A Retrospective Cohort Study on an Outbreak of Gastroenteritis Linked to a Buffet Lunch Served during a Conference in Accra
On 21st November, 2016, an outbreak of foodborne illness occurred after a buffet lunch served during a stakeholders’ consultation meeting held in Accra. An investigation was conducted to characterise the affected people, determine the etiologic food, the source of contamination and the etiologic agent and to implement appropriate public health measures to prevent future occurrences. A retrospective cohort study was conducted via telephone interviews, using a structured questionnaire developed from the buffet menu. A case was defined as any person suffering from symptoms of foodborne illness e.g. diarrhoea and/or abdominal cramps after eating food served during the stakeholder consultation meeting in Accra on 21st November, 2016. The exposure status of all the members of the cohort was assessed by taking the food history of each respondent during the telephone interview. The data obtained was analysed using Epi Info 7. An environmental risk assessment was conducted to ascertain the source of the food contamination. Risks of foodborne infection from the foods eaten were determined using attack rates and odds ratios. Data was obtained from 54 people who consumed food served during the stakeholders’ meeting. Out of this population, 44 people reported with symptoms of food poisoning representing 81.45% (overall attack rate). The peak incubation period was seven hours with a minimum and maximum incubation periods of four and 17 hours, respectively. The commonly reported symptoms were diarrhoea (97.73%, 43/44), vomiting (84.09%, 37/44) and abdominal cramps (75.00%, 33/44). From the incubation period, duration of illness and the symptoms, toxin-mediated food poisoning was suspected. The environmental risk assessment of the implicated catering facility indicated a lack of time/temperature control, inadequate knowledge on food safety among workers and sanitation issues. Limited number of food samples was received for microbiological analysis. Multivariate analysis indicated that illness was significantly associated with the consumption of the snacks served (OR 14.78, P < 0.001). No stool and blood or samples of etiologic food were available for organism isolation; however, the suspected etiologic agent was Staphylococcus aureus or Clostridium perfringens. The outbreak could probably be due to the consumption of unwholesome snack (tuna sandwich or chicken. The contamination and/or growth of the etiologic agent in the snack may be due to the breakdown in cleanliness, time/temperature control and good food handling practices. Training of food handlers in basic food hygiene and safety is recommended.
Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1131317Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 844
 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.
 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.
 CDC (2011). "Foodborne Illness." Food Safety. Retrieved 11 November, 2013, from www.cdc.gov/foodsafety/facts.html#what.
 Gumbo A., Bangure D., Gombe N. T., 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.
 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.
 King L. K., Awumbila B., Canacoo E. A., 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.
 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.
 Sloan-Gardner T. S., Glynn-Robinson A. J., Roberts-Witteveen A., Krsteski R., Rogers K., Kaye A., Moffatt C. R. An outbreak of gastroenteritis linked to a buffet lunch served at a Canberra restaurant. Communicable diseases intelligence quarterly report 2014, 38(4):E273-278.
 Johler S., Tichaczek-Dischinger P. S., Rau J., Sihto H. M., 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.
 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.
 Le Loir Y., Baron F., Gautier M. Staphylococcus aureus and food poisoning. Genetics and molecular research: GMR 2003, 2(1):63-76.
 Warren C. A. Enteric Clostridium Infections. In: Tropical infectious diseases: principles, pathogens and practice. 3rd edn. Edited by Guerrant R. L., Walker D. H., Weller P. F. Elsevier Health Sciences; 2011: 181-185.
 Kang G., Hart Ac., Shears P. Bacterial Enteropathogens. In: Manson's tropical diseases. 23rd edn. Edited by Farrar J., Hotez P., Junghanss T., Kang G., Lalloo D., White N. J. Elsevier Health Sciences; 2013: 398-399.
 Argudin M. A., Mendoza M. C., Rodicio M. R. Food poisoning and Staphylococcus aureus enterotoxins. Toxins 2010, 2(7):1751-1773.
 Gladwin M., Trattler B. Clinical microbiology made ridiculously simple: MedMaster; 2001.
 Lima G. C., Loiko M. R., Casarin L. S., Tondo E. C. Assessing the epidemiological data of Staphylococcus aureus food poisoning occurred in the State of Rio Grande do Sul, Southern Brazil. Brazilian journal of microbiology: (publication of the Brazilian Society for Microbiology) 2013, 44(3):759-763.
 Fetsch A., Contzen M., Hartelt K., Kleiser A., Maassen S., Rau J., Kraushaar B., Layer F., Strommenger B. Staphylococcus aureus food-poisoning outbreak associated with the consumption of ice-cream. International journal of food microbiology 2014, 187:1-6.