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File: 970207_aadch_014.txtEntameoba histolytica, giardia and salmonella were isolated from patient stools by a local national military laboratory. Coliform organisms were cultured from the ice. g. October l99O, King Fahd: 100 cases of gastroenteritis presented in less than one week. The suspected source was green salad or salad serving utensils from an on-base USAF-supervised dining tent. h. October 1990, Riyadh: 400 cases of gastroenteritis presented in less than one week. Shigella sonnet was cultured from the stools of 15 patients. Green salads prepared in a USAF- supervised dining tent by third country nationals and served during a dinner meal were implicated as the source of infection by time-distribution curve. i. November 1990, Cairo West: 15 cases presented over a three hour period with sudden onset of vomiting, prostration, abdominal cramping and diarrhea. A sanitation evaluation of the dining hall revealed no significant discrepancies. Leftover foods were shipped to NAMRU-6 (U.S. Navy laboratory) for analysis. Staphylococcus aureus enterotoxin was found in spaghetti and meat sauce. j. December 1990, Taif: 86 cases of gastroenteritis presented over a three day period, of which 79 were hospitalized. Medical management of these cases involved the temporary assignment from other ATHs of two auxiliary nursing teams. Most of the more seriously ill patients were transferred to a local national hospital along with four nurses, six medical technicians, two physicians, one diet therapist, and one laboratory technician. Salmonella, tyne O was cultured from 41 of 48 patients in a local national hospital laboratory. Also, 27% of patient stools reported contained Entameaba histolyica cysts. The suspected source was grossly contaminated (feces and feathers) raw eggs from an unapproved source which were served undercooked (soft-scrambled) for breakfast in a USAF-supervised dining facility. Ninety-seven percent of the ill patients had eaten eggs (other foods = 60-63%). Patients described the eggs as runny. The bottoms of the egg crates were contaminated with straw, feces and dirt. Approximately 201 of the eggs arrived cracked. Cracked eggs were not segregated and disposed of but rather were cooked and served. Although soiled with feces and feathers, no effort was made to wash the egg shells. Receipt inspection by EH had not been performed. Contracting and food service o~ficers were reportedly unaware of need to involve EH in the receipt inspection and approved source verification process. The dining facility handwashing stations for foodhandlers and patrons were inadequate and minimal use was made of those available. All eggs in remaining stock were subsequently destroyed. Approximately 400 m.an days or^ productivity were lost because of this outbreak. 4
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