The proof of the pudding is in the eating: an outbreak of emetic syndrome after a kindergarten excursion, Berlin, Germany, December 2007

G O Kamga Wambo; F Burckhardt; C Frank; P Hiller; H Wichmann-Schauer; I Zuschneid; J Hentschke; T Hitzbleck; M Contzen; M Suckau; K Stark

doi:10.2807/ese.16.15.19839-en

Surveillance and outbreak reports Open Access

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The proof of the pudding is in the eating: an outbreak of emetic syndrome after a kindergarten excursion, Berlin, Germany, December 2007
G O Kamga Wambo^1,2 , F Burckhardt^1,2 , C Frank¹ , P Hiller³ , H Wichmann-Schauer³ , I Zuschneid⁴ , J Hentschke⁵ , T Hitzbleck⁶ , M Contzen⁷ , M Suckau⁸ , K Stark¹
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Affiliations: ¹ Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany ² Postgraduate Training for Applied Epidemiology (PAE, German Field Epidemiology Training Programme), Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany ³ Federal Institute for Risk Assessment, Berlin, Germany ⁴ Public Health Authority Friedrichshain-Kreuzberg, Berlin, Germany ⁵ Institute for Food Safety, Drugs and Animal Health, Berlin, Germany ⁶ Veterinarian and Food Safety Authority, Tempelhof-Schöneberg, Berlin, Germany ⁷ Chemical and Veterinary State Laboratory (Chemisches und Veterinäruntersuchungsamt, CVUA), Stuttgart, Germany ⁸ Senate for Health, Environment and Consumer Protection, Berlin, Germany

Correspondence:
K Stark
starkk rki.de
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Citation style for this article: Kamga Wambo G O, Burckhardt F, Frank C, Hiller P, Wichmann-Schauer H, Zuschneid I, Hentschke J, Hitzbleck T, Contzen M, Suckau M, Stark K. The proof of the pudding is in the eating: an outbreak of emetic syndrome after a kindergarten excursion, Berlin, Germany, December 2007. Euro Surveill. 2011;16(15):pii=19839. https://doi.org/10.2807/ese.16.15.19839-en Received: 01 Oct 2010

Abstract

An outbreak of food poisoning (emetic syndrome) occurred in three kindergartens (A, B and C) in Berlin, Germany, on 3 December 2007 after an excursion during which food was served. We conducted a retrospective cohort study among the kindergarten children and personnel who participated in the trip. The overall attack rate among the 155 participants was 30%. It was 31% among the 137 children (aged two to six years) and 17% among adults (n=18). The consumption of rice pudding was significantly associated with disease. Among those who ate rice pudding, the attack rate was 36%, compared with 0% for non-eaters (relative risk: infinite, p<0.001, aetiological fraction: 100%), but differed significantly between kindergartens A (43%), B (61%) and C (3%), probably because groups were served from different pots. Bacillus cereus sensu stricto was identified from one vomit sample. The clinical and epidemiological characteristics suggest that B. cereus emetic toxin (cereulide) was the causative agent, although it could not be proven in the single vomit isolate. Inadequate food handling most probably led to the outbreak. Single-portion ready-to-eat rice pudding was recommended for subsequent excursions and no further cases of food poisoning occurred.