title: A Family Clustered Nitrite Intoxication Investigation in Gaoxin District, Suzhou, China, 2013.
abstract: BACKGROUND
  In April, 2013, a Suzhou Hospital reported a nitrite intoxication patient in coma as well as 2 family members with the similar symptom 5 days ahead. We investigated the event to identify the cause, source and possible pollution ways of the contamination.
  
  
  METHODS
  We defined case as any person living in YSHY community who has cyanosis and with at least one of the following symptoms: dizziness, headache, fatigue, tachycardia, drowsiness, nausea, vomiting, abdominal pain or diar-rhea during April 15 to April 25, 2013. We searched for case by interviewing community residents and reviewing clinics' medical records; information was then retrospectively collected on the patient's food history, cooking procedures and food sources.
  
  
  RESULTS
  We identified 3 nitrite intoxication cases, 1 male and 2 female from a family. The interval time between dinner and onset was < 1 hour. Retrospective survey showed 'sugar stir and mix asparagus' on April 17 and 'scrambled asparagus' on April 21 were suspected foods. Both suspected dishes had 'sugar' added, sourced from a clean-up of a neighboring rental house. Nitrite was detected in a vomitus sample, the 'sugar' and two leftover food samples.
  
  
  CONCLUSIONS
  This family clustered nitrite intoxication was induced by using unidentified nitrite as sugar to cook dishes. We recommend sodium nitrite should be dyed with bright colors to avoid mistaking it for plain salt or sugar, health departments strengthen food hygiene propaganda to improve people's recognition of food safety, and to alert them the dangerous of eating unidentified or unknown source food.
authors.affiliation: 1. China Field Epidemiology Training Program , Beijing, China ; 2. Songjiang Center for Disease Control and Prevention , Shanghai, China.
authors.forename: Ruiping
authors.initials: R
authors.lastname: Wang
authors.affiliation: 3. Suzhou Center for Disease Control and Prevention , Jiangsu, China.
authors.forename: Chengang
authors.initials: C
authors.lastname: Teng
authors.affiliation: 3. Suzhou Center for Disease Control and Prevention , Jiangsu, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Zhang
authors.affiliation: 3. Suzhou Center for Disease Control and Prevention , Jiangsu, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.affiliation: 1. China Field Epidemiology Training Program , Beijing, China.
authors.forename: George
authors.initials: G
authors.lastname: Conway
keywords: family clustered; nitrite intoxication; sugar; unidentified food