A foodborne outbreak of gastroenteritis caused by Norovirus and Bacillus cereus at a university in the Shunyi District of Beijing, China 2018: a retrospective cohort study

Abstract

Background On September 4, 2018, a boarding school in the Shunyi District of Beijing, China reported an outbreak of acute gastroenteritis. At least 209 suspected students caused of diarrhea and vomiting. The case was investigated, and control measures were taken to prevent further spread. Methods A retrospective cohort study was conducted among the school students and staff in order to test hypothesis that high risk of food served at the school canteen. We collected information on demographics, refectory records, person to person transmission by uniform epidemiological questionnaire. Risk ratios (RR) and 95% confidence intervals (CI) were calculated. Stool specimens of cases and canteen employees, retained food, water, and environmental swabs were investigated by laboratory analysis. Results We identified 209 cases (including 28 laboratory-confirmed cases) which occurred from August 29 to September 10. All cases were students, and the average age was 20, 52% were male. The outbreak lasted for 13 days, and peaked on September 5. Consumption of Drinks stall and Rice flour stall on September 1 (RR:3.4, 95%CI:1.5-7.8, and RR:7.6, 95%CI:2.8-20.2), Rice flour stall and Fish meal stall on September 2 (RR:4.0, 95%CI:1.2-13.6, and RR:4.6, 95%CI:1.7-12.5), muslim meal stall on September 4 (RR:2.7, 95%CI:1.3-5.4), Barbeque stall on September 5 (RR:3.0, 95%CI:1.2-7.0) were independently associated with increased risk of disease within the following 2 days. Among 35 specimens of rectal swabs or feces from students, 28 specimens were positive. Norovirus GI.6 alone was detected in 23 specimens, Bacillus cereus alone in 3 specimens and both norovirus GI.6 and Bacillus cereus in 2 specimens. 10 specimens of rectal swabs from canteen employees were positive for norovirus GI, and 2 specimens were positive for Bacillus cereus. Four retained food specimens were positive for Bacillus cereus, and environmental samples were negative for any viruses or bacteria. Conclusion Our investigation indicated that canteen employees were infected by two pathogens (norovirus and Bacillus cereus) and transmission may have been possible due to unhygienic practices. Student consumption of food or drink at high-risk stalls was determined as the probable cause of the outbreak.

Characterization of Bacillus cereus in Dairy Products in China

“…Consequently, the sale volume of milk in China will gradually augment, and the market prospect is considerable [ 55 , 56 ]. In view of the high demand for dairy products and the outbreaks of bacterial contamination in liquid milk and milk powder in China, it is urgent to carry out effective analytical tests, especially the detection of microbes during manufacturing, selling and importing of milk [ 12 , 57 , 58 , 59 ]. In addition, the uncertain microbial growth rate and toxicity of microbial metabolites all threaten food safety [ 60 , 61 , 62 , 63 ].…”

“…B. cereus and its virulence factors are frequently present in dairy products in China [ 12 , 13 , 14 , 15 , 57 , 58 ]. This not only impacts the quality of dairy products but also potentially impairs human health.…”

“…To produce a more forthright analysis of the Bacillus toxins, we collected the prevalence of the toxin genes in Bacillus samples from pasteurized milk and milk powder as they are the most popular dairy products in China [ 12 , 13 , 14 , 15 , 53 , 57 , 82 , 112 ] ( Figure 3 a). The data showed that the genes of nhe A B C were found in almost all the Bacillus isolates from pasteurized milk, while at least 80% of nhe A and approximate 100% nhe B and C in milk powder ( Table 1 and Table 2 and Figure 4 b).…”