Clostridium perfringens Outbreak Associated with School Lunch—New Taipei City, Taiwan, 2019

  • Other
  • Water or foodborne
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Background:
Clostridum perfringens is a spore-forming bacterium commonly found on raw meat and poultry, which may cause foodborne disease. In September 2019, an outbreak of gastroenteritis occurred in three schools in New Taipei City, Taiwan. More than 200 students became ill after eating school lunch provided by the same caterer on September 3. We investigated the outbreak to identify infection source and recommend preventive measures.

Methods:
We conducted a case-control study in two affected schools. We defined case-patients as students with onset of gastrointestinal symptoms occurring within 72 hours after eating school lunch on September 3, 2019. We conducted bivariate analyses to identify foods associated with illness. We tested stool samples of cases and leftover for common pathogens. We interviewed caterers and reviewed food preparation and delivery process.

Results:
We identified 199 cases and 387 controls. The median age of cases was 12 years (range 9-16 years). Main symptoms included diarrhea (n=165, 83%) and abdominal pain (n=134, 67%), with median incubation period of 15 hours. Illness was associated with consumption of braised chicken (OR=2.62, 95% CI 1.66-4.17). cpe-positive C. perfringens was detected in 10 of 16 stool samples. Kitchen’s logbooks and caterer’s reports showed cooking without measuring internal temperature of chicken, storing cooked foods in room temperature, and more than four hours from chicken cooking to consumption.

Conclusions:
Eating braised chicken was associated with the school outbreak of C. perfringens. We recommend caterers should strengthen the risk monitoring during preparation, cooking, storage and transportation of food for school lunches, and schools should contract caterers complying with food safety standards.

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