A large outbreak of Staphylococcus aureus among Cub Scouts and Girl Guides camp activities at Ban Khai District, Rayong Province, in February 2024

Abstract

Background: On February 8, 2024, the Office of Disease Prevention and Control Region 6, Chonburi (ODPC 6 Chonburi), received a report from the Rayong Provincial Public Health Office (PPHO) regarding students suspected of food poisoning after participating in a Scout camp activity at a school in Ban Khai District, Rayong Province. Approximately 60-70 students were affected. On February 9, 2024, the Disease Control Investigation and Control Team from ODPC 6 Chonburi, along with the Rayong PPHO and the SRRT of Ban Khai District, investigated the outbreak to confirm the diagnosis, study the epidemiological characteristics, identify risk factors, and propose appropriate control and prevention measures.Method: A descriptive epidemiological study was conducted by reviewing hospital data and conducting individual interviews to identify additional cases. Suspected cases included students or personnel exhibiting one or more symptoms, such as vomiting, stomach pain, diarrhea, watery stool, or nausea, between February 7–9, 2024. Environmental data from the school was also collected, and interviews were conducted with food preparers and teachers. Samples were taken from patients, food preparers, food, and suspected water sources, and laboratory tests were performed to identify potential pathogens. A retrospective cohort study was also conducted to identify risk factors for the disease.Results: This outbreak was identified as a common source outbreak. Interviews with 148 participants revealed 61 cases, yielding an attack rate of 41.22%. No fatalities were reported. Most patients experienced vomiting, stomach pain, and diarrhea, with an average incubation period of 3 hours. Four patients tested positive for Staphylococcus aureus, with a 57.14% positive rate (4 out of 7 cases) from vomit samples. The strain produced enterotoxins A (2 cases) and C (2 cases). The garlic chicken dish served at lunch on February 8, 2024, tested positive for S. aureus enterotoxin A, matching the strain found in the vomit samples. No samples from other dishes were tested for pathogens. Improper food handling and storage were identified as the cause, as the food was left at room temperature for several hours before being reheated. The environmental investigation also found that food handlers did not wear face masks or gloves and prepared food on the floor.Conclusion and Discussion: The food poisoning outbreak was caused by S. aureus, which produces Staphylococcal Enterotoxins. The key risk factor was improper food preparation and storage, underscoring the need for hygienic practices throughout all stages of food handling. It is essential to implement proper food hygiene practices in schools, and specific safety protocols should be developed for preparing food during educational activities involving large groups of students. These measures are crucial for monitoring and preventing future foodborne and waterborne disease outbreaks.