Blame the kids: 20 sick at Hong Kong kindergarten

The Centre for Health Protection (CHP) of the Department of Health is investigating an outbreak of acute gastroenteritis (AGE) at a kindergarten in Tseung Kwan O, and hence reminded the public and management of institutions to maintain personal and environmental hygiene against AGE.
The outbreak involves 20 students, comprising 13 boys and seven girls aged 2 to 5, as well as two female staff members, who have developed vomiting, diarrhea and fever since November 4. Among them, seven students and one staff member sought medical attention, while one was discharged upon hospitalisation. All affected persons have been in a stable condition.

Officers of the CHP conducted a site visit and provided health advice to the staff of the school concerning proper and thorough disinfection, the disposal of vomit, and personal and environmental hygiene.

20 toddlers sickened: An emetic Bacillus cereus outbreak in a kindergarten

 Bacillus cereus is a ubiquitous spore-forming, potential foodborne pathogen that may cause two types of gastrointestinal illnesses: diarrhea and emesis.

dirty.jobs.daycare.e.coliThe emetic syndrome results from the presence of a heat-resistant toxin, called cereulide, produced by B. cereus in food products. Although both syndromes are usually mild, with patients recovering after about 24 h, an intoxication can be fatal for vulnerable individuals such as children or elderly people

In Belgium, from 2007 until 2012, two to eight foodborne outbreaks were reported on a yearly basis in which B. cereus was identified as the causative agent. During this period 8 of 26 B. cereus  outbreaks were caused by emetic B. cereus  representing 147 cases and 1 death.

In this report, we describe a foodborne outbreak affecting 20 toddlers aged between 10 and 18 months caused by the consumption of a homemade mashed rice–cucumber–chicory meal contaminated with critical levels of the B. cereus emetic toxin.

This outbreak highlights the importance of respecting good hygienic practices and strict storage conditions. An ill staff member had been involved in the preparation of the implicated food and may have contaminated the food. Unfortunately, no fecal sample from the staff member could be analyzed and thus her role could not be confirmed. It is recommended to withdraw any ill person from food preparation activities, as stated by the Codex Alimentarius.

Moreover, the temperature in the refrigerator where the food was stored had never been registered by the director of the kindergarten. The refrigerator at the kindergarten did not meet the Belgian recommendation on refrigeration temperatures, which are recommended to be between 0 and 4_ C, although it was in accordance ( <  7_ C) with the Belgian and European Legislation. Storage of foods below 10_ C prevents the growth of strains that produce emetic toxin, while refrigeration below 4_ C is necessary to prevent growth of all types of B. cereus , including psychrotrophic strains. In this case, high levels of B. cereus were present and cereulide was detected in the leftovers. It is known that cooked rice supports cereulide production at temperatures from 15_ C to 37_ C.

gastro.daycare.sep.12Therefore, inappropriate and slow cooling probably allowed the development of B. cereus  and subsequent cereulide production in the rice. After cooking, the temperature of the food should be allowed to drop to 10_ C as quickly as possible and should ideally reach 4_ C to avoid any growth of B. cereus.

Portioning the rice for storage would also have helped to achieve a more rapid drop in temperature below 10_ C in the center of the bowl in which the rice was stored.

Subsequent to this outbreak, a plan for cleaning was established at the kindergarten, and measures for temperature control of the refrigerators were taken.

Given that hazardous levels of cereulide can be reached quickly as demonstrated in this investigation, it is important to remain vigilant during food preparation and food storage to prevent illness and outbreaks caused by B. cereus .

An emetic Bacillus cereus outbreak in a kindergarten: detection and quantification of critical levels of cereulide toxin

Foodborne Pathogens and Disease. January 2015, 12(1): 84-87

Delbrassinne Laurence, Botteldoorn Nadine, Andjelkovic Mirjana, Dierick Katelijne, and Denayer Sarah

http://online.liebertpub.com/doi/abs/10.1089/fpd.2014.1788#utm_source=ETOC&utm_medium=email&utm_campaign=fpd

3 sick with salmonella in kindergarten in Italy

Three cases of salmonellosis were found in three children attending the Parish Kindergarten in the Centrol per la Famiglia of Cassinone in Seriate, Italy. They belong to the spring group, consisting of children between 2- and 3-years-old.

A boy of two-and-a-half years began showing symptoms Friday and by Sunday, had to be hospitalized.

Lab testing prompted a salmonellosis diagnosis, as in the case of two other children from the kindergarten who have been hospitalized at the Pesenti Fenaroli hospital in Alzano.

The local health department has initiated an epidemiological study. As a precaution, the kindergarten has informed families with a letter.

Is a letter really a precaution?

Thanks to our Italian food safety friend for the notification and translation.

If a child poops in the forest, will anyone catch E. coli?

An open-air nursery, or forest kindergarten, sounds sorta cool (in German, Waldkindergarten), where the kids spend their days in the woods instead of a building with walls.

But poop could be a problem.

The Secret Garden Outdoor Nursery in Fife, Scotland, which operates in a woodland setting, had been ordered to use soap and water instead of wipes if staff and children visited a farm or walked across a field containing livestock.

The Scotsman reports the nursery argued that carrying up to ten litres of water into Letham Woods where the children play and learn was impractical and that the threat of catching E coli was being exaggerated.

Last night Cathy Bache, the nursery’s founder, welcomed the victory over what she described as Health Protection Scotland’s (HPS) "very unworkable" hand-washing policy, adding,

"It’s fantastic. We can now continue to operate as a nomadic nursery on our woodland site. If we’d had hand-washing imposed on us it would have made things a lot more difficult."

The potential hygiene issue came to light in July last year after concerns about handwashing were raised at an inspection by the Care Commission which regulates Scotland’s nurseries. The nursery complied with a request to use soap and water before reverting to wipes and gels last December.

A spokesman for the Care Commission, said: "The Secret Garden will now follow a ten-step programme of measures with regard to hand hygiene. The practice and procedures should also be approved by the individual parents of all children attending.

"However, we remain clear that children at the Secret Garden should wash their hands with soap and water whenever possible to maintain good infection prevention."

That’s because sanitizers do not work in the presence of organic material – dirt in a forest – and are ineffective against a number of viruses.