A foodborne outbreak linked to Bacillus cereus at two middle schools in a rural area of Chongqing, China, 2021

Bacillus cereus (B. cereus) is a common cause of foodborne illness. An outbreak of acute gastrointestinal illness occurred at two middle schools in a rural region of Chongqing, China, in 2021. This study aimed to elucidate the outbreak’s characteristics, identify risk factors, and determine the source of contamination. A retrospective cohort study and an environmental investigation were conducted. Vomit samples, anal swabs, and food samples were collected and tested by RT-PCR for 18 species of bacteria and viruses, including B. cereus. Positive samples of B. cereus underwent biochemical experiments and bacterial quantification. A total of 198 cases were reported in this outbreak, with an attack rate of 24.63%. The main symptoms were vomiting (100%), bellyache (83.33%), and dizziness (62.63%). The retrospective cohort study showed a significant association between the outbreak and rice noodles provided by a nearby food manufacturer (RR = 39.63, p < 0.001). B. cereus was detected in 20 vomit samples, three anal swabs, and seven rice noodles samples, with a count exceeding 10(3) CFU/g. These findings strongly suggested that the outbreak was linked to B. cereus-contaminated rice noodles. Enhancing food safety surveillance and promoting health measures among schools and food manufacturers in rural areas is crucial to prevent similar incidents in the future in Chongqing, China.