The Hong Kong Special Administrative Region’s Center for Food Safety reports 2015 was a fairly routine year for outbreaks and illnesses from foodborne diseases. harborhongkong_406x250In collaboration with the Department of Health (DH), the Center for Food Safety received 256 referrals from the DH on foodborne disease outbreaks affecting 993 people. During the past decade, the number of referrals decreased from 859 in 2006 to 279 in 2010, and has since remained stable between 216 and 350 per year. Bacterial foodborne agents remained the leading cause, being responsible for 78 percent of all foodborne disease outbreaks Hong Kong in 2015.  Salmonella, Vibrio parahaemolyticus and Clostridium perfringens were the top three agents. For the viral causes, norovirus, associated with the consumption of raw or undercooked bivalves, was the most common agent, causing 9 percent of all the outbreak referrals. Of the 256 cases investigated in 2015, contamination by raw food, inadequate cooking and contaminated raw food intended to be consumed raw were the most frequently identified contributing factors. Large-scale food poisoning outbreak related to “Hung Rui Chen” sandwiches Between July and August 2015, there were a total of 34 clusters of Salmonella food poisoning outbreaks that involved 96 patients consuming different varieties of “Hung Rui Chen” sandwiches purchased through various channels. All patients have since recovered without serious complications. Investigation showed that the incriminated sandwiches were manufactured and prepackaged in Taiwan, and imported by companies or taken by individuals into Hong Kong. The identical Salmonella Enteritidis strain was isolated from patients of 10 clusters, as well as from unconsumed sandwiches collected from the patients of one cluster. The same outbreak strain was isolated from the stool specimen of one patient who purchased the sandwiches directly from a shop at the Taiwan Taoyuan International Airport. The available findings pointed to a common source of contamination and the site of contamination was likely to have occurred outside Hong Kong before the sandwiches were packaged. Subsequent prolonged and improper storage of the sandwiches might have provided favorable conditions for the bacteria to grow and thus aggravated the size of the outbreak, officials reported. A larger outbreak was likely avoided because the CFS immediately followed up with the trade, traced the sources and distribution of the affected products, and urged the public not to consume the affected products. Food businesses were reminded to stop selling or using the affected products. To safeguard public health, the CFS banned all “Hung Rui Chen” sandwiches from being imported into and sold in Hong Kong as of Aug. 3, 2015. Enhanced inspection and surveillance of selling of the sandwich in question at retail outlets, collection points and online were mounted. No sale of the remaining stock of affected products was detected in any of these channels. Furthermore, the CFS also enhanced food safety publicity regarding the microbiological risks of perishable foods such as sandwiches. School outbreak accounted for another large percentage of total outbreak numbers In September 2015, there was a major food poisoning outbreak affecting 120 children and staff of a school. All had consumed the same type of box lunches, suspected to be contaminated with C. perfringens, that were provided by a food factory. hongkong_406x250The CFS visited the food factory and the school immediately upon receipt of notification. It was found that the cooked food ingredients were delivered to the school earlier than usual on the day of consumption of the meal in question and the documentation of temperature control was less than satisfactory. The CFS instructed the catering service to follow good food safety practices, particularly in keeping the cooked food for lunch boxes at a proper holding temperature before consumption. Enhanced follow-up inspections to the concerned food factory were conducted and no further related cases were reported afterwards. Outbreaks involving lunch boxes are not uncommon in Hong Kong. C. perfringens, commonly present in raw meat and poultry, is a well-recognized cause for foodborne disease in this setting. As the foods are prepared in large quantities in advance any lapse in food safety measures may lead to large-scale food poisoning outbreaks. The providers must cook the food thoroughly and keep them at safe temperatures, i.e. above 60˚C or at or below 4˚C, as effective preventive measures. The number of foodborne disease outbreaks in Hong Kong has remained at a relatively low level over the past few years as compared with years prior to about 2005. (To sign up for a free subscription to Food Safety News, click here.)