Questions to think about when reading the case study:
1. Deduce the likely organism that caused the case justifying the reasons behind your choice?
2. How does the numerical data help to explain the outbreak?
3. Where were the failures in the food processing systems?
4. Explain the likely scenarios that lead to the outbreak and the pattern of cases presented?
Criteria for assessment
1. Able to identify organism with appropriate supporting arguments.
2. Use the numerical data to explain the outbreak
3. Able to identify the failure of the process that lead to outbreak recognising underpinning scientific principles
4. Use of numerical data to support arguments
5. Evidence of appropriate reading to support study.
Report from the Bourghton and Tufnell Times
Outbreak of bug in nurseries in North London
104 children attending 10 nursery schools in North London have contracted a bug which causes bloody diarrhoea and is especially dangerous in children under 10 years old. The first case was on the evening of the 5th March when a four-year-old girl was admitted to Tufnell Bourghton Memorial hospital with bloody diarrhoea. The child is now in intensive care in a critical condition. He mother has been at her bed side ever since. The grandparents have said that their granddaughter has failure of her kidneys and is very poorly There have been at least 100 other cases of the illness in children attending the nurseries in question with 37 children admitted to hospital. 7 of these little ones are in intensive care.
The Local Education Authority have closed all of the ten nurseries involved and are working closely with the Health Authority to determine the extent of the outbreak. Parents have been asked to monitor their children closely for symptoms of diarrhoea and if they are worried to take their children to the doctor or, if very poorly to Accident and Emergency.
There has been a call to close all nurseries in the borough but the Health Authority have said that this is not necessary as only these 10 nurseries have been affected. It is known that at least 9 staff have reported illness.
The Health Protection Agency said they should be able to give a definitive answer as to which bug is the cause of the disease by the weekend. They have however confirmed that this outbreak is bacterial rather than viral and it is not norovirus. In the meantime one parent, who did not wish to be named, says she thought that the kitchens at her son’s nursery always looked dirty and that she was sure staff did not wash their hands regularly enough. Five of the nurseries belong to the Fly your Wings nursery group – a spokesman for the group declined to comment at this time.
This newspaper has continuously brought reports of poor food standards in our children’s schools. Perhaps it is time the Local Authority looked at funding for improvements. Meanwhile, we can only well for the sick children.
Report from Local Education Authority to Chief Medical Officer for Environmental Health.
This preliminary report is in response to the large outbreak, most likely of Eaaaaaa. coli O157 iaaaa identified as clustered around ten nurseries in the borough. The nurseries have a total of 270 children with 57 staff. The nurseries involved provide funded places for children attending either mornings only, afternoons only or all day. Those children who attend all day are given a packed lunch provided by the Local Education Authority catering supplier – Butrams (fictitious name).
The packed lunch is a cold meal generally consisting of vegetarian or fish sandwiches with a range of fillings – egg, jam, mayonnaise and cucumber, tuna and sweetcorn. The lunch box also contains raw salad vegetables, a fromage frais, dried or fresh fruit and cake. Most nurseries provide either apple juice or water to accompany the meal. The meals are delivered on a daily basis in small cardboard “lunch” packs. Whilst the meals should be refrigerated, it is not clear whether this is commonly practised.
But ramps supplies at least 34 other primary and secondary schools in the borough with school meals. Generally these meals are hot rather than cold. It has been established that in primary and secondary schools salad vegetables are provided through the schools themselves from separate suppliers. We have advised that no cold food should be delivered to any school in the borough until further notice. But ramps have been very co-operative and provided excellent guidelines for school canteens
There are a total of ten nurseries involved in this outbreak. They were all closed on the 8th March. Children at just one of these nurseries (ABC nursery) bring their own lunch. However, ABC nursery shares its premises with Early Start nursery especially the toilet facilities, playground and recreation room.
The Environmental Health Team have been in to each of the nurseries to inspect the kitchen facilities. None of the food served to the children was available for sampling or analysis. Butrams have provided some foods, similar to those served around the likely time of the outbreak, for microbiological analysis to the Health Protection Agency. The Local Education Authority will continue to fully co-operate with the Environmental Health Department.
Table 1. Total number of ill children and staff at 11 nurseries in borough as of 21st March.
|Nursery||Local Authority Packed lunches||Number of ill children||Number of children||Number of ill staff||Number of staff||Number ill children hospitalised|
|Prime and go||Yes||11||22||1||5||0|
|Safe and sound||Yes||8||16||2||5||1|
Table 2 Number of contacts
|Household contacts of staff||0||1||0||0||0||0|
|Household contacts of ill children||4||4||0||5||2||2|
|Household contacts of children at nursery but not ill||1||0||0||0||0||0|
Table 3 Frequency of symptoms reported by those at nursery and household contacts
BIO4501 Summative Assessment 1
- Logical progression of material. Major issues clearly identified and described.
- Able to identify organism with supporting argument arguments
- Clear argued case for determination of source and transmission
- Clear evidence of identification and application of the appropriate scientific principles underpinning food safety and the system that failed leading to outbreak
- Evidence of thorough background reading. Assignment is correctly referenced