Outbreak of Bacillus cereus food-poisoning with a fatality after a feast—Bagli Village, Bursa Province, Turkey, September 2012

Author (s): 

Orhun Kalkan, M. Gulay, B.-P. Zhu, F. Temel, M. B. Sucakli, M.A. Torunoglu

Background: On 11 September 2012, residents of Bagli Village in northwestern Turkey reported a diarrheal disease outbreak, including one death. We investigated to identify the cause and mode of transmission, and to implement control measures. Methods: A probable case was onset of diarrhea (≥3 episodes/day) plus ≥1 of the following symptoms during 9-12 September: nausea, vomiting, self-reported fever, abdominal pain. We reviewed medical records in the village’s two hospitals for case-finding. In a case-control investigation, we compared exposures of case-patients with control-patients randomly selected among asymptomatic village residents, frequency-matched to case-patients by age group. We used the horizontal method for enumerating bacteria in food samples for pathogen identification. Results: Of 26 case-patients identified, 23 (including one child that died) were residents of the village (attack rate: 5.5%). The main symptoms included diarrhea (100%), self-reported fever (87%), nausea (83%), abdominal pain (83%), and vomiting (48%). A village-wide feast occurred on Sunday, 9 September; only one course (mixed rice and chicken) was served. Leftover food stayed at room temperature (range: 13.8-29.5C) overnight and was distributed to village residents on Monday. The epidemic curve showed a small peak after Sunday’s meal, followed by a large peak following Monday’s meal. Half (50%) of case-patients vs. 20% of control-persons consumed Sunday’s meals (ORmatched=5.4, 95% CI: 2.0-15); 82% of case-patients vs. 2% of control-persons consumed Monday’s leftover food (ORmatched=176, 95% CI: 31-1689). B. cereus was identified in the leftover food in high concentration (3.3×108 bacteria/g). Autopsy showed multi-organ congestion suggesting sepsis as the cause for child’s death. Conclusions: This B. cereus outbreak was likely due to consumption of contaminated food stored at room temperature. Village residents were educated on safe food preparation and preservation practices. Key words: Bacillus cereus, outbreak, foodborne, case-control. Word count: 275

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