikawa City, Tokyo, 190-0031, Japan (tetanimot@ yahoo.co.jp). Infect Control Hosp Epidemiol 2017;38:885–887 © 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2017/3807-0024. DOI: 10.1017/ice.2017.70


references


1. Hehemann JH, Correc G, Barbeyron T, Helbert W, Czjzek M, Michel G. Transfer of carbohydrate-active enzymes from marine bacteria to Japanese gut microbiota. Nature 2010;464:908–912.


2. The second report on food poisoning due to school lunch in primary schools inTachikawa city. Tokyo Metropolitan Government website. http://www.metro.tokyo.jp/tosei/hodohappyo/press/2017/02/28/11. html. [in Japanese] Published 2017. Accessed March 5, 2017.


3. Dried seaweed to blame for mass food poisoning at schools. Asahi Shimbun website. http://www.asahi.com/ajw/articles/ AJ201703010055.html. Published 2017. Accessed March 5, 2017.


4. On the occurrence of food poisoning. Tokyo Metropolitan Government website. http://www.metro.tokyo.jp/tosei/hodo- happyo/press/2017/03/03/08.html. [in Japanese] Published 2017. Accessed March 5, 2017.


5. Li J, Predmore A, Divers E, Lou F. New interventions against human norovirus: progress, opportunities, and challenges. Annu Rev Food Sci Technol 2012;3:331–352.


6. DuPont HL. Acute infectious diarrhea in immunocompetent adults. NEnglJMed 2014;370:1532–1540.


7. Ahmed SM, Hall AJ, Robinson AE, et al. Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis. Lancet Infec Dis 2014;14:725–730.


8. Park JH, Jeong HS, Lee JS, et al. First norovirus outbreaks asso- ciated with consumption of green seaweed (Enteromorpha spp.) in South Korea. Epidemiol Infect 2015;143:515–521.


9. Roenqvist M, Aho E, Mikkelae A, et al. Norovirus transmission between hands, gloves, utensils, and fresh produce during simu- lated food handling. Appl Environ Microbiol 2014;80:5403–5410.


10. Serracca L, Rossini I, Battistini R, et al. Potential risk of norovirus infection due to the consumption of “ready to eat” food. Food Environ Virol 2012;4:89–92.


Accidental Occupational Exposure to Burkholderia pseudomallei in South Korea Did Not Result in Melioidosis


To the Editor—Melioidosisiscausedby Burkholderia pseudomallei and presents a high mortality rate of up to 40%.1 B. pseudomallei is endemic in Southeast Asia and northern Australia. In Korea, there have been several imported cases; however, there have been no autochthonous cases.2


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