Gazezova Saya, Nabirova Dilyara, Waltenburg Michelle, Rakhimzhanova Maral, Smagul Manar, Kasabekova Lena, Horth Roberta
Central Asia Field Epidemiology Training Program, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan.
Scientific and Practical Center for Sanitary and Epidemiological Expertise and Monitoring, Almaty, Kazakhstan.
BMC Infect Dis. 2024 Dec 25;24(1):1464. doi: 10.1186/s12879-024-10382-4.
From June 13-16, 2022, a regional epidemiological department in Kazakhstan reported an increase in acute gastroenteritis cases among people who consumed food from a wedding at a restaurant. An investigation was initiated to determine factors associated with acute intestinal infection and prevent further illness.
The investigation team conducted a retrospective cohort study among people who consumed event food. Participants were classified as a case if they were acutely ill with diarrhea, vomiting, fever, vomiting, or weakness from June 13-18. We interviewed people to collect information on demographics, symptoms, and food exposures at the event. We calculated food-specific attack rates and estimated adjusted relative risks (aRR) using multivariable Poisson regression, which was adjusted for sex, age, and foods consumed. Patient stool and gastric lavage samples, leftover food, and restaurant environmental samples were collected for bacterial culture and chemical analysis.
Of the 138 participants, 66 became ill; the attack rate was 48%. The most reported symptoms were diarrhea (92%), abdominal pain (91%), and fever (89%). Symptom onset occurred between 6 h and 4 days after the event (median = 1 day). Overall, 50 (76%) cases were hospitalized; no deaths were reported. In bivariable analysis, a greater proportion of cases than non-cases ate honey cake (89% vs. 13%, p < 0.01), and 45% of cases ate leftovers compared with 11% of non-cases (p < 0.01). In multivariable analysis, honey cake was the only risk factor associated with illness (aRR = 7.8, 95% confidence interval = 3.5-20.1, p < 0.01). Honey cakes, which use raw eggs in cream layers, had been stored at room temperature for three days before the event. Salmonella enterica serovar Enteriditis (S. Enteritidis) was isolated from all patient stool samples (49/49, 100%) and honey cake samples (2/2, 100%). Staphylococcus aureus was detected in 92% (35/38) of patient gastric lavage samples.
S. Enteritidis was this outbreak's most probable etiological agent based on clinical manifestations and isolation from participant and honey cake samples. The improper storage of cakes containing raw eggs was a key contributing factor. Leftover event food was discarded, and the restaurant was closed for disinfection. Future outbreaks could be prevented by increased food safety awareness.
2022年6月13日至16日，哈萨克斯坦一个地区的流行病学部门报告称，在一家餐厅食用婚宴食物的人群中，急性肠胃炎病例有所增加。于是展开了一项调查，以确定与急性肠道感染相关的因素，并预防进一步的疾病发生。
调查团队对食用了活动食物的人群进行了一项回顾性队列研究。如果参与者在6月13日至18日期间出现腹泻、呕吐、发烧、呕吐或虚弱等急性疾病症状，则被归类为病例。我们对这些人进行了访谈，以收集有关人口统计学、症状以及活动中食物暴露情况的信息。我们计算了特定食物的发病率，并使用多变量泊松回归估计调整后的相对风险（aRR），该回归对性别、年龄和食用的食物进行了调整。收集了患者的粪便和洗胃样本、剩余食物以及餐厅环境样本，用于细菌培养和化学分析。
在138名参与者中，66人患病；发病率为48%。报告最多的症状是腹泻（92%）、腹痛（91%）和发烧（89%）。症状在活动后6小时至4天内出现（中位数 = 1天）。总体而言，50例（76%）病例住院治疗；未报告死亡病例。在单变量分析中，食用蜂蜜蛋糕的病例比例高于非病例（89%对13%，p < 0.01），45%的病例食用了剩菜，而非病例为11%（p < 0.01）。在多变量分析中，蜂蜜蛋糕是唯一与疾病相关的风险因素（aRR = 7.8，95%置信区间 = 3.5 - 20.1，p < 0.01）。在奶油层中使用生鸡蛋的蜂蜜蛋糕在活动前已在室温下储存了三天。从所有患者粪便样本（49/49，100%）和蜂蜜蛋糕样本（2/2，100%）中均分离出肠炎沙门氏菌肠炎血清型（肠炎沙门氏菌）。在92%（35/38）的患者洗胃样本中检测到金黄色葡萄球菌。
根据临床表现以及从参与者和蜂蜜蛋糕样本中分离出病原体，肠炎沙门氏菌是此次疫情最可能的病原体。含有生鸡蛋的蛋糕储存不当是一个关键因素。活动剩余食物被丢弃，餐厅关闭进行消毒。提高食品安全意识可预防未来的疫情爆发。
