Investigation of a cluster of acute diarrhea outbreak among youth athletes at a temporary sports accommodation, School A, Mueang District, Chiang Rai Province, June 2024

Abstract

On June 8, 2024, the Disease Prevention and Control and Epidemiology Unit of Chiang Rai Prachanukroh Hospital was notified by the emergency department of multiple youth athletes presenting with diarrhea, abdominal pain, and vomiting. An outbreak investigation was conducted to confirm the outbreak, study outbreak characteristics, identify the source, and implement control measures. A descriptive and analytical study using a retrospective cohort design was performed. Data collection and active case finding were conducted, with case definition including any coach or athlete at the temporary sports accommodation of School A who exhibited at least two symptoms of fever, diarrhea, nausea/vomiting, or abdominal pain between June 3 and June 16, 2024. Environmental study was conducted, and stool and environmental samples were collected for bacterial culture. The investigation identified 118 individuals (coaches and athletes), with 41 cases meeting the case definition, and an attack rate of 34.7%. All cases were youth athletes. Escherichia coli was detected in stool samples, ice used for food storage, and drinking water from an ice container. Suspected sources were meal boxes prepared by coaches (adjusted odds ratio (aOR)=4.06, 95%CI=1.16-14.19, p<0.05) and drinking water from the ice container (aOR=7.29, 95% CI=1.89-28.04, p<0.05). Environmental assessments revealed improper food storage and inadequate sanitation, failing to meet food and water hygiene standards. Control measures included halting water consumption from the container, discontinuing food preparation at School A, and providing health education on food and water hygiene. Following these interventions, the number of cases declined, and no additional cases were reported before the competition ended. For future sporting events of a similar nature, proper venue preparation, resource allocation, and hygiene education for all stakeholders should be ensured. A hygiene auditing team should also be established to meet standards before the event to prevent recurring outbreaks.