• Original scientific article Food safety expertise among professional food handlers and consumers related to foodborne viruses: Case Slovenia Mateja Ambrožič1, Andreja KuKeC2, Mojca Jevšnik3* , Sonja Smole možinA1, Peter RaSpoR1* abStRaCt The objective of this quantitative survey was to determine the knowledge of Slovenian consumers and food handlers about viral food safety. For this reason, interviews were conducted using structured questionnaires and included 417 consumers and 61 food handlers. Foodborne viruses were not recognisable as distinctive foodborne hazards by food handlers, which demonstrates the lack of viral food safety knowledge using the chi-square test. The analysis pointed out that higher educated food handlers showed a lack of food safety expertise. However, at the same time, higher educated food handlers possessed more knowledge compared to less educated handlers. Multiple logistic regression analysis was performed on data restricted to consumer study group. The results pointed out that the lack of awareness and knowledge strongly prevails over the viral food safety knowledge and awareness. The analysis showed that consumers’ knowledge and awareness varied by consumers’ education level, age and gender. On the basis of these results, we can conclude that the profile of comprehension and consequences is not the same for food handlers and for consumers. The obtained results revealed that food safety educational initiatives should be developed to better inform consumers about safe food handling practices and habits to protect their health form foodborne disease, including viral infections. Key words: foodborne viruses, consumer, logistic regression analysis, food handler, food safety Received: 4. 5. 2016 Accepted: 6. 6. 2016 1 Department of Food Science and Technology, Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, 1000 Ljubljana, Slovenia 2 Public Health Centre, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1104 Ljubljana, Slovenia 3 Department of Sanitary Engineering, Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, 1000 Ljubljana, Slovenia * Corresponding authors Peter Raspor, Department of Food Science and Technology, Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, 1000 Ljubljana, Slovenia, e-mail: peter.raspor@guest.arnes.si Mojca Jevšnik, Department of Sanitary Engineering, Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, 1000 Ljubljana, Slovenia, e-mail: mojca.jevsnik@zf.uni-lj.si introduction During the past century, most foodborne diseases were attributed to bacterial pathogens. However, food and waterborne viral infections are becoming an increased challenge to public health [1, 2, 3, 4, 5]. Of the approximately 600 million cases of illness caused by foodborne hazards in 2010 worldwide, infectious agents that cause diarrheal di­seases accounted for the vast majority (550 million). Among them, noroviruses (NoV) were responsible for 120 million cases and hepatitis A virus (HAV) for 14 million cases [6). In the EU [2], foodborne viruses were identified as the most commonly detected causative agent in the reported foodborne outbreaks (20.4 % of all outbreaks) in 2014. 1,070 foodborne outbreaks were caused by viruses, implicated 11,740 cases, 2,486 hospitalizations and 2 deaths. National statistics on foodborne viral disease are not easily available and, where present, likely to reflect significant under-report- Food and waterborne viral ing. The burden of foodborne diseases to public health, welfare, and infections are becoming an economy has often been underestimated due to under-reporting, be- increased challenge to cause they cause short-term diseases or asymptomatic infection. Out- public health. breaks of foodborne diseases occurring in private homes are less likely to be reported than those in commercial and public premises, and it is believed that infections attributed to private homes are three times Consumption of ready-to-eat more frequent than those attributed to canteens [7]. Studies in the last foods contaminated by few years have highlighted gaps in food safety knowledge and critical safety violations regarding food handling at home [8, 9, 10] and by infected food handlers remains an important risk factor for viral outbreaks. food handlers [11, 12, 13, 14, 15]. Consumption of ready-to-eat foods contaminated by infected food handlers remains an important risk factor for viral outbreaks [11, 16]. Particularly oysters are commonly considered as the most fre- Virus contamination as a quently associated food vehicles in NoV outbreaks [17, 18]. Other consequence of human foods, especially raw materials like soft fruits and vegetables, are also recognized as relevant food vehicles of enteric viruses [19, 20, handling can occur at any 21]. The hands of food handlers may become contaminated with hu­ stage of the farm-to-fork man enteric viruses if the handlers are shedding viruses in their fae­ continuum. ces, changing diapers or cleaning toilet areas, and are not practising appropriate personal hygiene. These same viruses can be transmitted from human skin (hands) to foods and inanimate surfaces [12, 22, 23, 24], which serve as a secondary source of contamination if they come in contact with food. Virus contamination as a consequence of human handling can occur at any stage of the farm-to-fork continu­um. Most foodborne viruses are more resistant [25] than bacteria to com­monly used control measures, (e.g. refrigeration, freezing, pH, drying, UV radiation, heat, pressure, disinfection, etc.). There are currently no effective, realistic, and validated risk management options to eliminate viral contamination prior to consumption without changing the normal­ly desired characteristics of the food. Because the burden of viral food-borne disease, particularly NoV and HAV, is high, effective control strategies need to focus on the prevention of contamination. International Journal of Sanitary Engineering Research M. Ambrožič, A. Kukec, M. Jevšnik et al. • Food safety expertise among professional food handlers and consumers related to foodborne viruses... The vast majority of publications dealing with soft elements like cul­ture, trust and teamwork [58] of food safety expertise are by principle focused on bacteria and hygienic issues [26, 27, 28, 29]. We also contributed to those studies in the past [10, 15, 30, 31]. However, there is really a shortage on soft element within food safety dealing with foodborne viruses [18], especially for consumers’ studies. As the preventive measures developed for the reduction of bacterial infections and general hygienic measures are not always efficient to reduce viral infections and contamination, we need to implement additional meas­ures. However, with researching the root cause of infections detectable in clinical samples over time, food supply chains are identified as the major viral transmission route, where actions directed at prevention of viral foodborne infections are being evolved and established now. Nowa­days, it became essential to promote improvements in food safety with strong consideration of socio-cultural factors since the main actor in food safety circle is a person, who plays a crucial role in personal food safety management. Due to the lack of satisfactory data in Slovenia as well as worldwide, a pilot study among local professional food handlers and consumers was carried out to investigate food safety handling practice and knowledge of foodborne viruses as food safety hazards. The aim of this study was to find whether professional food handlers and consumers have viral food safety knowledge. mAteriAlS And methodS data collection Two self-administrable questionnaires (one for consumers and one for food handlers) were developed for this study. They both contained mul­tiple-choice questions with already offered answers, including “do not know” and “other” for minimizing the possibility of selecting the cor­rect answer by chance. To guarantee anonymity of respondents and enable easier identification of questionnaires, identity numbers were assigned to each questionnaire when collected. The questionnaires were pilot tested by 30 participants for questionnaires designed for consumers and 15 for food handlers during February to March of 2015 to confirm question clarity, identify response options, which resulted in minor modifications of questions’ wording. Each questionnaire took approximately 5 to 10 minutes to complete. A full study was conduct­ed from April to July of 2015. Food handlers Questionnaire for food handlers had eight questions, which were de­signed to assess food handlers’ knowledge and practical habits focused on viral food safety and three demographic questions (gender, year of birth; 7-level education scale). The questionnaires were delivered in two companies, which volunteered to participate in the pilot survey. In each food company, questionnaires were delivered to the responsible © Inštitut za sanitarno inženirstvo, 2016 person for the food safety, i.e. food technologist. The number of re­spondents was determined regarding the number of food handlers present on the day of investigation. Ninety-three questionnaires were distributed among food handlers and their content was explained to them by the responsible person during lunch time. Completed ques­tionnaires from two companies were mailed by the same day by re­sponsible food technologists. Consumers A cross-sectional study of consumers’ food safety knowledge inter­linked to foodborne viruses was conducted in different parts of Slove­nia. Gender and age distribution were controlled to assure a balanced structure of the sample by 20 interviewers, each of whom were distrib­uted 25 questionnaires (a total of 500 questionnaires). Interviewers were trained, final year students, who visited selected households or interviewed consumers in larger shopping centres. Interviewers briefly explained the purpose and nature of the study to the potential adult respondent over 18 years of age and sought permission for inclusion of their views in the survey. As interviewers conducted interviews in their home cities, a considerable geographical distribution of data was ob­tained. The questions in the questionnaire dedicated to consumers were designed and structured in three groups. The first group of questions including “Have you ever heard of foodborne viruses?”, “Is vomit infectious material?”, “When could you say that the food is con­taminated with viruses?” and “Applied handwashing practices” was designed to assess the knowledge and practice habits focused on foodborne viruses and its integration into food safety practices in con­sumers’ home. The second group of questions that embraced the questions “In your opinion, what are the sources of viral contamination?” and “In your opinion, where food can get contaminated by viruses?” was designed to assess consumers’ awareness of foodborne viruses and its role in food safety. The third group of questions consisted of the questions about the de­mographic data (gender, year of birth, 9-level education scale). data preparation Food handlers For statistical analysis, we prepared demographic data groups. The question of gender had “female” and “male” option. Year of birth was recoded into three categories: 30 years, 31-50 years, and 51 years. Education level was recoded from the initial 7 levels into three catego­ries: low (vocational level or less), middle (secondary school), and high (university degree or more). Recoding was used due to different level of food safety knowledge possession with intention to evaluate differences between them. International Journal of Sanitary Engineering Research M. Ambrožič, A. Kukec, M. Jevšnik et al. • Food safety expertise among professional food handlers and consumers related to foodborne viruses... Based on the correct/incorrect answers to the question, “What is food safety?” and “Recognition of most common foodborne microbial haz­ards in food supply chain”, respectively, we created variables “have knowledge”/“lack of knowledge”. When all the questions were an­swered correctly, criteria for “have knowledge” were fulfilled. Consumers For the statistical analysis, we prepared demographic data groups in the same way as described for food handlers. Based on the correct/incorrect answers to the first group of questions, which assess consumers’ knowledge, we created a new set of complex variables “have knowledge”/“lack of knowledge”. When all the ques­tions were answered correctly, criteria for “have knowledge” were ful­filled. Based on the correct/incorrect answers to the second group of ques­tions, which assess consumers’ awareness, we created a new set of complex variables “have awareness”/“lack of awareness”. Formulation of complex variables from multiple questions provides more accurate information about the knowledge or lack of knowledge and awareness or lack of awareness in the field of viral food safety. data analysis Food handlers The relationship between food handler’s demographic data (independ­ent variable) and the food handlers’ “knowledge”/“lack of knowledge” (dependent variables) of food safety meaning and recognition of the most common microbial hazards in food supply chain were analysed using the chi-square test. With the chi-square test, we analysed the relationship and significance between each observed demographic data and dependent variable. In the chi-square test p-value, 0.05 or less was considered significant. Consumers In the first step of the analysis, the relationship between dependent variables (“knowledge”/“lack of knowledge” and “awareness”/“lack of awareness” of viral food safety) and independent variables (demo­graphic variables) were analysed using the chi-square test. With the chi-square test, we analysed the relationship and significance between each observed demographic data and dependent variables. In the chi-square test p-value, 0.05 or less was considered significant. In the second step of our analysis, differences in complex variables “lack of knowledge” and “lack of awareness”, respectively (the ob­served outcomes), were adjusted to the effects of the observed demo­graphic data (independent variables) using binary multiple logistic re­gression. With binary multiple logistic regression, we analysed the relationship and significance between all the observed demographic data and dependent variables. Logistic regression provides a method © Inštitut za sanitarno inženirstvo, 2016 for modelling a binary response variable, which takes values 1 and 0. In our case, we tried to investigate how lack of knowledge and lack of awareness of participants can be predicted by observed demographic variable (e.g. gender). The dummy variables (reference group) were created for all independent variables considered in the model. The re­ference group in our analysis were (gender: female; age group: . 51, and education: high). In the results, we report the odds ratio (OR) and 95 % confidence interval (CI) with p-value. The OR is a measure representing the odds that an outcome would oc­cur in the presence of a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure [32]. Therefore, OR was a measure of the association between an exposure and an out­come. SPSS statistical package for Windows Version 21.0 (SPSS Inc., Chica­go, IL, USA) was used for all analyses in our study. reSultS And diScuSSion Food handlers A total of 61 questionnaires (out of 93) were obtained from food busi­ness operators in Slovenia, which contacted us to participate in the Training employees on food survey. The overall response rate to the survey was 65.6 %. Of the 61 safety practices has been food handlers taking part in the research, half of them (50.0 %) were shown to be one of the most female and half of them were male. As seen from Table 1, 8.9 % re- important programs that spondents were under 30 years old, 66.1 % between 31-50, and food establishments can 25.0 % were over 51 years old. As for the educational level, 40.7 % of respondents finished high school (25.4 % finished vocational level of implement. education or less, and 33.9 % had higher education. The most signifi­cant responses for this area are presented in Figure 1. Only a quarter (21.3 %) of respondents correctly defined food safety as the assurance that food will not cause harm to the consumer, although 90.2 % agreed to the question that an important part of food handlers’ job re­sponsibilities was to follow all the requirements for ensuring food safe­ty for a consumer. With this set of questions, we tested education and training efficiency, which are according to food safety management systems obligatory and necessary [33]. There is no doubt that effec­tiveness of education and training is an important factor contributing to the overall food safety. Training employees on food safety practices has been shown to be one of the most important programs that food esta­blishments can implement [34, 35]. However, knowledge assessment not necessarily shows actual knowledge and competences of food han­dlers’, but it is intended only for satisfying the legal requirements. Due to limited scientific research that assessed reported knowledge and behaviour related to foodborne viral transmission and prevention, we created questions, where we studied food handlers’ identification and recognition of the most common foodborne microbial hazards, in­cluding foodborne viruses in food supply chain. Knowledge (Figure 1) was found to be age-dependent, food handlers aged between 31-50 International Journal of Sanitary Engineering Research Figure 1: Understanding food safety meaning among 61 food handlers (a); identification and recognition of the most common foodborne microbial hazards, including foodborne viruses in food supply chain (b); norovirus (c) hepatitis A virus years possessed more knowledge compared to younger or older food handlers. As expected, we found that higher educated food handlers had better knowledge, which can be illustrated by correctly identified most common foodborne microbial hazards. It was already pointed out [36, 37] that knowledge is education-related. At the same time, we observed that higher educated food handlers showed a lack of food safety expertise (Figure 1), that can be illustrated by correctly identi­fied definition of food safety meaning. This observation can be ex­plained by the fact that higher educated food handlers are in leading positions and their job responsibilities are not strictly connected to food safety expertise. Despite the beneficial health effects of healthy foods, there is a grow­ing awareness concerning its microbial and chemical safety [38]. In­creased consumption of food traditionally eaten raw and globalization of international trade have also increased the risks of viral contamina­tion of foods, especially soft berry fruits, salad greens, shellfish and © Inštitut za sanitarno inženirstvo, 2016 ready to eat foods. In recent years, numerous foodborne outbreaks due to consumption of berry fruit [20] and shellfish [17] contaminated by human enteric viruses have been reported. Food handlers recognized steak tartar (75.4 %), shellfish, which are eaten raw (70.4 %), and cheeses from unpasteurized milk (45.9 %) as hazardous food items, while raspberries (42.6 %) and lettuce (34.5 %) as safe, and heat-treated shellfish (24.6 %) and salad meal at restaurants (24.6 %) as potentially safe item, although the virus-commodity combinations of greatest public health concern recognised NoV and HAV in prepared (ready-to-eat) foods, bivalve molluscs, fresh produced and HEV in tra­ditional pork dishes [18, 25, 39, 40, 41]. Food handlers play an important role in the transmission of enteric vi­ruses due to poor hygiene practices or being in contact with faecal mate­rial or vomit [15, 25]. Vomit was recognised (78.7 %) as infectious ma­terial, less than half (40.0 %) of respondents know period being infectious after recovery of gastroenteritis symptoms, and nearly half of them (45.9 %) correctly identified contamination routs with viruses. Our study revealed that although trained, food handlers do not recognize The importance of foodborne viruses as distinctive food safety hazards (Figure 1), which continuous and specific was already observed [14]. It was also revealed that food handlers are goal-oriented training to food not recognising ready-to-eat foods and fresh products as vehicles for handlers can lead to easily virus transmission, which indicates that the study population overall has poor knowledge of viral food safety practices. As a result, food safety improved sanitation trainings should be developed according to the recently developed Codex practices, such as health Alimentarius guidelines to control viruses in food to better inform food checking, adequate handlers on all-important aspects of viral food safety, although food handwashing, observation of handlers possess knowledge about microbial food safety and proper personal hygiene, consequences of poor hygiene practices. It was demonstrated [42, 43] prevention of cross- that the importance of continuous and specific goal-oriented training to contamination and correct food handlers can lead to easily improved sanitation practices, such as health checking, adequate handwashing, observation of proper personal sanitation procedures. hygiene, prevention of cross-contamination and correct sanitation procedures. Guidance documents on food hygiene and food transmittable diseases are essential for the training of food handlers. Foodborne viral infection remains very common in many parts of the world despite the measures already in place, mainly targeted at reducing bacterial contamination. For this reason, the Codex Alimentarius Commission decided to develop specific guidelines for the control of viruses in food, which have been available since 2012 [25]. The primary purpose of the codex guidelines for the control of viruses in food is to give guidance on how to prevent or minimize the presence of human enteric viruses in food, especially NoVs and HAV, and to emphasize that management strategies regarding foodborne viruses and associated illnesses should be different from those for bacterial pathogens. Guidelines are not disseminated as legally enforceable in national guidelines or regulations and consequently remain unknown to professionals. There is a need to disseminate current guidelines as good viral food safety practice via food safety authorities and professional associations, chambers and societies to enhance the awareness about foodborne viruses. International Journal of Sanitary Engineering Research M. Ambrožič, A. Kukec, M. Jevšnik et al. • Food safety expertise among professional food handlers and consumers related to foodborne viruses... Consumers A total of 417 questionnaires were obtained. The overall response rate to the survey was 83.4 %. As seen from Table 1, 60.3 % of the re­spondents were female and 39.7 % male. 43.9 % of respondents were under 30 years old, 24.9 % between 31-50, and 31.2 % was over 51 years old. Educational level of more than half of the respondents (53.0 %) was finished high school, 32.6 % finished vocational level of education or less, and 14.4 % have higher education. Outcomes re­vealed (Figure 3) that lack of knowledge strongly predominates over knowledge. This can also be illustrated by the fact that majority (94.2 %) of consumers were familiar with foodborne viruses and 68.8 % of consumers recognised vomit as infectious material. Howev­er, only 24.7 % of respondents correctly identified that viruses do not cause organoleptic properties of the contaminated food, which de­serves a special attention in education of consumers at all levels. Variable “awareness” was formulated to perceive the awareness of consumers related to viral food safety in domestic food preparation. The most significant responses for this group of questions are de­scribed in Figure 2, where outcomes revealed that also lack of aware­ness strongly prevails over having awareness. Female showed more vi­ral awareness compared to men, due to evolutionary expressed patterns for caring for the home and her family. It was also observed that higher educated consumers have more awareness about viral food safety in home kitchen compared to less educated. Nearly half (48.0 %) of the consumers were aware that food can become infected anywhere from farm to plate, and 47.7 % that human sewage and fae­ces; infected food handlers and animals harbouring zoonotic viruses are major sources of viral contamination. To our knowledge, this was the first study that assessed consumers knowledge and behaviour specifically focussed on the viral food safety knowledge and awareness. There is a serious lack of food safety viral studies dealing with consumers’ knowledge to compare our results with. We developed suitable methodology for addressing this chal­lenge. The approach was found relevant since it can be used specifi­cally for focussed groups like food handler study group but also for table 1: Demographic characteristics of food handlers and consumers Characteristics of survey respondents Food handlers (%) Consumers (%) Gender Female 50.0 60.3 Male 50.0 39.7 Age . 51 25.0 31.2 31-50 66.1 24.9 . 30 8.9 43.9 Education High 33.9 14.4 Middle 40.7 53.0 Low 25.4 32.6 N=61; N=417 food handlersconsumers © Inštitut za sanitarno inženirstvo, 2016 Figure 2: more diverse populations and is able to estimate the relationship be- Perceived awareness among 417 tween the observed outcomes and demographic variables. consumers related to viral food safety in domestic food preparationThe results of multiple logistic regression analysis of the consumers’ lack of knowledge impact (Table 2) in the model pointed out that the male consumers have 1.2 times higher odds (p = 0.458) than female consumers for lack of viral food safety knowledge. Compared with the above 51-years-old consumers, the consumers in the age group 31-50 years have 1.1 times higher odds (p = 0.420) than younger or older consumers. Consumers with low level of education (vocational level or less) have 1.3 times odds for lack of viral food safety knowledge than high-level educated consumers (p = 0.076). The model confirmed our assumptions that education, gender, and age influence the viral food safety knowledge. Education as a solution for the above-identified lack of knowledge strongly argues for specific training on foodborne viruses also for consumers. Verhoef et al. [14] in their study proposed that for food handlers and their managers, education is crucially important for ensuring viral food safety and improving public health importance. This step can only be achieved by well available and easy to under­stand education given material, which is respected and followed by consumers. These results emphasize the need for tailored educational programs to improve consumers and food handlers’ knowledge and awareness, as has been stressed many times in the last decade [10, Figure 3: 15, 29, 44, 45, 46, 47]. Perceived knowledge among 417 consumers related to viral food safety in domestic food preparation International Journal of Sanitary Engineering Research M. Ambrožič, A. Kukec, M. Jevšnik et al. • Food safety expertise among professional food handlers and consumers related to foodborne viruses... table 2: Results of multiple logistic regression analysis of the impact of consumers’ lack of knowledge on foodborne viruses in 417 consumers adjusted on gender, age, and education level independent variables oR 95 % c.i. limits for or p lower upper Gender Female 1.00 Male 1.209 0.732 1.998 0.458 Age 51 1.00 31-50 1.099 0.874 1.383 0.420 30 1.016 0.832 1.241 0.874 Education High 1.00 Middle 0.991 0.791 1.241 0.934 Low 1.277 0.975 1.672 0.076 Abbreviations: OR – odds ratio; C.I. – confidence interval; *p value 0.05 table 3: Results of multiple logistic regression analysis of the impact of consumers’ lack of awareness on foodborne viruses in 417 consumers adjusted on gender, age, and education level independent variables oR 95 % c.i. limits for or p lower upper Gender Female 1.00 Male 1.805 1.169 2.785 0.008* Age 51 1.00 31-50 1.062 0.882 1.278 0.525 30 1.196 1.005 1.424 0.044* Education High 1.00 Middle 1.131 0.928 1.378 0.223 Low 1.303 1.042 1.628 0.020* Abbreviations: OR – odds ratio; C.I. – confidence interval; *P value  0.05 The results of multiple logistic regression analysis of the impact of con­sumers’ awareness respectively (Table 3) of foodborne viruses in the model demonstrated that the male consumers have 1.8 times higher odds (p = 0.008) for the lack of viral awareness than female consum­ers. Compared to the above 51-year-old consumers, the consumers under 30 years of age had 1.2 times higher odds (p = 0.044) and low-level educated consumers (vocational level or less) had 1.3-higher odds for the lack of awareness than high-level educated consumers (p = 0.002). In addition, that model confirmed that viral food safety awareness is gender-, education-, and age-dependent. Our conclusions raised the need to implement activities to raise the awareness of key viral food safety issues. Education and training about basic food safety principles are emphasized as important factors contributing to the reduction of foodborne illnesses. However, it is of crucial importance that the message is specifically tailored and task-specific with regards to the needs of the target group. Improvement becomes more significant if substantiated with practical activity in comparison to those addressed only orally [48]. For this reason, the food © Inštitut za sanitarno inženirstvo, 2016 safety public health campaign to enhance household food safety awareness would be a suitable solution. The best worldwide good practice to enhance food safety awareness and education is Partnership for Food Safety Education in USA (FightBAC), whose goal is to promote food safety awareness to consumers and educate them how to handle and prepare food safely. However, with this aim, European Food Information Council (EUFIC) is also established, which is poorly known to consumers. Our study showed that there are gaps in consumers’ knowledge, practices, and awareness. In addition, the earlier studies conducted on adults have indicated that food safety knowledge tends to increase with age and practice: females have higher scores than males, and younger respondents show the greatest need for additional food safety education [49, 50, 51, 52]. Multiple logistic regression analysis identified education as a solution for knowledge improvement and enhanced awareness. The meta-analysis [27] has shown that food safety training increases knowledge and improves the attitudes about hand hygiene practices and that refresher training and recurrent emphasis on good food handling behaviour may have ongoing positive effects on handwashing practices. It was also emphasized [53] that special training may improve the knowledge of food safety but this does not always result in better and safer food handling behaviour. Unfortunately, we do not have many specific attempts to educate consumers about food safety Consumers play an after they finished obligatory education on primary level. However, important role in the consumers generally express their concerns about food safety issues, but transmission of hazards, only a few of them appear to be changing their food buying and including viruses. consumption behaviours in view of their concerns [10, 26]. Nevertheless, home kitchen is recognised as a source of verified outbreaks [2, 10]. Consumer behaviour and awareness toward viral food safety have shown that the levels of understanding, motivation, and trust need to be further cultivated especially in relation to education, age, and gender. All of them are based on awareness and knowledge, which were found as limiting factors for viruses in particular, as demonstrated with this research. Consumers play an important role in the transmission of hazards, in­cluding viruses. Consumers should be aware of potential risks, proper handling, and preparation of food for a safe and balanced everyday meal (54), however, they are not connected to food supply chain ac­cording to chain principles [54, 55, 56]. In addition, implemented vi­ral food safety guidelines [25] are not purposely designed for informing consumers [57]. At present, we are faced with insufficient knowledge and awareness of viral food safety issues among food handlers, accom­panied by consumers being insufficiently informed about food safety principles at home. The lower knowledge for viral food safety concepts indicates that food safety management failed to develop relevant and user-friendly approaches to educate both food handler and consumer about the implementation of recommended food safety practices asso­ciated with foodborne viruses as a response to globalisation and new consumption patterns. International Journal of Sanitary Engineering Research M. Ambrožič, A. Kukec, M. Jevšnik et al. • Food safety expertise among professional food handlers and consumers related to foodborne viruses... Increased awareness of the importance of good food hygiene practice and training in the production and handling of foods is necessary to minimize the transmission of foodborne viral illnesses. Higher educated food handlers have better knowledge of contamination agents, which indicates that education is a solution for knowledge improvement and enhanced awareness. Increased awareness of the importance of good food hygiene practice and training in the production and handling of foods is necessary to minimize the transmission of foodborne viral illnesses. Improving de­tection methods allows better monitoring of viruses in food and helps to improve the safety of those foods commonly associated with food-borne viral illnesses. The vast majority of publications dealing with soft elements of food safety expertise are by principle focused on bacteria and hygienic issues. However, there is really a shortage on soft ele­ment within food safety dealing with foodborne viruses [18], especially for consumers’ studies. limitAtionS of the Study Although this research was carefully prepared, we are aware of its limi­tations due to the lack of prior research studies in viral food safety field connected to human factor and consequently to the available data. That is the reason that the comparison based on scientific results can­not be done. Further research in this field of food safety is needed. concluSionS Trends in food supply chain like globalization of food supply chains, health and demographic situations, social situations (increased con­sumption of ready-to-eat foods on the one hand and raw and/or mini­mally processed foods on the other), and environmental conditions (e.g. pollution) present new challenges for food safety. Global integrat­ed farm-to-table approach and new consumption patterns enable that a contaminated food product can be consumed by a large number of people worldwide in a short period of time. On the one hand, we are facing insufficient knowledge and awareness of food safety issues among food handlers these days. Moreover we have insufficiently in­formed consumers about food safety principles at home. In our study, we drew the conclusions that food handlers, although trained, do not recognize foodborne viruses as distinctive foodborne ha­zards and are not sufficiently aware of the importance of foodborne virus­es as transmittable pathogens for ensuring safe food for consumers. Higher educated food handlers have better knowledge of contamination agents, which indicates that education is a solution for knowledge im­provement and enhanced awareness. Next to that, of consumers’ know­ledge strongly predominates over knowledge. Models for “viral food safety knowledge” and “viral food safety awareness” confirmed that education, age, and gender influence the viral food safety, which emphasizes the need for tailored educational programs to improve awareness with respect to viruses and to implement up-to-date findings into good practices, which will be available and easy to understand and to handle with con­sumers of all ages, educational background, and living circumstances. © Inštitut za sanitarno inženirstvo, 2016 acknowledgments Authors would like to thank all consumers and food handlers who gave their time to participate in the study. Next to that, we would like to thank food technologists and students who helped interviewing food handlers and consumers. ReFeRenCeS [1] Surveillance for foodborne disease outbreaks: http://www.cdc.gov/ foodsafety/fdoss/data/annual-summaries/ (4 May 2016). [2] EFSA. 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