Acute gastro-enteritis outbreak following intake of food offered to the deity in an urban locality, Coimbatore District, Tamil Nadu, India, 2018

  • Water or foodborne
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Background:
On 4 April, 2018, a cluster of gastro-enteritis was reported among devotees of religious festival held in a locality of Coimbatore District, South India. No outbreaks were reported from this locality during 2014-18. We identified potential sources for implementing control measures.

Methods:
We defined case as occurrence of vomiting, abdominal cramps and loose watery stools among attendees within 24 hours of eating food items offered at the festival on 3 April, 2018. We searched cases door-to-door. We described cases by time (epicurve) and calculated attack rate. We did a retrospective cohort study of festival attendees. We compared food-specific attack rates and calculated relative risk (RR) and 95% Confidence Interval (CI). We tested blood and stool specimen for pathogens. We interviewed food handlers and did environmental investigations.

Results:
Of 61 attendees, 52 had illness (Overall attack rate=85%; Male=75%,Female=96%). Following food distribution in the morning, cases started reporting from 4 pm and reached peak at 10 pm and the last case was reported on 4 April evening [Median time=12 hours]. Attendees reported diarrhea (96%), vomiting (85%) and abdominal cramps (77%). Incidence was higher among those who ate specific sweet (49 of 51) than who did not (3 of 10) [RR=3.2; 95% CI: 1.2 to 8.2]. This sweet was prepared by hand mixing of dried rice flakes, palm jaggery and ghee on previous night and was stored at room temperature. We did not identify pathogens in the blood but for E. coli in the stools. Food items were unavailable for testing. Ghee was adulterated with palmolein oil.

Conclusion:
Symptoms and incubation period were suggestive of illness due to Bacillus cereus though not confirmed. The implicated sweet could have been contaminated potentially by food handlers, improper storage and or delayed preparation/serving. We recommended food safety and hygiene during preparation and shortening of time interval of serving.

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