consumption of inadequately cooked shellfish such as
cockles. Prolonged cooking results in a tough unpal-
atable product, and thus the aim of treatment must be
to apply the minimum heat necessary to render shell-
fish safe. Studies on the inactivation of hepatitis A
virus in shellfish led to recommendations that the
internal temperature of shellfish meat should be
raised to 90
C and maintained for 1.5 min. These
recommendations were adopted by the UK shellfish
industry and subsequently accepted as a valid method
of treatment by the European Commission. Later
studies, using feline calicivirus as a model, indicated
that these conditions were also adequate for inactiva-
tion of the NLVs. Epidemiological evidence strongly
supports the view that this treatment is effective for
the inactivation of gastroenteritis viruses. Since early
1988, there have been no further reports in England
and Wales of any viral illness, either hepatitis A or
gastroenteritis, from shellfish heat-treated according
to the recommendations.
0039 Foods may be contaminated during preparation
and serving by infected food handlers. Both the gas-
troenteritis viruses and hepatitis A virus are extremely
infectious in low doses and thus are spread easily
from infected persons. Persons with symptoms should
be excluded from handling food. However, food
handlers with very minimal symptoms have been im-
plicated in the transmission of NLVs. There is a little
circumstantial evidence that asymptomatic excretion
of virus occurs, but in the absence of more definitive
data, it is generally recommended that people should
be allowed to resume work 48 h after symptoms have
ceased. That recommendation was based on the rapid
decline in virus shedding observed by electron micro-
scopy and in practice appears to work satisfactorily.
However, NLVs often can be detected by PCR for a
longer period than by electron microscopy and, in
some instances, for up to a week after the onset of
symptoms. It is not clear if persons shedding virus
detectable by PCR are infectious after symptoms
have ceased. Recommendations on how long to ex-
clude people from work need to be kept under review.
0040 Excretion of hepatitis A virus precedes symptoms,
and hence, early exclusion of infectious food handlers
is not usually possible. An effective vaccine is avail-
able. Currently, in the UK, hepatitis A vaccine is used
selectively for persons at high risk, such as travelers.
It is not generally used for food handlers except in
outbreak situations. If exposure is known to have
occurred, the use of normal human immunoglobulin
might be considered in persons at risk of developing
illness.
0041 In the kitchen, prevention of transmission of vir-
uses through foods largely depends on rigorous appli-
cation of normal good hygiene practices, including
frequent hand washing and thorough washing of
fruit and vegetables. Shellfish must be regarded as a
potential source of infection, and uncooked shellfish
should be kept separate from other food items that
are not to be cooked. If vomiting occurs, virus may be
spread over a wide area. Uncovered food should be
discarded. Even food that is to be cooked is a poten-
tial source of cross-contamination. Work surfaces,
door handles, and toilet areas should be cleaned thor-
oughly. Chlorine-based disinfectants are considered
the most effective. Handling of food should be kept
to a minimum. Wearing gloves may prevent fecally
contaminated fingers coming into contact with food
but will not prevent transfer of organisms from con-
taminated work surfaces.
See also: Contamination of Food; Food Poisoning:
Statistics; Shellfish: Contamination and Spoilage of
Molluscs and Crustaceans; Zoonoses
Further Reading
Advisory Committee on the Microbiological Safety of Food
(1998) Report on foodborne viral infections. London:
The Stationery Office.
Appleton H (2000) Control of foodborne infections. British
Medical Bulletin 56: 172–183.
Cliver DO (1997) Foodborne viruses. In: Doyle MP, Beu-
chat LR and Montville TJ (eds) Food Microbiology:
Fundamentals and Frontiers, pp. 437–446. Washington,
DC: ASM Press.
Desslberger U (2000) Viruses associated with acute diar-
rhoeal disease. In: Zuckerman AJ, Banatvala JE and
Pattison JR (eds) Principles and Practice in Clinical Vir-
ology, 4th edn., pp. 235–252. Chichester, UK: John
Wiley.
Evans HS, Madden P, Douglas C et al. (1998) General
outbreaks of infectious intestinal disease in England
and Wales: 1995 and 1996. Communicable Disease
and Public Health 1: 165–171.
Food Standards Agency (2000) A report of the study of
infectious intestinal disease in England. London: The
Stationery Office.
Harrison TJ, Dusheiko GM and Zuckerman AJ (2000)
Hepatitis viruses. In: Zuckerman AJ, Banatvala JE and
Pattison JR (eds) Principles and Practice in Clinical Vir-
ology, 4th edn., pp. 187–233. Chichester, UK: John
Wiley.
Hui YH, Sattar SA, Murrell KD, Nip W-K and Stanfield PS
(eds) (2000) Foodborne Disease Handbook, Volume 2:
Viruses, Parasites, Pathogens, and HACCP, 2nd edn.
Chapters 2–9. New York: Marcel Dekker.
Lees D (2000) Viruses and bivalve shellfish. International
Journal of Food Microbiology 56: 81–116.
Millard J, Appleton H and Parry JV (1987) Studies on
heat inactivation of hepatitis A virus with special refer-
ence to shellfish. Epidemiology and Infection 98:
397–414.
6010 VIRUSES