An Epidemiological Study on an Outbreak of Gastroenteritis Linked to Dinner Served at a Senior High School in Accra
Background: An outbreak of gastroenteritis occurred in December 2019 after students of a Senior High School in Accra were served with kenkey and fish during their dinner. An investigation was conducted to characterize the affected people, the source of contamination, the etiologic food and agent. Methods: An epidemiological study was conducted with cases selected from the student population who were ill. Controls were selected from among students who also ate from the school canteen during dinner but were not ill. Food history of each case and control was taken to assess their exposure status. Epi Info 7 was used to analyze the data obtained from the outbreak. Attack rates and odds ratios were calculated to determine the risk of foodborne infection for each of the foods consumed by the population. The source of contamination of the foods was ascertained by conducting an environmental risk assessment at the school. Results: Data were obtained from 126 students, out of which 57 (45.2%) were cases and 69 (54.8%) were controls. The cases presented with symptoms such as diarrhea (85.96%), abdominal cramps (66.67%), vomiting (50.88%), headache (21.05%), fever (17.86%) and nausea (3.51%). The peak incubation period was 18 hours with a minimum and maximum incubation periods of 6 and 50 hours respectively. From the incubation period, duration of illness and the symptoms, non-typhoidal salmonellosis was suspected. Multivariate analysis indicated that the illness was associated with the consumption of the fried fish served, however this was statistically insignificant (AOR 3.1.00, P = 0.159). No stool, blood or food samples were available for organism isolation and confirmation of suspected etiologic agent. The environmental risk assessment indicated poor hand washing practices on the part of both the food handlers and students. Conclusion: The outbreak could probably be due to the consumption of the fried fish that might have been contaminated with Salmonella sp. as a result of poor hand washing practices in the school.
[1] Jahan S: Epidemiology of Foodborne Illness. In: Scientific, Health and Social Aspects of the Food Industry. edn. Edited by Valdez DB. InTech; 2012: 322-348.
[2] Epp T, Parker S: Factors in Foodborne Disease Control: A Brief Overview of Issues in Changing Zoonotic Disease Transmission and the Roles of Public Health and Veterinary Professionals. Journal of agromedicine 2009, 14(2):228-234.
[3] Foodborne Illness (www.cdc.gov/foodsafety/facts.html#what)
[4] Gumbo A, Bangure D, Gombe NT, Mungati M, Tshimanga M, Hwalima Z, Dube I: Staphylococcus aureus food poisoning among Bulawayo City Council employees, Zimbabwe, 2014. BMC research notes 2015, 8:485.
[5] Osei-Tutu B, Anto F: Trends of reported foodborne diseases at the Ridge Hospital, Accra, Ghana: a retrospective review of routine data from 2009-2013. BMC infectious diseases 2016, 16(1):139.
[6] King LK, Awumbila B, Canacoo EA, Ofosu-Amaah S: An assessment of the safety of street foods in the Ga district, of Ghana; implications for the spread of zoonoses. Acta Tropica 2000, 76:39-43.
[7] Malm K, Nyarko K, Yawson A, Gogo B, Lawson A, Afari E: Foodborne illness among school children in Ga East, Accra. Ghana medical journal 2015, 49(2):72-76.
[8] Sloan-Gardner TS, Glynn-Robinson AJ, Roberts-Witteveen A, Krsteski R, Rogers K, Kaye A, Moffatt CR: An outbreak of gastroenteritis linked to a buffet lunch served at a Canberra restaurant. Communicable diseases intelligence quarterly report 2014, 38(4):E273-278.
[9] Johler S, Tichaczek-Dischinger PS, Rau J, Sihto HM, Lehner A, Adam M, Stephan R: Outbreak of Staphylococcal food poisoning due to SEA-producing Staphylococcus aureus. Foodborne pathogens and disease 2013, 10(9):777-781.
[10] Venuto M, Garcia K, Halbrook B: Analyses of the Contributing Factors Associated With Foodborne Outbreaks in School Settings (2000–2010). Journal of environmental health 2015, 77(7):16-21.
[11] Daniels NA, Mackinnon L, Rowe SM, Bean NH, Griffin PM, Mead PS: Foodborne disease outbreaks in United States schools. The Pediatric Infectious Disease Journal 2002, 21(7):623-628.
[12] FDA: Bad Bug Book: Handbook of Microorganisms, Foodborne Pathogenic, Natural Toxins. US Food and Drug Administration: Silver Spring, MD, USA (accessed on 1 July 2014) 2005.
[13] Krishnasamy VP, Marshall K, Dewey-Mattia D, Wise M: Outbreak Characteristics and Epidemic Curves for Multistate Outbreaks of Salmonella Infections Associated with Produce: United States, 2009-2015. Foodborne pathogens and disease 2020, 17(1):15-22.
[14] Control CfD, Prevention: Interpretation of Epidemic (Epi) Curves during Ongoing Outbreak Investigations. In.; 2013.
[15] Warren CA: Enteric Clostridium Infections. In: Tropical infectious diseases: principles, pathogens and practice. 3rd edn. Edited by Guerrant RL, Walker DH, Weller PF: Elsevier Health Sciences; 2011: 181-185.
[16] Microorganisms FP, Handbook NT: Bad Bug Book. Center for Food Safety & Applied Nutrition http://www cfsan fda gov/~ mow/intro html accessed October 2005, 24.
[17] Procedures to investigate Foodborne illness. In: International Association for Food Protection. 2014.
[18] Reis RS, Horn F: Enteropathogenic Escherichia coli, Samonella, Shigella and Yersinia: cellular aspects of host-bacteria interactions in enteric diseases. Gut pathogens 2010, 2(1):8.
[19] Kurtz JR, Goggins JA, McLachlan JB: Salmonella infection: Interplay between the bacteria and host immune system. Immunology letters 2017, 190:42-50.
[20] Chen HM, Wang Y, Su LH, Chiu CH: Nontyphoid salmonella infection: microbiology, clinical features, and antimicrobial therapy. Pediatrics and neonatology 2013, 54(3):147-152.
[21] Bula-Rudas FJ, Rathore MH, Maraqa NF: Salmonella Infections in Childhood. Advances in pediatrics 2015, 62(1):29-58.
[22] Crump JA, Sjölund-Karlsson M, Gordon MA, Parry CM: Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections. Clinical microbiology reviews 2015, 28(4):901-937.
[23] Acheson D, Hohmann EL: Nontyphoidal salmonellosis. Clinical Infectious Diseases 2001, 32(2):263-269.
[24] Akabanda F, Hlortsi EH, Owusu-Kwarteng J: Food safety knowledge, attitudes and practices of institutional food-handlers in Ghana. BMC public health 2017, 17(1):40.
[25] Annor GA, Baiden EA: Evaluation of food hygiene knowledge attitudes and practices of food handlers in food businesses in Accra, Ghana. Food Nutr Sci 2011, 2.
[26] Kunadu AP-H, Ofosu DB, Aboagye E, Tano-Debrah K: Food safety knowledge, attitudes and self-reported practices of food handlers in institutional foodservice in Accra, Ghana. Food Control 2016, 69.
[27] Leitner E, Zarfel G, Luxner J, Herzog K, Pekard-Amenitsch S, Hoenigl M, Valentin T, Feierl G, Grisold AJ, Högenauer C: Contaminated handwashing sinks as the source of a clonal outbreak of KPC-2-producing Klebsiella oxytoca on a hematology ward. Antimicrobial agents and chemotherapy 2015, 59(1):714-716.
[28] Hutin Y, Luby S, Paquet C: A large cholera outbreak in Kano City, Nigeria: the importance of hand washing with soap and the danger of street-vended water. Journal of water and health 2003, 1(1):45-52.
[29] Todd EC, Greig JD, Bartleson CA, Michaels BS: Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 3. Factors contributing to outbreaks and description of outbreak categories. Journal of food protection 2007, 70(9):2199-2217.
[30] Ababio PF, Lovatt P: A review on food safety and food hygiene studies in Ghana. Food Control 2015, 47:92-97.
[31] Leclerc H, Schwartzbrod L, Dei-Cas E: Microbial agents associated with waterborne diseases. Critical reviews in microbiology 2002, 28(4):371-409.
[32] Kopilovic B, Ucakar V, Koren N, Krek M, Kraigher A: Waterborne outbreak of acute gastroenteritis in a costal area in Slovenia in June and July 2008. Eurosurveillance 2008, 13(34):1-3.
[33] O'Reilly CE, Bowen AB, Perez NE, Sarisky JP, Shepherd CA, Miller MD, Hubbard BC, Herring M, Buchanan SD, Fitzgerald CC: A waterborne outbreak of gastroenteritis with multiple etiologies among resort island visitors and residents: Ohio, 2004. Clinical Infectious Diseases 2007, 44(4):506-512.
[34] Beaudeau P, de Valk H, Vaillant V, Mannschott C, Tillier C, Mouly D, Ledrans M: Lessons learned from ten investigations of waterborne gastroenteritis outbreaks, France, 1998–2006. Journal of Water and Health 2008, 6(4):491-503.
[35] Mellou K, Sideroglou T, Potamiti-Komi M, Kokkinos P, Ziros P, Georgakopoulou T, Vantarakis A: Epidemiological investigation of two parallel gastroenteritis outbreaks in school settings. BMC public health 2013, 13(1):241.
[1] Jahan S: Epidemiology of Foodborne Illness. In: Scientific, Health and Social Aspects of the Food Industry. edn. Edited by Valdez DB. InTech; 2012: 322-348.
[2] Epp T, Parker S: Factors in Foodborne Disease Control: A Brief Overview of Issues in Changing Zoonotic Disease Transmission and the Roles of Public Health and Veterinary Professionals. Journal of agromedicine 2009, 14(2):228-234.
[3] Foodborne Illness (www.cdc.gov/foodsafety/facts.html#what)
[4] Gumbo A, Bangure D, Gombe NT, Mungati M, Tshimanga M, Hwalima Z, Dube I: Staphylococcus aureus food poisoning among Bulawayo City Council employees, Zimbabwe, 2014. BMC research notes 2015, 8:485.
[5] Osei-Tutu B, Anto F: Trends of reported foodborne diseases at the Ridge Hospital, Accra, Ghana: a retrospective review of routine data from 2009-2013. BMC infectious diseases 2016, 16(1):139.
[6] King LK, Awumbila B, Canacoo EA, Ofosu-Amaah S: An assessment of the safety of street foods in the Ga district, of Ghana; implications for the spread of zoonoses. Acta Tropica 2000, 76:39-43.
[7] Malm K, Nyarko K, Yawson A, Gogo B, Lawson A, Afari E: Foodborne illness among school children in Ga East, Accra. Ghana medical journal 2015, 49(2):72-76.
[8] Sloan-Gardner TS, Glynn-Robinson AJ, Roberts-Witteveen A, Krsteski R, Rogers K, Kaye A, Moffatt CR: An outbreak of gastroenteritis linked to a buffet lunch served at a Canberra restaurant. Communicable diseases intelligence quarterly report 2014, 38(4):E273-278.
[9] Johler S, Tichaczek-Dischinger PS, Rau J, Sihto HM, Lehner A, Adam M, Stephan R: Outbreak of Staphylococcal food poisoning due to SEA-producing Staphylococcus aureus. Foodborne pathogens and disease 2013, 10(9):777-781.
[10] Venuto M, Garcia K, Halbrook B: Analyses of the Contributing Factors Associated With Foodborne Outbreaks in School Settings (2000–2010). Journal of environmental health 2015, 77(7):16-21.
[11] Daniels NA, Mackinnon L, Rowe SM, Bean NH, Griffin PM, Mead PS: Foodborne disease outbreaks in United States schools. The Pediatric Infectious Disease Journal 2002, 21(7):623-628.
[12] FDA: Bad Bug Book: Handbook of Microorganisms, Foodborne Pathogenic, Natural Toxins. US Food and Drug Administration: Silver Spring, MD, USA (accessed on 1 July 2014) 2005.
[13] Krishnasamy VP, Marshall K, Dewey-Mattia D, Wise M: Outbreak Characteristics and Epidemic Curves for Multistate Outbreaks of Salmonella Infections Associated with Produce: United States, 2009-2015. Foodborne pathogens and disease 2020, 17(1):15-22.
[14] Control CfD, Prevention: Interpretation of Epidemic (Epi) Curves during Ongoing Outbreak Investigations. In.; 2013.
[15] Warren CA: Enteric Clostridium Infections. In: Tropical infectious diseases: principles, pathogens and practice. 3rd edn. Edited by Guerrant RL, Walker DH, Weller PF: Elsevier Health Sciences; 2011: 181-185.
[16] Microorganisms FP, Handbook NT: Bad Bug Book. Center for Food Safety & Applied Nutrition http://www cfsan fda gov/~ mow/intro html accessed October 2005, 24.
[17] Procedures to investigate Foodborne illness. In: International Association for Food Protection. 2014.
[18] Reis RS, Horn F: Enteropathogenic Escherichia coli, Samonella, Shigella and Yersinia: cellular aspects of host-bacteria interactions in enteric diseases. Gut pathogens 2010, 2(1):8.
[19] Kurtz JR, Goggins JA, McLachlan JB: Salmonella infection: Interplay between the bacteria and host immune system. Immunology letters 2017, 190:42-50.
[20] Chen HM, Wang Y, Su LH, Chiu CH: Nontyphoid salmonella infection: microbiology, clinical features, and antimicrobial therapy. Pediatrics and neonatology 2013, 54(3):147-152.
[21] Bula-Rudas FJ, Rathore MH, Maraqa NF: Salmonella Infections in Childhood. Advances in pediatrics 2015, 62(1):29-58.
[22] Crump JA, Sjölund-Karlsson M, Gordon MA, Parry CM: Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections. Clinical microbiology reviews 2015, 28(4):901-937.
[23] Acheson D, Hohmann EL: Nontyphoidal salmonellosis. Clinical Infectious Diseases 2001, 32(2):263-269.
[24] Akabanda F, Hlortsi EH, Owusu-Kwarteng J: Food safety knowledge, attitudes and practices of institutional food-handlers in Ghana. BMC public health 2017, 17(1):40.
[25] Annor GA, Baiden EA: Evaluation of food hygiene knowledge attitudes and practices of food handlers in food businesses in Accra, Ghana. Food Nutr Sci 2011, 2.
[26] Kunadu AP-H, Ofosu DB, Aboagye E, Tano-Debrah K: Food safety knowledge, attitudes and self-reported practices of food handlers in institutional foodservice in Accra, Ghana. Food Control 2016, 69.
[27] Leitner E, Zarfel G, Luxner J, Herzog K, Pekard-Amenitsch S, Hoenigl M, Valentin T, Feierl G, Grisold AJ, Högenauer C: Contaminated handwashing sinks as the source of a clonal outbreak of KPC-2-producing Klebsiella oxytoca on a hematology ward. Antimicrobial agents and chemotherapy 2015, 59(1):714-716.
[28] Hutin Y, Luby S, Paquet C: A large cholera outbreak in Kano City, Nigeria: the importance of hand washing with soap and the danger of street-vended water. Journal of water and health 2003, 1(1):45-52.
[29] Todd EC, Greig JD, Bartleson CA, Michaels BS: Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 3. Factors contributing to outbreaks and description of outbreak categories. Journal of food protection 2007, 70(9):2199-2217.
[30] Ababio PF, Lovatt P: A review on food safety and food hygiene studies in Ghana. Food Control 2015, 47:92-97.
[31] Leclerc H, Schwartzbrod L, Dei-Cas E: Microbial agents associated with waterborne diseases. Critical reviews in microbiology 2002, 28(4):371-409.
[32] Kopilovic B, Ucakar V, Koren N, Krek M, Kraigher A: Waterborne outbreak of acute gastroenteritis in a costal area in Slovenia in June and July 2008. Eurosurveillance 2008, 13(34):1-3.
[33] O'Reilly CE, Bowen AB, Perez NE, Sarisky JP, Shepherd CA, Miller MD, Hubbard BC, Herring M, Buchanan SD, Fitzgerald CC: A waterborne outbreak of gastroenteritis with multiple etiologies among resort island visitors and residents: Ohio, 2004. Clinical Infectious Diseases 2007, 44(4):506-512.
[34] Beaudeau P, de Valk H, Vaillant V, Mannschott C, Tillier C, Mouly D, Ledrans M: Lessons learned from ten investigations of waterborne gastroenteritis outbreaks, France, 1998–2006. Journal of Water and Health 2008, 6(4):491-503.
[35] Mellou K, Sideroglou T, Potamiti-Komi M, Kokkinos P, Ziros P, Georgakopoulou T, Vantarakis A: Epidemiological investigation of two parallel gastroenteritis outbreaks in school settings. BMC public health 2013, 13(1):241.
@article{"International Journal of Medical, Medicine and Health Sciences:80099", author = "Benjamin Osei Tutu and Rita Asante and Emefa Atsu", title = "An Epidemiological Study on an Outbreak of Gastroenteritis Linked to Dinner Served at a Senior High School in Accra", abstract = "Background: An outbreak of gastroenteritis occurred in December 2019 after students of a Senior High School in Accra were served with kenkey and fish during their dinner. An investigation was conducted to characterize the affected people, the source of contamination, the etiologic food and agent. Methods: An epidemiological study was conducted with cases selected from the student population who were ill. Controls were selected from among students who also ate from the school canteen during dinner but were not ill. Food history of each case and control was taken to assess their exposure status. Epi Info 7 was used to analyze the data obtained from the outbreak. Attack rates and odds ratios were calculated to determine the risk of foodborne infection for each of the foods consumed by the population. The source of contamination of the foods was ascertained by conducting an environmental risk assessment at the school. Results: Data were obtained from 126 students, out of which 57 (45.2%) were cases and 69 (54.8%) were controls. The cases presented with symptoms such as diarrhea (85.96%), abdominal cramps (66.67%), vomiting (50.88%), headache (21.05%), fever (17.86%) and nausea (3.51%). The peak incubation period was 18 hours with a minimum and maximum incubation periods of 6 and 50 hours respectively. From the incubation period, duration of illness and the symptoms, non-typhoidal salmonellosis was suspected. Multivariate analysis indicated that the illness was associated with the consumption of the fried fish served, however this was statistically insignificant (AOR 3.1.00, P = 0.159). No stool, blood or food samples were available for organism isolation and confirmation of suspected etiologic agent. The environmental risk assessment indicated poor hand washing practices on the part of both the food handlers and students. Conclusion: The outbreak could probably be due to the consumption of the fried fish that might have been contaminated with Salmonella sp. as a result of poor hand washing practices in the school.
", keywords = "Case control study, food poisoning, handwashing, Salmonella, school.", volume = "14", number = "12", pages = "414-6", }
