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OBJECTIVES  This study aimed to reveal the epidemiologic characteristics of the outbreak of gastroenteritis caused by  Salmonella enterica  serovar Thompson in Busan Metropolitan City and to identify points for improvement to prevent of food-borne disease outbreak.    METHODS  This was a case-control study. The control group comprised asymptomatic students in the same classes of the cases. The presence or absence of symptoms, ingestion of each food provided by school meal service, and commonly ingested foods in addition to those foods in meal service were investigated. Moreover, specimens collected from rectal swab, preserved foods, and environmental surface were tested.    RESULTS  Of the 6,092 subjects, 1,111 (1,083 students, 22 school personnel, and 6 foodservice employees) were included in the case group; this corresponded to an 18.4% attack rate. Symptoms included diarrhea (n=1,051, 94.6%), abdominal pain (n=931, 83.8%), febrile sensation (n=502, 45.2%), and vomiting (n=275, 24.8%). The epidemic curves of each 10 schools were unimodal. Investigation of food intake showed a significantly high odds ratio for chocolate cake in 5 out of the 10 schools. Laboratory test detected  Salmonella enterica  serovar Thompson both in rectal swab specimens of 9 schools and in collected preserved chocolate cakes of 9 schools. Pulsed-field gel electrophoresis test result showed that  Salmonella enterica  seorvar Thompson isolated from human and foods were the same.    CONCLUSIONS  The source of infection for the  Salmonella enterica  serovar Thompson outbreak in the 10 schools of Busan Metropolitan City is chocolate cake. Traceback investigation for origin of contaminated food in food-borne disease outbreak and safety control during food production should be more enhanced.

A large outbreak of Salmonella enterica serovar Thompson infections associated with chocolate cake in Busan, Korea