Pallab Sarmah

Background & objectives: Food and waterborne illnesses remain a neglected public health issue in India. Events with large gatherings frequently witness outbreaks of acute diarrheal diseases due to consumption of contaminated food or water or poor food handling practices. In the present study, an outbreak of acute diarrhoeal disease (ADD) occurring among the attendees of a birthday party in rural Dibrugarh district in the northeastern Indian State of Assam was investigated. Methods: Sociodemographic information along with details of ADD outbreak that included information about source of foods, food handlers, illness details, etc., were collected using an outbreak investigation form for descriptive and analytical epidemiology. Rectal swabs from affected individuals and food handlers were collected along with bore-well water samples and tested in the laboratory by performing bacterial culture, biochemical analysis and polymerase chain reaction. Due to the delayed report on the outbreak, collecting leftover food for laboratory testing and analysis was impossible. Results: A total of 25 cases of ADD had similar signs and symptoms. The mean incubation period for developing acute diarrhoea was 26.36±8.76 (± standard deviation) hours from food consumption. The overall attack rate was 60.04 per cent (25/41); 20 per cent (5/25) required hospitalization. Thirteen rectal swab samples were tested for pathogens and found positive for Shigella sonnei. Antibiotic susceptibility test of isolated S. sonnei showed resistance to nalidixic acid, ciprofloxacin and cefotaxime. Consumption of one of the food items - chicken curry was significantly associated with illness (Odds Ratio=14.8; 95% Confidence Interval: 2.75-85.11); P valueS. sonnei infection could be implicated in the investigated food-borne diarrhoeal disease outbreak and that there was a potential for human-poultry cross-infection. Additionally, the study revealed concerning levels of S. sonnei resistance to recommended antibiotics and drew attention to their public health relevance.

Circulation of antimicrobial resistant (AMR) bacteria in the environment, animals, and humans is a major concern. Food chain is an important link to spread AMR across the biosphere. Global warming, preserved and fast foods availability, random use of un-prescribed antimicrobials, unplanned bio-waste management, and using high doses of antibiotics and bio-fertilizers to agricultural fields and animal farms, increase the threat of spreading AMR bacteria. Current study reports prevalence of AMR in enteric pathogens isolated from food, food handlers, environment, and diarrheal patients. The incidence data on AMR pathogens were collected from Assam, Sikkim, Tripura, and Arunachal Pradesh, India, through a well-structured market and hospital surveillance. There were 428 (3.0%) enteric pathogens detected in food and 184 (5.3%) in clinical samples. Most of the pathogens were resistant (70–100%) to commonly used antimicrobials in treatment of diarrheal infection. Result showed a spread of AMR across food chain, underscoring need for swift preventive intervention.