Abstract
OBJECTIVESThis study aimed to reveal the epidemiologic characteristics of the outbreak of gastroenteritis caused by Salmonella enterica serovar Thompson in Busan Metropolitan City and to identify points for improvement to prevent of food-borne disease outbreak.METHODSThis was a case-control study. The control group comprised asymptomatic students in the same classes of the cases. The presence or absence of symptoms, ingestion of each food provided by school meal service, and commonly ingested foods in addition to those foods in meal service were investigated. Moreover, specimens collected from rectal swab, preserved foods, and environmental surface were tested.RESULTSOf the 6,092 subjects, 1,111 (1,083 students, 22 school personnel, and 6 foodservice employees) were included in the case group; this corresponded to an 18.4% attack rate. Symptoms included diarrhea (n=1,051, 94.6%), abdominal pain (n=931, 83.8%), febrile sensation (n=502, 45.2%), and vomiting (n=275, 24.8%). The epidemic curves of each 10 schools were unimodal. Investigation of food intake showed a significantly high odds ratio for chocolate cake in 5 out of the 10 schools. Laboratory test detected Salmonella enterica serovar Thompson both in rectal swab specimens of 9 schools and in collected preserved chocolate cakes of 9 schools. Pulsed-field gel electrophoresis test result showed that Salmonella enterica seorvar Thompson isolated from human and foods were the same.CONCLUSIONSThe source of infection for the Salmonella enterica serovar Thompson outbreak in the 10 schools of Busan Metropolitan City is chocolate cake. Traceback investigation for origin of contaminated food in food-borne disease outbreak and safety control during food production should be more enhanced.
Highlights
Notified outbreaks of gastroenteritis in South Korea have continuously increased from 261 cases in 2013 to 422 cases in 2015 and 544 cases in 2017
Busan Metropolitan City has received reports from Community Health Centers of each corresponding district, gu, of 4 schools, in that there were several students who complained of gastrointestinal symptoms such as diarrhea, abdominal pain, vomiting, and febrile sensation from 10 a.m. to 3 p.m. in September 5, 2018
On September 6, the Ministry of Food and Drug Safety and the Korea Centers for Disease Control and Prevention (KCDC) announced that 13 schools in the country including Busan reported outbreaks of gastroenteritis until September 5, and the same chocolate cakes provided to those schools were suspected as the source of infection
Summary
Notified outbreaks of gastroenteritis in South Korea (here after Korea) have continuously increased from 261 cases in 2013 to 422 cases in 2015 and 544 cases in 2017. On September 6, the Ministry of Food and Drug Safety and the Korea Centers for Disease Control and Prevention (KCDC) announced that 13 schools in the country including Busan reported outbreaks of gastroenteritis until September 5, and the same chocolate cakes provided to those schools were suspected as the source of infection. They ordered to stop the distribution and sales of this chocolate cake. Thereafter, the Ministry of Food and Drug Safety and the KCDC announced that there were outbreaks of gastroenteritis in 57 mass meal services that provided the chocolate cake in 12 provinces including Busan until September 10, resulting in 2,207 case reports
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