In Hajj 2009, there were 665 cases of food poisoning among Hajj pilgrims to Saudi Arabia. We investigated an outbreak of foodborne illness among pilgrims from Sudan reported with Gastrointestinal illnesses to determine the source and make recommendations to prevent future outbreaks.
Methodology
We conducted a 1:1 case-control study to identify food items and circumstances responsible. Information was collected by face-to-face interviews using a standardized questionnaire collecting demographics, food history, symptoms and their onset, and clinical course. A case was defined as any pilgrim from Sudan, that stayed in the concerned hotel and had GI symptoms between 8pm of 23th Aug to 1 am 24th Aug. Controls were asymptomatic individuals recruited from the same hotel. Laboratory tests were conducted on food samples, stool samples, nasal and throat samples. Inspection for food handling at restaurant
Results
We identified 141 cases (69% female). Mean age was 52.9 years. Symptoms reported included nausea (83%), vomiting (75%), diarrhea (61%), abdominal pain (60%), and fever (10%). The mean incubation period was 2.16 hours. All cases recovered in < 24 hours. Only chicken had significant odds ratio (OR=3.0, 95% CI 1.0-8.6; p=0.033). No standard foodborne pathogens were detected by laboratory testing. Toxin testing was not performed due to unavailability of kits. We observed improper food preparation and storage.
Conclusion
This outbreak was most likely caused by eating contaminated chicken. We recommended education of food handlers about safe food practices and ensure that restaurants employ safe food preparation, storage, and transportation practices, particularly during mass gatherings such as the hajj.