Kids dying from foodborne illness hits me like a punch in the gut. After following illnesses and outbreaks for 15 years I still take pause to think about my kids when I see a tragic story involving children.
Outbreaks rarely end with the classic smoking gun resolution (a genetically matched strain in the food/environment and stool). Epidemiology, in the absence of pathogen matches, is king and uncertainty is reduced with reliable data and statistics. Once a possible food/site match is made, investigators go out to the field and check the food handling out.
A conscientious investigator can talk about possible risk factors in a report – but the subsequent reporting and broken telephone game of sharing the information can bleed potential factors into must-have-happened fact.
A few years ago an environmental health officer shared her concerns about how the story gets changed between the field and the report interpretation. She had investigated a outbreak blamed on poor handwashing shared with me that her notes showed no soap at the time she was in the kitchen a week after the illnesses were reported – that was translated into poor handwashing by the staff at the time of the outbreak.
She felt that was an extrapolation wrought with assumptions.
Folks who used the example didn’t care.
Getting the risk factor story right really matters.
According to the Straits Times a four-year-old boy in Singapore tragically died from salmonellosis and court proceedings point to food handling practices a shopping center food court stall. Based on the coverage, I’m not sure it’s that simple. And I wouldn’t call it a misadventure.
Shayne Sujith Balasubraamaniam, together with his mother and two-year-old sister, came down with food poisoning on Jan 19 this year, a day after his mother had bought food, including tahu goreng and curry chicken, from a nasi padang stall at Kopitiam food court at Northpoint Shopping Centre.
All three were taken brought to Bukit Batok Polyclinic the next day. Shayne was assessed to be severely dehydrated and was prescribed medication.
He showed apparent signs of recovery, but deteriorated on Jan 22 when his mother found him unconscious at home. He died in hospital about two hours later from salmonella septicaemia.
On Thursday, State Coroner Marvin Bay said in his findings that the boy’s death underscores that careless food handling and inattention to proper hygienic practices can result in catastrophic consequences on young and vulnerable persons. He found the boy’s death to be one of misadventure.
The most significant lapse, the inquiry heard, was the practice of partial cooking and refreezing of chicken parts. The kitchen would receive 80 parts of chicken as a batch. After washing the batch, 60 chicken parts were refrozen for use the next day. They would be stored with plastic bags with other raw food at the freezer, a practice which would encourage cross-infection between the raw and partially cooked food. Swabs from the tongs used to handle food, and the blender found a high concentration of bacteria that exceeded safety limits.
While the post-outbreak investigation demonstrates serious issues with food handling at the business, I’m not sure what was presented is enough to link the salmonellosis. If the stored chicken was partially cooked it implies that it would be further cooked – which if temperatures exceeded 165F would result in a 5-log reduction of Salmonella. Maybe cross contamination between raw and sorta raw chicken is really a factor – especially if there weren’t other illnesses. Or maybe the washing step spread pathogens around the kitchen.