Clostridium perfringens in London, July 2009: two weddings and an outbreak

J Eriksen,D Zenner,K Grant,D Kumar,S R Anderson

doi:10.2807/ese.15.25.19598-en

Abstract

Food poisoning outbreaks caused by Clostridium perfringens enterotoxin occur occasionally in Europe but have become less common in recent years. This paper presents the microbiological and epidemiological results of a large C. perfringens outbreak occurring simultaneously at two weddings that used the same caterer. The outbreak involved several London locations and required coordination across multiple agencies. A case-control study (n=134) was carried out to analyse possible associations between the food consumed and becoming ill. Food, environmental and stool samples were tested for common causative agents, including enterotoxigenic C. perfringens. The clinical presentation and the epidemiological findings were compatible with C. perfringens food poisoning and C. perfringens enterotoxin was detected in stool samples from two cases. The case-control study found statistically significant associations between becoming ill and eating either a specific chicken or lamb dish prepared by the same food handler of the implicated catering company. A rapid outbreak investigation with preliminary real-time results and the successful collaboration between the agencies and the caterer led to timely identification and rectification of the failures in the food handling practices.

Highlights

Food poisoning caused by C. perfringens is quite common [1]
Recent evidence has shown that healthy human food handlers can carry enterotoxigenic C. perfringens indicating that poor personal hygiene in catering staff is a risk factor for this foodborne illness [5]
This paper presents the findings of a point-source outbreak linking two weddings and one caterer in three London boroughs

Summary

Introduction

Food poisoning caused by C. perfringens is quite common [1]. We report the unusual occurrence of a simultaneous outbreak of C. perfringens at two large venues in London in July 2009. Gastrointestinal illness caused by C. perfringens is characterised by sudden onset of abdominal pain followed by diarrhoea, and less commonly by vomiting and fever. Disease symptoms are caused by an enterotoxin produced by C. perfringens type A strains. If food containing high numbers (>105 cfu/g) of C. perfringens vegetative cells is consumed, the bacterial cells can sporulate and produce enterotoxin in the human small intestine. Most C. perfringens food poisoning outbreaks are caused by a failure of adequate food preparation procedures. Recent evidence has shown that healthy human food handlers can carry enterotoxigenic C. perfringens indicating that poor personal hygiene in catering staff is a risk factor for this foodborne illness [5]

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