Investigating an outbreak of Clostridium perfringens gastroenteritis in a school using smartphone technology, London, March 2013

Abstract

and staff at a school in London reported gastrointestinal symptoms; onset peaked 8 to 12 hours after a lunch served in the school on 21 March. We performed a retrospective cohort study of all students and staff. We defined cases as school attenders on 20 and 21 March with onset of gastrointestinal symptoms between 20 and 23 March. We tested food, environmental and stool samples of cases for common pathogens and bacterial toxins. We administered an online questionnaire via email, encouraging the use of smartphones to respond, to measure risk of illness for food items eaten at school on 20 and 21 March. Survey response was 45%. Adjusted risk ratios were generated in a multivariable analysis. Those who ate chicken balti on 21 March were 19.3 times more likely to become ill (95% confidence interval: 7.3-50.9). Clostridium perfringens was detected in all 19 stool samples collected. Within eight school hours of its launch, 412 of 561 (73%) responders had completed the survey. Hygienic standards in the kitchen were satisfactory. The investigation was done rapidly due to smartphone technology and we recommend considering this technology in future outbreaks.

An epidemiological review of gastrointestinal outbreaks associated withClostridium perfringens, North East of England, 2012–2014

“…Environmental investigations are therefore reliant upon retrospective reporting of documented practices. The difficulties associated with using this type of information have been highlighted in other outbreak investigations [13]. Outbreaks may occur in settings which appear, based on the documentation available, to have good food handling practices in place, particularly where processes may have temporarily changed, e.g.…”

“…It has been estimated that C. perfringens is the third most frequent cause of bacterial foodborne disease in England and Wales [12]. Outbreaks of food poisoning due to C. perfringens have been described in a number of settings [5,[13][14][15][16][17] and are commonly associated with high protein foods of animal origin [14]. In the UK the primary cause of C. perfringens outbreaks is reported to be poor temperature control and storage of meat dishes [18].…”

FoodChain-Lab: A Trace-Back and Trace-Forward Tool Developed and Applied during Food-Borne Disease Outbreak Investigations in Germany and Europe

“…Integration of information collected from mobile devices, as has been explored in the field of epidemiological investigation. There, exposed persons have been interviewed using smart phones which proved to increase response rates and speed up data collection considerably [ 26 ].…”

Improving vaccine registries through mobile technologies: a vision for mobile enhanced Immunization information systems

“…Mobile reminders may also improve response rates in outbreak settings. 12 Allowing vaccinees to report AEFIs in this manner would need to be evaluated to ensure the usefulness of these reports. 13 We have piloted the use of an app to report AEFIs following influenza vaccination in healthcare workers.…”