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Gastronomic Gastroenteritis at The Fat Duck


Nienke E. van Houten
Faculty of Health Sciences
Simon Fraser University


This interrupted case study was inspired by and uses data from one of the largest commercial restaurant associated outbreaks of norovirus reported in the literature. It applies basic principles of epidemiology and outbreak investigation to a shellfish-linked norovirus outbreak at a Michelin star restaurant in the UK in 2009. The details of the case are taken directly from the report that was produced by the health protection agency and publications that followed. Students take on the role of an infection control team (ICT) that is responsible for identifying the extent and source of the outbreak. They are taken through different stages of the outbreak investigation and at each stage asked what their team would do in response to given pieces of information. Specifically, students uncover the scope and source of the outbreak using descriptive and basic analytical epidemiology methods. The case is suitable for first or second year introductory courses in microbiology, epidemiology, or other infectious disease related topics.


  • Review steps of an outbreak investigation in the context of a food-borne disease investiEdit Case Recordgation.
  • Understand the role of descriptive epidemiology in the context of an outbreak, and the importance of defining a case.
  • Interpret an epidemic curve and calculate incubation period from a graph produced from outbreak data.
  • Identify transmission mode and predict the impact on the spread of the outbreak and explain what is meant by secondary transmission.
  • Distinguish between case-control and cohort study and determine which study type is appropriate for this outbreak investigation.


outbreak investigation; norovirus; foodborne illness; restaurant; Blumenthal; Fat Duck; gastroenterology; food poisoning; epidemic curve

Topical Areas


Educational Level

Undergraduate lower division



Type / Methods




Subject Headings

Epidemiology  |   Microbiology  |   Food Science / Technology  |   Science (General)  |  

Date Posted


Teaching Notes

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Supplemental Materials

There are four reading assignments associated with this case study, excerpted from the AFMC Primer on Population Health (2017). The chapter and section number where the material appears in the Primer is indicated in parentheses below. The complete work may be downloaded from

  Reading 1: Detection and control of outbreaks (11.1)
  Reading 2: Patterns of disease development in a population: the epidemic curve (7.4)
  Reading 3: Modes and control of transmission (11.3)
  Reading 4: Observational studies (5.7)

Answer Key

Answer keys for the cases in our collection are password-protected and access to them is limited to paid subscribed instructors. To become a paid subscriber, begin the process by registering.


Allie Smith
Honors Studies
Texas Tech University
I utilized the COMPENDIUM OF ACUTE FOODBORNE AND WATERBORNE DISEASES, CENTERS FOR DISEASE CONTROL AND PREVENTION, 2003 along with this case study (distributed at Part I, Question 5, after the students had made their own list of suspected pathogens) to allow the students to look at a comprehensive list of potential pathogens in a foodborne outbreak. This list became helpful again at Part II, Question 13 so the students could actually see a list of pathogens and their associated incubation times to narrow the list of suspected pathogens in this outbreak. My class was a lower-level undergraduate class that would not have been able to come up with a comprehensive pathogens list or know the incubation times of these diseases off the top of their heads.

This is a great suggestion. Thank you!
Nienke E van Houten