Date: Thu 3 Aug 2017
Source: Kuensel [edited]
About 40 people suspected of food poisoning from salmonellosis were treated at Punakha district hospital and the national referral hospital in Thimphu last week [week of 24 Jul 2017].
On [26 Jul 2017], some 18 people including children visited the emergency unit at the national referral hospital in Thimphu complaining of vomiting, diarrhea, and abdominal cramps. The family had a birthday celebration the previous day [25 Jul 2017]. Of the 25 people at the celebration, 17 who ate the birthday cake, and one who did not eat the cake fell sick. The cake was bought from a bakery in Thimphu. The hospital informed the Royal Centre for Disease Control (RCDC) of the suspected food poisoning case, which then informed the Bhutan Agriculture and Food Regulatory Authority (BAFRA).
Another 7 people with similar symptoms were admitted to the hospital on [27 Jul 2017] when BAFRA and RCDC officials were questioning the patients of the earlier incident. On investigation, it was found that these 7 people had also eaten cakes from the same bakery on [26 Jul 2017]. Of the 8 in the family, the one who did not eat the cake did not fall sick.
BAFRA's deputy chief regulatory and quarantine officer, Sithar Dorjee, said the authority investigated the food items that members of both families had consumed: "Other food items were not found to have significance on their illness." Besides the samples of cakes consumed by the 2 families, samples of cakes on sale and those left by the customers in the bakery were sent to RCDC and the National Food Testing Laboratory in Yusipang on [27 Jul 2017] for testing.
Sithar Dorji said that although the laboratory did not confirm that the families fell ill because of the cake, BAFRA temporarily closed the bakery to prevent further cases since the clinical epidemiological evidence is linked to the bakery. The authority has seized the cakes from the bakery and disposed of them. A notification was served to rectify some non-compliance issues on the requirements regarding food hygiene and safety.
BAFRA's director general, Namgay Wangchuk said, "When it comes to food safety, we cannot compromise."
The results from the samples confirmed the presence of the bacterium salmonella, which was also found in the stool and vomit of the patients, Sithar Dorjee said. "Salmonella bacteria might have come from the egg used in cakes or contaminated from a person." Sithar Dorjee said the RCDC might send the result abroad for serotyping since there is no facility in the country to test if the bacteria were from the eggs or contaminated by food handlers.
He said the bakery had sold 13 cakes of the same kind to the 2 families over the 2 days. "The 2 cakes might have not been properly stored for longer period of time before consuming, which resulted in the multiplication of the bacteria or maybe people did not report the illness." He also said that the cake topping is most likely to be contaminated since raw egg white is used for toppings. If there is infection in poultry, then the eggs will also be infected thereby contaminating the cake. Eggs from the same farm are also being tested for the bacterium.
Food poisoning can be caused by bacteria, viruses, or parasites at any stage such as when they are growing, packaged, stored, shipped, or cooked. Certain food like raw eggs and uncooked meat are more likely to harbour harmful agents. The chances of getting food poisoning are higher in summer and food can start to spoil within an hour when exposed to extreme heat.
BAFRA has taken some corrective and precautionary measures to prevent contamination. The workers at the bakery were also provided food handler's training that includes food hygiene and proper storage. "The bakery will be allowed to reopen once they comply with all required corrective measures because it is contamination," he [sic] said. "However, we will increase the frequency of inspection of the bakery." The authority inspected the bakery about a month ago.
Sithar Dorjee said the frequency of inspection depends on the risks. "If a restaurant or bakery has a history of non-compliance to the authority's requirement on food hygiene and safety, we will frequently inspect."
The bakery owner said he is yet to know the findings of the test so he couldn't comment. However, he said that if people fall ill after eating cake from his bakery then he could be at fault. But, since the cakes were taken out of the bakery, improper storage or keeping the cake in a vehicle for a longer time could also contaminate the cake. He said that since the affected families had a birthday celebration, other food items could also have caused food poisoning. "We maintain proper storage of our products."
Meanwhile, on [28 Jul 2017], about 15 monks of Talo monastery in Punakha [district] visited the Punakha district hospital after suffering from vomiting, diarrhea, fever, and stomach cramps. Of the total, 10 monks were admitted to the hospital then. Currently, there are 2 monks admitted in the hospital.
Punakha [district] health officer, Dechenmo, said the monks said that they started falling ill after they ate a cake offered to the monastery by some devotees during the 1st Sermon of Lord Buddha on [27 Jul 2017]. According to the monks, 2 cakes were offered to the monastery and those who ate the small cake fell ill while those who consumed the other cake did not fall sick.
Dechenmo said that the 2 monks who are still in the hospital are recovering and will be discharged from the hospital in a few days. "We cannot investigate the source of the cake because we don't know who offered the cake to the monastery."
The health assistant of Nubgang BHU visited the monastery and disinfected all toilets. The monks were also educated on the prevention of the disease. "The monks came to the hospital at the right time and everything was under control," Dechenmo said. "If we are not careful and not treated on time, then food poisoning can be fatal." [byline: Dechen Tshomo]
[By definition, baked goods by being baked should be free of bacterial risk but the products can still be the reservoir of foodborne illness. This can occur if the product is undercooked or if icing or filling, which might be placed after baking, is the contaminated substance. The contamination may be from a component of the icing or filling or be contaminated from a bakery worker.
It is not clear if the monastery outbreak is due to salmonellosis, but certainly could have been. - ProMED Mod.LL]
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