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Fua’di MT, Er B, Lee S, Chan PP, Khoo J, Tan D, Li H, Muhammad IR, Raj P, Kurupatham L, Lee V, Tan LK, Chan JSH, Li A, Aung KT. Characteristics of Gastroenteritis Outbreaks Investigated in Singapore: 2018-2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:64. [PMID: 38248529 PMCID: PMC10815581 DOI: 10.3390/ijerph21010064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/30/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024]
Abstract
There is a need to study the characteristics of outbreaks via Singapore's outbreak surveillance system to understand and identify the gaps in food safety for targeted policy interventions due to the increasing trend in gastroenteritis outbreaks and consequential increase in foodborne-related deaths and economic burden on public health systems worldwide. A total of 171 gastroenteritis outbreaks were investigated in Singapore from January 2018 to December 2021. This study analyzed the annual trend of investigated gastroenteritis outbreaks, the proportion of outbreaks by implicated sources of food, and the proportion of the type of pathogens identified from human cases, food samples, and environmental swabs collected from outbreak investigations. Among the foodborne gastroenteritis outbreaks (n = 121) investigated in Singapore, approximately 42.1% of the outbreaks had food prepared by caterers, 14.9% by restaurants, and 12.4% had food prepared by in-house kitchens. Clostridium perfringens and Salmonella were the most common causative pathogens in foodborne outbreaks throughout the analysis period. The food samples and environmental swabs collected were mostly detected for Bacillus cereus. Norovirus was the most common causative pathogen in non-foodborne outbreaks and was mainly attributable to preschools. This highlights the importance of monitoring and educating the catering industry and preschools to prevent future outbreaks.
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Affiliation(s)
- Muhd Tarmidzi Fua’di
- National Centre for Food Science, Singapore Food Agency, 7 International Business Park, Techquest, Singapore 609919, Singapore; (M.T.F.); (B.E.); (J.K.); (D.T.); (H.L.); (L.K.T.); (J.S.H.C.); (A.L.)
| | - Benjamin Er
- National Centre for Food Science, Singapore Food Agency, 7 International Business Park, Techquest, Singapore 609919, Singapore; (M.T.F.); (B.E.); (J.K.); (D.T.); (H.L.); (L.K.T.); (J.S.H.C.); (A.L.)
| | - Sylvester Lee
- Communicable Disease Division, Ministry of Health, Singapore 169854, Singapore; (S.L.); (P.P.C.); (I.R.M.); (P.R.); (V.L.)
| | - Pei Pei Chan
- Communicable Disease Division, Ministry of Health, Singapore 169854, Singapore; (S.L.); (P.P.C.); (I.R.M.); (P.R.); (V.L.)
| | - Joanna Khoo
- National Centre for Food Science, Singapore Food Agency, 7 International Business Park, Techquest, Singapore 609919, Singapore; (M.T.F.); (B.E.); (J.K.); (D.T.); (H.L.); (L.K.T.); (J.S.H.C.); (A.L.)
| | - Desmond Tan
- National Centre for Food Science, Singapore Food Agency, 7 International Business Park, Techquest, Singapore 609919, Singapore; (M.T.F.); (B.E.); (J.K.); (D.T.); (H.L.); (L.K.T.); (J.S.H.C.); (A.L.)
| | - Huilin Li
- National Centre for Food Science, Singapore Food Agency, 7 International Business Park, Techquest, Singapore 609919, Singapore; (M.T.F.); (B.E.); (J.K.); (D.T.); (H.L.); (L.K.T.); (J.S.H.C.); (A.L.)
| | - Imran Roshan Muhammad
- Communicable Disease Division, Ministry of Health, Singapore 169854, Singapore; (S.L.); (P.P.C.); (I.R.M.); (P.R.); (V.L.)
| | - Pream Raj
- Communicable Disease Division, Ministry of Health, Singapore 169854, Singapore; (S.L.); (P.P.C.); (I.R.M.); (P.R.); (V.L.)
| | - Lalitha Kurupatham
- Communicable Disease Division, Ministry of Health, Singapore 169854, Singapore; (S.L.); (P.P.C.); (I.R.M.); (P.R.); (V.L.)
| | - Vernon Lee
- Communicable Disease Division, Ministry of Health, Singapore 169854, Singapore; (S.L.); (P.P.C.); (I.R.M.); (P.R.); (V.L.)
| | - Li Kiang Tan
- National Centre for Food Science, Singapore Food Agency, 7 International Business Park, Techquest, Singapore 609919, Singapore; (M.T.F.); (B.E.); (J.K.); (D.T.); (H.L.); (L.K.T.); (J.S.H.C.); (A.L.)
| | - Joanne Sheot Harn Chan
- National Centre for Food Science, Singapore Food Agency, 7 International Business Park, Techquest, Singapore 609919, Singapore; (M.T.F.); (B.E.); (J.K.); (D.T.); (H.L.); (L.K.T.); (J.S.H.C.); (A.L.)
- Department of Food Science and Technology, National University of Singapore, 2 Science Drive 2, Singapore 117543, Singapore
| | - Angela Li
- National Centre for Food Science, Singapore Food Agency, 7 International Business Park, Techquest, Singapore 609919, Singapore; (M.T.F.); (B.E.); (J.K.); (D.T.); (H.L.); (L.K.T.); (J.S.H.C.); (A.L.)
- Department of Food Science and Technology, National University of Singapore, 2 Science Drive 2, Singapore 117543, Singapore
| | - Kyaw Thu Aung
- National Centre for Food Science, Singapore Food Agency, 7 International Business Park, Techquest, Singapore 609919, Singapore; (M.T.F.); (B.E.); (J.K.); (D.T.); (H.L.); (L.K.T.); (J.S.H.C.); (A.L.)
- Department of Food Science and Technology, National University of Singapore, 2 Science Drive 2, Singapore 117543, Singapore
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore 637551, Singapore
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Papanikou S, Sideroglou T, Chrysostomou A, Kyritsi MA, Spaniolas S, Bouboulis D, Mouchtouri VA, Mellou K. A Point Source Gastroenteritis Outbreak in a High School Putatively Due to Clostridium perfringens: Timely Investigation Is Everything. Foodborne Pathog Dis 2023; 20:41-46. [PMID: 36723604 DOI: 10.1089/fpd.2022.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
On May 28, 2021, several gastroenteritis cases were reported among students and staff of a high school on a Greek island. Lunches were delivered daily at the school by a catering company. We conducted a retrospective cohort study. Cases were defined as students or school staff presenting with diarrhea and abdominal pain between May 27 and 29, 2021. We used a self-administered questionnaire to collect the data. In the univariate analysis, we calculated food-specific attack rates (ARs), relative risks (RRs), and confidence intervals (95% CIs). Statistically significant variables (p < 0.05) were included in the multivariable model. Stool samples were collected from students on the same day of notification and were tested for bacteria, viruses, and parasites. The local food safety authority also inspected the school and the catering company premises. The food samples were sent to the reference laboratory for analysis. We received 129 responses from 174 students and staff members (response rate: 74%). Thirty cases were identified (AR, 23%). Of the 11 significant food items in the univariate analysis, the consumption of spaghetti with minced meat on May 27 (odds ratio 53.40, 95% CI: 3.9-736.1, 97% of cases exposed) was independently associated with the onset of gastroenteritis. Clostridium perfringens was detected in two of the three students' stool samples. Six samples from spaghetti with minced meat were positive for C. perfringens and four of those also tested positive for Bacillus cereus. Environmental investigation revealed non-compliances concerning food personnel training and Hazard Analysis and Critical Control Points (HACCP) plan implementation in the food establishment. Timely investigation and samples collection allowed the identification of the probable source of the outbreak. Changes, regarding the reception and distribution of meals in the school, were applied. Recommendations were given to the catering establishment focusing on adequate personnel training and HACCP issues, especially regarding temperature/time controls during all production, handling, and distribution phases.
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Affiliation(s)
- Sofia Papanikou
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden.,Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization (NPHO), Athens, Greece
| | - Theologia Sideroglou
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization (NPHO), Athens, Greece
| | - Anthi Chrysostomou
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization (NPHO), Athens, Greece
| | - Maria A Kyritsi
- Regional Public Health Laboratory (PEDY) of Thessaly, Larissa, Greece.,Department of Medicine, Laboratory of Hygiene and Epidemiology, University of Thessaly, Larissa, Greece
| | - Stelios Spaniolas
- Regional Directorate of North Aegean, Hellenic Food Authority (EFET), Mytilini, Greece
| | - Dimitrios Bouboulis
- Regional Directorate of North Aegean, Hellenic Food Authority (EFET), Mytilini, Greece
| | - Varvara A Mouchtouri
- Regional Public Health Laboratory (PEDY) of Thessaly, Larissa, Greece.,Department of Medicine, Laboratory of Hygiene and Epidemiology, University of Thessaly, Larissa, Greece
| | - Kassiani Mellou
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization (NPHO), Athens, Greece
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Bendary MM, Abd El-Hamid MI, El-Tarabili RM, Hefny AA, Algendy RM, Elzohairy NA, Ghoneim MM, Al-Sanea MM, Nahari MH, Moustafa WH. Clostridium perfringens Associated with Foodborne Infections of Animal Origins: Insights into Prevalence, Antimicrobial Resistance, Toxin Genes Profiles, and Toxinotypes. BIOLOGY 2022; 11:551. [PMID: 35453750 PMCID: PMC9028928 DOI: 10.3390/biology11040551] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 12/14/2022]
Abstract
Several food-poisoning outbreaks have been attributed to Clostridium perfringens (C. perfringens) worldwide. Despite that, this crisis was discussed in a few studies, and additional studies are urgently needed in this field. Therefore, we sought to highlight the prevalence, antimicrobial resistance, toxin profiles, and toxinotypes of C. perfringens isolates. In this study, 50 C. perfringens isolates obtained from 450 different animal origin samples (beef, chicken meat, and raw milk) were identified by phenotypic and genotypic methods. The antimicrobial susceptibility results were surprising, as most of the isolates (74%) showed multidrug-resistant (MDR) patterns. The phenotypic resistance to tetracycline, lincomycin, enrofloxacin, cefoxitin/ampicillin, and erythromycin was confirmed by the PCR detections of tet, lnu, qnr, bla, and erm(B) genes, respectively. In contrast to the toxinotypes C and E, toxinotype A prevailed (54%) among our isolates. Additionally, we found that the genes for C. perfringens enterotoxin (cpe) and C. perfringens beta2 toxin (cpb2) were distributed among the tested isolates with high prevalence rates (70 and 64%, respectively). Our findings confirmed that the C. perfringens foodborne crisis has been worsened by the evolution of MDR strains, which became the prominent phenotypes. Furthermore, we were not able to obtain a fixed association between the toxinotypes and antimicrobial resistance patterns.
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Affiliation(s)
- Mahmoud M. Bendary
- Department of Microbiology and Immunology, Faculty of Pharmacy, Port Said University, Port Said 42511, Egypt; or
| | - Marwa I. Abd El-Hamid
- Department of Microbiology, Faculty of Veterinary Medicine, Zagazig University, Zagazig 44511, Egypt; or
| | - Reham M. El-Tarabili
- Department of Bacteriology, Immunology and Mycology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia 41522, Egypt; or
| | - Ahmed A. Hefny
- Veterinary Hospital, Faculty of Veterinary Medicine, Zagazig University, Zagazig 44511, Egypt;
| | - Reem M. Algendy
- Milk Hygiene Food Control Department, Faculty of Veterinary Medicine, Zagazig University, Zagazig 44511, Egypt;
| | | | - Mohammed M. Ghoneim
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Ad Diriyah 13713, Saudi Arabia;
| | - Mohammad M. Al-Sanea
- Pharmaceutical Chemistry Department, College of Pharmacy, Jouf University, Sakaka 72341, Saudi Arabia
| | - Mohammed H. Nahari
- Department of Clinical Laboratory Sciences, Najran University, Najran 66216, Saudi Arabia;
| | - Walaa H. Moustafa
- Microbiology and Immunology Department, Faculty of Pharmacy, Helwan University, Cairo 19448, Egypt;
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Mellou K, Kyritsi M, Chrysostomou A, Sideroglou T, Georgakopoulou T, Hadjichristodoulou C. Clostridium perfringens Foodborne Outbreak during an Athletic Event in Northern Greece, June 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203967. [PMID: 31627449 PMCID: PMC6843328 DOI: 10.3390/ijerph16203967] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 01/02/2023]
Abstract
Background: Food safety is a major public health consideration during athletic events. On 27 June 2019, the Hellenic National Public Health Organization was notified of a cluster of gastroenteritis cases among athletes of four of the 47 teams participating at the Panhellenic Handball Championship for children. Methods: A retrospective cohort study among the members of the four teams was performed. The local public health authority visited the restaurants where common meals took place, amassed information on the preparation of meals, and collected samples of leftovers. Stool samples were tested for Salmonella spp. and Shigella spp. Results: Consumption of minced beef had a statistically significant association with disease occurrence [RR:8.29 (95%CI 1,31-52,7)]. Samples of meat were found positive for Clostridium perfringens. It was documented that the meat was not stored and re-heated as indicated. Stool samples were negative for Salmonella spp. and Shigella spp. and were not tested for the Clostridium perfringens toxin. Conclusion: Specific standards should be kept to prevent outbreaks during athletic events. This was the first time that a foodborne outbreak due to Clostridium perfringens was investigated in the country. Laboratory investigation for toxins should be enhanced, especially in foodborne outbreaks where clinical manifestations of cases are found to be compatible with infection caused by a toxin.
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Affiliation(s)
- Kassiani Mellou
- National Public Health Organisation (EODY), 15123 Athens, Greece.
| | - Maria Kyritsi
- Regional Public Health Laboratory (PEDY) of Thessaly, 41221 Thessaly, Greece.
- Department of Hygiene and Epidemiology, Medical School, University of Thessaly, 41500 Larissa, Greece.
| | | | | | | | - Christos Hadjichristodoulou
- Regional Public Health Laboratory (PEDY) of Thessaly, 41221 Thessaly, Greece.
- Department of Hygiene and Epidemiology, Medical School, University of Thessaly, 41500 Larissa, Greece.
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