Food Poisoning among Zonal Games Participants, Kadoma, Zimbabwe, 2015 T. P. Juru, D. Chirundu, N.T Gombe, R. Chikodzore ZiMA CONFERENCE August 2015

Introduction Foodborne illness is caused by eating contaminated food (WHO,2014). Improper handling, preparation and food storage. Microorganisms such Salmonellae spp, E. Coli. are causative agents At risk populations include: –Young, old, immuno suppressed

Introduction Students and teachers camped for sporting competition. Gastrointestinal illness was reported among participants. Admissions at Kadoma General Hospital –More than 30 cases by 27/02/15

Specific Objectives Describe the outbreak in terms of person, place and time. Establish signs and symptoms Identify the source of infection Identify the possible causative agent. Audit Kadoma City Health’s response

Materials and Methods Study Type: –Retrospective Cohort Study Study Setting: –Kadoma City,Zimbabwe Study Population: –Participants who attended camp (N=90) – Those who had shared food(n=7) Data Collection: – Interviewer administered questionnaires –Checklists –Swabbing

Materials and Methods Data Capture and Processing: –Epi Info 7 TM used - Generated frequencies, means, proportions –Google Earth for Spot map –Food Pathogen Advisor Software Permission and Ethical considerations –Kadoma City Health Department –Ministry of Education –Health Studies Office Written Informed consent obtained Confidentiality maintained

RESULTS

Demographic Characteristics of Respondents, Kadoma, 2015

Age of Respondents, Food Poisoning, Kadoma,2015

Description of the Outbreak by Person –Of the Respondents 76 fell ill Female 35( 46%) Male 41(54) –Attack rate Teachers was 68.4% Students was 85.3% (p>0.03) Female students 93% Male students 79%

Clinical Presentation of Food Poisoning Cases by Sex, Kadoma City, 2015(n=76)

Spot Map of Kadoma showing the Distribution of Schools and Attack Rates

Epi Curve for Food Poisoning Cases, Kadoma, February, 2015

Foods Items associated with Illness, Kadoma, February 2015 (n=92)

Independents Factors associated with Food Poisoning among Participants, Kadoma, 2015

Measures of Impact for those who ate Marinated Chicken, Kadoma City, Zimbabwe, 2015 Food TypeMeasure of Impact Attributable Risk Percentage (%) Population Attributable Risk Population Attributable Risk Percentage (%) Marinated Chicken per

Laboratory Investigations Salmonella typhi isolated from 7/11 stool specimen No other enteric organisms were isolate d

Environmental Assessment Open shelves for non- perishable storage No hand washing facility in restaurant Hand operated bin in the kitchen Two functional toilets –One had dirty sink and toilet

City Health Preparedness and Response Preparedness – EPR plan available –City health not involved in planning gathering –Adequate oral rehydration sachets –Under stock of ciprofloxacin and metronidazole Response –Initial investigation within two hours of reporting –Coordination meeting held on the 2 nd and 5 th March 2015 –Multi-disciplinary approach – Inter sectorial collaboration –No notification from District Hospital

Discussion All cases fell within one incubation period Similar median incubation period for students and teachers –Time of exposure the same –Common food source Clinical presentation suggestive of bacterial infection –Typical of non-typhoid salmonellosis (WHO,2008 ) –Supported by incubation period of hours – Incubation period of non-typhoid salmonella ~ 6 – 48 hours (4days)

Discussion Salmonella typhi isolated not consistent with : –clinical presentation –Incubation period (7-28 days) –Mutation Eating cold marinated chicken was a risk factor –Time lapse between preparation and consumption –Salmonella serotypes are mainly found in poultry, egg and beef ( WHO,2008) Good coordination fostered timely response –Aided by EPR plan –Collaboration ensured patients were treated despite shortages

Limitations of the study Left over food was not available for culture Water and Chemical analysis not done Minimal recall bias cannot be excluded

Conclusion This was a point source foodborne outbreak. The incubation period and clinical presentation are suggestive of non-typhoid salmonellosis Whilst S. typhi was isolated, it could not have caused this food poisoning. Cold Marinated Chicken served as a vehicle of transmission. The City health department was prepared to manage events related to mass gatherings

Recommendations Inter collaboration between schools and City Health – Ministry of Education & Assistant Director Health food preparation at place of event and served hot – School heads Purchase foot operated bins and also avail hand washing facilities.– Restaurant owner Health Education on promotion of food and personal hygiene should be provided -EHT. Training of District Hospital personnel on disease notification - DMO

Public Health Actions Taken

Public Health Actions Health Education was given IEC material was distributed Health education talk to camped secondary school teacher and students Procurement of Hand washing facilities at restaurant

Acknowledgments CDC Study Participants School Heads. Health Studies Office Kadoma City Council MPH-FETP Colleagues

Thank you

Measures of Impact

Attributable Risks for Food served at the Zonal Games at Kadoma, 2015