JMIR Publications

ABSTRACT

Background:

On the 6th of October 2019, fifty five residents in Bala'ama town in Al-Mafraq in Jordan were admitted to local health care center complaining of symptoms of food poisoning. Foodborne diseases are considered to be a major public health concern that affects morbidity and mortality (1,2,3). Many causes attributed to foodborne diseases, there exists biological causes such as: bacteria, viruses, and parasites, and chemical causes such as: chemicals, toxins, and allergens (1,3,4,5). Also, several foodborne outbreaks are due to contamination of food during its preparation, handling, and storage (3,4,8). In addition, internationally increased globalization leads to transmission of food pathogens across countries threatening trade and economy (3,5). Food poisoning is a well-known disease that results in many symptoms affecting the human being such as nausea, vomiting, diarrhea, and abdominal pain that may not be differentiated from other diagnoses (2). To correctly identify a foodborne outbreak, it should occur in more than two persons after consuming similar food and it should be confirmed epidemiologically and microbiologically (6). Moreover, many of these outbreaks are not reported or investigated because most patients do not seek medical care (1,2). It is difficult to estimate the burden of foodborne diseases for which data is extremely limited (1,2). Countries of eastern Mediterranean region have gone rapid urbanization affecting the lifestyle in food consumption and production and hence increasing cases of food poisoning (7). Studies of rules for food safety are limited in Jordan particularly in view of the procedures of food preparation, handling and supply (8). Consequences of food poisoning may result in severe complications when exposed to high doses of pathogens especially in high risk groups such as young age, pregnant women, elderly and the immunocompromised (3,5). In addition, foodborne diseases can lead to several losses at different levels; in work, economy, tourism and food sales (2). This issue imposes health authorities to establish food safety regulations, education and effective surveillance system (3, 7, 8). In order to achieve the desired goal, there should be a cooperation between all sectors that have a bearing food safety (7).

Objective:

The main purpose of this study is to describe the food poisoning outbreak in Al-Mafraq city in Jordan and to identify the source of contamination.

Methods:

This descriptive epidemiological study is a cross sectional study that signifies the source of contamination for food poisoning outbreak in Al Mafraq city in Balama town that has a population of 16,000 inhabitants . Official data were obtained from the records of the directorate of communicable diseases in the ministry of health. Collected data include age, gender, occupation, place of residence, symptoms, number of cases, ill and hospitalized patients, date of onset of symptoms, and food implicated. Following the notification of food poisoning outbreak on the 8th of October 2019, the investigation team visited the health center in Al Mafraq to collect data related to this outbreak. Stool samples were collected from 25 patients who seeked medical care in the health center and a line listing for the cases was made. Stool samples were also examined for two of the restaurant workers and sent to the central lab to identify the causative agent. Food samples were tested from Hummus in coordination with the FDA from the accused restaurant. Furthermore, water sampling was performed in coordination with the directorate of environmental health from the water tanks in the restaurant and from some of the citizens’ houses. Informed consent form was obtained from the directorate of communicable diseases in the ministry of health.

Results:

The total number of cases was 55 patients with no admissions to hospitals. The majority of cases were approved to eat Hummus from the accused restaurant. All patients experienced food poisoning symptoms; 48 cases experienced watery diarrhea and 3 cases had bloody diarrhea, 43 cases had vomiting, 49 cases also had abdominal pain, and 52 cases had fever. Onset of symptoms ranged from the 6th of October 2019 to the 10th of October 2019 The age ranged from 1 to 73 years old, with a median age of 9 years old Females constitute a percentage of 53% 25 stool samples were tested with the results showing 15 shigella soneii and 7 rotavirus. Chloride concentration was zero in the water sample taken from the accused restaurant.

Conclusions:

Epidemiological data and laboratory results indicated that the event was related to food poisoning outbreak raised from consuming Hummus contaminated with shigella soneii.