NO LINKS IDENTIFIED BETWEEN GASTROENTERITIS INCIDENTS TRACED TO MANDARIN ORCHARD HOTEL, FOODTALKS CATERER & MANUFACTURER & TUNG LOK MILLENIUM PTE LTD

             The Ministry of Health (MOH), National Environment Agency (NEA) and Agri-Food & Veterinary Authority of Singapore (AVA) have completed investigations into the separate gastroenteritis incidents traced to Mandarin Orchard Hotel, FoodTalks Caterer & Manufacturer and Tung Lok Millennium Pte Ltd.    

2.            Based on the epidemiological findings, clinical presentation and laboratory findings, there are no links identified between the three gastroenteritis incidents, or to the salmonellosis outbreak traced to Spize Restaurant at River Valley Road.

Mandarin Orchard Hotel

3.            As of 13 December 2018, a total of 315 cases were reported to have developed gastroenteritis symptoms after attending five separate events held at the Grand Ballroom at Mandarin Orchard Hotel at 333 Orchard Road between 1 and 3 December 2018. 14 cases were hospitalised, of whom 13 have since been discharged. The remaining case is in stable condition.

4.            Joint inspections were conducted by MOH, NEA and AVA on 4 and 5 December 2018, and the banquet kitchen serving the Grand Ballroom was suspended on 5 December 2018. At the same time, the hotel was instructed to close and conduct thorough cleaning and disinfection of the Grand Ballroom. Additional joint inspections were conducted on 6 and 10 December 2018, and interviews with the staff of Mandarin Orchard Hotel were held. The interviews revealed that there was improper cleaning of vomitus in the Grand Ballroom, and banquet servers had continued to work while ill.

5.            The investigations suggest that this is an outbreak of norovirus[1] gastroenteritis. There is strong evidence of severe contamination of the Grand Ballroom with norovirus from poor environmental and personal hygiene practices. Norovirus was detected from the stool samples collected from five cases, three food handlers and 28 service staff, including banquet servers who reported to have continued working while they were ill. Environmental swabs collected from the Grand Ballroom also detected norovirus from environmental surfaces such as carpet, tables, chairs, unused table cloths, cutlery and drinking glasses from the Grand Ballroom. In addition, faecal coliforms were detected in the food sample and Bacillus cereus from various environmental swabs, such as those taken from the surfaces of utensils and door handles.

6.            The suspension of the banquet kitchen and closure of the Grand Ballroom will continue to be in place until NEA is satisfied that the public health risks including the satisfactory disinfection of the premises, have been addressed.

FoodTalks Caterer & Manufacturer 

7.            131 cases were reported to have developed gastroenteritis symptoms after consuming food prepared by FoodTalks Caterer & Manufacturer at Bedok North during a pre-school day camp on 26 November 2018. None of the cases were hospitalised.

8.            A joint inspection was conducted by MOH, NEA and AVA on 27 November 2018. Several hygiene lapses and poor kitchen habits were identified, including  lack of proper segregation between raw and ready-to-eat food in the same chiller compartment, use of the same preparation table for raw food and ready-to-eat food items, evidence of cockroach infestation and preparation of ready-to-eat food items one to two days before consumption.

9.            While the exact causative agent could not be identified, the short incubation period from consumption of the food to development of symptoms, and the predominant symptom of vomiting, suggest that the outbreak was likely due to ingestion of toxins produced by bacteria in the food.

Tung Lok Millennium Pte Ltd  

10.         190 cases were reported to have developed gastroenteritis symptoms after consuming food prepared by Tung Lok Millennium Pte Ltd at 1 Expo Drive during an event held between 19 and 21 November 2018. None of the cases were hospitalised.

11.         Tung Lok provides catering services for several other events at Expo, which caters to a large number of people and in view of potential ongoing transmission then the caterer’s operating license was suspended after the joint inspection conducted by MOH, NEA and AVA on 23 November 2018. Several hygiene lapses and poor kitchen habits were identified, including no provision of soap for handwashing and improper use of ice dispensing utensil for ready-to-eat ice.

12.         An environmental swab taken from the bento packing table tested positive for Bacilus cereus. As the majority of the cases had recovered by the time MOH was informed of the outbreak, stool samples were not available for analysis to identify the causative agent. Nonetheless, based on the predominant symptoms of diarrhoea and abdominal pain without fever, the pathogen involved is unlikely to be related to any of other three outbreaks reported.

Follow Up Actions

13.         The authorities will continue to place the implicated premises under close surveillance and work with them to improve their food hygiene practices. Our officers will be conducting further inspections to ensure that the implicated premises maintain good hygiene standards, and that the kitchen staff observe proper personal hygiene and food handling practices.

14.       The suspension of the banquet kitchen at Mandarin Orchard Hotel, closure of its Grand Ballroom and the suspension of Tung Lok Millennium will continue to be in place until NEA is satisfied that the public health risks have been addressed. NEA will also be taking enforcement actions against these licensees, as well as FoodTalks Caterer & Manufacturer for the lapses observed at the implicated premises.

15.       NEA and AVA have stepped up checks on food establishments as the year-end festive season approaches. With the increase in volume of consumers dining out and ordering catered food, all food operators must ensure that the food sold is prepared hygienically and safe for consumption. We will not hesitate to take action against any operators for failing to maintain food safety. NEA has also engaged key representatives from the Association of Catering Professionals Singapore (ACAPS) and the Restaurant Association of Singapore (RAS) about the importance of food hygiene and safety. In addition, NEA and AVA advise all food operators and consumers to practise good food and personal hygiene. We will continue to maintain our strict stance on food safety and ensure compliance from the food operators. 

16.       To further safeguard public health, NEA will continue to review the overall regulatory framework, including the current penalty regime, to strengthen accountability of operators and ensure that food establishments take greater responsibility for the hygiene standards of their premises and operational processes. This will be part of the efforts to enhance regulatory oversight over all food related matters and further strengthen our food safety regime.

[1] Norovirus is a common virus that causes gastroenteritis and can spread easily from contaminated food or environmental surfaces.