Foodborne Illness Outbreak Investigation in a High-Profile Sports Club
Cavanagh et al. Sports Medicine - Open
Foodborne Illness Outbreak Investigation in a High-Profile Sports Club
Kwendy Cavanagh 0
Travers Johnstone 0
Essi Huhtinen 0
Zeina Najjar 0
Peter Lorentzos 1
Craig Shadbolt 2
John Shields 2
Leena Gupta 0
Key Points
0 Sydney Local Health District Public Health Unit , King George V Building, Missenden Road, Camperdown, NSW 2050 , Australia
1 Sports team physician , Sydney , Australia
2 New South Wales (NSW) Food Authority, 6 Avenue of the Americas , Newington, NSW 2127 , Australia
A foodborne illness outbreak involving an elite sports team was investigated by a public health unit in Sydney, Australia. An epidemiological association was established between gastrointestinal illness and the consumption of food supplied by an external caterer, with a lamb meal most strongly associated with illness. Genetically identical Salmonella isolates were identified from clinical specimens, residual food items, and an environmental swab taken from the catering premises. The training schedule and other club operations were significantly affected by this outbreak. Increased susceptibility due to regular shared activities and the potential for significant impact upon performance indicates that sports clubs must ensure that food suppliers comply with the highest standards of hygiene. Collaboration with public health authorities assists in source identification and prevention of further transmission.
Public health; Communicable diseases; Sports; Disease outbreaks; Athletes; Salmonella; Foodborne illness
Background
An estimated 4.1 million cases of foodborne illness are
reported in Australia each year, and outbreaks are
common [
1
]. Despite the frequency of such outbreaks in the
general population [
1, 2
], infectious disease outbreaks of
any type in sporting teams are not frequently described
in the literature [
3–5
]. The few reported outbreaks in
sporting teams in Australia have mainly been caused by
environmental pathogens, such as Cryptosporidium [
6,
7
] and Aeromonas hydrophila [
8
], rather than foodborne
organisms. In Australia, only two published outbreaks
relating to food and sports were identified on review; an
outbreak of gastroenteritis amongst six persons
associated with a team lunch [
9
] and a Staphylococcus aureus
outbreak amongst 22 participants of an elite event [
10
].
Internationally, reports of gastroenteritis in sports teams
have been linked to ice used in drinks [
11
], a football
game [
12
], a rowing tournament [
13
] and more recently,
an outbreak of Salmonella affecting a number of European
ice hockey teams was linked to catering venues at the
event [
13
]. However, such accounts are not numerous,
suggesting that foodborne illness outbreaks in sporting
teams are likely to be significantly underreported.
Sports teams may be at increased risk of infectious
diseases due to their close physical interactions, exposing
them to both point-source and person-to-person
transmission [
3, 4, 12
]. Teams may also be at risk of
foodborne illness because of mass catering at training, events
or functions. Furthermore, when food is prepared for
specific dietary circumstances or needs of sportspersons,
adherence to strict food safety principles is required.
Large-scale sporting events will often have risk
management plans which include food safety as a significant
area for risk mitigation [
14
]. However, when catering is
on a smaller, more routine scale, such plans or
consideration of food safety may not be a particular priority.
This report describes an outbreak of Salmonella
amongst the team and staff of a professional sports club
during training season, the challenges involved in the
investigation, and practical implications for future
prevention and management of similar incidents amongst
sportspersons.
Case Report
In late 2014, a public health unit (PHU) in Sydney was
notified by the doctor of a professional sports team of 33
players and staff at a sports club who had developed
gastrointestinal symptoms within a 24-h period. In New
South Wales (NSW), Australia, suspected foodborne
illness outbreaks are notifiable to public health authorities
under the NSW Public Health Act 2010 [
15
]. In line with
NSW health guidelines [
16
], an outbreak investigation
was initiated in conjunction with the NSW Food
Authority (NSW FA), the lead food regulatory agency, to
determine the cause and control any ongoing risk.
The PHU conducted a retrospective cohort study, with
the cohort being defined as all individuals who attended
the sports club premises within a 72-h period
surrounding the first reported onset of illness. A case was
defined as a member of the cohort who developed
gastrointestinal symptoms within the 7 days following
their attendance at the club. A modified standard
questionnaire [
17
] was used to collect details of any illness
and of foods consumed. Ninety-one people attended the
club during this period, forming the cohort; 76 of t (...truncated)