First documented outbreak of Bongkrekic acid food poisoning in Taiwan, March-April 2024

Between March 19 and March 24, 2024, 33 people became ill after dining at a restaurant in Taipei, Taiwan. Nine were hospitalized, seven of whom were admitted to an intensive care unit (ICU). Six died as a result of the outbreak. The Bongkrekic acid (BA) toxin was identified as the cause of the food poisoning. For the first time in Taiwan, BA food poisoning was documented.

Using case data and restaurant consumption records, the daily attack rate (AR), case-fatality ratio (CFR) and time to seek healthcare were estimated. The estimated CFR was compared directly against CFRs reported in previous outbreaks.

The AR varied from 43.8 % to 80.4 % during the outbreak (mean: 60.3 %). The mean estimate of the CFR was 20.0 %, with only one patient who was admitted to an intensive care unit surviving (out of seven). The CFR was higher than in past outbreaks in Indonesia (14.0 %) but lower than in China (39.5 %). The time to seek healthcare was shorter for hospitalized cases (mean 3.4 days) than non-hospitalized cases (mean 5.6 days).

The substantial AR and CFR, and poor outcomes for hospitalized cases, indicate that implementing rigorous food safety measures to prevent future outbreaks is crucial. Improved outbreak preparedness, including increasing public awareness and strengthening regulations relating to the production and storage of food products prone to BA contamination, are needed to prevent and mitigate the impacts of future BA poisoning events. This is essential for public health in Taiwan and elsewhere.