An outbreak investigation of Staphylococcus aureus foodborne disease, Muang District, Satun Province, Thailand during 11-12 June 2020
Keywords:
food poisoning, pancake roll, Staphylococcus aureus, Satun, ThailandAbstract
Background: On 10 June 2020, a cluster of food poisoning cases in Satun Province, Thailand was notified. An investigation was conducted to verify the diagnosis, identify the magnitude and distribution of the outbreak, identify possible contamination, and provide recommendations.
Methods: A retrospective cohort study was conducted. We reviewed medical records, interviewed involved people, performed an active case finding. The onset of symptoms, clinical presentations, and food consumption histories were collected using a structured questionnaire. Laboratory studies of the patients, food, and environment were examined. The inspection of food handlers’ hygiene, cooking, and storage process was performed.
Results: A total of 24 cases among 73 people got food poisoning between 9 and 10 June 2020. The attack rate was 32.9%. The most common symptom was nausea/vomiting (91.7%) followed by watery diarrhea equally to fatigue (75.0%), abdominal pain (70.8%), flatulence (29.2%), dry mouth (20.8%), fever (12.5), bloody diarrhea (8.3%), and hypotension (4.2%), respectively. Ten of twenty-four cases were inpatients. A stool culture of an inpatient shows positive for Staphylococcus aureus with enterotoxin gene. From the analytic study, the custard filling pancake roll (Adjusted OR = 16.6, 95% CI = 3.4–80.9) which the filling was stored outside the refrigerator for more than 2 hours, and spicy salad (Adjusted OR 7.5, 95% CI 1.1–52.4) which stored in the same compartment of the custard filling served on 9 June 2020 were incriminated as the food item responsible for the outbreak.
Conclusion: There was an outbreak of Staphylococcus aureus with a possibility caused by contaminated food from shop A. Leaving cooked food in room temperature >2 hours were highly suspicious to be the cause. Following the standard of food safety, storing food as recommended, and prevent cross-contamination are the important factors to prevent future outbreaks
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