Food Poisoning Outbreak from Contaminated Fish-Balls
WARALUK TANGKANAKUL,M.D.*,
DIRAK DATAPON, B.Sc.***,
PlY ANIT THARMAPHORNPILAS, M.D., M.P.H.**,
SOMJAI SUT ANTAYA W ALEE, B.Sc. ****
Affiliation : *Division of General Communicable Diseases, Department of Communicable Disease Control, Ministry of Public Health, Nonthaburi 11000,
**Division of Epidemiology, Ministry of Public Health,
***Bangkruai Hospital, Nonthaburi Provincial Health Office, Nonthaburi 11000,
****Division of Food, Food and Drug Administration, Ministry of Public Health, Nonthaburi 11000, Thailand.
AbstractOn February 9'h, 1998, a food poisoning outbreak occurred at a boarding school for under-
privileged students. An unmatched case-control study was done. An environmental survey, labo-
ratory study of rectal swab culture, fish-balls, water and the cooking utensils were also performed.
There were 132 suspect cases, of which the attack rate in teachers was 9.8 per cent (4/41), 16.7
per cent (1/6) in the food handlers and 15.7 per cent (127/810) in the students. The median incu-
bation period was 18 hours. Analysis of food consumption revealed those who ate lunch noodles
had the highest risk (OR 3.8, 95% CI 0.6 - 25.9). In details of food components, those who ate
fish-balls in curry had the only significant risk (OR 3.5, 95% CI 1.2 -1 0.8) of becoming ill when
compared to those who did not. Fish-balls in noodles and curry had a dose response relationship.
Bacterial culture from 25 grams of fish-balls was positive for Vibrio parahaemolyticus. The
fish-balls in noodles and curry were identified as the implicated food. The modes of contamina-
tion were uncooked food, cooking utensils and the food handlers. The manufacturer, which had
no license to operate and had poor standards of sanitation, was closed by the Food and Drug
Administration.
Keywords : Food Poisoning, Vibrio Parahaemolyticus, Thailand
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