By: Candess Zona-Mendola

On November 7, 2016, 29 children became ill after eating lunch at their daycare, Ave Marie Friends Preparatory School in Lauderhill, Florida. Within mere hours after eating, the children, aged between 1 and 10 years old, began vomiting and having diarrhea. Some children became severely ill so quickly, that they required immediate medical attention via stretcher and ambulance to the nearby emergency rooms. They were transported to three different hospitals to be exact. – Plantation General Hospital, Broward Health Medical Center and Broward Health Coral Springs. Broward Sheriff Fire Rescue, Sunrise Police, and Sunrise Fire Rescue were the heroes of the day, as they assisted with transport of the ill children to hospitals and directed traffic. The local first responders, the fire department, were called to the various daycares to aid the sick children and figure out the source of the rapid illnesses.

Initially, first responders believed there may be a gas leak. The schools were closed the following day, and an investigation ensued. When a leak was not found, the only reasonable conclusion was the food. According to Assistant Fire Chief Jeff Levyof Lauderhill Fire Rescue, “the only common denominator is what the children ate for lunch.” The Florida Department of Health in Miami‐Dade County Office of Epidemiology, Disease Control, and Immunization Services were called to the scene, and thankfully, was able to secure several samples of leftovers from lunch. These included: ham and turkey from sandwiches, vegetables, black eyed peas and dinner rolls. The samples were sent to the state’s Bureau of Public Health Laboratories in Jacksonville, Florida for pathogenic testing to find what bacteria or virus was the cause of the outbreak.

While testing was ongoing, several agencies jumped into action to aid those already called to the scene. The Broward County Health Department Epidemiology Program, the Broward Sheriff’s Child Protective Investigation Section, acting on behalf of the Florida Department of Children & Families, and Florida Department of Business and Professional Regulation also joined the investigation into the 29 cases. It was soon apparent that they were not the only ones who were victim to gastrointestinal illness. At 9 other daycares in Broward and Miami-Dade counties, more children were sick. The victim count grew to 149 sick children and six ill pre-school teachers – 117 children from 8 Miami-Dade daycare centers and 32 children from 2 Broward County schools.

The Florida agencies interviewed all of the daycares with sick children and found there was a common state-funded catering company that served them all. According to the report from the Florida Health Food and Waterborne Disease Program, we “[were] provided a list of 16 daycares within Miami‐Dade County that participate in the Child Care Food Program and subcontract meals from the catering company. Each child care center was contacted to obtain the total number of children & staff and a line list of ill persons. Line lists included information on age, gender, symptoms, and whether the individual visited a medical provider.”

On November 9, 2016, he inspections and investigations into the catering company for the affected daycares, Healthy Children Catering, commenced within that week. The Florida agencies conducted 5 inspections of Health Children Catering’s premises within a few day period. Their findings were concerning to say the least. Several food safety violations were apparent from the onset. Dumpsters were full and overflowing. Food debris and grease were found on food-contact surfaces. The proper sanitization methods were not in place. There were several repeat violations from previous inspections, including employees failing to wash hands, employees failing to put on gloves, standing water, and raw meats being stored on the floor. These violations did not even account for the worst of what was found. Improper food temperatures and dented/ rusted cans were among the highest priority of the violations.

Following the investigations, the agencies put a stop order on the catering company’s sale of the canned goods, as well as, Congri (rice and beans); pork, turkey sandwiches and cooked vegetables. The agencies conducted follow-up inspections to ensure that violations have been corrected. On November 10, 2016, the Florida agencies fined the company for 14 un-rectified violations. The company was not ordered to close, and remains open for business.

Meanwhile, the test results from the state laboratory returned. Staphylococcus aureus (Staph) was found in the turkey and ham samples. According to the final report, “S. aureus levels in the ham exceeded those (106 CFU/gram of food) typically known to cause illness.” All other samples were negative for both Staph and Bacillus cereus. There were no specimens collected from any of those who were sick. According to the state laboratory,

“Samples including leftover ham, turkey, mixed vegetables, black eyed peas and dinner rolls were analyzed by BPHL‐Jacksonville and the findings of their analysis identified Staphylococcus aureus at 108 colony forming units (CFU’s) per gram in the ham and turkey collected. Evidence of S. aureus was not found in the other foods. Samples were negative for Bacillus cereus. Samples of the food saved for quality control purposes by the caterer were sent to a private laboratory for analysis. Those results were negative for enteric pathogens.”

The state laboratory provided the following table of their epidemiology results:

Dayc a re Number of Cases Number of Attendees Attack Rate (%) Sex (% Male) Age Range (Years) Median Age (Years) Hospitalized (%)
A 11 13 84.6 54.6 1.6 – 4.8 3.7 15.4
B 24 61 39.3 50.0 1.6 – 10.5 3.6 14.8
C 4 40 10.0 25.0 1.9 – 4.5 4.0 5.0
D 13 63 20.6 23.1 1.7 – 4.4 2.3 7.9
E 9 10 90.0 33.3 1.6 – 5.2 3.9 20.0
F 13 86 15.1 30.8 2.2 – 5.4 3.2 5.8
G 7 70 10.0 57.1 1.3 – 6.1 1.7 4.3
H 36 60 60.0 47.2 1.1 – 5.18 3.2 31.7
I 21 30 70.0 ‐‐ ‐‐ ‐‐ 9.5
J 11 23 47.8 ‐‐ ‐‐ ‐‐ 0
TOTAL 149 456 32.6 42.7 1.1‐10.5 3.3 11.7

After three months of investigation, on March 3, 2017, the agencies together issued a final report. The cause of the outbreak was determined to be Staphylococcal food poisoning (SFP) from Staphylococcus aureus (Staph), likely from the ham or turkey served by Healthy Children Catering. The final report states that Health Children Catering’s food safety violations “resulted in an environment that is conducive to S. aureus multiplication and toxin production.” The agencies left the company with a final warning, and reported “[c]aterers serving young children should be aware of the risks associated with improper food handling and storage. Safe food preparation in lunch programs, particularly child care centers, is essential.”

Since the outbreak, the affected daycares found alternative catering companies. The final report confirmed that there were no deaths as a result of the outbreak.