title: Investigation of an outbreak of vomiting in nurseries in South East England, May 2012.
abstract: On 30 May 2012, Surrey and Sussex Health Protection Unit was called by five nurseries reporting children and staff with sudden onset vomiting approximately an hour after finishing their lunch that day. Over the following 24 h 50 further nurseries supplied by the same company reported cases of vomiting (182 children, 18 staff affected). Epidemiological investigations were undertaken in order to identify the cause of the outbreak and prevent further cases. Investigations demonstrated a nursery-level attack rate of 55 out of 87 nurseries (63·2%, 95% confidence interval 52·2-73·3). Microbiological tests confirmed the presence of Bacillus cereus in food and environmental samples from the catering company and one nursery. This was considered microbiologically and epidemiologically consistent with toxin from this bacterium causing the outbreak. Laboratory investigations showed that the conditions used by the caterer for soaking of pearl haricot beans (known as navy bean in the USA) used in one of the foods supplied to the nurseries prior to cooking, was likely to have provided sufficient growth and toxin production of B. cereus to cause illness. This large outbreak demonstrates the need for careful temperature control in food preparation.
authors.affiliation: Surrey and Sussex Health Protection Team,Kent Surrey Sussex Public Health England Centre,County Hall North,Chart Way,West Sussex,UK.
authors.forename: M
authors.initials: M
authors.lastname: Nicholls
authors.affiliation: Surrey and Sussex Health Protection Team,Kent Surrey Sussex Public Health England Centre,County Hall North,Chart Way,West Sussex,UK.
authors.forename: B
authors.initials: B
authors.lastname: Purcell
authors.affiliation: Public Health England Food,Water & Environmental Microbiology Laboratory Porton,Porton Down,Salisbury,UK.
authors.forename: C
authors.initials: C
authors.lastname: Willis
authors.affiliation: Public Health England,Gastrointestinal Bacteria Reference Unit Microbiological Services Colindale,London,UK.
authors.forename: C F L
authors.initials: CF
authors.lastname: Amar
authors.affiliation: Field Epidemiology Services,Victoria Office,Public Health England,London,UK.
authors.forename: S
authors.initials: S
authors.lastname: Kanagarajah
authors.affiliation: Public Health England Food,Water & Environmental Microbiology Laboratory Porton,Porton Down,Salisbury,UK.
authors.forename: D
authors.initials: D
authors.lastname: Chamberlain
authors.affiliation: Public Health England,Gastrointestinal Bacteria Reference Unit Microbiological Services Colindale,London,UK.
authors.forename: D
authors.initials: D
authors.lastname: Wooldridge
authors.affiliation: Surrey and Sussex Health Protection Team,Kent Surrey Sussex Public Health England Centre,County Hall North,Chart Way,West Sussex,UK.
authors.forename: J
authors.initials: J
authors.lastname: Morgan
authors.affiliation: University of Liverpool,Institute of Infection and Global Health,Liverpool,UK.
authors.forename: J
authors.initials: J
authors.lastname: McLauchlin
authors.affiliation: Public Health England,Gastrointestinal Bacteria Reference Unit Microbiological Services Colindale,London,UK.
authors.forename: K A
authors.initials: KA
authors.lastname: Grant
authors.affiliation: Surrey and Sussex Health Protection Team,Kent Surrey Sussex Public Health England Centre,County Hall North,Chart Way,West Sussex,UK.
authors.forename: L
authors.initials: L
authors.lastname: Harvey-Vince
authors.affiliation: Rother District Council,Environmental Health,Town Hall,Bexhill on Sea,East Sussex,UK.
authors.forename: M
authors.initials: M
authors.lastname: Padfield
authors.affiliation: Surrey and Sussex Health Protection Team,Kent Surrey Sussex Public Health England Centre,County Hall North,Chart Way,West Sussex,UK.
authors.forename: R
authors.initials: R
authors.lastname: Mearkle
authors.affiliation: North West London Health Protection Team,Public Health England,London,UK.
authors.forename: J Y
authors.initials: JY
authors.lastname: Chow
mesh_terms: D000328:Adult; D001409:Bacillus cereus / Q000302:isolation & purification*; D001427:Bacterial Toxins / Q000506:poisoning*; D002675:Child, Preschool; D004196:Disease Outbreaks; D004739:England / Q000453:epidemiology; D005516:Food Microbiology; D005522:Food Services / Q000592:standards; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007223:Infant; D009725:Nurseries, Hospital; D027805:Phaseolus / Q000382:microbiology*; D014839:Vomiting / Q000382:microbiology*
chemical_list: D001427:Bacterial Toxins
keywords: Bacillus cereus; bacterial infections; outbreaks