Diagnosis and investigation of the

outbreak The epidemiologist is concerned with diagnosing the cause of the outbreak and, therefore, a search is made to discover a common food that has been eaten by all the persons who have succumbed to the illness. The foodstuff is likely to be one particular ingredient of the meal, rather than the whole meal and samples should be taken for culture. If nothing is grown, this does not rule out a Staphylococcal or Clostridia food poisoning cause and finer questioning on foodstuffs consumed might be the only way to discover the offending item. (See Section 2.2.5 on how to analyse the relative importance of different foods eaten.)

Period of communicability In Salmonella infection, organisms can be excreted for up to 1 year although it is generally just for a period of weeks.

Occurrence and distribution Food poisoning is found worldwide with large outbreaks associated with gatherings of people, such as celebrations and weddings. Many small outbreaks and those occurring in the home go unreported unless individuals are ill enough to be hospitalized. Sometimes a batch of food is infected and distributed to several outlets, so as soon as the food-poisoned item is discovered, all of it must be traced and destroyed.

Control and prevention All suspect food must be destroyed and if it is part of a common foodstuff, then all must be traced and disposed of. The source of contamination, such as an abattoir, must be looked for and control measures implemented. Prevention is by proper cooking of food and personal hygiene. Where repeated attacks occur, a search for a carrier should be made amongst food handlers. Anyone with a septic or discharging sore should be banned from handling and preparing food.

Food must be stored, prepared and cooked properly (Section 3.3.2). Establishments that prepare food, such as restaurants and hotels, should be regularly inspected and certified.

Treatment The treatment of cases of food poisoning is supportive with fluids and electrolytes (either orally or intravenous).

Surveillance Food handlers should be checked by supervisors and food establishments visited on a regular basis by health inspectors.

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