1. What is this study about?

This manuscript describes a foodborne disease outbreak that took place in the City of Cape Town Metropolitan District, the investigation that occurred, and the public health response that was instituted to control the outbreak. The outbreak was linked to a particular restaurant in Cape Town. 

2. Why does this matter?

Globally, 600 million people fall ill and 420 000 people die every year after eating contaminated food. Low- and middle-income countries are particularly vulnerable, with 137 000 people dying in Africa every year. The increase in foodborne illnesses/poisonings in South Africa in 2024 is evidence of this, with a national disaster being declared to address these incidents. Restaurants, tuck shops, and fast food establishments can be a source of foodborne illnesses. Foodborne illness outbreaks are underreported and generally not well investigated (no source identified, no food samples collected, etc.) and documented.  

3. How did the surveillance come about?

The National Institute for Communicable Diseases (NICD) operates a hotline that clinicians can use to seek advice or report matters of public health concern. A clinician contacted the NICD to report that he had seen several patients with gastroenteritis on the same day, all of whom had consumed food at the same restaurant. The NICD informed the Communicable Disease Control unit of the Western Cape Department of Health and Wellness, and a public health response was instituted.

4. What was your role in the study?

As an epidemiologist, I was part of a team that collated and analysed the epidemiological data collected by the environmental health practitioners using the case investigation forms. We also collated all the investigation findings (epidemiological, clinical, and environmental) to guide the investigation and determine if the control measures implemented were successful in controlling the outbreak. The Communicable Disease Control unit felt it was important to document this well-investigated foodborne disease outbreak, and I was responsible for writing the article to elaborate on the lessons learnt and to develop clear recommendations for improving multi-sectoral and interdisciplinary activities during such investigations. 

5. Why should people read this article?

This article uses the 7-1-7 principle to assess the timeliness of the response to the outbreak. The public health actions that were instituted to control the outbreak are described, and lessons can be learnt for future foodborne disease outbreak investigations. 

6. What impact do you hope this surveillance will have on public health policy and access to healthcare?

My hope is that we continue the discussion on the risk and importance of foodborne diseases and how they can be prevented. We also need national Shigella guidelines to guide outbreaks caused by Shigella. It is important for individuals with a foodborne disease to access healthcare for proper clinical management and that specimens are collected. Clinical specimens are needed to identify the causative organism and to enable the implementation of appropriate public health measures. This requires co-ordinated action by multiple stakeholders, including provincial and district Communicable Disease Control co-ordinators and municipal environmental health practitioners, whose roles are critical to an effective response.

Ms Janine Bezuidenhoudt is a Provincial Field Epidemiologist in the Western Cape Province and the National Institute for Communicable Diseases.

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