Beetroot salad suspected in flight-related outbreaks; 43 passengers sickened

Beetroot salad contaminated with Staphylococcus aureus was the likely source of illness onboard two flights from Nepal.

The Centre for Health Protection (CHP) of the Department of Health in Hong Kong said 43 passengers, 22 men and 21 women, on two flights from Kathmandu earlier this month were affected.

They developed symptoms of food poisoning such as vomiting, nausea, abdominal pain, and diarrhea, about 1src to 6src minutes after having inflight meals. Patients were aged between 11 and 75 and none of them required hospitalization.

Stool samples from two patients tested positive for Staphylococcus aureus. Clinical symptoms and incubation periods were compatible with food poisoning by Staphylococcus aureus.

Role of manual preparation
CHP contacted 12src passengers on the affected flights through face-to-face interviews, phone calls, e-mails, and a hotline, as part of the epidemiological investigation.

This revealed that all 43 affected passengers had consumed food served on the plane and had not eaten any other common item before boarding. Based on results from a case-control study, the beetroot salad was the only item statistically associated with developing disease.

From 5srcsrc servings of food supplied on the two flights, the CHP collected samples, including two of beetroot salad, from the same batches of food that were left undistributed on the planes, but results showed Staphylococcus aureus did not exceed the relevant standard.

CHP found the beetroot salad had been supplied exclusively to flights operated by Cathay Pacific Airways from Kathmandu to Hong Kong since January.

Two inspections of the food factory revealed the preparation of beetroot salad involved a number of manual handling steps that might increase the risk of contamination with Staphylococcus aureus. CHP told the factory to stop supplying the salad. Since this action, there have been no reports of food poisoning on flights.

CHP recommended that the factory minimize manual handling during the food preparation process, and to use utensils and equipment to avoid direct hand contact with ingredients as much as possible.

In a statement, Cathay Pacific Airways said it acknowledged the findings and, given the link to the salad, took steps to remove it from circulation.

“From the onset of the incidents, Cathay Pacific Airways has been fully cooperating with the relevant authorities, including the CHP of the Department of Health, in their investigations in an open and transparent manner. Cathay Pacific Airways has already taken additional measures to reinforce its end-to-end food handling process and staff training to further strengthen food hygiene, including adopting all recommendations made by the CHP of the Department of Health.”

Other outbreak and unregistered outlet
The Centre for Health Protection (CHP) is also investigating another food poisoning cluster affecting 13 people.

Patients are four males and nine females aged between 34 and 64, who developed abdominal pain and diarrhea about 24 to 66 hours after having lunch at Ying Garden Seafood Dining at To Kwa Wan.

Affected people had consumed a variety of items, including “siu mei” such as roast chicken, barbecued pork, and other hot dishes.

An investigation by the Centre for Food Safety (CFS) of the Food and Environmental Hygiene Department did not rule out the risk of cross-contamination during the preparation process.

In other news, a man has been sentenced to prison for operating an unlicensed food premises.

The man was given three weeks’ imprisonment suspended for 18 months for the same offence in early 2src23. As he committed the offence in March 2src23, during his suspended sentence, the court sentenced him to one week in prison, running consecutively, making a total jail term of four weeks.

A spokesman for the Food and Environmental Hygiene Department (FEHD) said the agency detected an unlicensed food premises on Tung Choi Street, Mong Kok. From January to March 2src23, FEHD conducted enforcement against the unlicensed premises, issued two summons and three arrests against the operator.

Any person who operates a food business which involves the sale of meals for consumption on the premises must obtain a general restaurant or a light refreshment