title: Multiple outbreaks of gastroenteritis that were associated with 16 funerals and a unique caterer and spanned 6 days, 2011, Québec, Canada.
abstract: In January 2011, multiple acute gastroenteritis outbreaks that spanned many days and were related to attendance at funerals were reported to public health units in Quebec. An epidemiological investigation was initiated to identify the source of the contamination and to explain the extent of the contamination over time. Thirty-one cohorts of individuals attended different funerals held between 14 and 19 January. All attendees were served a cold buffet made by the same caterer. Of these 31 cohorts, 16 (with a total of about 800 people) contained individuals who reported being ill after the funeral. Symptoms were mainly diarrhea (89 to 94% of individuals), vomiting (63 to 90%,) and fever (26 to 39%), with a median incubation period of 29 to 33 h and a median duration of symptoms of 24 to 33 h, suggesting norovirus-like infection. Among the 16 cohorts, 3 were selected for cohort studies. Among those three cohorts, the mean illness rate was 68%. Associations were found between those who fell ill and those who had consumed pasta salad (relative risk [RR] = 2.4; P = 0.0022) and ham sandwiches (RR = 1.8; P = 0.0096). No food handlers reported being sick. No stool samples were provided by individuals who became ill. Environmental and food samples were all negative for causative agents. Although the causative agent was not clearly identified, this investigation raised many concerns about the importance of preventing foodborne transmission of viral gastroenteritis and generated some recommendations for management of similar outbreaks.
authors.affiliation: Ministère de la Santé et des Services sociaux, 1075 chemin Ste-Foy, Québec, Province de Québec G1S 2M1, Canada. colette.gaulin@msss.gouv.qc.ca
authors.forename: Colette
authors.initials: C
authors.lastname: Gaulin
authors.forename: Soulyvane
authors.initials: S
authors.lastname: Nguon
authors.forename: Marie-Andree
authors.initials: MA
authors.lastname: Leblanc
authors.forename: Danielle
authors.initials: D
authors.lastname: Ramsay
authors.forename: Sophie
authors.initials: S
authors.lastname: Roy
mesh_terms: D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000209:etiology / Q000635:transmission; D015331:Cohort Studies; D003967:Diarrhea / Q000453:epidemiology; D004196:Disease Outbreaks; D005506:Food Contamination / Q000032:analysis*; D005511:Food Handling / Q000379:methods*; D005516:Food Microbiology; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000209:etiology; D005759:Gastroenteritis / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D006920:Hygiene; D029322:Norovirus / Q000302:isolation & purification / Q000472:pathogenicity; D011792:Quebec / Q000453:epidemiology