Marine Toxin Food Poisoning Outbreak among owners and workers in Restaurant-A, Bangkok, Thailand, 28 – 29 September 2013
Keywords:
food poisoning, marine toxin, ciguatoxin, red snapper, ThailandAbstract
Background: On 29 September 2013, the Bureau of Epidemiology (BoE), Ministry of Public Health received a notification from Ramathibodi Poison Center that a cluster of workers of Restaurant-A visited hospitals with suspected tetrodotoxin poisoning. Thus joint investigation was conducted to confirm diagnosis and verify outbreak, describe epidemiological characteristics of the outbreak, identify source of outbreak and implement control measures and provide recommendations for further prevention.
Methods: Descriptive study was used to investigation. We reviewed medical records of the workers and interviewed Restaurant-A owner, chef, and workers by semi-structured questionnaire. We conducted a retrospective cohort study to evaluate risk factors among Restaurant-A workers and owners (n=22). A walk through survey was conducted and collected samples for laboratory testing.
Results: A total of 11 (50%) workers and owner of Restaurant-A met our case definition. One hundred percent showed numbness at any site, 91% of watery or loose diarrhea. Median of incubation period was 4 hrs. (Range 2 – 9 hrs.). For univariate analysis who ate fish’s head in the hotpot spicy lemongrass soup was a risk factor (RR = 5.71, 95%CI = 1.30 – 864.97) and dose-response relationship between fish’s head consumption and food poisoning cases was presented (p < 0.05).
Conclusion: The cause of this outbreak cannot be definitely identified but it might be ciguatoxin-contaminated red snapper. Surveillance for marine toxin poisoning especially ciguatoxin should be strengthened for awareness of marine poisoning in patient with gastrointestinal and neurological symptoms and history of marine product consumption.
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