Upload
abel
View
71
Download
6
Tags:
Embed Size (px)
DESCRIPTION
Scombroid Food Poisoning in Frozen seafood factory, Samutprakarn Province, 21– 25 July 2007. Nalinee Hongchumpon, DVM. 1 st year FETP trainee. Introduction to Scombroid (Histamine) poisoning. Consumption foods that contain high level of histamine and other vasoactive amines and compounds - PowerPoint PPT Presentation
Citation preview
1
Scombroid Food Poisoning in Frozen seafood factory,Samutprakarn Province, 21– 25 July 2007Nalinee Hongchumpon, DVM.
1st year FETP trainee
2
Introduction to Scombroid (Histamine) poisoning Consumption foods that contain high level of
histamine and other vasoactive amines and compounds
Eating spoiled fish of families Scombridae and Scomberesocidae
Tuna Mackerel Sardine
Histamine formed by histidine decarboxylating enzyme
Histidine decarboxylase producing bacteria : Proteus morganii Enterobactor aerogenes
3
Skipjack tuna
Yellowfin tuna
4
Mackerel Sardine
5
Introduction to Scombroid (Histamine) poisoning
Symptoms very rapidly : burning sensation in the mouth, rash on upper body, drop in blood pressure, nausea, vomiting and diarrhea
Incubation period : 30 minutes after consumption (long last several days)
Histamine level (US FDA) : Flesh fish ≤ 100 ppm. Hazardous level ≥ 200 ppm
6
Background
BoE received report from Samutprakarn provincial health office on 24th July 2007
Food poisoning outbreak among employees in frozen seafood factory in Samutprakarn province on 21st July 2007
BoE sent investigation team during 24th – 25th July 2007
7
Objective
To confirm diagnosis and outbreak To define etiologic agent and cause of
the outbreak To implement control and prevention
measure
8
Methodology Descriptive study
Interviewed the patients who had been admitted in the hospitals
Interviewed staffs who worked in the frozen seafood factory
Active case finding Analytic study
Case – control study case : control = 1:2
Structured questionnaires were used for collecting data
9
Methodology Environmental survey
Interviewed food handler about process of cooking each lunch menu
Collected frozen tuna and fried fermented tuna the same lot as the patients ate on 21st July 2007, frozen mackerel and water samples for laboratory testing
Survey factory product line
10
Case definition A case was defined as an employee who worked
in the Frozen Seafood Factory S on 21st July 2007 and had symptoms as the criteria:
Criteria: Two major criteria or one major criterion plus two minor criteria Major criteria: diarrhea, nausea, vomiting,
flushing, abdominal cramp, mouth numbness, extremities numbness, dry mouth, rash, itchy and swelling
Minor criteria: headache, diplopia, fever and fatigue
Total number of cases: 89 persons
11
Control definition Any persons who worked in the frozen
seafood factory on 21st July 2007 and did not has the symptoms meeting the criteria as case
Selected by systemic random sampling: Every 4 persons by the listed name and skipped the person who was defined as case
Total number of control : 176 persons
12
Statistical analysis
Type of data Categorical data : percentage of
symptoms, each kind of food Continuous data : Median for age
Software Epi-data: To collect data Stata: to analyze data
13
Results
14
Descriptive part
Seafood factory located at Muang district, Samutprakarn province
100% seafood production export 1,084 employees in 4 different section All employees have lunch at cafeteria
15
Attack rate by section Sectio
nNo. of cases
No. of employees
Attack rate(%)
Fish 41 430 9.5
Shrimp
21 222 9.5
Squid
23 178 12.9
Back office
4 224 1.8
16
Attack rate by food itemsFood items
No. of cases
No. of eating
Attack rate(%)
Fermented tuna
88 193 45.6
Papaya salad
17 67 25.4
Gang Tai-pla
16 66 24.2
Gang kua 10 37 27.0
Bamboo soup
31 118 26.3
Fried kana 22 89 24.7
Fried bean 14 40 35.0
Plain rice 76 216 35.2
Fried rice 3 14 21.4
Drinking water
85 245 34.7
17
Number of patients by time of onset, seafood factory,
Samutprakarn province, 21st July 2007
0
5
10
15
20
25
30
Onset time(hrs/mins)
Number of patients
Median ICP 120 Minutes (IQR 60 – 180 minutes)
First groupof having lunch
18
Percentage of each symptoms (n=89)
24.7
25.8
27.0
37.1
46.1
53.9
58.4
59.6
59.6
71.9
0 10 20 30 40 50 60 70 80 90 100
rash
vomiting
mouth numbness
flushing
abd cramp
diarrhea
nausea
fatique
dry mouth
headache
19
Analytic part
20
Univariated Analysis
Risk factor
s
Case Control
OR95%C
IExpNon-exp
ExpNon-exp
Fermented tuna
88 1 105 71 59.59.8-
2409.1
Papaya salad 17 72 50 126 0.6 0.3-1.1
Gang Tai-pla
16 73 50 126 0.6 0.3-1.1
Gang kua
10 79 27 149 0.7 0.3-1.6
Bamboo soup
31 58 87 89 0.6 0.3-1.0
Fried kana
22 67 67 109 0.5 0.3-1.0
Fried bean
14 75 26 150 1.1 0.5-2.3
Plain rice
76 13 140 49 1.5 0.7-3.3
Fried rice
3 86 11 165 0.5 0.1-2.1
Drinking water
85 4 160 16 2.1 0.7-9.0
21
Dose-responsePieces Case Control OR 95%CI
0 1 71 1.0 -
< 2 24 50 34.15.1-
1420.4
2 -3 28 36 55.28.2-
2288.4
≥ 4 36 19 134.519.2-
5531.2Chi – square for trend = 59.1 p – value < 0.00001
22
Environmental survey
23
Environment & Producing line Divided into 4 sections >>> fish, shrimp,
squid and back office Employees have to take a bath and
changed working suit before entering each section
24
Kitchen & Cafeteria Kitchen and Cafeteria were in the same
building but separated in each part Food handler bought and cooked lunch
day by day
25
Fermented Tuna cooked Frozen tuna fermented with ingredient Left in room temperature for a few day Fried before serving as lunch
Water supply Drinking water Producing line
26
Frozen tuna Fried fermented tuna
27
Laboratory result
Specimens Histamine
level (ppm.)Bacterial culture
Fresh Tuna 3.92 Bacillus cereus Fried Fermented Tuna
446.18 Not found Enteropathogenic
Bacteria
28
Discussion
Scombroid food poisoning outbreak Previous case in Thailand Reported case in other country Histamine level, Fish family, Time,
Temperature, Bacteria Association between case and risk
factor
29
Limitations
Most of patients got mild symptoms look like food allergy
Self recovery in 8-12 hours Misclassifications No reference laboratory to determine
histamine level in human
30
Recommendations Keep raw flesh fish ≤ 4 ํC prevents bacterial
growth and formation of histidine decarboxylase enzyme
Frozen fish should not be exposed to temperature above 4 ํC for more than 12 hours
Histamine concentration periodically determined In case of other food allergy, Physicains have to
ask about history of eating seafood and the relations of patient group – eat from the same restuarant –
31
Conclusions Scombroid food poisoning had
occurred in seafood factory Employees were eating fried
fermented tuna which contain high level of histamine at lunch time 21st July 2007
Common source outbreak
32
Acknowledgement Seafood factory Samutprakarn provincial health office District and Sub district health office Samutprakarn Hospital Puttharaksa health center Department of Fisheries Department of Medical Science