How did a Cape Town restaurant become the source of a foodborne disease outbreak in February 2024?
Foodborne diseases (FBD) are illnesses caused by eating contaminated food. The World Health Organisation (WHO) estimates that globally, one in ten people, about 600 million individuals, fall ill from FBD every year, with 420,000 deaths. Low and middle-income countries are especially vulnerable. In the African region, an estimated 91 million people suffer from FBD annually, with about 137,000 deaths, representing roughly a third of the global toll.
FBD can result from various hazards, including bacteria, viruses, parasites, as well as chemicals like pollutants, natural toxins, and food allergens. These hazards cause more than 200 illnesses, ranging from short-term stomach problems to chronic diseases, cancer, permanent disability, and death.
Within the retail food industry, five main risks contribute to FBD outbreaks: poor personal hygiene, incorrect food holding time and temperature, contaminated equipment, insufficient cooking, and food sourced from unsafe suppliers. Data from the Centers for Disease Control and Prevention (CDC), covering the years 2017 to 2019, indicate that 40% of FBD outbreaks involve at least one factor linked to food contaminated by ill or infectious food workers.
In South Africa, FBD outbreaks are a category 1 notifiable medical condition, requiring healthcare workers to notify authorities within 24 hours. The case definition used for an FBD outbreak in South Africa is any food-poisoning incident involving two or more individuals linked to a common food or beverage source.
On 8 February 2024, the Western Cape Provincial Communicable Disease Control Co-ordinator was notified by the National Institute for Communicable Diseases (NICD) of a potential FBD outbreak linked to a restaurant. Around 22:00, a general practitioner reported patients presenting with severe diarrhoea and high temperatures.
The following report describes the investigation of the foodborne disease outbreak linked to a restaurant in the Western Cape, highlighting the importance of early detection and a coordinated response.
Materials and Methods
Stool specimens from seven hospitalised patients were tested at a local private laboratory using a gastrointestinal PCR panel. This test detects multiple bacterial, viral, and parasitic pathogens commonly associated with stomach illness. One specimen underwent additional microscopy, culture, and sensitivity testing.
Rectal swabs from 41 restaurant staff were collected and submitted to the NICD Centre for Enteric Diseases. These were tested with a similar PCR panel to screen for enteric pathogens.
Results
A total of 85 individuals were contacted: 51 restaurant staff members (60%) and 34 patrons (40%). Among these, 46 (54%) were symptomatic, 12 staff (24%), and all 34 patrons. Case investigation forms were completed for 28 individuals. The median age of symptomatic cases was 35 years, with most aged 30 to 39 years (27%). Fifteen patrons (44%) were hospitalised; no staff required hospitalisation. No deaths were reported.
For a more in-depth look into this thought-provoking report, download the full article below.
