Abstract
BackgroundSalmonella enterica, with more than 2500 diverse typhoidal and non-typhoidal serotypes (NTS), are foodborne bacterial pathogens of global public health concern. NTS are the most commonly reported causes of foodborne acute gastroenteritis (AGE). Contaminated food products (meat, poultry, eggs and dairy) have been reported to be a source of more than 95% NTS infections. An outbreak of food poisoning occurred among schoolchildren exposed to food provided by the government-sponsored National School Nutrition Programme (NSNP) at a local public primary day school in North West province, South Africa. An epidemiological, environmental and microbiological investigation was conducted to establish the existence and extent of the outbreak, identify the source(s) and causative agent(s) and institute appropriate control and preventive measures.MethodsAn epidemiological investigation was conducted, including a review of the clinical records of the persons exposed, laboratory testing of the pathological specimens collected, environmental testing of the food samples and food preparation areas.ResultsA total of 164 children developed clinical symptoms of AGE following ingestion of processed maize meal, beans and vegetables. Salmonella enterica serovar Heidelberg (S. Heidelberg) was the causative agent for this AGE outbreak in 92.0% of the cases. The median duration of illness was 2 days with a case fatality rate (CFR) of 0.6%. The main food product that was contaminated was samp (processed maize meal) that had been poorly stored and prepared (53.4%).ConclusionA timeously-initiated epidemiological, environmental and microbiological an investigation led to the conclusion that the etiologic agent of this outbreak was S. Heidelberg, and the most probable food vehicle of transmission was cooked samp served to learners within the NSNP.
Highlights
A suspected case was defined as any person who: (1) attended school and/or their contacts, (2) had ingested at least one of the food items served at school and (3) fell ill between the 24 and 28 October, with any of an acute gastroenteritis (AGE) illness symptoms within 72 hours
Mean age of the learner cases was estimated to 10.5 ± standard deviation (s.d.) of 2.9 years, with nearly 90% being children younger than 14 years old (Table 1)
A timeously-initiated epidemiological, environmental and microbiological investigation led to the conclusion that the etiologic agent of this outbreak was S
Summary
Salmonella enterica, with more than 2500 diverse typhoidal and non-typhoidal serotypes (NTS),[1,2,3,4] are foodborne bacterial pathogens of global public health concern.[5,6] Non-typhoidal serotypes are the most commonly reported causes of foodborne acute gastroenteritis (AGE),[4,7,8] causing about 93.8 million cases (85.6% foodborne) and 155 000 deaths globally per annum; both among children younger than 5 years old and those older than 5 years in the general population.[1,7,8,9,10,11,12] Nearly 2.6% of the global cas and deaths occur in Africa.[10] About 60% – 80% of all human Salmonella infections (salmonellosis) occur sporadically all over the population of the United States (US).[8] Despite that, clusters of large outbreaks in places of mass feeding have been reported recently.[4,8,13].
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