All restaurants must prioritise food safety and good hygiene practices, including training new staff and regularly retraining existing staff in appropriate food handling processes to prevent foodborne diseases. This is one of the key recommendations from a study published this week in the Public Health Bulletin South Africa (PHBSA).

The study, which investigated a foodborne disease outbreak linked to a Cape Town restaurant in February 2024, highlights the significant public health threat posed by foodborne diseases (FBDs). Globally, FBDs are responsible for an estimated 420,000 deaths each year and the loss of 33 million healthy lives.

In South Africa, FBD outbreaks are classified as Category 1 Notifiable Medical Conditions (NMCs) and must be investigated to determine the cause and implement corrective measures to reduce illness and prevent further cases.

The PHBSA report outlines the investigation and response following the notification of a suspected FBD outbreak at a Cape Town restaurant. A total of 46 suspected cases was identified – 12 staff members and 34 patrons. Clinical specimens (stool or rectal swabs) were collected from 49 individuals, of which 33 tested positive for Shigella spp. or enteroinvasive Escherichia coli (EIEC), including six patrons and 27 staff. Shigella spp. and EIEC are closely related bacteria that cause gastroenteritis (stomach flu) in humans.

Environmental health inspections revealed issues including overstocking of cold storage and non-compliance with the “first-in, first-out” principle. While a definitive source of contamination could not be identified, contaminated food or a food handler was likely responsible. The outbreak was attributed to Shigella spp. or EIEC.

Lead investigator Ms Janine Bezuidenhoudt stressed the importance of the study given the limited reporting and investigation of foodborne illnesses. “Globally, 600 million people fall ill and 420 000 die every year after consuming contaminated food. Low- and middle-income countries are particularly vulnerable, with 137 000 people dying annually in Africa. The rise in foodborne illnesses and poisonings in South Africa in 2024 has led to the declaration of a national disaster. Restaurants, tuck shops, and fast-food establishments can all be sources of these illnesses,” she said.

“I hope this study continues the conversation about the risk and importance of foodborne diseases and how they can be prevented. We urgently need national Shigella guidelines to guide outbreak responses. It is also crucial for individuals with foodborne illness to seek healthcare for proper diagnosis and treatment, including specimen collection,” she added.

A review of FBD outbreaks reported on the NMC system shows that for the period 2022-2024, there were about 437 notifications of foodborne disease outbreaks that came through the NMC system. However, underreporting remains a concern, as many affected individuals do not seek medical care.

The public is reminded to practise good food hygiene by:

• Washing hands before handling food and after using the bathroom.
• Regularly cleaning surfaces and utensils to prevent cross-contamination.
• Separating raw and cooked foods.
• Cooking food to an internal temperature of at least 75 °C.

This article is part of PHBSA, an initiative of the National Institute for Communicable Diseases and the National Institute for Occupational Health, which provides timely, actionable disease surveillance information for South Africa and the broader Southern African Development Community (SADC).

Read the full article here.

Read the full media statement here.