Foodborne Outbreak investigation in Sabya town, Gizan region, Saudi Arabia, November 2021. A case control study
- Water or foodborne
Background
Food poisoning is a major public health problem in many countries, including Saudi Arabia. On November 1, 2021, Sabya reported unexpected number of cases with gastrointestinal illness, presented to emergency room of Sabya general hospital, following a lunch from a local restaurant. Our investigation aims to confirm the outbreak's existence, identify the cases, identify the causal agent or organism and recommend future preventative measure.
Methods
A 1:1 unmatched case control study was conducted using an interview questionnaire. A case was defined as anyone who ate lunch at the restaurant on November 1, 2021 and complained of one or more of the following symptoms within 6 hours of food consumption: nausea, vomiting, abdominal pain, diarrhea, or fever. We defined a control as anyone who ate from the same restaurant at the same time and did not acquire symptoms. For each food item, odds ratio (OR) was calculated.
Results
No death was reported. Ninety-five cases were identified including (84%) male. The age ranged between 5– 64 years (mean 27.11±12.13) and the main nationality was Yemeni (66%) followed by Saudi (34%). Majority of cases developed nausea (98%) and abdominal pain (80%). The incubation period was 30 minutes- 6 hours (mean 2 hours). Marsah (a mixture of flour, dates, and honey) was found to be significantly associated with illness (OR= 552.2, 95%CI= 128-2378) and Staphylococcus aureus were detected all the three ingredients. All food handlers involved in the preparation of Marsah had a positive swab for staph aureus too.
Conclusion
Based on our results, we conclude that this outbreak originated from contaminated Marsah with Staph aureus due to the negligence of restaurant food handlers. Implementation of early control measures was crucial in preventing this outbreak. We recommend to further educate the food handlers about food safety.
Food poisoning is a major public health problem in many countries, including Saudi Arabia. On November 1, 2021, Sabya reported unexpected number of cases with gastrointestinal illness, presented to emergency room of Sabya general hospital, following a lunch from a local restaurant. Our investigation aims to confirm the outbreak's existence, identify the cases, identify the causal agent or organism and recommend future preventative measure.
Methods
A 1:1 unmatched case control study was conducted using an interview questionnaire. A case was defined as anyone who ate lunch at the restaurant on November 1, 2021 and complained of one or more of the following symptoms within 6 hours of food consumption: nausea, vomiting, abdominal pain, diarrhea, or fever. We defined a control as anyone who ate from the same restaurant at the same time and did not acquire symptoms. For each food item, odds ratio (OR) was calculated.
Results
No death was reported. Ninety-five cases were identified including (84%) male. The age ranged between 5– 64 years (mean 27.11±12.13) and the main nationality was Yemeni (66%) followed by Saudi (34%). Majority of cases developed nausea (98%) and abdominal pain (80%). The incubation period was 30 minutes- 6 hours (mean 2 hours). Marsah (a mixture of flour, dates, and honey) was found to be significantly associated with illness (OR= 552.2, 95%CI= 128-2378) and Staphylococcus aureus were detected all the three ingredients. All food handlers involved in the preparation of Marsah had a positive swab for staph aureus too.
Conclusion
Based on our results, we conclude that this outbreak originated from contaminated Marsah with Staph aureus due to the negligence of restaurant food handlers. Implementation of early control measures was crucial in preventing this outbreak. We recommend to further educate the food handlers about food safety.