On the morning of - July 17th 2011, 26 reported cases were presented to Asir Central Hospital and Abha General Hospital in Abha city complaining of gastroenteritis symptoms of diarrhea, vomiting, abdominal pain and fever. It was found that they belonged to one group from the House of Social Education coming from Qasim who visited Abha this summer. A local team was formed from Environmental Health Directorate in Asir to conduct an investigation into this outbreak and laboratory specimens were taken from patients, workers and remnants of food and crockery. Field Epidemiology Training Program (FETP) requested a team to investigate this outbreak.
Methodology
A descriptive study followed by a retrospective cohort study was conducted to identify food items and restaurants responsible for this outbreak; exposure was each food item and each suspected restaurant
Results
The total members of the House of Social Education in Qasim who were visiting Abha city were 71 persons. All were Saudis and males. On 16-7-2011 most of them visited Abha marketing festival and had their dinner there. 40 persons complained of gastrointestinal like symptoms and 32 of them visited the hospital for management.43 persons (60.6%) of them had dinner from restaurant A, 14 persons (19.7%) had dinner from restaurant B and 24 persons (33.8%) of them had dinner from other restaurants. Diarrhea and abdominal pain were the most complained about symptoms, where the majority of ill persons 39 (97.5%) developed diarrhea and 35 (87.5%) of them had abdominal pain. Fever and headache were complained of by 27 (67.5%) of the ill persons. The onset of symptoms showed in general (without specifying restaurants) a range from one hour to 31 hours and 30 minutes with mean incubation period of 8 hours and 33 minutes, and median of 5 hours and 15 minutes. In general, all 40 cases ate from restaurants at the Abha marketing festival with an attack rate of 0.615. There were no cases among the 6 persons who did not eat there. Most of cases ate from two famous restaurants, 29 cases ate from restaurant A (Attack rate = 0.643), 9 cases ate from restaurant B (Attack rate = 0.659), and 15 cases ate from other restaurants (Attack rate= 0.652).There were four food items fried potatoes, cheese and meat tortilla from restaurant A and sambosa from other restaurants which were a statistically significant risk for this outbreak with RRs of 1.84 (CI= 1.25-2.70), 1.59 (CI= 1.09-2.31) 1.84 (CI= 1.48-2.28) and 1.82 (CI= 1.33-2.49) respectively. Laboratory investigations were done for 26 of the patients and showed positive growth of Salmonella enteritis for 15 of them. The lunch on the same day was distributed to all the members of the House of Social Education on 12 plates that were a mix of rice, chicken and salad (cucumber) together. The first symptoms appeared 16 hours and 39 minutes as average and with a median of 13 hours and 30 minutes after the launch meal.
Conclusion
The cause of this outbreak is Salmonella enteritis but the source was unclear. At the same time, there were several suspected places that could possibly explain this outbreak ,they were eating dinner in Abha marketing festival restaurants, other places of eating at the marketing festival and the launch meal in the Social Education House.