Medical Journal of Malaysia

MJM, Vol 70 Supplement 1 September 2015

An outbreak of Escherichia Coli food poisoning at Teluk Keke, Malaysia 2012

Liza A Latip*, Balkis AK **, Mohd J***, Anwa A***

* Hulu Terengganu District Health Office, Terengganu, Malaysia, ** Kuala Terengganu District Health Office, Terengganu, Malaysia, *** Terengganu State Health Department, Malaysia


Introduction: E. coli is a significant cause of bacterial diarrhoeal illness worldwide and transmitted by food or water contaminated with animal or human faeces. On October 14th, 2012, twenty participants of Athlete Retreat in Perhentian Island presented with vomiting, diarrhoea, abdominal pain, nausea and fever. An investigation commenced immediately to determine the causal agent, mode of transmission and risk factors as well as to recommend control and prevention measures to avoid subsequent similar outbreak. 

Methods: A case was defined as any athlete with vomiting, diarrhoea, abdominal pain, nausea and fever started on October 12th, 2012. A structured questionnaire was used to carry out face-to-face interview. A case-control study was carried out. Three days food history was obtained from cases and controls. Hazard analysis and critical control points (HACCP) was done. Samples from environment and water supply were taken for laboratory testing to identify causal agent. Data analysis was done using SPSS version 15.

Results: Twenty cases and 60 controls were interviewed. Six out of 9 food items consumed during dinner on October 13th showed significant risk. The highest risk was shrimp curry (Odds Ratio 16.6; 95% CI: 2.1-132.3).  Source of water showed contaminated by coliform >181cfu/100ml. HACCP also indicated a problem with the water source. Septic tanks were located approximately 10 meters higher than water source.

Conclusion: This food poisoning outbreak is probably due to the enterotoxigenic E. coli (ETEC) caused by ingestion of the contaminated untreated water. Immediate action measures taken included chlorinating the water source (a well). This well is to be chlorinated 3 monthly until the premise has been supplied with treated water. In the meantime, the visitors were advised to drink only boiled or bottled water.

Keywords: disease outbreak, well water, E.coli