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On 7 January 2021, the health manager at Bheramara, Bangladesh notified the Institute of Epidemiology, Disease Control, and Research (IEDCR) that eighteen people were hospitalized for acute gastrointestinal illness. We investigated to characterize the outbreak, identify the source and contain it. We conducted a retrospective cohort study after confirming that all cases ate a funeral meal on 5 January. Cases were attendees who ate the lunch and had ≥3 loose stools in 24 hours or vomiting from 5 January. We interviewed attendees with a semi-structured questionnaire. A Food Safety Inspector examined the food preparation areas. Stool and water samples were tested. Food-specific-attack rates, risk-ratios, and 95% confidence interval (CI) were calculated. Common symptoms were diarrhea (94%) and vomiting (42%). The median incubation period was 16 (range 7-23) hours. The attack rate of lunch attendees was 62% (72/117) with one death. Attendees who reported eating reheated rice had a significantly higher risk of having acute gastrointestinal symptoms than those who did not (RR 2.6, 95% CI 1.1-6.3). No pathogenic organism was isolated. We suspected inadequately reheated rice was the source of the outbreak. We recommend proper cooking, storage, and adequate reheating of rice in a clean environment to prevent future outbreaks.
Keywords: acute gastroenteritis, bacillus cereus, reheated rice, outbreak, Bangladesh
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