title: Investigating an outbreak of staphylococcal food poisoning among travellers across two Australian states.
abstract: BACKGROUND
  Staphylococcus aureus is a common cause of staphylococcal food poisoning in Australia with several outbreaks associated with foods prepared by commercial caterers. Laboratory testing on cases of gastrointestinal illness caused by enterotoxin-producing S. aureus is not routinely done as this condition is self-limiting. Hence outbreaks of such illness may go undetected.
  
  
  METHODS
  A retrospective cohort study was conducted among a group of tourists who were hospitalized in Sydney shortly after flying from Queensland. The group had consumed food prepared by a restaurant on the Gold Coast before transit. Laboratory analyses on stool specimens were conducted in Sydney. An environmental assessment of the restaurant in the Gold Coast was conducted, and environmental specimens were assessed for contamination.
  
  
  RESULTS
  Epidemiological investigations linked the outbreak to a restaurant in the Gold Coast where the suspected food was produced. Stool samples from two of the hospitalized cases were confirmed to have enterotoxin-producing S. aureus, and several environmental samples were found to be contaminated with S. aureus as well. Investigations suggested that absence of hand washing and other unhygienic food handling at the implicated restaurant was the likely cause of this outbreak.
  
  
  CONCLUSIONS
  Food poisoning due to toxin-mediated S. aureus is frequently undetected and underreported. Public health units should consider toxin-producing pathogens such as S. aureus when investigating outbreaks where vomiting is the predominant symptom and occurs rapidly after consuming food.
authors: Public Health Unit, South Western Sydney Local Health District, New South Wales, Australia .
authors: Stephanie
authors: S
authors: Fletcher
authors: Public Health Unit, South Western Sydney Local Health District, New South Wales, Australia .
authors: Leng
authors: L
authors: Boonwaat
authors: Environmental Health Services, Public Health Unit, Gold Coast, Queensland, Australia .
authors: Terry
authors: T
authors: Moore
authors: Sydney South West Pathology Service, Liverpool Hospital, New South Wales, Australia .
authors: Ruchir
authors: R
authors: Chavada
authors: Public Health Unit, South Western Sydney Local Health District, New South Wales, Australia .
authors: Stephen
authors: S
authors: Conaty
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D004196:Disease Outbreaks; D004866:Equipment Contamination; D005260:Female; D005516:Food Microbiology; D006801:Humans; D006920:Hygiene / Q000592:standards; D008297:Male; D012147:Restaurants / Q000592:standards; D012189:Retrospective Studies; D013202:Staphylococcal Food Poisoning / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014195:Travel