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Epidemiologic investigation Epidemiological investigation of a food-borne outbreak in a kindergarten
Kyoung Mi Kim1orcid , Eun-Suk Cho1orcid , Seong Bae Ahn2orcid , Eun Ok Kang3orcid , Jong-Myon Bae4,4orcid
Epidemiol Health 2023;e2023047
DOI: https://doi.org/10.4178/epih.e2023047 [Accepted]
Published online: April 17, 2023
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1Jeju Center for Infectious Diseases Control and Prevention, Jeju Special Self-Governing Province, Korea
2Bureau of Health-Welfare-Women, Jeju Special Self-Governing Province, Jeju-do, Korea
3Jeju Special Self-Governing Province Institute of Health and Environment Research , jeju-do, Korea
4Jeju National University School of Medicine, Jeju-si, Korea
Corresponding author:  Jong-Myon Bae,
Email: aquopura@gmail.com
Received: 10 January 2023   • Revised: 17 March 2023   • Accepted: 17 March 2023
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Abstract

Objectives
On Monday, September 6, 2021, at a kindergarten in Jeju Province, a large number of children vomited and developed food poisoning symptoms, and this necessitated an epidemiological investigation.
Methods
The team surveyed symptoms and food intake history of kindergarten children, teachers, and workers who ate lunch between September 2 (Thu) and September 6 (Mon), excluding weekends. In addition to rectal swabs, environmental samples from preserved foods, cooking utensils, drinking water, and refrigerator handles were collected. Pulsed field gel electrophoresis for genetic fingerprint analysis (PFGE) was also performed.
Results
There were 19 cases among 176 subjects, which indicated an attack rate of 10.8%. The epidemic curve showed a unimodal shape, and the average incubation period was 2.6 h. While no food was statistically significant in food intake history, the analysis of 35 rectal smear samples detected Bacillus cereus in 7 children, 4 teachers, and 1 cooking staff. Enterotoxins were also detected in 12 samples. Out of 38 environmental samples, Bacillus cereus and enterotoxins were detected in the morning snack cereal, lunch bean sprouts, and afternoon snack steamed potatoes on Monday, September 6th. The result of the PFGE test on 10 isolates of Bacillus cereus showed that there was no genetic homology.
Conclusions
Our results indicated that this outbreak was simultaneously caused by various strains of Bacillus cereus from the environment.

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