Every year, an estimated 600 million people worldwide – almost one in ten – become sick and 420 000 die after eating contaminated food. Forty percent of those who experience foodborne diseases are children under five years old, with 125 000 deaths every year globally.
When considering foodborne illnesses, short-term symptoms like nausea, vomiting and diarrhoea often come to mind. However, foodborne illnesses can be a recipe for more severe, chronic conditions such as cancer, kidney failure, and brain disorders. It can also signal an emerging infectious disease outbreak and become a global health security threat.
In Cambodia, food safety is a major public health concern, with over 7 000 cases and almost 200 deaths recorded between 2014 and 2023. More specifically, 134 outbreaks of foodborne diseases between 2014 and 2019 were linked to poor hygiene practices during food preparation, incorrect storage temperature control, cross-contamination, and the use of unsafe water and ingredients.
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Samaki Market in Kampot Province is one of the many traditional food markets in Cambodia, where locals go for almost everything from clothes to raw meat. The open environment of such markets reflects how crucial safe environmental conditions are in food safety.
A recent food poisoning outbreak in the Kampong Thom province led to two deaths and 45 hospitalizations. People across three districts became ill after consuming Khmer noodles from a well-established local vendor with a long history of operation in the province. Symptoms included watery diarrhoea, vomiting and fever, triggering a rapid response from health authorities.
To prevent further casualties, the Kampong Thom Provincial Health Department’s Rapid Response Team alerted the Ministry of Health’s Communicable Disease Control Department, which quickly assembled the multisectoral Foodborne Outbreak Investigation and Response Team to lead the investigation jointly with the local investigation team.
With technical support from the World Health Organization (WHO) and funding from the United States Agency for International Development in Cambodia (USAID/Cambodia), the investigation started with extensive fieldwork to gather firsthand accounts and identify the potential causes and transmission pathways of the outbreak. During this process, WHO provided the team with critical resources and expertise, including guidance on establishing the Incident Management System and activating the Emergency Operation Center. The team also received support in collecting and analyzing data for a targeted response.
The investigation encompassed epidemiological, environmental, and occupational analyses, alongside laboratory tests. Seven stool samples from hospitalized patients, two samples of suspected Khmer noodles, and 18 environmental samples from the local water sources were sent to the National Institute of Public Health and the National Health Quality Control Center for further analysis.
Keeping Communities Safe
The laboratory results revealed the presence of Shigella and E. Coli in human samples, which indicated environmental contamination, while E. Coli and Staphylococcus aureus found in food samples suggested poor food hygiene practices. In addition, E. Coli was detected in water samples from the local river and wells, which pointed to water contamination. The team also found unsanitary conditions at the noodle production site including dust, foul odors, a nearby toilet, and unsuitable food preparation surfaces.
In response, the Kampong Thom Provincial Administration temporarily halted the distribution of Khmer noodles and launched an educational campaign on hygiene, safe water, and food safety for producers in the affected community. Eventually, the outbreak was contained, but the lessons learned left a lasting impact on the community and beyond.
“The quick response to the Kampong Thom outbreak reminds us of the importance of being prepared for the unexpected, which is also a focus of this year’s World Food Safety Day event in Cambodia. It's crucial we ensure regularly updated emergency plans, a coordinated approach across all government agencies and authorities, with efficient mechanisms for rapid information exchange. We need to be ready for whatever comes next to ensure we keep our communities safe,” said H.E. Dr Ly Sovann, Advisor and Director of the Communicable Disease Control Department of the Ministry of Health.
Food Safety is Everyone’s Business
The Kampong Thom food poisoning outbreak serves as a stark reminder of the critical need for stronger food safety regulations and monitoring, and ongoing collaboration across levels and institutions using the One Health approach. The incident also highlights the essential role of having a strong national public health authority with the capacity to rapidly investigate and respond to potential outbreaks, and of community engagement in responding to public health crises. Prompt reporting from local authorities in Kampong Thom Province and coordinated efforts among government agencies and health partners were key to the rapid response.
“The U.S. government is committed to supporting Cambodia through innovative approaches like the Preparedness and Response for Emerging Threats initiative. By building on lessons learned from past outbreaks and two decades of collaboration to address emerging public health threats, we can better protect communities from foodborne threats while being ready for emerging threats in the future,” said Ms Kerry Pelzman, USAID/Cambodia Mission Director. “Cambodia’s progress in strengthening its health security systems to be able to rapidly investigate and respond to public health incidents is commendable.”
Ultimately, the Kampong Thom outbreak shows that foodborne illnesses are largely preventable. Being ready to manage food safety incidents requires dedicated efforts from policymakers, food safety authorities, farmers, food business operators and consumers – food safety is everyone’s business.