Drastic decrease of Salmonella Enteritidis isolated from humans in Belgium in 2005, shift in phage types and influence on foodborne outbreaks

In Belgium, non-typhoidal salmonellosis and campylobacteriosis are the two most frequently reported foodborne illnesses. During 2005, a 71% decrease of Salmonella Enteritidis infections compared with the average annual number cases in the period 2000-2004 was recorded by the Belgian National Reference Centre for Salmonella and Shigella. After the peak of 1999, the total number of salmonellosis cases decreased gradually, with the exception of 2003 when an increase was again recorded due to the rise of isolates belonging to the serotype Enteritidis. PT4, the predominant phage type of serotype Enteriditis over recent years (except in 2003), became the second most prevalent phage type in 2005 after PT21. We present in this paper the epidemiology (incidence and trends) of human salmonellosis in Belgium and assess the role of the vaccination programme in layer flocks on the decline of the incidence of human salmonellosis and foodborne outbreaks due to S. Enteritidis.

Recurrent multistate outbreak of Salmonella Newport associated with tomatoes from contaminated fields, 2005

Salmonella Newport causes more than an estimated 100,000 infections annually in the United States. In 2002, tomatoes grown and packed on the eastern shore of Virginia contaminated with a pan-susceptible S. Newport strain caused illness in 510 patients in 26 states. In July-November 2005, the same strain caused illness in at least 72 patients in 16 states. We conducted a case-control study during the 2005 outbreak, enrolling 29 cases and 140 matched neighbourhood controls. Infection was associated with eating tomatoes (matched odds ratio 9.7, 95% confidence interval 3.3-34.9). Tomatoes were traced back to the eastern shore of Virginia, where the outbreak strain was isolated from pond water used to irrigate tomato fields. Two multistate outbreaks caused by one rare strain, and identification of that strain in irrigation ponds 2 years apart, suggest persistent contamination of tomato fields. Further efforts are needed to prevent produce contamination on farms and throughout the food supply chain.

[Anaerobic gas-producing clostridial endogenic infection in patient with salmonellosis]

Anaerobic gas-producing clostridial infection is one of most severe complications of mainly gunshot wound of war period, in peace time occurs very seldom. The rare clinical case of anaerobic gas-producing clostridial endogenic infection with fulminant course in patient with salmonellosis produced by group B salmonella typhimurium. The disease was finished with fatal outcome in 8.5 hours after appearance of pain syndrome in right thigh with consequent fulminant development of gas gangrene with arterial hypotension on 4th day after onset of gastroenteric form of medium severity salmonellosis. Clinical, microbiological and postmortem data are represented.

The use of clinical profiles in the investigation of foodborne outbreaks in restaurants: United States, 1982-1997

Improving the efficiency of outbreak investigation in restaurants is critical to reducing outbreak-associated illness and improving prevention strategies. Because clinical characteristics of outbreaks are usually available before results of laboratory testing, we examined their use for determining contributing factors in outbreaks caused by restaurants. All confirmed foodborne outbreaks reported to the Centers for Disease Control and Prevention (CDC) from 1982 to 1997 were reviewed. Clinical profiles were developed based on outbreak characteristics. We compared the percentage of contributing factors by known agent and clinical profile to their occurrence in outbreaks of unclassified aetiology. In total, 2246 foodborne outbreaks were included: 697 (31%) with known aetiology and 1549 (69%) with aetiology undetermined. Salmonella accounted for 65% of outbreaks with a known aetiology. Norovirus-like clinical profiles were noted in 54% of outbreaks with undetermined aetiology. Improper holding times and temperatures were associated with outbreaks caused by Clostridium perfringens, Bacillus cereus, Staphylococcus aureus, and Salmonella, and also with outbreaks of undetermined aetiology that fitted diarrhoea-toxin and vomiting-toxin clinical profiles. Poor personal hygiene was associated with norovirus, Shigella, and Salmonella, and also with outbreaks that fitted norovirus-like and vomiting-toxin clinical profiles. Contributing factors were similar for outbreaks with known aetiology and for those where aetiology was assigned by corresponding clinical profile. Rapidly categorizing outbreaks by clinical profile, before results of laboratory testing are available, can help identification of factors which contributed to the occurrence of the outbreak and will promote timely and efficient outbreak investigations.

Comparison of molecular typing methods for the differentiation of Salmonella foodborne pathogens

Bacteria belonging to the genus Salmonella are among the leading causes of foodborne disease of bacterial etiology. These bacteria are also widely disseminated throughout the animal kingdom. The ability to identify the food source from which a human pathogen originated would be of great value in reducing the incidence of foodborne disease and the extent of disease outbreaks due to Salmonella. To date, efforts to identify the origin of these pathogens have centered on phenotypic and genotypic characterization of Salmonella isolates. This review focuses molecular or genotypic techniques that are currently being used for typing, and examines their strengths and weaknesses for determining the source of Salmonella foodborne infections.

Mechanism of infection of a human isolate Salmonella (3,10:r:-) in chicken ileum: ultrastructural study

BACKGROUND & OBJECTIVE

Originally isolated from severe human food-poisoning cases, Salmonella (3,10:r:-), a monophasic variety of otherwise diphasic serotypes such as S. weltevreden and S. simi, causes serious infections in man, animals and poultry. Mechanism of infection of this versatile and deadly organism is important to understand for its control. The objective of this study was to enhance our understanding of infection of Salmonella (3,10:r:-) in vivo at cellular level.

METHODS

Aliquots of 10(9) cfu of Salmonella (3,10:r:-) organisms were injected intra-ileally in 24 h pre-fasted 3 month old broiler chickens by standard ligated ileal loop method. After 18 h, the fluid accumulated in the ileum was drained and small tissue pieces were fixed in 2.5 per cent buffered (pH 7) glutaraldehyde and subsequently in 1 per cent aqueous osmium tetraoxide. Ultra-thin sections of araldite-embedded tissue pieces were examined under transmission electron microscope operated at 100 KV after staining with uranyl acetate and lead citrate.

RESULTS

Over 70 per cent of salmonellae interacting within 300 nm with ileal epithelial cells developed numerous surface blebs of periplasmic extensions designated "periplasmic organelles" (POs). Large sized POs were apparently pinched off as outer membrane vesicles (OMVs), 50-90 nm in diameter. Type III secretion needle complex-like "rivet complexes" (RCs) were viewed to rivet the bacterial outer and inner membranes together, allowing only pockets of periplasm to expand/inflate in order to liberate OMVs. Many OMVs were found visibly docked on the plasma membrane of host epithelial cells. The invading organisms appeared to leave the epithelial cells so as to find entry into the lymphatic vessels, where, they again appeared to be closely interacting with ileal macrophages, by forming numerous POs and concomitantly liberating OMVs. Inside the cytoplasm of macrophages, numerous tight phagosomes were seen, each containing two organisms. The final stage appeared to contain replicated salmonellae, four in each loose phagosome and, at the same time, macrophages also showed signs of apoptotic disintegration, culminating in the release of replicated salmonellae.

INTERPRETATION & CONCLUSION

Outer membrane vesicles released from a fiercely virulent human isolate, Salmonella 3,10:r:- pathogens have been implicated in translocating biochemical signals from the host-interactive organisms to the eukaryotic cells at both stages of invasion leading to epithelial cell and macrophage infection in vivo, in the chicken ileal model. A comprehensive cellular mechanism at ultrastructural level is outlined for typhoid-like Salmonella infections caused by this humans-infecting organism.

Outbreak of Salmonella Braenderup infections associated with Roma tomatoes, northeastern United States, 2004: a useful method for subtyping exposures in field investigations

Salmonella Braenderup is an uncommon serotype in the United States. In July 2004, a multistate outbreak of Salmonella Braenderup diarrhoeal infections occurred, with 125 clinical isolates identified. To investigate, we conducted a case-control study, enrolling 32 cases and 63 matched controls. Cheese, lettuce and tomato eaten at restaurants all appeared to be associated with illness. To further define specific exposures, we conducted a second study and asked managers of restaurants patronized by patients and controls about cheese, lettuce and tomato varieties used in dishes their patrons reported consuming. This information was obtained for 27 cases and 29 controls. Roma tomatoes were the only exposure significantly associated with illness (odds ratio 4.3, 95% confidence interval 1.2-15.9). Roma tomatoes from two restaurants were traced back to a single tomato packing house. The methods used in this field investigation to define specific exposures may be useful for other foodborne outbreaks.

Limited genetic diversity in Salmonella enterica serovar Enteritidis PT13

Background

Salmonella enterica serovar Enteritidis has emerged as a significant foodborne pathogen throughout the world and is commonly characterized by phage typing. In Canada phage types (PT) 4, 8 and 13 predominate and in 2005 a large foodborne PT13 outbreak occurred in the province of Ontario. The ability to link strains during this outbreak was difficult due to the apparent clonality of PT13 isolates in Canada, as there was a single dominant pulsed-field gel electrophoresis (PFGE) profile amongst epidemiologically linked human and food isolates as well as concurrent sporadic strains. The aim of this study was to perform comparative genomic hybridization (CGH), DNA sequence-based typing (SBT) genomic analyses, plasmid analyses, and automated repetitive sequence-based PCR (rep-PCR) to identify epidemiologically significant traits capable of subtyping S. Enteritidis PT13.

Results

CGH using an oligonucleotide array based upon chromosomal coding sequences of S. enterica serovar Typhimurium strain LT2 and the Salmonella genomic island 1 successfully determined major genetic differences between S. Typhimurium and S. Enteritidis PT13, but no significant strain-to-strain differences were observed between S. Enteritidis PT13 isolates. Individual loci (safA and fliC) that were identified as potentially divergent in the CGH data set were sequenced in a panel of S. Enteritidis strains, and no differences were detected between the PT13 strains. Additional sequence-based typing was performed at the fimA, mdh, manB, cyaA, citT, caiC, dmsA, ratA and STM0660 loci. Similarly, no diversity was observed amongst PT13 strains. Variation in plasmid content between PT13 strains was observed, but macrorestriction with BglII did not identify further differences. Automated rep-PCR patterns were variable between serovars, but S. Enteritidis PT13 strains could not be differentiated.

Conclusion

None of the methods identified any significant variation between PT13 strains. Greater than 11,300 base pairs of sequence for each of seven S. Enteritidis PT13 strains were analyzed without detecting a single polymorphic site, although diversity between different phage types of S. Enteritidis was observed. These data suggest that Canadian S. Enteritidis PT13 strains are highly related genetically.

Gastrointestinal microbial ecology and the safety of our food supply as related to Salmonella

Salmonella causes an estimated 1.3 million human foodborne illnesses and more than 500 deaths each year in the United States, representing an annual estimated cost to the economy of approximately $2.4 billion. Salmonella enterica comprises more than 2,500 serotypes. With this genetic and environmental diversity, serotypes are adapted to live in a variety of hosts, which may or may not manifest with clinical illness. Thus, Salmonella presents a multifaceted threat to food production and safety. Salmonella have been isolated from all food animals and can cause morbidity and mortality in swine, cattle, sheep, and poultry. The link between human salmonellosis and host animals is most clear in poultry. During the early part of the 20th century, a successful campaign was waged to eliminate fowl typhoid caused by Salmonella Gallinarum/Pullorum. Microbial ecology is much like macroecology; environmental niches are filled by adapted and specialized species. Elimination of S. Gallinarum cleared a niche in the on-farm and intestinal microbial ecology that was quickly exploited by Salmonella Enteritidis and other serotypes that live in other hosts, such as rodents. In the years since, human salmonellosis cases linked to poultry have increased to the point that uncooked chicken and eggs are regarded as toxic in the zeitgeist. Salmonellosis caused by poultry products have increased significantly in the past 5 yr, leading to a USDA Food Safety and Inspection Service "Salmonella Attack Plan" that aims to reduce the incidence of Salmonella in chickens below the current 19%. The prevalence of Salmonella in swine and cattle is lower, but still poses a threat to food safety and production efficiency. Thus, approaches to reducing Salmonella in animals must take into consideration that the microbial ecology of the animal is a critical factor that should be accounted for when designing intervention strategies. Use of competitive exclusion, sodium chlorate, vaccination, and bacteriophage are all strategies that can reduce Salmonella in the live animal, but it is vital to understand how they function so that we do not invoke the law of unintended consequences.

Prevalence and Antibiotic Resistance of Salmonella Isolated from a Poultry Farm and Processing Plant Environment in the State of Kuwait

The prevalence of Salmonella isolated from a poultry farm and from the poultry processing plant environment were evaluated from August 2004 to July 2005 along with microbial antibiotic resistance. In total, 3242 samples were collected from the farm and processing plant. Samples collected from the farm included hatching eggs, paper liners, litter, feed, water, drinkers, air, bird rinse, and ceca. While samples collected from the processing plant included carcass rinse and ceca. Out of 2882 samples collected from the farm, the overall percentage prevalence of Salmonella was 5.4% with prevalence rates of 10%, 1.5%, 0.7%, 0.2%, 13.5%, and 12.6% for hatching eggs, litter, feed, drinkers, bird rinse and ceca, respectively. No Salmonella were detected in any of the paper liner, water, or air samples. Out of 360 samples collected from the processing plant, the overall percentage prevalence of Salmonella was 4.7% with prevalence rates of 6.1% and 3.3% for carcass rinse and ceca samples, respectively. Salmonella Enteritidis was the most prevalent serotype. All of the isolates were resistant to at least one antibiotic and 10 different resistance profiles were found among 173 isolates of Salmonella Enteritidis. Resistance to ampicillin, nalidixic acid, and tetracycline were the most common. The widespread occurrence of multiple resistant Salmonella Enteritidis is a cause for concern, and local regulatory enforcement agencies should ensure prudent use of antibiotics.

The Attribution of Human Infections with Antimicrobial ResistantSalmonellaBacteria in Denmark to Sources of Animal Origin

Based on the Danish Salmonella surveillance in 2000-2001, we developed a mathematical model for quantifying the contribution of each major animal-food sources to human salmonellosis caused by antimicrobial resistant bacteria. Domestic food products accounted for 53.1% of all cases, mainly caused by table eggs (37.6%). A large proportion (19%) of cases were travel related, while 18% could not be associated with any source. Imported food products accounted for 9.5% of all cases; the most important source being imported chicken. Multidrug and quinolone resistance was rarely found in cases acquired from Danish food, but was common in cases related to imported products (49.7% and 35.6% of attributable cases) and travelling (26.5% and 38.3% of attributable cases). For most serovars, the quinolone-resistant isolates were found to be associated with relatively more human infections than that of resistant isolates, which in turn was higher than that of susceptible isolates. This may be due to quinolone-resistant isolates having a higher ability to survive food processing and/or cause disease. This study showed domestic food to be the most important source of Salmonella infections in Denmark, but infections with multidrug- and quinolone-resistant isolates were more commonly caused by imported food products and travelling, emphasizing the need for a global perspective on food safety and antimicrobial usage.

Novel Surveillance ofSalmonella entericaSerotype Heidelberg Epidemics in a Closed Community

Pathogen and disease surveillance and control represent important public health priorities in high-density and high-risk populations such as nursing homes, cruise ships, military bases, hospitals, and prisons. Reportable disease investigations, along with syndromic surveillance, have been used to identify and characterize outbreaks in their early stages. In this study, we provide evidence that ongoing wastewater monitoring could be used to supplement these traditional methods in at-risk closed communities. During 2003-2005, a systematic and regularly timed human and farm-animal wastewater sampling scheme existed in several geographically distinct locations of a multisite population in Texas. In early July 2003, an outbreak of gastroenteritis caused by Salmonella enterica serotype Heidelberg occurred in the human population at one site. Wastewater samples from the weeks before, during, and after the outbreak were tested for the pathogen. Selective culture, serogrouping, and serotyping techniques as well as real-time polymerase chain reaction and pulsed field gel electrophoresis were used to detect and characterize the Salmonella Heidelberg in each sample. The ability to detect the causative pathogen of an outbreak while it circulates in the host populations prior to and after an outbreak, as well as during the outbreak peak, suggests that wastewater could be used as a supplemental disease surveillance tool. To further explore this possibility, two subsequent outbreaks of uncharacterized gastroenteritis in additional locations were also investigated using wastewater samples.

Pulsed-Field Gel Electrophoresis Subtyping Database for FoodborneSalmonella entericaSerotype Discrimination

Nontyphoid Salmonella is one of the main causes of bacterial gastroenteritis worldwide and is responsible for 65% of reported outbreaks of foodborne diseases in France. Serotyping is widely used for isolate preliminary identification, but it poorly discriminates strains. Rapid, efficient molecular subtyping tools have therefore been developed for the investigation of outbreaks. We evaluated the performance of the pulsed-field gel electrophoresis (PFGE) method for discrimination of 31 Salmonella serotypes frequently isolated in France. We set up a genomic database of Salmonella strains isolated from food, animals, the environment, and humans to improve the management of contamination and reactions to foodborne disease outbreaks. We studied 1128 isolates by PFGE, according to the standardized PulseNet protocol. We identified 452 PFGE patterns, 67.5% of which corresponded to a single isolate. The ability of this method to distinguish between isolates was estimated by calculating the Simpson index and the 95% confidence interval. Values obtained ranged between 0.33 (0.11-0.54) to 0.99 (0.96-1.00), depending on serotype. Epidemiological information about isolates was used for analyses of intra- and interserotype diversity results and for determining whether PFGE patterns were linked to the source of the isolate. Clustering analysis of the PFGE patterns obtained confirmed that serotype and PFGE genotype were closely linked. Some PFGE patterns were identified as major patterns, each of these patterns being found in at least 10 isolates. The database generated has already proved its effectiveness in epidemiological investigations in livestock production and foodborne outbreaks.

[Food borne infectious outbreaks, Austria 2005]

In Austria, a total of 606 food borne outbreaks, affecting 1,910 people altogether (including 368 hospitalized patients and 1 fatal outcome) were documented in 2005. Salmonella spp. and Campylobacter spp. accounted for 99% of all reported outbreaks. Fortysix (8%) of the 606 outbreaks were acquired abroad. Bacteria caused all but one of the 560 domestically acquired food borne outbreaks: 427 (76%) were due to Salmonella spp., 128 (23%) due to Campylobacter spp. and two outbreaks each due to enterohaemorrhagic Escherichia coli and Yersinia enterocolitica. Norovirus caused an outbreak affecting 22 persons. The respective hospitalization rate for domestically acquired Salmonella spp. and Campylobacter spp. infections was 20% and 16%. Of those outbreaks where information as to the source was provided, eggs were implicated in 57%, meat products (especially poultry) in 30% and milk or dairy products (especially raw milk) in 4%. The ratio between family outbreaks and general outbreaks was 89% to 11%. For general outbreaks the following locations of exposure were given: commercial food suppliers (incl. restaurants, cafeterias) 34 x, family celebrations 14 x, nursery schools 4 x, festivities (e.g. fairs) 3 x, nursing homes twice and once a mixed outbreak involving commercial food suppliers plus homes (Austria-wide S. Enteritidis PT19 outbreak). In our opinion, the relatively high number of family outbreaks merely reflects the still insufficient quality of epidemiological outbreak investigation in Austria, i.e. lack of consolidating individual clusters into larger food borne outbreaks which exceed district or provincial borders.

An outbreak of gastroenteritis in a campsite in Romania, July 2007

Between 8 and 13 July 2007, an outbreak of acute gastroenteritis involving 117 holiday-makers (children and adults) at a campsite in Romania was investigated by the Constanta District Public Health Authority (CDPHA). The camp complex has a capacity for 4,200 people and includes four canteens.

Salmonellosis outbreak in connection with the Formula One race, August 2007 in Hungary

An outbreak of acute gastroenteritis affecting 31 people occurred between 3 and 5 August 2007 during the Formula One race that took place at the Hungaroring in Mogyoród, Hungary. The venue has a capacity of around 200,000 spectators.

Identification and molecular characterization of Salmonella spp. from unpasteurized orange juices and identification of new serotype Salmonella strain S. enterica serovar Tempe

Several Salmonella enterica serotypes were isolated from unpasteurized orange juice samples analysed as a follow-up to an outbreak in 1999 of S. enterica serotype Muenchen in the Pacific Northwest regions of United States. Eleven S. enterica strains were serotyped and identified as S. enterica serotype Muenchen (2), S. enterica serotype Hidalgo (2), S. enterica serotype Alamo (1), S. enterica serotype Gaminera (2), S. enterica serotype Javiana (2) and a new serotyped strain S. enterica serotype Tempe (2). The identity of the new serotype S. enterica serovar Tempe serotype 30:b:1,7:z33 was confirmed by the National Salmonella Reference Laboratory at NCID/CDC, Atlanta. These strains were sensitive to ampicillin, chloramphenicol, kanamycin, tetracycline, streptomycin and sulfisoxazole antibiotics. Isolates were screened for invasion (invA) and virulence (spvC) genes using specific primers for these two genes by polymerase chain reaction. All strains were positive for invA gene giving 321-bp fragment, however negative to virulence spvC gene. For pulsed-field gel electrophoresis (PFGE) analysis, Salmonella strain plugs were made and digested with XbaI and subjected to 18-h electrophoresis. The PFGE patterns were different for each S. enterica serotypes suggesting the several origins of contamination in outbreak. S. enterica serotype.

Prevalence, distribution and characterisation of ceftiofur resistance in Salmonella enterica isolated from animals in the USA from 1999 to 2003

Third-generation cephalosporin (3GC) antimicrobials are the drugs of choice for treatment of salmonellosis in children. Salmonella isolated in the USA are assayed by the National Antimicrobial Resistance Monitoring System (NARMS) for resistance to antimicrobials including first-, second- and third-generation cephalosporins. From 1999 to 2003, 34,411 Salmonella were isolated from animals in the USA, of which 10.9% were found to be resistant to ceftiofur, a 3GC used in animals, whilst only 0.3% were resistant to ceftriaxone, a 3GC used in human medicine. Ceftiofur resistance rose from 4.0% in 1999 to 18.8% in 2003. Isolates from diagnostic laboratories had higher levels of resistance (18.5%), whereas levels in isolates from on-farm (3.4%) and slaughter (7.1%) sources were lower. Animals with a higher than average proportion of resistant Salmonella included cattle (17.6%), horses (19.2%) and dogs (20.8%). Levels in turkeys (6.8%), chickens (7.1%), eggs (3.6%) and swine (4.6%) were lower. Resistance varied between Salmonella serotypes. A few serotypes had significantly high levels, e.g. S. Newport was 70.4% ceftiofur resistant. Resistance was predominantly associated with bla(CMY-2)-encoding plasmids. These data suggest that the acquisition of resistance plasmids and the spread of specific serotypes harbouring these plasmids are driving the observed resistance to ceftiofur in Salmonella animal isolates.

Isolation of Salmonella Enteritidis phage type 30 from a single almond orchard over a 5-year period

In 2001, Salmonella Enteritidis phage type (PT) 30 was isolated from drag swabs of 17 61-ha almond orchards on three farms linked to an outbreak of salmonellosis associated with consumption of raw almonds. The objective of this study was to evaluate the long-term persistence of Salmonella Enteritidis PT 30 in one of the almond orchards associated with the outbreak. Swabs (gauze saturated with full-strength sterile evaporated skim milk and attached to string) were pulled along the orchard floor in a standardized manner for 55 m. At each sample time, two pooled samples (four swabs each) were collected from each orchard quadrant. Swabs were enriched for Salmonella using a delayed secondary enrichment procedure developed for isolation of Salmonella from poultry houses. Suspect Salmonella isolates were selected, confirmed, serotyped, and phage typed, and pulsed-field gel electrophoresis (PFGE) patterns were determined after cleavage with XbaI and BlnI. Salmonella was recovered infrequently from pooled samples collected from January through July (3 of 56 samples, 5.3%). In general, Salmonella isolation frequency per sample time increased during and immediately after the harvest, when large amounts of dust were generated in or near the orchard: August, 4 (20%) of 20 samples; September, 13 (20%) of 64 samples; October, 27 (42%) of 64 samples; November, 4 (25%) of 16 samples; and December, 2 (25%) of 8 samples. All 53 Salmonella isolates during the 5 years were identified as Salmonella Enteritidis PT 30, and two PFGE patterns that differed by the presence of an approximately 40-kb fragment were identified. These data demonstrate the potential for long-term environmental persistence of Salmonella in almond orchards.

Joint spatial analysis of gastrointestinal infectious diseases

A major obstacle in the spatial analysis of infectious disease surveillance data is the problem of under-reporting. This article investigates the possibility of inferring reporting rates through joint statistical modelling of several infectious diseases with different aetiologies. Once variation in under-reporting can be estimated, geographic risk patterns for infections associated with specific food vehicles may be discerned. We adopt the shared component model, proposed by Knorr-Held and Best for two chronic diseases and further extended by (Held L, Natario I, Fenton S, Rue H, Becker N. Towards joint disease mapping. Statistical Methods in Medical Research 2005b; 14: 61-82) for more than two chronic diseases to the infectious disease setting. Our goal is to estimate a shared component, common to all diseases, which may be interpreted as representing the spatial variation in reporting rates. Additional components are introduced to describe the real spatial variation of the different diseases. Of course, this interpretation is only allowed under specific assumptions, in particular, the geographical variation in under-reporting should be similar for the diseases considered. In addition, it is vital that the data do not contain large local outbreaks, so adjustment based on a time series method recently proposed by (Held L, Höhle M, Hofmann M. A statistical framework for the analysis of multivariate infectious disease surveillance data. Statistical Modelling 2005a; 5: 187-99) is made at a preliminary stage. We will illustrate our approach through the analysis of gastrointestinal diseases notification data obtained from the German infectious disease surveillance system, administered by the Robert Koch Institute in Berlin.

Pathotyping of Salmonella enterica by analysis of single-nucleotide polymorphisms in cyaA and flanking 23S ribosomal sequences

The egg-contaminating phenotype of Salmonella enterica serotype Enteritidis was linked to single-nucleotide polymorphisms (SNPs) occurring in cyaA, which encodes adenylate cyclase that produces cAMP and pyrophosphate from ATP. Ribotyping indicated that SNPs in cyaA were linked to polymorphisms occurring in the rrlC and rrlA 23S ribosomal subunits. Phylogenetic analysis of cyaA discriminated between Salmonella enterica serotypes and within serotype Enteritidis. Serotypes Typhimurium, Heidelberg and Enteritidis produced one, three and six cyaA allelic variants, respectively, among the set of 56 isolates examined. Asparagine(702) of CyaA was converted to serine in a biofilm-producing isolate. Statistical analysis was applied to 42 other genes encoding proteins between 800 and 1000 amino acids (aa). Results show that the 848 aa CyaA of serovar Enteritidis evolved by nucleotide substitutions that did not significantly alter the purine-to-pyrimidine nucleotide substitution ratio, which was a characteristic of large genes that was positively correlated with increasing gene size. In summary, these analyses link SNPs occurring in the rrlC-rrlA genomic fragment of S. enterica to genetic drift within S. Enteritidis that is associated with egg contamination.

A registry-based study on the association between human salmonellosis and routinely collected parameters in Michigan, 1995-2001

PURPOSE

Salmonella serotypes are among the most common bacterial causes of foodborne gastroenteritis in the United States, associated with approximately 1.4 million human illnesses annually. Studies on trends of the serotypes and host-related factors are necessary for the development of effective prevention plans for foodborne diseases caused by these pathogens.

MATERIALS AND METHODS

To determine the epidemiologic trends of human infections with the most common Salmonella serotypes in Michigan, we analyzed cases of culture-confirmed salmonellosis at the Michigan Department of Community Health (MDCH) from 1995 to 2001.

RESULTS

A total of 6797 cases were reported, with an average annual incidence per 100,000 population (AAI) of 9.9. Among cases for which information on Salmonella serotype were available (6292 cases), the most common serotypes were S. Typhimurium (1596 cases, 26%), followed by S. Enteritidis (1309, 22%), S. Heidelberg (466, 8%) and S. Newport (222, 4%). From 1998 to 2001, the incidence of S. Typhimurium and S. Enteritidis decreased significantly by 39% (95% confidence interval [CI], 49% to 26% decrease) and 32% (95% CI, 44% to 18% decrease) respectively. Whereas the incidence of S. Newport increased by 101% (95% CI, 25% to 225% increase) and S. Heidelberg remained stable. Infection with these serotypes frequently occurred in the summer months. As a group, infants had the highest AAI for all Salmonella serotypes (75.0), S. Typhimurium (21.9), S. Enteritidis (14.0), S. Heidelberg (5.4), and S. Newport (1.7). Among patients whose race was known, blacks had a significantly higher AAI compared to whites for S. Typhimurium (2.5 vs. 1.3; RR = 2.3, 95% CI, 1.6-3.3), S. Enteritidis (1.4 vs. 1.1; relative rate (RR) = 1.4; 95% CI, 1.1-1.6), S. Heidelberg (0.8 vs. 0.3; RR = 3.6; 95% CI, 2.8-4.6), and S. Newport (0.3 vs. 0.1; RR = 2.8; 95% CI, 1.9-4.2). Among patients whose ethnicity was known, Hispanics had a significantly higher AAI for S. Enteritidis compared to non-Hispanics (1.0 vs. 0.5; RR = 1.9; 95% CI, 1.2-3.0), but not different significantly for S. Typhimurium, S. Heidelberg, and S. Newport.

CONCLUSION

This study revealed the emergence of S. Newport and the high incidence of the most common Salmonella serotypes among infants, people of African descent, and Hispanics. This information can be used by the state and local health departments of Michigan to enhance salmonellosis prevention efforts by rationalizing the allocation of appropriate public health resources and personnel.

Salmonella enteritidis in broiler chickens, United States, 2000-2005

TOC summary line: Greater sampling and monitoring efforts are needed to reverse a significant increase in prevalence.

US Department of Agriculture Food Safety and Inspection Service (FSIS) data on Salmonella enterica serotype Enteritidis in broiler chicken carcass rinses collected from 2000 through 2005 showed the annual number of isolates increased >4-fold and the proportion of establishments with Salmonella Enteritidis–positive rinses increased nearly 3-fold (test for trend, p<0.0001). The number of states with Salmonella Enteritidis in broiler rinses increased from 14 to 24. The predominant phage types (PT) were PT 13 and PT 8, 2 strains that a recent Foodborne Diseases Active Surveillance Network (FoodNet) case-control study associated with eating chicken. FSIS is directing more sampling resources toward plants with marginal Salmonella control to reduce prevalence in products including broilers. The policy targets establishments with common Salmonella serotypes of human illness, including Salmonella Enteritidis. Voluntary interventions should be implemented by industry.

Outbreak of Salmonella Typhimurium infection traced to imported cured sausage using MLVA-subtyping

On 28 November 2006, a patient in Norway was diagnosed with Salmonella Typhimurium infection. He contacted the district food safety office in Trondheim as he suspected the source to be Spanish-produced cured sausages he had bought on a ferry between Kiel, Germany and Oslo, Norway in October 2006.

A hotel-based outbreak of Salmonella enterica subsp. Enterica serovar Enteritidis (Salmonella Enteritidis) in the United Kingdom, 2006

An outbreak of food-borne Salmonella Enteritidis PT4 occurred in Cumbria, in north-west England, in the summer of 2006. Fifteen people, all with positive stool samples, met the case definition; three of these were admitted to hospital, including one patient who died. Preliminary investigations suggested a link to a meal served at a local hotel. A case control study was implemented, together with microbiological and environmental investigations. Fifteen microbiologically confirmed cases and 27 unmatched controls were included in the study, controls being randomly selected from people who had eaten at the hotel on the same day. The epidemiological evidence indicated a very strong association between infection and consumption of tiramisu made with raw shell eggs, although none were available for microbiological investigation. These results are in line with other salmonellosis outbreaks that have been associated with the use of raw shell eggs in food manufacturing and production. This paper highlights the continuing need for a greater awareness by those who work in the food industry of the health risks associated with the consumption of raw shell eggs.

[Clinical and microbiological features of Salmonella gastroenteritis in children]

The aim of our study was to evaluate the role of Salmonella spp in children hospitalised for acute gastroenteritis, and to study clinical and microbiological features of paediatric salmonellosis in our geographical area. In all, 540 patients admitted from March to September 2003 with symptoms of acute enteritis to the Infectious Diseases department of the "G. Di Cristina" hospital in Palermo were enrolled. Stool samples were collected within 48 hours of admission and tested for intestinal pathogens (bacterial, viral, parasites). Salmonella spp was detected in 18.5% of samples. The median age of infected children was 4.5 years. Salmonella enteritidis (49%) and Salmonella typhimurium (37%) were the most commonly identified genotypes. S. enteritidis infection was more frequently characterized by vomiting (65.3%) and dehydration (61.2%). Bloody diarrhoea was more common in S. typhimurium infection (40.5%). All strains were susceptible to ceftriaxone, while 40% of strains were resistant to tetracyclines and 37% to ampicillin.

Large outbreaks of Salmonella Typhimurium phage type 135 infections associated with the consumption of products containing raw egg in Tasmania

This report describes one of the largest egg-associated outbreaks of foodborne illness in Australia for many years. Between June and December 2005, five outbreaks of Salmonella Typhimurium phage type 135 were identified in Tasmania, leading to 125 laboratory-confirmed cases. Public health investigations included case and food handler interviews, cohort studies, environmental health investigations of food businesses, microbiological testing, traceback, and inspections and drag swabbing of an egg farm. These investigations enabled identification of foods containing raw egg or foods contaminated through inadequate food handling and/or storage procedures as possible vehicles for infection. A particular poultry farm was reported as the common source of eggs. Interventions targeting the general public and food handlers to promote better handling of egg products, and advice to egg producers regarding harm minimisation strategies led to the series of outbreaks being brought under control.

Listeria monocytogenes F2365 carries several authentic mutations potentially leading to truncated gene products, including inlB, and demonstrates atypical phenotypic characteristics

Searches of the genome annotation of Listeria monocytogenes F2365, an isolate from the 1985 listeriosis epidemic in California, showed that this strain carries 20 authentic mutations resulting in premature stop codons, including a nonsense mutation in inlB. Here we showed that L. monocytogenes F2365 demonstrates atypical virulence-associated characteristics, including significantly (P < 0.05) reduced invasion efficiency in Caco-2 cells as compared with a closely related lineage I serotype 4b strain as well as significantly (P < 0.05) greater variation in invasiveness when grown under different conditions compared with standard laboratory control and other lineage I serotype 4b strains. In addition, L. monocytogenes F2365 demonstrated distinct growth characteristics, including a significantly (P < 0.05) reduced exponential growth rate when compared with laboratory control and other lineage I serotype 4b outbreak-associated strains as well as a significantly (P < 0.05) longer lag phase duration time compared with another lineage I serotype 4b strain. Our results support that L. monocytogenes F2365 is characterized by genotypic and phenotypic properties that are atypical of other L. monocytogenes strains.

Two consecutive large outbreaks of Salmonella enterica serotype Agona infections in infants linked to the consumption of powdered infant formula

BACKGROUND

An increase of isolation of Salmonella Agona was observed in January through February 2005 among infants in France.

METHODS

Case-control study, food trace-back and microbiologic investigations were promptly carried out.

RESULTS

A total of 141 confirmed cases <12 months of age were identified. Most had diarrhea (99%; bloody 56%) and fever (75%) and 36% were hospitalized for 5 days on average and none died. In the case-control analysis, all 23 cases and none of the 23 controls had consumed powdered formula of brand A (P < 10(-5)). Active follow up of all cases showed that after the withdrawal of formula A, cases that had consumed formula A decreased rapidly, but new cases had consumed another formula (brand B). The trace-back found that 5 batches of formula B had been manufactured on the same production line as formula A. Forty-four cases were linked to formula A and 92 to formula B. All routine controls performed by the producers were negative for Salmonella. However, enhanced microbiologic investigations yielded S. Agona in one of 176 samples of formula A, in 4 of 27 tins of formula B consumed by cases and in 6 of 420 environmental swabs from the production line. All clinical, food and environmental isolates were of the same pulsed-field gel electrophoresis profile.

CONCLUSIONS

Powdered infant formulas are not sterile products and may contain low levels of Salmonella. Routine microbiologic controls are insufficient to detect a low-grade contamination, which may cause serious illness and outbreaks among infants.

Re-assessment of risk factors for sporadic Salmonella serotype Enteritidis infections: a case-control study in five FoodNet Sites, 2002-2003

Active surveillance for laboratory-confirmed Salmonella serotype Enteritidis (SE) infection revealed a decline in incidence in the 1990s, followed by an increase starting in 2000. We sought to determine if the fluctuation in SE incidence could be explained by changes in foodborne sources of infection. We conducted a population-based case-control study of sporadic SE infection in five of the Foodborne Diseases Active Surveillance Network (FoodNet) sites during a 12-month period in 2002-2003. A total of 218 cases and 742 controls were enrolled. Sixty-seven (31%) of the 218 case-patients and six (1%) of the 742 controls reported travel outside the United States during the 5 days before the case's illness onset (OR 53, 95% CI 23-125). Eighty-one percent of cases with SE phage type 4 travelled internationally. Among persons who did not travel internationally, eating chicken prepared outside the home and undercooked eggs inside the home were associated with SE infections. Contact with birds and reptiles was also associated with SE infections. This study supports the findings of previous case-control studies and identifies risk factors associated with specific phage types and molecular subtypes.

Regional, seasonal, and antimicrobial resistance distributions of salmonella typhimurium in Canada: a multi-provincial study

BACKGROUND

This study was conducted to describe the geographical and seasonal distributions of reported human Salmonella Typhimurium (ST) definitive type 104 (DT104) cases, to compare these characteristics to those of non-DT1 04 cases, and to investigate specific antimicrobial resistance (AMR) patterns in four Canadian provinces.

METHODS

All laboratory-confirmed ST cases originating from passive reporting in Alberta, British Columbia, and Saskatchewan, and every second case in Ontario identified from December 1999 through November 2000 were investigated.

RESULTS

A total of 470 human Salmonella Typhimurium cases were identified during the study period. DT104 was the most common phage type, although its incidence varied by province. The proportion of DT104 cases living in urban Ontario, British Columbia and Saskatchewan did not differ from the general population, but in Alberta, the DT104 cases were more likely to live in rural areas. Overall, DT104 isolates were more often R-type ACSSuT compared to non-DT104 cases, and R-type AKSSuT was often associated with DT208. DT104 cases displayed no seasonality whereas non-DT104 cases were more frequent in the summer than in the winter.

INTERPRETATION

Our results suggest that DT104 and non-DT104 cases vary by province, urban vs. rural residential status and by resistance patterns. Lack of seasonality in the DT104 cases may indicate a lesser influence of the agro-environmental route (i.e., farm -manure - water and direct contact) compared to the agro-food route (i.e., farm - animals -food) for these infections. Strain characterization and integration of surveillance information related to ST from animal, food and humans is warranted.

The key role of pulsed-field gel electrophoresis in investigation of a large multiserotype and multistate food-borne outbreak of Salmonella infections centered in Pennsylvania

Five different serotypes of Salmonella enterica were implicated in a large outbreak linked to fresh Roma tomatoes served at gas station deli counters in Pennsylvania and nearby states during July 2004: S. enterica serotypes Javiana, Anatum, Thompson, Typhimurium, and Muenchen. One of these serotypes, Anatum, was isolated from both tomatoes and patients. Pulsed-field gel electrophoresis (PFGE) played a key role in identifying the outbreak-associated isolates and distinguishing them from unrelated sporadic isolates. It also demonstrated that the genetic fingerprints of serotype Anatum isolates derived from patients were indistinguishable from those derived from tomatoes. Rapid communication of PFGE fingerprints with other public health laboratories through the Centers for Disease Control and Prevention's PulseNet USA national molecular surveillance network for bacterial food-borne pathogens facilitated the tracking of this outbreak in other states. The work described in this report emphasizes the laboratory's role in core public health functions and services, thereby providing a highly visible example of public health in action.

An outbreak of Salmonella enteritidis infections linked to a restaurant in Riga, August 2006

On 16 August 2006, seven cases of acute intestinal infection were reported to the Riga branch of the State Agency “Public Health Agency”

Two separate outbreaks of Salmonella enteritidis phage type 14b food poisoning linked to the consumption of the same type of frozen food

OBJECTIVES

To ascertain, using a combination of epidemiological, environmental and microbiological methods of investigation, a possible link between two outbreaks of salmonella food poisoning.

METHODS

Case-control studies were carried out on the known at-risk populations. Environmental investigations took place in the food preparation areas used for the social functions and microbiological examinations were carried out on faecal specimens obtained from cases, environmental swabs, and food specimens when these were available.

RESULTS

In both outbreaks, illness was associated with the consumption of sesame prawn toast (outbreak one P<0.004; outbreak two P<0.0001). Salmonella enteritidis phage type 14b was cultured from the faecal specimens of cases in both outbreaks and from a packet of sesame prawn toast used for the second outbreak function. Molecular typing methods indicated that the salmonella cultures obtained in both outbreaks were indistinguishable from each other and from cultures obtained from imported Spanish eggs in a previous survey. Imported Spanish eggs were used in the manufacture of the sesame prawn toast.

CONCLUSIONS

Adequate cooking must take place of raw food products, which should be clearly labelled as such. Manufacturers should consider, when possible, the use of pasteurized egg in the preparation of food products.

Outbreak of typhoid fever in vaccinated members of the French Armed Forces in the Ivory Coast

In 2001, an outbreak of typhoid fever occurred among the members of the French Armed Forces. All had received a typhoid vaccination as per the immunization schedule practiced in the Armed Forces (every 5 years). A retrospective cohort study was conducted in 94 personnel. The objectives were to confirm the diagnosis, determine the source of contamination and identify the factors associated with defective vaccinal efficacy. Twenty-four cases were clinically identified. A cucumber salad was identified as the contaminating dish (Risk Ratio = 3.6; 95%CI 1.5-8.9). Only one factor was related to defective vaccinal efficacy; the risk of typhoid fever was two-fold higher in people vaccinated more than 3 years previously (Risk Ratio = 2.2; 95%CI, 1.1-4.2). Compliance with food hygiene rules could have prevented 24 cases of typhoid fever. Nevertheless, repeat vaccination against typhoid fever is now conducted every 3 years in the French Forces, in compliance with the manufacturers' recommendations.

Surveillance and management of salmonella food poisoning

Reports of Salmonella Montevideo in UK chocolate have put foodborne disease back in the headlines. This article looks at the nature, prevalence and management of this public health problem and highlights the importance of surveillance.

Human salmonellosis in travellers is highly correlated to the prevalence of salmonella in laying hen flocks

Comparison of the recent European Food Safety Authority (EFSA) report on the prevalence of salmonella in laying hen flocks

Outbreak of Salmonella Kedougou in Norway associated with salami, April-June 2006

Nasjonalt folkehelseinstituttet (the Norwegian Institute of Public Health, NIPH) has recently completed the investigation of a nationwide outbreak

Identification of Salmonella enterica serovar Typhimurium using specific PCR primers obtained by comparative genomics in Salmonella serovars

Salmonella enterica serovar Typhimurium is a major foodborne pathogen throughout the world. Until now, the specific target genes for the detection and identification of serovar Typhimurium have not been developed. To determine the specific probes for serovar Typhimurium, the genes of serovar Typhimurium LT2 that were expected to be unique were selected with the BLAST (Basic Local Alignment Search Tool) program within GenBank. The selected genes were compared with 11 genomic sequences of various Salmonella serovars by BLAST. Of these selected genes, 10 were expected to be specific to serovar Typhimurium and were not related to virulence factor genes of Salmonella pathogenicity island or to genes of the O and H antigens of Salmonella. Primers for the 10 selected genes were constructed, and PCRs were evaluated with various genomic DNAs of Salmonella and non-Salmonella strains for the specific identification of Salmonella serovar Typhimurium. Among all the primer sets for the 10 genes, STM4497 showed the highest degree of specificity to serovar Typhimurium. In this study, a specific primer set for Salmonella serovar Typhimurium was developed on the basis of the comparison of genomic sequences between Salmonella serovars and was validated with PCR. This method of comparative genomics to select target genes or sequences can be applied to the specific detection of microorganisms.

UK Health Protection Agency view on food alert announcing the recall of a number of confectionery products

The UK Food Standards Agency issued a Food Alert on 23 June