Date of Conferral



Doctor of Public Health (DrPH)


Public Health


Talmage Holmes


This study examined the strength of association between food workers and food to norovirus in comparison to bacteria associated with foodborne-related gastroenteritis by whether norovirus had a direct (physical evidence), indirect (statistical evidence), or suspect (neither of the two) association with food or food handlers. The Centers for Disease Control and Prevention considers norovirus to cause the largest number of foodborne-related gastroenteritis cases in the United States. The association of norovirus with foodborne outbreaks through its information data collection form focuses on the food worker as the typical source. Yet, many outbreaks are not foodborne in nature. The gap in the research is the evidence supporting the theory that norovirus transmission is the same as bacterial transmission. A secondary data anaylsis was conducted on the data from the electronic Foodborne Outbreak Reporting System between 1998 and 2006. An odds ratio analysis showed no similarity between proportion of the implicated and nonimplicated numbers of outbreaks from norovirus and those from Salmonella. The odds ratios also showed a stronger similarity between proportions of food handler implicated outbreaks from norovirus than from Salmonella. An analysis showed, though, a significant emphasis was not placed on the food handler but on other indirect routes of transmission of norovirus in outbreaks. The analysis also indicated that norovirus transmission was not mainly through food. Norovirus transmission appeared to be through person-to-person rather than food and had more similarities with pandemic influenza than gastroenteritis-associated bacteria. A change in approach to norovirus by local, state, and federal agencies could have social change implications for prevention, surveillance, and public health programs to reduce infection and outbreaks.