A large food-borne outbreak of group A streptococcal pharyngitis in an industrial plant: Potential for deliberate contamination

Dorit Nitzan Kaluski, Estrella Barak, Zalman Kaufman, Lea Valinsky, Esther Marva, Zina Korenman, Zeev Gorodnitzki, Ruth Yishai, Deborah Koltai, Alex Leventhal, Shimon Levine, Ofra Havkin, Manfred S. Green

Research output: Contribution to journalArticlepeer-review

Abstract

Contamination of food with streptococci could present with unusual outbreaks that may be difficult to recognize in the early stages. This is demonstrated in a large food-borne outbreak of streptococcal pharyngitis that occurred in 2003 in a factory in Israel. The outbreak was reported to the public health services on July 2 and an epidemiologic investigation was initiated. Cases and controls were interviewed and throat swabs were taken. An estimated 212 cases occurred within the first 4 days, the peak occurring on the second day. There was a wave of secondary cases during an additional 11 days. The early signs were of a respiratory illness including sore throat, weakness and fever, with high absenteeism rates suggesting a respiratory illness. As part of a case-control study, cases and controls were interviewed and throat swabs taken. Illness was significantly associated with consumption of egg-mayonnaise salad (odds ratio 4.2, 95% confidence interval 1.4-12.6), suggesting an incubation period of 12-96 hours. The initial respiratory signs of food-borne streptococcal pharyngitis outbreaks could delay the identification of the vehicle of transmission. This could be particularly problematic in the event of deliberate contamination.

Original languageEnglish
Pages (from-to)618-621
Number of pages4
JournalIsrael Medical Association Journal
Volume8
Issue number9
StatePublished - Sep 2006
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported by Consejo Nacional de Ciencia y Tecnolog?a (CONACYT) project # 166621-Z. We thank Alonso Rodriguez-Navarro and Centro de Biotecnolog?a and Gen?mica de Plantas-Universidad Polit?cnica deMadrid (CBGP-UPM) for the use of equipment and laboratory facilities. We thank Dr. Francisco Rubio (Departamento de Nutrici?n Vegetal, Centro de Edafolog?a y Biolog?a Aplicada del SEGURA-CSIC, Murcia, Spain) for the donation the yeast strain with the HAK1-transporter of C. annuum (CaHAK1). For their excellent technical assistance we thank Blanca Garciadebl?s (Centro de Biotecnolog?a and Gen?mica de Plantas-Universidad Polit?cnica de Madrid, CBGP-UPM). We also thank CONACYT for the scholarships awarded to NR (#205076) and EB (#224261) for her doctoral studies and to the grand to CONACYT (166621).

Keywords

  • Bioterrorism
  • Case-control study
  • Food-borne outbreak
  • Streptococcal pharyngitis

ASJC Scopus subject areas

  • Medicine (all)

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