A Clostridium perfringens Food Poisoning Outbreak in a School Caused by Precooked Pork Skin, Thailand, 2024
DOI:
https://doi.org/10.59096/osir.v19i3.279922Keywords:
food poisoning, school, outbreak, Clostridium perfringensAbstract
Objectives: In September 2024, a food poisoning outbreak occurred at a school in Buriram, a northeastern province of Thailand. We investigated to confirm the outbreak and diagnosis, describe its epidemiological characteristics, identify the source, and provide recommendations.
Methods: We reviewed food poisoning situations and conducted an active case finding in the school. A suspected case was anyone at the school between 17–21 Sep 2024 with diarrhea or vomiting; confirmed cases had gastrointestinal pathogens detected in stool specimens or rectal swabs. We conducted interviews on food preparation and a matched case-control study using conditional logistic regression model to identify the contaminated food. Samples of food, water, and utensils were also tested for bacterial and viral contamination.
Results: A total of 658 cases were reported (attack rate of 40.0%), 97.1% presenting with watery diarrhea. The outbreak began on 17 September in the afternoon, peaked that night, and ended on 21 September. Analytical study implicated spicy pork salad from 17 September lunch as the source (adjusted odds ratio 18.99, 95% confidence interval 1.86–193.70). Investigation revealed that its ingredient, precooked pork skin, was improperly stored and the cooked lunch was not reheated before serving. Testing confirmed Clostridium perfringens in 17 cases, as well as in leftover spicy pork salad and pork skin samples.
Public Health Recommendations: This incident highlights the risks of improper food handling. We recommend avoiding keeping food ingredients at room temperature, thorough reheating precooked ingredients, and adherence to food safety standards for the school canteen.
References
World Health Organization. Estimating the burden of foodborne diseases [Internet]. Geneva: World Health Organization; [cited 2025 Jan 23]. <https://www.who.int/activities/estimating-the-burden-of-foodborne-diseases>
Department of Disease Control, Ministry of Public Health (TH). Digital disease surveillance dashboard [Internet]. Nonthaburi: Department of Disease Control; [cited 2026 May 8]. <https://dvis3.ddc.moph.go.th/t/DDC_CENTER_DOE/views/DDS2/sheet33?%3Aembed=y&%3AisGuestRedirectFromVizportal=y>
Department of Disease Control, Ministry of Public Health (TH). Modernized event-based surveillance [Internet]. Nonthaburi: Department of Disease Control; [cited 2026 May 8]. <https://mebs-ddce.ddc.moph.go.th/events/search>
Srisaeng S, Chirapongsathorn S, Soonthornworasiri N, Poovorawan K, Pan-Ngum W. Burden of diarrhoeal diseases among hospitalised patients in Thailand: a retrospective national database analysis (2014-2022). Lancet Reg Health Southeast Asia. 2026 Apr 6;48:100761. doi:10.1016/j.lansea.2026.100761.
Charoenwat B, Suwannaying K, Paibool W, Laoaroon N, Sutra S, Thepsuthammarat K. Burden and pattern of acute diarrhea in Thai children under 5 years of age: a 5-year descriptive analysis based on Thailand National Health Coverage (NHC) data. BMC Public Health. 2022 Dec 1;22(1):1161. doi:10.1186/s12889-022-13598-8.
Pahtspot. Economic impact of foodborne illnesses in the food industry and how to prevent them PathSpot Technologies [Internet]. New York: Pathspot Technologies; [cited 2025 Jan 23]. <https://pathspot.com/economic-impa ct-of-foodborne-illnesses-in-the-food-industry-and-how-to-prevent-them/>
Bloomberg School. A foodborne illness outbreak could cost a restaurant millions, study suggests [Internet]. Baltimore (MD): Johns Hopkins Bloomberg School of Public Health; 2018 Apr 16 [cited 2025 Jan 23]. <https://publichealth.jhu.edu/2018/a-foodborne-illness-outbreak-could-cost-a-restaurant-millions-study-suggests>
Bureau of Food and Water Sanitation. Clean Food Good Taste Guideline. Nonthaburi: Department of Health, Ministry of Public Health (TH); 2021. Thai.
Heredia NL, Labbe RG. Clostridium perfringens Infection. In: Labbe RG, Garcia S, editors. Guide to foodborne pathogens. 2nd ed. Hoboken (NJ): Wiley; 2023 Aug 8. p.82–90. doi:10.1002/9781118684856.ch5.
National Center for Emerging and Zoonotic Infectious Diseases. Facts about food poisoning [Internet]. Atlanta: Centers for Disease Control and Prevention (US); 2025 Nov 24 [cited 2026 May 8]. <https://www.cdc.gov/food-safety/data-research/facts-stats/index.html>
Ministerial Regulation on Sanitation of Food. Standard food sanitation inspection form for canteen, 2018 [Internet]. Nonthaburi: Department of Health, Minisry of Public Health (TH); [cited 2025 Jan 23]. <https://foodsan.anamai.moph.go.th/th/food-sanitation/download/?did=204396&id=75018&reload=>. Thai.
StatsDirect; University of Liverpool. Sample size for matched case-control studies [Internet]. Wirral: StatsDirect; [cited 2026 May 29]. <https://www.statsdirect.com/help/sample_size/matched_case_control.htm>
National Center for Emerging and Zoonotic Infectious Diseases. Symptoms of C. perfringens food poisoning [Internet]. Atlanta: Centers for Disease Control and Prevention (US); 2025 Jan 30 [cited 2025 Jan 23]. <https://www.cdc.gov/clostridium-perfringens/signs-symptoms/index.html>
Ministry of Public Health. Notification of the Ministry of Public Health (No. 416) B.E. 2563 (2020) Issued by virtue of the Food Act B.E. 2522 Re: Prescribing the quality or standard, principles, conditions and methods of analysis for pathogenic microorganisms in foods. Royal Thai Government Gazette. Volume 137, Special part 237 Ngor (Date 2020 Sep 2): 9.
Department of Medical Science, Ministry of Public Health. The notification of the Department of Medical science: Microorganism quality standard for foods and utensils [Internet]. Nonthaburi: Department of Medical Science, Ministry of Public Health; 2017 [cited 2025 Jan 23]. 10 p. <http://bqsf.dmsc.moph.go.th/bqsfWeb/wp-content/uploads/2017/Publish/e-book/dmsc-micro3.pdf>. Thai.
Ameme DK, Alomatu H, Antobre-Boateng A, Zakaria A, Addai L, Fianko K, et al. Outbreak of foodborne gastroenteritis in a senior high school in South-eastern Ghana: a retrospective cohort study. BMC Public Health. 2016 Jul 13;16:564. doi:10.1186/S12889-016-3199-2.
Papanikou S, Sideroglou T, Chrysostomou A, Kyritsi MA, Spaniolas S, Bouboulis D, et al. A point source gastroenteritis outbreak in a high school putatively due to Clostridium perfringens: timely investigation is everything. Foodborne Pathog Dis. 2023 Feb 1;20(2):41–6. doi:10.1089/FPD.2022.0057.
Dominguez-Berjon MF, Sanz-Moreno JC, Redondo-Sobrado R, Azpiazu-Garrido M, Moreno-Civantos A, et al. [Foodborne outbreak by Clostridium perfringens in a school dining room]. Med Clin (Barc) [Internet]. 2003 Jun 14 [cited 2025 Jan 23];121(2):58–60. <https://pubmed.ncbi.nlm.nih.gov/12828885/>. Spanish.
National Center for Emerging and Zoonotic Infectious Diseases. About C. perfringens food poisoning [Internet]. Atlanta: Centers for Disease Control and Prevention (US); 2024 Apr 3 [cited 2025 Jan 23]. <https://www.cdc.gov/clostridium-perfringens/about/index.html>
National Center for Emerging and Zoonotic Infectious Diseases. Preventing C. perfringens food poisoning [Internet]. Atlanta: Centers for Disease Control and Prevention (US); 2024 Apr 3 [cited 2025 Jan 23]. <https://www.cdc.gov/clostridium-perfringens/prevention/index.html>
National Center for Emerging and Zoonotic Infectious Diseases. Treating C. perfringens food poisoning [Internet]. Atlanta: Centers for Disease Control and Prevention (US); 2024 Apr 3 [cited 2026 May 29]. <https://www.cdc.gov/clostridium-perfringens/treatment/index.html>
Dryden MS, Keyworth N, Gabb R, Stein K. Asymptomatic foodhandlers as the source of nosocomial salmonellosis. J Hosp Infect. 1994;28(3):195–208. doi:10.1016/0195-6701(94)90102-3.
Todd ECD, Greig JD, Bartleson CA, Michaels BS. Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 2. Description of outbreaks by size, severity, and settings. J Food Prot. 2007;70(8):1975–93. doi:10.4315/0362-028X-70.8.1975.
National Center for Emerging and Zoonotic Infectious Diseases. Preventing food poisoning [Internet]. Atlanta: Centers for Disease Control and Prevention (US); 2025 Nov 24 [cited 2026 May 29]. <https://www.cdc.gov/food-safety/prevention/index.html>
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