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An outbreak of staphylococcal food poisoning among 364 charter-flight passengers and crew members is described. Symptoms appeared just before landing, about an hour after a meal containing contaminated ham had been served. 143 passengers were admitted to hospital. 1 patient developed acute anuria and 1 had hemiplegia and aphasia; both recovered. Fever and bloody stools were recorded with unusual frequency.
An outbreak of staphylococcal food poisoning in Europe caused by contaminated lasagne was detected and monitored by both national and international surveillance systems. The common source was a pasta-producing factory in Italy and high levels of Staphylococcus aureus were detected in packets of dried lasagne distributed in Luxembourg, the UK, France and Italy. Forty-seven cases were reported in the UK. Outbreaks of staphylococcal food poisoning attributed to mishandling during the food processing stage are uncommon and pasta as the food vehicle is rare. Prompt recognition of the outbreak and rapid identification of the food vehicle enabled most of the consignment to be withdrawn from the market.
Cheese made from sheep milk was implicated in food-poisoning incidents in December 1984 and January 1985. Bacteriological examination of batches of cheese failed to reveal a viable pathogen but enterotoxin A produced by Staphylococcus aureus was present. This was the first time that enterotoxin was detected in a food produced in the UK which was associated with poisoning and from which viable Staph. aureus could not be isolated. Subsequent detailed examination of milk, yoghurt and cheese from the same producer revealed that contamination with Staph. aureus was associated with post-infection carriage as well as clinical illness in ewes on the farm. Strains producing enterotoxon. A were still intermittently present in the bulk milk used for cheese production nearly 2 years afterwards, apparently in the absence of clinical illness in the sheep. The possible effects of heat treatment are discussed. Any changes in legislation should cover all non-human mammalian milk used for human consumption.
On Feb. 3, 1975, 196 (57%) of 344 passengers and 1 steward aboard a commercial aircraft contracted a gastrointestinal illness characterised by nausea, vomiting, abdominal cramps, and diarrhoea; 142 passengers and the steward were admitted to hospital. Symptoms developed shortly after a ham and omelette breakfast had been served. An investigation strongly incriminated ham as the vehicle of the outbreak, and the source seems to have been a cook with lesions on his fingers. The attack-rate was 86% for passengers who ate the ham handled by this cook and 0% for passengers who ate ham handled exclusively by another food preparer. Before being served, the ham and omelette had been held at room temperature for 14 h and at 10 degrees C (50 degrees F) for 14 1/2 h Specimens of stool and vomitus from ill passengers, left-over food, and the finger lesions of the cook were positive for Staphylococcus aureus of identical phage types and antibiotic sensitivities. Preformed enterotoxin was detected in the left-over ham and omelette. This outbreak re-emphasises that people with infected lesion should not handle food and that foods must be stored at temperatures low enough to inhibit the growth of bacteria. To ensure against a common foodborne illness incapacitating the entire flight crew, cockpit crew members should eat different meals prepared by different cooks.
Staphylococcus aureus strains isolated from the 391 confirmed cases of staphylococcal food poisonings in Tokyo, in the period 1967-1986, were studied for their coagulase types. Consequently, it was found that all the isolates could be classified into the coagulase types II, III, VI and VII. Namely, the isolates from 54 (13.8%) of 391 outbreaks were typed as type II, 72 (18.4%) as type III, 38 (9.7%) as type VI, and 227 (58.1%) as type VII, respectively. Throughout the investigation, it was found that the outbreaks of staphylococcal food poisonings due to coagulase type VII organisms were remarkably increased since 1975.
From February through April 1989, four outbreaks of staphylococcal food poisoning in the United States were associated with eating mushrooms canned in the People's Republic of China (PRC). In the four outbreaks, 99 persons who ate at a suspect facility developed gastrointestinal symptoms within 24 h, including 18 who were hospitalized. Illness was associated with eating mushrooms at a university cafeteria (relative risk [RR] = 53.0), a hospital cafeteria (RR = 13.8), a pizzeria (odds ratio [OR] = infinity), and a restaurant (OR = infinity) (all P < .0001). Staphylococcal enterotoxin A was found by ELISA in mushrooms at the sites of two outbreaks and in unopened cans from the three plants thought to have produced mushrooms implicated in outbreaks. These investigations led to multistate recalls and a US Food and Drug Administration order to restrict entry into the United States of all mushrooms produced in the PRC; until this action, the United States imported approximately 50 million pounds yearly.
An outbreak of gastroenteritis in a school district in the United States was determined to be staphylococcal food poisoning due to 2% chocolate milk containing staphylococcal enterotoxin A (SEA). Twelve one-half pint (approx 0.28 l) cartons of the 2% chocolate milk from this outbreak were analyzed for the quantity of SEA present in the milk. The amount of SEA in the cartons varied from 94 to 184 ng with the average being 144 ng (mean = 139 +/- 45). The attack rate for vomiting among those who consumed more than one carton was greater (38.3%) than among those who consumed only one carton (31.5%) with the highest attack rate among those who consumed three or more cartons (44.4%).
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Between 1969 and 1990 strains of Staphylococcus aureus from 359 outbreaks and sporadic cases of staphylococcal food poisoning in the United Kingdom were examined in the PHLS Food Hygiene Laboratory for the production of enterotoxin. In a number of instances the incriminated foods were also examined for the presence of enterotoxin. Strains from 79% of incidents produced enterotoxin A alone or together with another enterotoxin. The level of S. aureus present in the foods ranged from no viable S. aureus detected to 1.5 x 10(10) c.f.u./g with a median of 3.0 x 10(7) c.f.u./g. Enterotoxin was detected in foods in the absence of viable S. aureus in only two outbreaks and in both cheese was the implicated food. Meat, poultry or their products were the vehicle in 75% of incidents with ham and chicken most frequently implicated. Other foods included fish and shellfish (7%) and milk and milk products (8%). Most contamination took place in the home followed by restaurants and shops. Seventy-one percent of the incident strains were lysed by phages of group III or I/III.
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Two methods are described for the extraction of enterotoxin from foods incriminated in incidents of staphylococcal food poisoning. Enterotoxin was detected serologically in 12 of 24 food samples from 20 separate incidents: eight samples contained enterotoxin A, three contained D and one both A and B. The amount of enterotoxin in nine foods, based on 100% recovery, varied from 0.02 to 0.09 mug./g.Data are also given on the numbers of Staphylococcus aureus isolated from samples of food from 39 food poisoning incidents. Colony counts varied between 7.5 x 10(5) and 9 x 10(9)/g. with a median value of 7 x 10(7)/g.
Staphylococcal contamination of intact, hard-boiled eggs resulted in the food poisoning of an estimated 300 children out of 850 who had participated in an Easter egg hunt. Enterotoxigenic staphylococci that were isolated from the Easter eggs matched that obtained from an infected cook who prepared the eggs three to five days before the hunt and which he left unrefrigerated. Experimental studies demonstrated that heated eggs can absorb 2 mL of contaminated cool water through intact eggshells. When water was inoculated with pathogenic staphylococci at even low contamination levels, rapid growth and enterotoxin production within cooked eggs could be easily duplicated. This is the first large outbreak of its type; safeguards can and should be employed to prevent future ones.
Two waves of vomiting and/or diarrhoea affected approximately 215 of the 715 passengers on a Caribbean cruise ship. The outbreak was independently associated with eating cream-filled pastries at two separate meals. Staphylococcus aureus phage type 85/+ was isolated from cases and pastry cooks, but not from controls. This is the first well-documented outbreak of staphylococcal food poisoning on a cruise ship.
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The trend in many communities toward centralized school lunch preparation potentially increases the risk of foodborne illness. Foods often are prepared long before serving and may be distributed to satellite schools by persons with little formal training in safe techniques of food preparation or food service. In May 1990, an outbreak of staphylococcal food poisoning occurred in elementary schools in a Rhode Island community participating in such a program. In the investigation of the outbreak, students in schools that reported cases were interviewed. Food preparation, handling, and distribution were reviewed. At School E, 662 lunches were prepared and distributed to 4 additional schools (schools A-D). Schools A and B accounted for nearly all cases of the food poisoning, with rates of 47 percent and 18 percent. Eating ham increased the risk of illness (62 percent of those consuming ham and 3 percent of those who did not, relative risk = 18.0, 95 percent confidence interval = 4.0, 313.4). Large amounts of Staphylococcus aureus were cultured, and preformed enterotoxin A was identified in leftover ham. A food handler, who tested positive for the implicated enterotoxic strain S. aureus, reported having removed the casings from two of nine warm ham rolls 48 hours prior to service. Because of improper refrigeration, prolonged handling, and inadequate reheating, the ham was held at temperatures estimated at 10-49 degrees Celsius (50-120 degrees Fahrenheit) for a minimum of 15 hours. The potential for larger outbreaks prompted a statewide training program in safe food preparation for school lunch personnel, which may have applications for other communities.