Foodborne Disease outbreak associated with eating at a Wedding - Palghar District, Maharashtra, India, 2018.

BACKGROUND

A foodborne disease outbreak among wedding attendees from Makunsar village, Palghar district, Maharashtra state, India, was reported on February 18, 2018.

OBJECTIVES

The outbreak investigation was conducted to find out the epidemiology of the outbreak and to identify the etiologic agent and risk factors.

METHODS

A case-control study was carried out, where cases (patients), controls, and food handlers were interviewed and leftover foods were collected for culture. A case was defined as a person having vomiting or diarrhea (i.e., ≥3 loose stools within 24 h) who attended the wedding ceremony at Makunsar village, Palghar district, Maharashtra, on February 18, 2018. Attack rate and odds ratio (OR) were calculated with 95% confidence intervals (CIs).

RESULTS

Out of 75 cases, 63% were female. Altogether, forty-two (56%) cases were hospitalized, and later on, all of them were discharged from hospital without any mortality. About 93%, 68%, 43%, and 41% of the cases reported with vomiting, nausea, abdominal pain, and diarrhea, respectively. The median incubation period was found to be 4 h (range: 2-8 h). Eating gaajar halwa (carrot pudding) was significantly associated with illness (OR: 12.8; 95% CI: 3.5-46). Gaajar halwa is prepared with khoa, a perishable milk product. The gaajar halwa culture yielded no growth.

CONCLUSION

The case-patients' clinical presentation and incubation period were consistent with enterotoxin-producing Staphylococcus aureus as the probable etiologic agent. The epidemiologic investigation identified the probable etiologic agent and food source in a low-resource community setting. Community food handlers were educated on food preparation hygiene and safe storage measures to prevent future outbreaks.