A Diarrhoeagenic <i>Enteropathogenic</i> <i>Escherichia coli</i> (<i>EPEC</i>) Infection Outbreak That Occurred among Elementary School Children in Gyeongsangbuk-Do Province of South Korea Was Associated with Consumption of Water-Contaminated Food Items

• Main Authors: Min-A Lim, Ji-Yeong Kim, Dilaram Acharya, Bishnu Bahadur Bajgain, Ji-Hyuk Park, Seok-Ju Yoo, Kwan Lee
• Format: Article
• Language: English
• Published: MDPI AG 2020-04-01
• Series: International Journal of Environmental Research and Public Health
• Subjects: diarrhoea; <i>enteropathogenic Escherichia coli</i> outbreak; epidemiology; school feeding
• Online Access: https://www.mdpi.com/1660-4601/17/9/3149

(1) Background: In response to the notification made by an elementary school authority that reported a number of elementary school children being absent in three schools as a result of gastroenteritis symptoms on 4 July 2018, in Gyeongsangbuk-Do Province, South Korea, an epidemic investigation was carried out to determine the extent, cause, and source of the outbreak in order to prevent secondary cases and make recommendations to prevent future recurrences. (2) Methods: In this epidemiologic study, a total of 106 human subjects (school children, staff members, and cooks) who had consumed the possibly contaminated foodstuffs were enrolled retrospectively. Human specimens from clinically defined cases, food and drinks, supply and storage of them, and environmental and sanitary conditions were also assessed by observation, laboratory tests, and survey questionnaires—where and whatever applicable. The attack rate and positive rate for human specimens were first presented followed by the calculation of the relative risk ratio (RR) with 95% CI (confidence intervals) in order to identify the exposure and outcome relationships. (3) Results: The attack rate was 12.26% (13/106) for those who had ingested the food items at the three schools and the positive rate of enteropathogenic <i>Escherichia coli</i> (<i>EPEC</i>) was 15.38% (2/13). The relative risk (RR) of developing food poisoning of those who consumed the cucumber chili with ssamjang and seasoned cucumber and chives were 4.55 (95% CI 1.05–19.54) and 9.20 (95% CI 1.24–68.22), respectively. In addition, within the human specimens as well as the water and environmental samples different strains of diarrhoeagenic <i>enteropathogenic Escherichia coli</i> (<i>EPEC</i>) were detected. (4) Conclusions: Provision of safe and wholesome water access to all elementary schools by concerned authorities, especially during the likely seasons of water source contamination, as well as health education promotion about foodborne outbreaks to all school stakeholders is therefore recommended.