Parasites Foodborne Illness

Parasites may be present in food or in water and can be identified as causes of foodborne
or waterborne illness in the U.S. They range in size, from tiny single-celled organisms to worms
visible to the naked eye. Their lifecycle may also vary. While some parasites use a permanent
host, others go through a series of developmental phases using different animal or human hosts.
The illnesses they can cause range from mild discomfort to debilitating illness and possibly
death.

What Are Parasites?

Parasites are organisms that derive nourishment and protection from other living
organisms known as hosts. They may be transmitted from animals to humans, from humans to
humans, or from humans to animals. Several parasites have emerged as significant causes of
foodborne and waterborne illness. These organisms live and reproduce within the tissues and
organs of infected human and animal hosts and are often excreted in feces. They may be
transmitted from host to host through consumption of contaminated food and water, or by putting
anything into your mouth that has touched the stool (feces) of an infected person or animal.
Parasites are of different types and range in size from tiny, single-celled, microscopic organisms
(protozoa) to larger, multi-cellular worms (helminths) that may be seen without a microscope.
The size ranges from 1 to 2 micrometers to 2 meters long. Some common parasites are Giardia
duodenalis, Cryptosporidium parvum, Cyclospora cayetanensis, Toxoplasma gondii, Trichinella
spiralis, Taenia saginata (beef tapeworm), and Taenia solium (pork tapeworm).

Cryptosporidium parvum

Cryptosporidium parvum (C. parvum), cause of the disease cryptosporidiosis also called
"Crypto", is a one-celled, microscopic, shelled parasite and a significant cause of waterborne and
foodborne illness worldwide. It is found in the intestines of many herd animals including cows,
sheep, goats, deer and elk. The illness could be intestinal, tracheal or pulmonary.

How Do People Get Cryptosporidiosis?

This parasite can be found in soil, food, water or surfaces that have been contaminated
with feces from infected humans or animals. People get cryptosporidiosis by consuming food or
water contaminated with C. parvum oocysts. Oocysts are the infective stage of the parasite. The
oocysts are the environmentally resistant stage of the organism and are shed in the feces of a
human or animal host.

Symptoms of Intestinal Cryptosporidiosis

Symptoms include watery diarrhea, stomach cramps, upset stomach and slight fever.
Some cases may be without symptoms.

When Will Symptoms Appear? What Is the Duration?

 Symptoms appear 2 to 10 days after ingestion of C. parvum oocysts. The illness usually
goes away without medical intervention in 3 to 4 days. For healthy people, symptoms may last
up to 2 weeks. For individuals with weakened immune systems, cryptosporidiosis can be serious,
long-lasting, and sometimes fatal.

Risk for Contracting Cryptosporidiosis

Those at risk include:

 Day care providers and children attending daycare centers

 Young children, pregnant women, older adults, and persons with weakened immune
systems, including those with HIV/AIDS infection, cancer, diabetes, kidney disease, and
transplant patients, or those individuals undergoing chemotherapy.
 International travelers, known as traveler's diarrhea; and
 Hikers, campers or any other persons who may drink from untreated water supplies.

Prevention of Cryptosporidiosis

 Wash hands with warm water and soap before handling foods and eating, and after going
to the bathroom, changing diapers and handling animals.
 Drink water only from treated municipal water supplies.
 When hiking, camping, or traveling to countries where the water supply may be unsafe to
drink, either avoid drinking the water or boil it for 1 minute to kill the parasite. Drinking
bottled beverages can be a safe alternative.
 Do not swallow water while swimming.
 Do not swim in community swimming pools if you or your child has cryptosporidiosis.
 Drink only pasteurized milk, juices, or cider.
 Wash, peel or cook raw fruits and vegetables before eating.
 Do not use untreated manure to fertilize fruits and vegetables. Watering untreated manure
can spread the organism.

Cyclospora cayetanensis
 Cyclospora cayetanensis (C. cayetanensis), cause of cyclosporiasis, is a one-celled,
microscopic parasite. Currently little is known about this organism, although cases of
cyclosporiasis are being reported from various countries with increasing frequency.

People Get Cyclosporiasis

People get Cyclosporiasis the following ways:

 By consuming food or water contaminated with C. cayetanensis oocysts. Oocysts are the
infective stage of the organism.
 By putting anything into your mouth that has touched the stool of a person or animal with
cyclosporiasis.

Symptoms of Cyclosporiasis

Symptoms include watery diarrhea (sometimes explosive), loss of appetite, bloating,

stomach cramps, nausea, vomiting, muscle aches, low-grade fever and fatigue. Some cases are
without symptoms. Symptoms are more severe in persons with weakened immune systems.

When Will Symptoms Appear?

Symptoms typically appear about 1 week after ingestion of C. cayetanensis oocysts. If

untreated, the symptoms may last a week to more than a month. Symptoms may return.

Risk for Contracting Cyclosporiasis

Persons of all ages are at risk for infection. Young children, pregnant women, older
adults, and persons with weakened immune systems including those with HIV/AIDS infection,
cancer, diabetes, kidney disease, and transplant patients, or those individuals undergoing
chemotherapy may be at greater risk for infection.

How to Prevent Cyclosporiasis

 Wash hands with water and soap before handling foods and eating, and after going to the
bathroom, changing diapers and handling animals.
 Make sure infected individuals wash their hands frequently to reduce the spread of
infection.
 Drink water only from treated municipal water supplies.
  When hiking, camping, or traveling to countries where the water supply may be unsafe to
drink, either avoid drinking the water or boil the water for 1 minute to kill the parasite.
Drinking bottled beverages can be a safe alternative.
 Do not swim in community swimming pools if you or your child has cyclosporiasis.
 Wash, peel or cook raw fruits and vegetables before eating.

Toxoplasma gondii

Toxoplasma gondii (T. gondii), cause of the disease toxoplasmosis, is a single-celled,

microscopic parasite found throughout the world. It is the third leading cause of death from
foodborne disease. It is interesting to note that these organisms can only carry out their
reproductive cycle within members of the cat family. In this parasite-host relationship, the cat is
the definitive host. The infective stage, oocyst, develops in the gut of the cat. The oocysts are
then shed into the environment with cat feces.

People Get Toxoplasmosis

People get toxoplasmosis the following ways:

 Fecal-oral: Touching your hands to your mouth after gardening, handling cats, cleaning a
cat's litter box, or anything that has come into contact with cat feces.
 Mother-to-fetus if mother is pregnant when first infected with T. gondii.
 Through organ transplants or blood transfusions, although these modes are rare.

Symptoms of Toxoplasmosis
 Toxoplasmosis is relatively harmless to most people, although some may develop “flu-
like” symptoms, such as swollen lymph glands and/or muscle aches and pains. In otherwise
healthy individuals, the disease is usually mild and goes away without medical treatment.
However, dormant non-infective parasites can remain in the infected individual for life. An
unborn child may contract the parasite congenitally resulting in severe outcomes including
miscarriage or stillbirth.

However, persons with weakened immune systems such as those with HIV/AIDS
infection, organ transplant recipients, individuals undergoing chemotherapy, and infants may
develop severe toxoplasmosis. Severe toxoplasmosis may result in damage to the eyes or brain.
Infants becoming infected before birth can be born intellectually disabled or with other mental or
physical problems.

When Will Symptoms Appear? What Is the Duration?

 The time that symptoms appear varies, but generally symptoms will appear 1 week to 1
month after consuming the parasite.
 Infants infected while still in the womb may show no symptoms at birth but develop
symptoms later in life.
 The duration of the illness depends on the health and immune status of the host. Persons
with weakened immune systems may experience illnesses of long duration, possibly
resulting in death.

Risk for Contracting Severe Toxoplasmosis

Those at risk include:

 Persons with weakened immune systems including those with HIV/AIDS infection, organ
transplant recipients, or those individuals undergoing chemotherapy.
 Infants born to mothers who become infected with T. gondii shortly before becoming
pregnant or during pregnancy. Those mothers exposed to T. gondii longer than 6 months
before becoming pregnant rarely transmit toxoplasmosis to their infants.

Prevention Toxoplasmosis

 If you are pregnant or planning to become pregnant, or if you have a weakened immune
system, you should discuss your risk of contracting toxoplasmosis with your health care
provider.
 Wear clean latex gloves when handling raw meats, or have someone who is healthy and
not pregnant, handle the meats for you.
 Cook all raw beef, pork, lamb and veal steaks, chops, and roasts to a minimum internal
temperature of 145 degrees F, as measured with a food thermometer, before removing
meat from the heat source. For safety and quality, allow meat to rest for at least three
minutes before carving or consuming. For reasons of personal preference, consumers
may choose to cook meat to higher temperatures.
  Cook all raw ground beef, pork, lamb and veal to an internal temperature of 160 degrees
F, as measured with a food thermometer.
 Cook all poultry to a safe minimum internal temperature of 165 degrees F, as measured
with a food thermometer.
 Wash hands, cutting boards and other utensils thoroughly with hot, soapy water after
handling raw meats.
 Clean cat litter boxes daily because cat feces more than a day old can contain mature
parasites.
 Wash hands thoroughly with water and soap after handling cats or cleaning cat litter
boxes, especially before you handle or eat food.
 Wear gloves when you handle garden soil or sandboxes. Cats may use gardens or
sandboxes as litter boxes. Cover sandboxes to prevent cats from using them as litter
boxes.
 Help prevent cats from becoming infected with T. gondii by discouraging them from
hunting and scavenging.
 Feed cats commercially made cat foods or cook their food.

Trichinella spiralis

Trichinella spiralis, cause of trichinellosis (also known as trichinosis) is an intestinal

roundworm whose larvae may migrate from the digestive tract and form cysts in various muscles
of the body. Infections occur worldwide but are most prevalent in regions where pork or wild
game is consumed raw or undercooked. The incidence of trichinosis has declined in the U.S. due
to changes in hog feeding practices. Presently, most cases in this country are caused by
consumption of raw or undercooked wild game.

People Get Trichinellosis

People get trichinellosis (trichinosis) by consuming raw or undercooked meats such as

pork, wild boar, bear, bobcat, cougar, fox, wolf, dog, horse, seal or walrus infected
with Trichinella larvae. The illness is not spread directly from person to person.

Symptoms of Trichinellosis

The first symptoms are nausea, diarrhea, vomiting, fever, fatigue and abdominal pain,
followed by headaches, eye swelling, aching joints and muscles, weakness and itchy skin. In
severe infections, persons may experience difficulty with coordination and have heart and
breathing problems. Death may occur in severe cases.

When Will Symptoms Appear? What Is the Duration?

Abdominal symptoms may appear within 1 to 2 days after eating contaminated meat.
Further symptoms, such as eye swelling and aching muscles and joints, may begin 2 to 8 weeks
after infection. Mild cases may assume to be flu. Symptoms may last for months.

Risk for Contracting Trichinellosis

 Persons consuming raw or under cooked pork or wild game. Persons with weakened
immune systems including those with HIV/AIDS infection, organ transplant recipients, or those
individuals undergoing chemotherapy may be at a greater risk for infection.

Prevention Trichinellosis

 Wash your hands with warm water and soap after handling raw meat.
 Cook all raw pork steaks, chops and roasts to a minimum internal temperature of 145
degrees F, as measured with a food thermometer, before removing meat from the heat
source. For safety and quality, allow meat to rest for at least three minutes before carving
or consuming. For reasons of personal preference, consumers may choose to cook meat
to higher temperatures.
 Clean meat grinders thoroughly each time you grind meat at home.

Taenia saginata/Taenia solium (Tapeworms)

Taenia saginata (beef tapeworm) and Taenia solium (pork tapeworm) are parasitic
worms, known as helminths. Taeniasis is the name of the intestinal infection caused by adult-
stage tapeworms (beef or pork tapeworms). Cysticercosis is the name of the tissue (other than
intestinal) infection caused by the larval stage of the pork tapeworm only.

It is interesting to note that humans are the definitive hosts of both organisms. This means
that the reproductive cycle, and thus egg production by the organisms, occurs only within
humans. Eggs are passed in human feces, and may be shed into the environment for as long as
the worms remain in the intestines, as long as 30 years. In addition, the eggs may remain viable
in the environment for many months. These diseases are more prevalent in underdeveloped
countries where sanitation practices may be substandard and in areas where pork and beef are
consumed raw or undercooked. They are relatively uncommon in the U.S., although travelers
and immigrants are occasionally infected.

People Get Taeniasis

People get Taeniasis by consuming raw or undercooked infected beef or pork.

Symptoms of Taeniasis

Most cases of infection with adult worms are without symptoms. Some persons may
experience abdominal pain, weight loss, digestive disturbances and possible intestinal
obstruction. Irritation of the perianal area can occur, caused by worms or worm segments exiting
the anus.

When Will Symptoms Appear? What Is the Duration?

T. saginata (beef tapeworm) infections appear within 10 to 14 weeks. T. solium (pork

tapeworm) infections appear within 8 to 12 weeks. Taeniasis may last many years without
medical treatment.
Prevention Taeniasis

Cook all raw beef and pork steaks, chops and roasts to a minimum internal temperature of
145 degrees F, as measured with a food thermometer, before removing meat from the heat
source. For safety and quality, allow meat to rest for at least three minutes before carving or
consuming. For reasons of personal preference, consumers may choose to cook meat to higher
temperatures.

People Get Cysticercosis

People get cysticercosis the following ways:

 By consuming food or water contaminated with the eggs of T. solium (pork tapeworm).
Worm eggs hatch and the larvae then migrate to various parts of the body and form cysts
called cysticerci. This can be a serious or fatal disease if it involves organs such as the
central nervous system, heart or eyes.
 By putting anything into your mouth that has touched the stool of a person infected
with T. solium.
 Some persons with intestinal tapeworms may infect themselves with eggs from their own
feces as a result of poor personal hygiene.

Symptoms of Cysticercosis

Symptoms may vary depending on the organ or organ system involved. For example, in
muscles, lumps under the skin may result. Cysticercosis can cause blurred vision in the eyes. An
individual with cysticercosis involving the central nervous system (neurocysticercosis) may
exhibit neurological symptoms, such as psychiatric problems or epileptic seizures. Death is
common.

When Will Symptoms Appear? What Is the Duration?

Symptoms usually appear from several weeks to several years after becoming infected
with the eggs of the pork tapeworm (T. solium). Symptoms may last for many years if medical
treatment is not received.

Risk for Contracting Cysticercosis

Persons traveling to countries where sanitation may be substandard, and the water supply
may be unsafe. Young children, pregnant women, older adults, and persons with weakened
immune systems including those with HIV/AIDS infection, cancer, diabetes, kidney disease, and
transplant patients, or those individuals undergoing chemotherapy may be at greater risk for
infection.

Prevention Cysticercosis

 Drink water only from treated municipal water supplies.

 Do not eat undercooked pork or meat.
  When traveling to countries where the water supply may be unsafe, either avoid the water
or boil it for 1 minute to kill parasite eggs. Avoid ice in those same areas. Drinking
bottled beverages or hot coffee and tea are safe alternatives.

Foodborne Viruses

Viral infections are the leading cause of gastroenteritis globally and may also cause
enterically transmitted hepatitis and illness after migrating from the human intestine to other
organs. Various viruses have been implicated in foodborne illness, with three viruses: norovirus
(NoV), hepatitis A virus (HAV), and hepatitis E virus (HEV) causing the most significant burden
of foodborne illness and outbreaks. Rotavirus, sapovirus, enterovirus, astrovirus and enteric
adenovirus have also been associated with foodborne transmission but are currently not
considered to be as significant.
Annually, NoV causes an estimated 125 million cases of foodborne illness with 35,000
deaths recorded globally. HAV is estimated to cause 14 million cases of foodborne illness with
28,000 deaths recorded globally. There are currently no global estimates for HEV available. NoV
and HAV primarily originate from the human intestine. They are excreted in high numbers
through faeces or vomit. Symptoms are typically nausea, vomiting, diarrhoea and abdominal
pain. In the case where a person has a hepatitis A or E infection, jaundice is also a common
symptom. HEV is a zoonotic pathogen primarily associated with contaminated pork products.
These viruses low infectious dose and robust survival in food and various environments facilitate
the spread of viral infections. Fresh produce may be extrinsically contaminated during primary
production or contaminated when prepared or handled by an infected food handler. Pork
products may be intrinsically contaminated with HEV and cause a risk of illness if not cooked
properly. Since HEV is endemic to many pig populations, control measures focusing on
prevention of animal infection on the farm are being proposed.
Viruses differ from bacteria in terms of infectivity, persistence, and epidemiology, posing
significant concerns for food safety. Current food safety guidelines often lack validation for
foodborne viruses, leading to uncertainties about the effectiveness of control measures.
Moreover, existing control strategies are frequently inadequate for managing these viruses, and
reliable indicator organisms for viruses are currently unavailable. Good hygienic, agricultural
and manufacturing practices are essential to avoid introducing viruses into raw materials and
food handling environments, as is the consideration of viruses during the development of
HACCP and food safety management plans. Considering that enteric viruses often result in mild
symptoms, are difficult or impossible to culture, and that global pathogenic viral surveillance
systems are limited, it is expected that the number of foodborne viral disease cases will rise over
time as diagnostic methods and surveillance systems improve. In the UK, only one norovirus
prevalence study has been conducted to date: the Norovirus Attribution Study performed in
2015/16 (see Further Reading for more details).
What are foodborne viruses?
Viruses do not grow or make their own energy and can only replicate using a living host
cell. Outside a host cell they are totally inert, incapable of reproducing or carrying out other
metabolic processes and must hijack living cells to replicate. Viruses have, therefore, been
considered to lie at, or beyond, the edge of what is considered to be a living organism. Typically,
they have an approximately spherical shape with a diameter of 25 to 30 nanometres (nm). They
are so small that they can only be observed using an electron microscope. Viruses often show
high resistance to stresses typically used in food manufacturing and preservation, such as heat,
freezing and UV light. Viruses may be shed in extremely high numbers (up to 10 7 to 1010 virus
particles per gram of stools), and vomit may contain a minimum of 10 6 particles. Foodborne
viruses have a low infectivity dose of 100 or fewer particles, and this, combined with the high
numbers shed, can lead to large outbreaks in a relatively short time.
Norovirus
Noroviruses are a highly diverse group of non-enveloped viruses within
the Caliciviridae family and are among the leading causes of sporadic infections and epidemic
outbreaks of gastroenteritis in humans. The diversity within noroviruses is reflected in their
classification into ten genogroups, each containing multiple genotypes. Genogroups GI and GII
are primarily responsible for human infections, with GII accounting for a significant portion of
norovirus-related illnesses worldwide. Other genogroups (GIII through GX), have host ranges
that include pigs, bovines, canines, felines, bats, mice and macaques. Each genogroup contains
several genotypes that exhibit genetic variability. Notably, the GII genogroup includes the most
prevalent genotype, currently responsible for numerous epidemic outbreaks worldwide.
Noroviruses exhibit significant genetic evolution, often undergoing rapid mutations, allowing
them to adapt and evade immune responses, contributing to their role as recurrent pathogens. The
virus’s single-stranded, positive-sense RNA genome contains three open reading frames (ORFs)
encoding various proteins that are crucial for viral replication and assembly. The disease is self-
limiting, typically 12-48 hours to 3 days for the majority of people, usually mild, and
characterised by nausea, vomiting, diarrhoea, myalgias and abdominal pain. Prolonged virus
shedding of up to 8 weeks may occur in asymptomatic people and immunosuppressed
individuals. Headache and low-grade fever may occur and there is anecdotal evidence that there
may be other diseases caused by norovirus including infant necrotising enterocolitis. The
primary route of transmission is person-to-person transmission through the faecal-oral and
vomit-oral routes and indirectly through food (ready-to-eat including leafy vegetables and herbs,
berries and foods handled after cooking), water and environment. In Europe, outbreaks in
healthcare facilities are common.
Hepatitis A Virus
HAV is a member of the enterovirus group within the Picornaviridae family. Identified
in 1973, HAV is one of six hepatitis viruses, designated A, B, C, D, E, and G. Structurally, HAV
comprises a single RNA molecule encased within a protein icosahedral capsid measuring 27 to
32nm in diameter and is non-enveloped. The primary mode of transmission is the faecal-oral
route. Once ingested, HAV replicates exclusively within liver cells, is excreted in bile, and
subsequently shed in the faeces of infected individuals. In developed countries, the incidence of
hepatitis A is relatively low. However, outbreaks still occur. For instance, in 2021, an outbreak in
the UK was linked to the consumption of Medjool dates. Additionally, frozen berries have been
associated with several HAV outbreaks across Europe, emphasising the need for stringent food
safety measures.
Hepatitis A is a liver infection which is usually a mild illness characterised by symptoms similar
to influenza including sudden onset of fever, malaise, nausea, joint pain, dark-coloured urine,
pale stools, anorexia and abdominal discomfort, followed in several days by jaundice, usually
with complete recovery within 2 months. The illness can be more severe the older the person is,
with infected children under 6 years not experiencing noticeable symptoms. The minimum
infectious dose required for HAV infection in humans is unknown but is presumed to be
approximately 10 to 100 virus particles, with the incubation period being dependent upon the
number of particles ingested (fewer particles mean a longer incubation period). The incubation
period for hepatitis A varies from 10 to 50 days (average 28 days) with a long communicability
period from early in the incubation period to about a week after the development of jaundice.
The middle of the incubation period (2 weeks before symptoms develop) presents the greatest
period of communicability, well before the first presentation of symptoms during peak shedding
of the virus. Many infections with HAV are asymptomatic, especially in children. Symptoms are
occasionally more severe, particularly in people with pre-existing liver conditions with
convalescence taking up to 3 months. Patients suffer from feeling chronically tired during
convalescence with an inability to work. Fatality is rare, usually occurring in the elderly. Once
the virus has been contracted lifelong immunity develops. The UK Health Security Agency
publishes updates of Laboratory Reports of HAV infections in England and Wales, the latest
covering January to March 2021.
Routine vaccination of all food handlers is not currently performed, although it could be
considered as an additional control measure.
Hepatitis E Virus
HEV belongs to the genus Orthohepevirus within the family Hepeviridae and has been
formally given the taxonomical name Paslahepevirus balayani. It is a positive-stranded RNA
virus approximately 7.5 kb in length. The virus is icosahedral in shape, with a diameter of 27−34
nm. The virion is composed entirely of viral protein and RNA. As of 2024, there are eight
recognised genotypes (gt) of HEV, each containing several sub genotypes or strains. Genotypes
1 and 2 exclusively infect humans. Genotypes 3 and 4, however, are zoonotic - capable of
infecting humans as well as various wild and farmed animals such as pigs, wild boar, rabbits, and
deer. Genotypes 5 and 6 are known to infect wild boar. Genotype 7, while primarily associated
with camels, has also been recorded in a human infection. Finally, genotype 8 is known to infect
camels. The number of confirmed non-travel related hepatitis E cases in the UK has increased
particularly since 2010, with similar trends observed in several European countries such as
Germany, Netherlands, Spain and the Czech Republic. Several reports have implicated the
consumption of specific foodstuffs in the UK as being correlated with HEV infection, but to
date, no food has been directly associated with infection in the UK .
From the intestinal tract, the virus reaches the liver through an unknown route and
mechanism. HEV appears to replicate primarily in liver and gallbladder cells but has been noted
in the small intestine, lymph nodes, colon and salivary glands. The incubation period following
exposure can range from 3 to 8 weeks, with a mean of 6 weeks. The human infectious dose is
currently unknown. The disease is usually mild, asymptomatic and self-resolves in 2 weeks; it is
usually seen in age groups 15−40 and can be asymptomatic in children. Symptoms include
jaundice, malaise, anorexia, enlarged tender liver, abdominal pain, arthralgia, hepatomegaly,
vomiting and fever. Chronic hepatitis has been reported in organ transplant recipients and in
patients with active HIV infections. Extended faecal shedding when present occurs for
approximately 2 weeks after jaundice develops. Fulminant hepatic failure has been observed
especially in pregnant women where mortality rates rise from less than 1% to 25%. In
immunocompromised patients, hepatitis E can be persistent and also associated with increased
mortality and morbidity in people with progressed liver disease.
Replication
Viruses can be considered obligate intracellular parasites because the production of
progeny viruses takes place within a host cell. Progeny is formed from the production by the host
cell of viral nucleic acid and protein; these viral constituents are capable of ‘self-assembly’
within the cell, spontaneously forming viral progeny. Release of the virus is seldom reliant
purely on the lysis of the host cell and can be released in a number of ways.
Particulate phase
The viral form that is transmitted from cell to cell and from one host to another is called a
particle. If the virus particle’s outer layer contacts a homologous receptor on a susceptible cell’s
plasma membrane, the virus’s protein coat, or lipid envelope if present, attaches and infection
ensues. To be food or water-borne, a virus must be capable of infectivity upon ingestion by the
host in a cell type that is accessible from the digestive tract.

Replicative phase
The virus particle attaches and is engulfed by the host cell (usually the whole particle)
through what is believed to be a passive process into the cytoplasm – the host cell does all of the
work although a high proportion of particles are rejected after coming into contact with a
homologous receptor. Uncoating of the protein coat or lipid envelope occurs during the
engulfment process with nucleic acid and intrinsic viral enzymes being released into the host
cell. As necessary, the viral nucleic acid is transcribed and translated by the cell; this induces
production of viral nucleic acid, protein and other constituents required. As quantities are
produced, the progeny self-assembly begins; viruses produced in the intestinal tract are called
‘enteric’. If progeny fully mature within the host cell, then particulate release may not be
immediate, and the particles may accumulate within the cell; release of the particles is typically
gradual rather than the normal bacteriophage ‘burst’. Viruses in animal cells may slowly ‘leak’
through the plasma cell membrane or may stay associated with the cell. The replication cycle
may take from between 8 hours to over 24 hours in a single cell.
Survival
Enteric viruses are usually resistant to environmental stresses such as heat and acid. The
majority are also resistant to freezing and drying, are stable in contact with lipid solvents and
may be resistant to ultrahigh hydrostatic pressure. These properties enable foodborne viruses to
 survive in pickled, marinated and acidic foods. Enteric viruses are capable of surviving and
retaining infectivity in marine, estuarine and freshwater for several weeks at 4°C, and survival
may be increased by attachment to sediment or particulate matter.
 NoV - noroviruses are resistant to drying and can survive on almost any hard surface (including
glass, door handles and railings, for example) for up to 12 hours. Norovirus can survive for at least
56 days on stainless steel and 15 days on carpet. The virus is relatively resistant to high levels of
chlorine (up to 10ppm free chlorine) and to varying temperatures. In chilled and frozen
environments NoV may be able to survive for months or even years. NoV remains infective after
being subjected to pH 2.7 for 3 hours at ambient temperature. While the virus is inactivated by
boiling, it can remain infectious at 60°C for 30 minutes and can survive some pasteurisation and
steaming processes. It should be noted that since there is no routine and robust infectivity assay yet
available for NoV, survival studies have been performed mainly by using surrogate viruses which
mimic the characteristics of NoV, or molecular methods (e.g. the reduction of NoV RT-PCR units),
so this information is yet to be verified.
 HAV - readily inactivated by heating foods to 85°C for 1 minute but is not subject to thermal
denaturation at lower temperatures (70°C for up to 10 min). HAV can survive chilled and frozen
temperatures for prolonged periods e.g. several months. Disinfection with a 1:100 dilution of
household bleach in water (0.5mg free chlorine for 30 minutes), or cleaning solutions containing
quaternary ammonium and/or HCl, are also effective in inactivating HAV, although the virus is
resistant to disinfection by some organic solvents and by a pH as low as 3, acid treatment (e.g. pH 1
for 2 h at room temperature) is effective. HAV can survive in the environment for at least 12 weeks
at 25°C when excreted in human faeces and can remain infectious after 1 month on environmental
surfaces at ambient temperatures, and three to four hours in faecal matter on a person's hand. It has
been found to survive for several days in experimentally contaminated freshwater, seawater,
wastewater, soils, marine sediment, live oysters, and creme-filled cookies. HAV is more resistant to
heat and drying than other enteroviruses.
 HEV - in February 2016, the Food Standards Agency (FSA) and the European Food Safety
Authority (EFSA) jointly organised a workshop on foodborne viruses, including HEV.
Subsequently, in 2017, EFSA published a scientific opinion on the public health risks associated
with HEV as a foodborne pathogen. These findings highlighted significant evidence gaps and
identified research priorities, such as developing an assay to evaluate HEV infectivity in food and
investigating its thermal stability. Current evidence suggests that heating impacts HEV stability,
but there is uncertainty regarding the virus's survival at relevant temperatures and in different food
matrices. This complexity is furthered by HEV's ability to exist in various states, with or without a
viral envelope, or with a partial envelope, all of which can be present simultaneously in a product.
The UK FSA funded additional research, providing further insights. The recommended
time/temperature range for short-time cooking is between 65°C and 75°C, but data remain
inconsistent. It has been suggested that assays directly evaluating detection or infectivity, such as
cell culture or ICC (integrated cell culture)-PCR, are necessary to determine the precise conditions
for eliminating HEV.

Food and water-borne outbreaks

It is difficult to estimate the proportion of foodborne disease caused by viruses due to
under-reporting, the lack of surveillance systems, often high levels of person-to-person infection,
 and the inability of existing systems to determine the proportion of disease that is transmitted by
foodborne routes relative to other common routes. Increases in population, scarcity of clean
water, changes in eating habits such as the increased consumption of food eaten raw, and the
globalisation of the supply chain are all contributing to the increase and spread of viral
foodborne disease.
The following are just some examples of outbreaks associated with foodborne viruses over the
years:
Norovirus
 In May 2005, 2 outbreaks in Denmark were reported associated with the consumption of imported
frozen raspberries.
 A cluster of outbreaks was attributed to contaminated commercial ice in 1987 in Wilmington,
Delaware.
 In 2005, an outbreak in France was reported associated with the consumption of imported frozen
raspberries.
 An outbreak caused by norovirus GII/4 in school lunches, in Tochigi Prefecture, Japan in
December 2007 affecting 18 children and 5 adults, possibly linked to salad was reported.
 In January 2009, at a military base in Germany, 36 cases of norovirus were reported, linked to the
consumption of contaminated salad.
 January 2010 in Tennessee (USA) 13 people affected by consuming cake in a restaurant.
 February 2012, Missouri (USA), 139 cases associated with fruit salad at a banquet.
 In 2012, the largest recorded outbreak (~12,000 cases) of norovirus in Germany was associated
with imported frozen strawberries from China.
 In 2016 in the UK, hundreds of people were ill with norovirus symptoms, which affected both staff
and customers, after an outbreak in a popular Mexican restaurant chain.
 In 2017, an outbreak of norovirus at a restaurant chain in the US sickened over 130 people.
 A norovirus outbreak in 2018 in the US and Canada was linked to the consumption of raw oysters
from British Columbia, Canada.
 In 2023, norovirus was the suspected cause of a large outbreak at Airbus Atlantic’s Christmas
lunch in France, where over 700 staff became ill.
Hepatitis A
 Clam associated outbreak in Shanghai in 1988 with 280,000 people affected due to contamination
and inadequate cooking.
 More than 50 residents in South Cambridgeshire (UK) in 1991 where the vehicle was believed to
be bread.
 213 cases in Maine (USA) in 1997 attributed to the consumption of frozen strawberries
 November 2005 in France 111 cases were reported due to the consumption of oysters
 In 2011, seven people were believed to have contracted HAV from sun-dried tomatoes in the UK.
 In 2013, 165 people became ill in a multistate US outbreak attributed to pomegranate arils.
 In 2016, an outbreak in USA was linked to the consumption of frozen strawberries.
 In 2018 six EU countries reported confirmed cases that may have been associated with a single
food product.
 In 2021 31 cases in the UK were linked to the consumption of Medjool dates, with more than three-
quarters hospitalised.
 Hepatitis E has been the cause of sporadic cases and epidemic forms with the primary
vehicle being ingestion of faecally contaminated drinking water with foodborne outbreaks
involving the consumption of deer meat, wild boar meat, and pork products.
 In New Delhi, in 1955, following the contamination of the city's drinking water, 29,000 cases of
icteric hepatitis occurred.
 Indian subcontinent (1975, 1978, 1980) and USSR (1983): several major outbreaks.
 In 2007, in Corsica, seven cases of Hepatitis E were attributed to raw figatellu (a dish made with
pig liver).
 In 2024 an outbreak in Finland related to the consumption of pork products resulted in 120 cases,
with at least 42 people needing hospital treatment.
Detection
Detecting viruses in foods is more difficult than identifying foodborne bacteria. Enteric
viruses, such as HAV and NoV, are exceptionally small (approximately 100 times smaller than
bacteria) and are usually found in low numbers on foods. Due to their low infectious dose, only
minimal quantities of these viruses are needed to pose a health risk when present in food. They
do not alter the appearance, taste, or smell of the food, making their presence undetectable
through sensory evaluation. Additionally, they cannot proliferate in food, and unlike foodborne
bacteria, their numbers cannot be increased through enrichment in nutrient media in the
laboratory. Analysts must, therefore, employ complex methods to determine if a food sample is
contaminated with viruses. NoV and HAV can be detected in foods using an international
standard method (ISO15216 parts 1 & 29, 10). This method is suitable for use on shellfish, fresh
and frozen produce such as leafy greens and soft berry fruits, bottled water and food contact
surfaces. Testing is based on the detection of viral nucleic acids by real-time PCR and therefore
does not provide any indication of infectivity. Although there are several methods to detect HEV
already published11, there is currently no standardised method available; efforts to develop such a
method are underway by the working group ISO/TC 34/SC 9/WG 31 within the International
Organization for Standardization (ISO). Although detection of foodborne viruses has been
performed for many years, it is still not considered a routine method, due to the lack of
regulation or criteria for limits of viruses in foods. In the UK there are very few laboratories with
either the expertise or capability to detect viruses in foods.