In February 1983, an outbreak of staphylococcal food poisoning
occurred on a Caribbean cruise ship sailing from the United States.
The probable source was cream pastries served during two separate
meals.
The overall attack rate of acute gastroenteritis on board,
estimated from the 56 passengers who responded to a 10% systematic
survey of the 715 passengers, was 32%. Ninety-four percent of
patients filling out questionnaires complained of nausea and/or
vomiting, 82% reported diarrhea, and 60% reported abdominal cramps.
Symptoms usually subsided within 12 hours, although 36% of patients
indicated illness lasted at least 2 days. The incubation period
ranged from 1 to 8 hours (median 5 hours).
When plotted by time of onset, the number of cases peaked
twice,
corresponding to meals served 2 days apart. Forty-six (95.8%) of
48
patients and 20 (58.8%) of 34 well passengers ate the cream pastry
served for dessert on the evening of February 22 (p 0.001). Seven
(70%) of 10 patients and four (13.3%) of 30 controls ate a similar
pastry item for lunch on February 24 (p 0.001).
Staphylococcus aureus, phage type 85/+, was isolated from the
stools of five (38.4%) of 13 patients cultured and from none of
nine
controls. The same staphylococcal phage type was grown from a
perirectal swab, an anterior nares culture, and a swab of a forearm
lesion from three of the seven crew members who made pastry.
Pastries
from the implicated meals were not available for culture because
the
pastry kitchen routinely disposed of leftovers. Cultures of the
mixture used to prepare the cream filling were positive.
Investigation of the ship's pastry kitchen did not reveal any
improper food handling in the preparation of the pastry items.
Refrigeration temperatures were adequate, and the foodhandlers were
free of pustular skin lesions. However, because the pastry was
prepared in large quantities in several steps by a number of
foodhandlers, opportunities could have existed for the introduction
of
staphylococci into the pastry, with adequate time for incubation of
the enterotoxin.
Reported by Div of Quarantine, Center for Prevention Svcs, Dengue
Br,
Div of Vector-Borne Viral Diseases, Enteric Diseases Br, Div of
Bacterial Diseases, Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: Although Staphylococcus remains the second most
common etiologic agent (after Salmonella) in foodborne outbreaks in
the United States, this is the first well-documented outbreak of
staphylococcal food poisoning on a cruise ship sailing from the
United
States. This outbreak emphasizes the importance of extreme care in
adequately refrigerating perishable food items prepared in large
kitchens. The elaboration of staphylococcal enterotoxin requires
incubation at temperatures above 6.7 C (44 F). The investigation
also
shows the value of phage typing to support epidemiologic evidence
on
the probable source of an outbreak, despite the inability to
culture
the implicated food item.
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