Watch what you eat this holiday! – A Gastroenteritis Advisory

The festive season is upon us, which means meeting friends and eating out more than usual. However, it is prudent for everyone to be extra cautious when eating out.

Singapore has recently witnessed a spate of four food poisoning outbreaks since November 2018. These food poisoning incidents have affected more than 400 people, with the most serious incident involving a fatality after more than 80 people were taken ill after consuming bento box lunches. More than 20 people were hospitalised, including a 38-year-old auxiliary police officer who sadly passed away.

The latest outbreak, first reported on December 2, affected 175 people after they had taken meals during four separate events over a three-day period.

What is Gastroenteritis (also known as stomach flu or food poisoning)?

Gastroenteritis (commonly referred to as “stomach flu”) is a stomach and/or intestinal infection that produces watery diarrhoea, abdominal cramps, nausea or vomiting, and sometimes fever. This could be due to consuming food or water that has been contaminated by viruses / bacteria, their toxins and occasionally parasites. Symptoms may start within hours to days after consuming the contaminated food. Depending on the cause of the inflammation, symptoms may last from one day to more than a week.

What is an outbreak of food poisoning?

Simply put, an outbreak is the occurrence of a volume of food poisoning cases at a particular place and time resulting from the ingestion of a common food and/or water source.

Who is at risk for gastroenteritis?

Young children: Children in child care centres or schools are vulnerable because it takes time for a child’s immune system to mature. If there are stomach flu cases in your child’s class, you might want to take extra precaution. And if your kid is the one down with stomach flu, stay away from school as long as you can!

Older adults: Older adults, particularly those in nursing home, are vulnerable, because their immune systems weaken and they live in close contact with others who may pass along germs.

School children, churchgoers or dormitory residents: Any place where groups of people come together can be a breeding ground for bacteria and viruses to pass around.

Anyone with a weakened immune system: If your resistance to infection is low — for instance, if your immune system is compromised by chemotherapy, HIV/AIDS or another medical condition — you may be especially at risk.

What are some common viruses / bacteria that commonly cause gastroenteritis?

In the recent outbreaks, investigations by the National Environment Agency (NEA) and the Ministry of Health (MOH) found six different types of pathogens. Learn more about what they are and how they come to be:

Salmonella Typhimurium and Salmonella Albany

Salmonella is the one bacteria everyone knows, thanks to Gordon Ramsay. It spreads through contaminated water or food, or through ingestion of raw or undercooked meat or eggs, hence Mr Ramsay’s wrath upon discovering undercooked meat. It was the main cause of the food poisoning incident from Spize Restaurant at River Valley.

Faecal Coliforms

Faecal coliforms are a group of bacteria commonly found in faeces. Ingestion of such bacteria may not be immediately harmful, but their presence indicates a high risk of other harmful pathogens.

Bacillus Cereus

Consumption of bacillus cereus and the toxins it produces results in an illness nicknamed “fried rice syndrome” due to the first recognised outbreaks being linked to fried rice. The heat from cooking stimulates the bacteria to reproduce, and leaving the food at room temperatures allows the bacteria to incubate. Reheating the food briefly does not kill bacillus cereus nor does it neutralise the toxins it produces.


Norovirus is highly contagious and is usually transmitted by consuming contaminated food or drink, touching contaminated surfaces, or having contact with an infected person (e.g. caring for or sharing utensils with an infected person). Norovirus gastrointestinal disease (GID) outbreaks occur frequently in closed settings, with high attack rates. It has been responsible for several outbreaks in Singapore in recent years.

Campylobacter Jejuni

A bacteria that can be contracted through ingestion of the organism in undercooked chicken or pork, contaminated food, water or unpasteurised milk. It is also commonly found in animal faeces.

What treatment is available for food poisoning?

Hydrate, hydrate, hydrate! In most cases of food poisoning, treatment is mainly supportive and you’ll just have to wait for all the bad stuff to leave your body. Drink lots of water, isotonic drinks, eat small, low-fat meals, and rest up! Make sure that you’re urinating normally and that your urine is light and clear.

Antibiotics are not usually recommended but may be used for some types of bacterial or parasitic infections.

How soon can I resume my duties at work?

Take as much as time as your body needs! But no really, if you are directly involved in handling / packing / preparing food, you should not work until at least 2 days until your symptoms have resolved. Depending on the severity of your symptoms your doctor will advise you on at last 2 days rest. 

Anyone with gastroenteritis should stay away from places such as schools and child care centres and avoid duties requiring handling of food and beverage. We want to avoid getting more people infected. 

When do I need to return to see the doctor?

 In most cases, symptoms resolve quickly and no special treatment is necessary, but if the following continues, it’s time to see the doctor again: 
– Frequent episodes of vomiting and inability to keep liquids down
– Bloody vomit or stools
– Diarrhoea for more than three days
– Extreme pain or severe abdominal cramping
– Fever that is not settling.
– Signs or symptoms of dehydration — excessive thirst, dry mouth, little or no urination, severe weakness, dizziness, or light-headedness, dry diapers for infants (for more than 4-6 hours)
– Neurological symptoms such as blurry vision,
– Muscle weakness and tingling in the arms

Practice good hygiene habits

Practicing good hygiene habits such as washing your hands thoroughly after going to the bathroom and when working with food can minimise your risk of contracting gastroenteritis. When cooking, keep your kitchen surfaces clean when working with raw foods and keep these types of foods away from each other.

During this holiday season, make sure you take note of the hygiene practices  wherever you’re eating at. Watch out for what you’re eating, observe how the food is being prepared, and check whether the place you’re eating at is known to have/not have good hygiene standards. Do not take the risk if you feel the food you’re about to consume may be compromised.

If you’re concerned as to whether or not you are covered for gastroenteritis in your insurance plan, don’t hesitate to contact us to check. Don’t let gastroenteritis affect your Christmas!

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