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BACKGROUND: In 2013, the Pennsylvania Department of Health was notified of 14 persons experiencing gastroenteritis, six of whom visited a single emergency department; all attended the same annual community luncheon the day before.
METHODS: Attendees were interviewed regarding food item consumption and subsequent gastroenteritis. Luncheon staff described food preparation techniques. Ill persons’ stools were cultured for routine bacterial pathogens by clinical laboratories. Leftover food samples were collected for pathogen and toxin testing at the state public health laboratory. Data were managed/analyzed using EpiInfo 7.1.
RESULTS: The luncheon was held from 10am-2pm, with take-out meals available. Entrees (sliced ham, beef barbeque, hot dogs), sides (stuffing, mashed potatoes and gravy, green beans, ham and bean soup), and desserts (five pie and nine homemade ice cream flavors) were served. This group held <3 events annually and were not subject to PA Department of Agriculture food sanitarian oversight. Food handling description indicated likely time-temperature abuse: 7 pre-cooked hams were previously frozen for approximately one year, counter-thawed at room temperature overnight, reheated, sliced, refrigerated, reheated, and served. Homemade ice cream was made with fresh eggs cooked into custard prior to flavoring/freezing. Eighty-nine of ~200 luncheon attendees were interviewed. Twenty-seven (30%) outbreak-associated cases consumed luncheon food and subsequently reported at least one of: nausea, vomiting, diarrhea, or abdominal cramps. One case was hospitalized and recovered; none died. Twenty (74%) reported illness onset the day/evening of the event. Four food items were epidemiologically associated with illness: sliced ham (RR: ∞, 95% CI: undefined), coconut cream pie (RR: 3.7, 95% CI: (2.6-5.2)), peach pie (RR: 4.3, 95% CI: (2.9-6.5)), and black walnut ice cream (RR: 2.0, 95% CI: (1.1-4.0)). Two bacterial pathogens and their associated toxins were identified: Staphylococcus aureus and S. aureus enterotoxins A and B (sliced ham), and Bacillus cereus and B. cereus enterotoxin (stuffing, raspberry, black walnut and peanut butter ice creams). Four stool samples tested negative for routine enteric pathogens, but were not tested for Staphylococcus aureus or Bacillus cereus.
CONCLUSIONS: This summary describes an outbreak of gastroenteritis associated with a non-regulated community luncheon with a relatively high attack rate of 30%. Multiple food safety issues were identified. Epidemiologic and laboratory evidence support contamination with S. aureus and B. cereus, however because patient stool specimens were not tested for these pathogens, this cannot be definitively determined. Proper food handling, including avoidance of time-temperature abuse can help to reduce the risk of foodborne illness.