Original Articles
Vol. 14 No. 3 (2025)
https://doi.org/10.4081/ijfs.2025.13521

Multidisciplinary management of a norovirus outbreak in Tuscany, Italy

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Received: 23 December 2024
Accepted: 1 April 2025
Published: 10 June 2025
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Foodborne outbreak, foodborne disease, outbreak management, official control, norovirus

Authors

Clara Girardi
https://orcid.org/0009-0007-8282-9267
Department of Veterinary Sciences, University of Pisa; Veterinary Public Health and Food Safety Functional Unit, Local Health Competent Authority Toscana Centro, Pistoia, Italy.
Lucia Kundisova
Hygiene and Public Health Service Function Unit, Local Health Competent Authority Toscana Centro, Pistoia, Italy.
Francesca Marconi
https://orcid.org/0000-0003-4662-4006
Department of Veterinary Sciences, University of Pisa, Italy.
Alessandra Guidi
Department of Veterinary Sciences, University of Pisa, Italy.
Johanna Alexandra Iamarino
Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Italy.
Veronica Gallinoro
https://orcid.org/0000-0002-4015-3402
Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Italy.
Silvia Mele
Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Italy.
Giovanni Nardone
Veterinary Public Health and Food Safety Functional Unit, Local Health Competent Authority Toscana Centro, Pistoia, Italy.
Maurizio Grani
Veterinary Public Health and Food Safety Functional Unit, Local Health Competent Authority Toscana Centro, Pistoia, Italy.
Giovanni Munaò
Veterinary Public Health and Food Safety Functional Unit, Local Health Competent Authority Toscana Centro, Firenze, Calenzano, Italy.
Luca Cianti
https://orcid.org/0009-0005-5659-5298
Veterinary Public Health and Food Safety Functional Unit, Local Health Competent Authority Toscana Centro, Firenze, Calenzano, Italy.
Paola Picciolli
Hygiene and Public Health Service Function Unit, Local Health Competent Authority Toscana Centro, Pistoia, Italy.
Ylenia Zizzo
Preventive Healthcare Activities Simple Departmental Operative Structure, Local Health Competent Authority Toscana Centro, Empoli-Prato-Pistoia, Italy.
Loria Bianchi
Microbiology Unit, S. Jacopo Hospital, Pistoia, Italy.
Martina Sartoni
martina.sartoni@vet.unipi.it
https://orcid.org/0000-0002-4430-8598
Department of Veterinary Sciences, University of Pisa, Italy.

Norovirus (NoV) is one of the most frequent agents responsible for foodborne outbreaks. Transmission occurs through the consumption of contaminated food or water or via contact with contaminated surfaces. The low infectious dose and high environmental resistance of the virus facilitate its spread within communities and healthcare settings, complicating epidemiological investigations. This study aims to highlight the management strategies and key entities involved in outbreak response, emphasizing the importance of coordinated efforts to share best practices. The outbreak occurred in Tuscany in April 2024 and affected multiple school groups. The response team was activated in accordance with guidelines for managing foodborne diseases and comprised various public health authorities. The team undertook a series of coordinated actions, including epidemiological investigation, official controls, sampling, and analysis of relevant matrices to identify high-risk foods. Food and water samples collected during the official inspection at the accommodation facility involved in the first wave of the outbreak were tested for potential pathogenic bacteria. Additionally, fecal samples from ten hospitalized cases were analyzed for pathogenic bacteria and viruses. Among all these analyses, only the fecal samples from the examined cases tested positive for NoV genogroups GI and GII. In light of these results, during the second wave, food and water were tested again for the same potential pathogenic bacteria and for the presence of NoV. Furthermore, NoV was investigated in staff fecal samples and environmental surfaces. A total of four fecal samples from staff and two environmental swabs tested positive for NoV genogroups GI and GII. Our multidisciplinary investigation suggests that an initial foodborne transmission may have led to environmental contamination. This finding underscores the critical role of food safety culture in outbreak prevention and control. To reduce the risk of viral gastroenteritis, specific awareness initiatives and training programs should be offered to both food sector operators and the general public.

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1.
Multidisciplinary management of a norovirus outbreak in Tuscany, Italy. Ital J Food Safety [Internet]. 2025 Jun. 10 [cited 2025 Dec. 17];14(3). Available from: https://www.pagepressjournals.org/ijfs/article/view/13521
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