The North Carolina Division of Public Health was told by the Pitt County Health Department (PCHD) that people who had a catered Thanksgiving lunch were ill with diarrhea and abdominal pain.
Investigation found the caterer had prepared the lunch food in an uninspected, residential kitchen.
Multiple factors
This alongside extended time between turkey preparation and consumption, failure to monitor and control temperature before and during transport resulted in an anerobic environment conducive to C. perfringens spore germination and growth, said the study.
C. perfringens grows in cooked foods left at room temperature. Symptoms include vomiting and abdominal cramps within six to 24 hours after eating.
It is one of the most common bacterial causes of food poisoning but the number is likely underreported due to mildness of symptoms, brief illness duration and lack of routine testing by public health officials, said the Centers for Disease Control and Prevention (CDC).
Clostridium perfringens and poultry and C. perfringens and beef ranked among the top pathogen-commodity pairs most commonly responsible for outbreak-related illnesses, according to an analysis of outbreaks from 1998–2008 by the CDC.
Among 80 attendees, 58 (73%) completed a survey, including 44 respondents who reported illnesses meeting the case definition; among these, 41 reported diarrhea, and 40 (91%) abdominal pain.
Symptom onset began a median of 13 hours after lunch (one to 22 hours).
Risk for illness among people who ate turkey or stuffing (38 of 44; 86%), which were plated and served together, was significantly higher than illness among those who did not eat them (six of 14).
C. perfringens testing
Five stool specimens from ill people and 20 food samples were submitted to CDC for C. perfringens detection. Stools were tested for C. perfringens enterotoxin (CPE) using reversed passive latex agglutination.
Stool culture and enumeration of C. perfringens colony forming units (CFU) was done for five samples of foods implicated by the epidemiologic investigation (one stuffing and four turkey).
CPE was detected in all five stool specimens. C. perfringens containing the CPE gene was recovered from all five stool specimens and from all four turkey samples; one turkey sample contained >105 CFU/g.
“These findings confirm the need for commercial food preparers to adhere to existing food safety regulations, including use of permitted facilities and having a certified kitchen manager on staff,” according to the study.
“Caterers should be aware of the risks associated with improper storage of prepared food for long periods and the importance of temperature monitoring and regulation during food preparation and handling.”
Source: Morbidity and Mortality Weekly Report (MMWR) Weekly / November 25, 2016 / 65(46);1300–1301
“Notes from the Field: Clostridium perfringens Gastroenteritis Outbreak Associated with a Catered Lunch - North Carolina, November 2015”
Authors: Jessica L. Rinsky, E. Berl, V. Greene; J. Morrow, A. Didomenico; J. MacFarquhar, G.A. Gómez; C. Lúquez, C. Williams