Risk factors for salmonella food poisoning in the domestic kitchen--a case control study

Developing a risk management framework to improve public health outcomes by enumerating and serotyping Salmonella in ground turkey

Salmonella enterica continues to be a leading cause of foodborne morbidity worldwide. A quantitative risk assessment model was developed to evaluate the impact of pathogen enumeration and serotyping strategies on public health after consumption of undercooked contaminated ground turkey in the USA. The risk assessment model predicted more than 20,000 human illnesses annually that would result in ~700 annual reported cases. Removing ground turkey lots contaminated with Salmonella exceeding 10 MPN/g, 1 MPN/g, and 1 MPN/25 g would decrease the mean number of illnesses by 38.2, 73.1, and 95.0%, respectively. A three-class mixed sampling plan was tested to allow the detection of positive lots above threshold levels with 2-6 (c = 1) and 3-8 samples per lot (c = 2) using 25-g and 325-g sample sizes for a 95% probability of rejecting a contaminated lot. Removal of positive lots with the presence of highly virulent serotypes would decrease the number of illnesses by 44.2-87.0%. Based on these model prediction results, risk management strategies should incorporate pathogen enumeration and/or serotyping. This would have a direct impact on illness incidence linking public health outcomes with measurable food safety objectives, at the cost of diverting production lots.

Salmonella in eggs: From shopping to consumption-A review providing an evidence-based analysis of risk factors

Nontyphoidal salmonellae are among the most prevalent foodborne pathogens causing gastrointestinal infections worldwide. A high number of cases and outbreaks of salmonellosis are associated with the consumption of eggs and egg products, and several of these occur at the household level. The aim of the current study is to critically evaluate the current status of knowledge on Salmonella in eggs from a consumer's perspective, analyzing the hazard occurrence and the good practices that should be applied to reduce salmonellosis risk. Following a HACCP (Hazard Analysis and Critical Control Point) based approach, some steps along the food journey were identified as Critical Consumer Handling (CCH)-steps in which consumers, through their behavior or choice, can significantly reduce the level of Salmonella in eggs and egg products. From shopping/collecting to consumption, each of these steps is discussed in this review to provide an evidence-based overview of risk factors of human salmonellosis related to egg consumption. The main message to consumers is to choose Salmonella-free eggs (those that some official entity or producer guarantees that does not contain Salmonella), when available, especially for dishes that are not fully heat treated. Second, as guaranteed Salmonella-free eggs are only available in a few countries, refrigerated storage from the point of collection and proper cooking will significantly reduce the risk of salmonellosis. This will require a revision of the actual recommendations/regulations, as not all ensure that eggs are maintained at temperatures that prevent growth of Salmonella from collection until the time of purchasing.

Contamination by Meat Juice When Shopping for Packages of Raw Poultry

Raw poultry products often are contaminated with Salmonella and Campylobacter, and these bacteria can be transmitted through meat juice on the packages. An observational study was conducted to assess consumer exposure to meat juice during shopping and to quantify the transmission of meat juice from poultry packages to hands and other surfaces. Ninety-six participants completed the shopping study; 402 swabs were collected and analyzed for the presence of meat juice by an immunoassay. Overall, meat juice was detected on 61% of poultry package surfaces, 34% of shoppers' hands, 41% of grocery bags, 60% of kitchen surfaces, and 51% of food item surfaces. When meat juice was detected on the purchased poultry packages, the chance of the meat juice being on the shopper's hands, grocery bags, food items, and kitchen surfaces was significantly higher ( P < 0.005) compared with packages on which meat juice was not present. Shoppers who had poultry wrapped separately during checkout had a significantly lower ( P < 0.05) chance of meat juice on the food items. However, using plastic bags and wrapping poultry separately did not significantly reduce the likelihood of meat juice on kitchen surfaces at home due to consumers' practices of repackaging before storage. Results suggested that the transfer of meat juice through direct contact with the poultry packages is a major concern during shopping and should be prevented.

Tackling Salmonella Persister Cells by Antibiotic-Nisin Combination via Mannitol

Bacterial persisters (defined as dormant, non-dividing cells with globally reduced metabolism) are the major cause of recurrent infections. As they neither grow nor die in presence of antibiotics, it is difficult to eradicate these cells using antibiotics, even at higher concentrations. Reports of metabolites (which help in waking up of these inactive cells) enabled eradication of bacterial persistence by aminoglycosides, suggest the new potential strategy to improve antibiotic therapy. Here we propose, mannitol enabled elimination of Salmonella persister cells by the nisin-antibiotic combination. For this, persister cells were developed and characterized for their typical properties such as non-replicative state and metabolic dormancy. Different carbon sources viz. glucose, glycerol, and mannitol were used, each as an adjunct to ampicillin for the eradication of persister cells. The maximum (but not complete) killing was observed with mannitol-ampicillin, out of all the combinations used. However, significant elimination (about 78%) could be observed, when nisin (an antimicrobial peptide) was used with ampicillin in presence of mannitol, which might have mediated the transfer of antibiotic-nisin combination at the same time when the cells tried to grab the carbon molecule. Further, the effectiveness of the trio was confirmed by flow cytometry. Overall, our findings highlight the potential of this trio-combination for developing it as an option for tackling Salmonella persister cells.

Factors Influencing Knowledge, Food Safety Practices and Food Preferences During Warm Weather of Salmonella and Campylobacter Cases in South Australia

OBJECTIVE

To assess food safety practices, food shopping preferences, and eating behaviors of people diagnosed with Salmonella or Campylobacter infection in the warm seasons, and to identify socioeconomic factors associated with behavior and practices.

METHODS

A cross-sectional survey was conducted among Salmonella and Campylobacter cases with onset of illness from January 1 to March 31, 2013. Multivariable logistic regression analyses examined relationships between socioeconomic position and food safety knowledge and practices, shopping and food preferences, and preferences, perceptions, and knowledge about food safety information on warm days.

RESULTS

Respondents in our study engaged in unsafe personal and food hygiene practices. They also carried out unsafe food preparation practices, and had poor knowledge of foods associated with an increased risk of foodborne illness. Socioeconomic position did not influence food safety practices. We found that people's reported eating behaviors and food preferences were influenced by warm weather.

CONCLUSIONS

Our study has explored preferences and practices related to food safety in the warm season months. This is important given that warmer ambient temperatures are projected to rise, both globally and in Australia, and will have a substantial effect on the burden of infectious gastroenteritis including foodborne disease. Our results provide information about modifiable behaviors for the prevention of foodborne illness in the household in the warm weather and the need for information to be disseminated across the general population. An understanding of the knowledge and factors associated with human behavior during warmer weather is critical for public health interventions on foodborne prevention.

Prevalence and Antimicrobial Resistance of Enterobacteriaceae in Shell Eggs from Small-Scale Poultry Farms and Farmers' Markets

Public health concerns over the emergence of antimicrobial resistant bacteria have increased recently. The purpose of this study was to investigate the prevalence of antimicrobial resistant Enterobacteriaceae in shell eggs purchased from small poultry farms and farmers' markets. A total of 504 eggs were pooled to make 252 composite samples, consisting of 2 eggs per composite. The microbial quality of shell eggs was determined by standard quantitative, biochemical, and PCR techniques. Susceptibility to 13 antimicrobial agents was determined by the Kirby-Bauer disk diffusion technique, and results were interpreted based on Clinical and Laboratory Standards Institute values. Shell eggs and egg contents were positive for Escherichia coli (11.9 and 5.2%, respectively), Enterobacter (9.1 and 7.9%), and Serratia (11.5 and 4.8%). Salmonella was isolated from 3.6% of egg shells but not from egg contents. Mean (±SD) Enterobacteriaceae levels (4.4 ± 2.0 log CFU per eggshell) on shell eggs from poultry farms was significantly higher (P ≤ 0.05) than that on shell eggs from farmers' markets (2.1 ± 1.3 log CFU per eggshell). Of the 134 isolates recovered, resistance among isolates from farm and market shell eggs to erythromycin was most common (48.5 and 32.8%, respectively) followed by ampicillin (44.8 and 17.2%), and tetracycline (29.9 and 17.2%). The multiple antibiotic resistance index value for E. coli and Pantoea was 0.62, and that for Salmonella and Klebsiella terrigena was 0.08, indicating that Enterobacteriaceae in shell eggs can be resistant to multiple antimicrobial agents. These data reveal that shell eggs from small poultry farms and farmers' markets can harbor antimicrobial resistant pathogenic and commensal bacteria. Thus, failure to properly handle shell eggs poses a potential health hazard to consumers.

A QMRA Model for Salmonella in Pork Products During Preparation and Consumption

As part of a quantitative microbiological risk assessment (QMRA) food chain model, this article describes a model for the consumer phase for Salmonella-contaminated pork products. Three pork products were chosen as a proxy for the entire pork product spectrum: pork cuts, minced meat patties, and fermented sausages. For pork cuts cross-contamination is considered the most important process and therefore it is modeled in detail. For minced meat, both cross-contamination and undercooking are the relevant processes. For those commodities bacterial growth during transport and storage is also modeled. Fermented sausages are eaten raw and the production may be defective. Variability between consumers' behavior and the impact of variability between production processes at the farm and abattoir are taken into account. Results indicate that Salmonella levels on products may increase significantly during transport and storage. Heating is very efficient at lowering concentrations, yet cross-contamination plays an important role in products that remain contaminated. For fermented sausage it is found that drying is important for Salmonella reduction. Sensitivity analysis revealed that cross- contamination factors "knife cleaning" and "preparation of a salad" are important parameters for pork cuts. For minced meat cleaning of the board, salad consumption, refrigerator temperature, and storage time were significant.

Consumer Shell Egg Consumption and Handling Practices: Results from a National Survey

Numerous cases and outbreaks of Salmonella infection are attributable to shell eggs each year in the United States. Safe handling and consumption of shell eggs at home can help reduce foodborne illness attributable to shell eggs. A nationally representative Web survey of 1,504 U.S. adult grocery shoppers was conducted to describe consumer handling practices and consumption of shell eggs at home. Based on self-reported survey data, most respondents purchase shell eggs from a grocery store (89.5%), and these eggs were kept refrigerated (not at room temperature; 98.5%). As recommended, most consumers stored shell eggs in the refrigerator (99%) for no more than 3 to 5 weeks (97.6%). After cracking eggs, 48.1% of respondents washed their hands with soap and water. More than half of respondents who fry and/or poach eggs cooked them so that the whites and/or the yolks were still soft or runny, a potentially unsafe practice. Among respondents who owned a food thermometer (62.0%), only 5.2% used it to check the doneness of baked egg dishes when they prepared such a dish. Consumers generally followed two of the four core "Safe Food Families" food safety messages ("separate" and "chill") when handling shell eggs at home. To prevent Salmonella infection associated with shell eggs, consumers should improve their practices related to the messages "clean" (i.e., wash hands after cracking eggs) and "cook" (i.e., cook until yolks and whites are firm and use a food thermometer to check doneness of baked egg dishes) when preparing shell eggs at home. These findings will be used to inform the development of science-based consumer education materials that can help reduce foodborne illness from Salmonella infection.

Salmonella require the fatty acid regulator PPARδ for the establishment of a metabolic environment essential for long-term persistence

Host-adapted Salmonella strains are responsible for a number of disease manifestations in mammals, including an asymptomatic chronic infection in which bacteria survive within macrophages located in systemic sites. However, the host cell physiology and metabolic requirements supporting bacterial persistence are poorly understood. In a mouse model of long-term infection, we found that S. typhimurium preferentially associates with anti-inflammatory/M2 macrophages at later stages of infection. Further, PPARδ, a eukaryotic transcription factor involved in sustaining fatty acid metabolism, is upregulated in Salmonella-infected macrophages. PPARδ deficiency dramatically inhibits Salmonella replication, which is linked to the metabolic state of macrophages and the level of intracellular glucose available to bacteria. Pharmacological activation of PPARδ increases glucose availability and enhances bacterial replication in macrophages and mice, while Salmonella fail to persist in Pparδ null mice. These data suggest that M2 macrophages represent a unique niche for long-term intracellular bacterial survival and link the PPARδ-regulated metabolic state of the host cell to persistent bacterial infection.

Case-control studies of sporadic enteric infections: a review and discussion of studies conducted internationally from 1990 to 2009

Epidemiologists have used case-control studies to investigate enteric disease outbreaks for many decades. Increasingly, case-control studies are also used to investigate risk factors for sporadic (not outbreak-associated) disease. While the same basic approach is used, there are important differences between outbreak and sporadic disease settings that need to be considered in the design and implementation of the case-control study for sporadic disease. Through the International Collaboration on Enteric Disease "Burden of Illness" Studies (the International Collaboration), we reviewed 79 case-control studies of sporadic enteric infections caused by nine pathogens that were conducted in 22 countries and published from 1990 through to 2009. We highlight important methodological and study design issues (including case definition, control selection, and exposure assessment) and discuss how approaches to the study of sporadic enteric disease have changed over the last 20 years (e.g., making use of more sensitive case definitions, databases of controls, and computer-assisted interviewing). As our understanding of sporadic enteric infections grows, methods and topics for case-control studies are expected to continue to evolve; for example, advances in understanding of the role of immunity can be used to improve control selection, the apparent protective effects of certain foods can be further explored, and case-control studies can be used to provide population-based measures of the burden of disease.

Large outbreak ofSalmonellaEnteritidis PT8 in Portsmouth, UK, associated with a restaurant

Seventy-five individuals withSalmonellainfection were identified in the Portsmouth area during August and September 2009, predominantlySalmonellaEnteritidis phage type 8. Five patients were admitted to hospital. A case-case comparison study showed that a local restaurant was the most likely source of the infection with a risk of illness among its customers 25-fold higher than that of those who did not attend the restaurant. A case-control study conducted to investigate specific risk factors for infection at the restaurant showed that eating salad was associated with a threefold increase in probability of illness. Changing from using ready washed lettuces to lettuces requiring washing and not adhering strictly to the 48 hours exclusion policy for food handlers with diarrhoea were likely to have contributed to the initiation and propagation of this outbreak. Possibilities for cross-contamination and environmental contamination were identified in the restaurant.

Source attribution of human salmonellosis using a meta-analysis of case-control studies of sporadic infections

Salmonella is an important cause of human illness. Disease is frequently associated with foodborne transmission, but other routes of exposure are recognized. Identifying sources of disease is essential for prioritizing public health interventions. Numerous case-control studies of sporadic salmonellosis have been published, often using different methodologies and settings. Systematic reviews consist of a formal process for literature review focused on a research question. With the objective of identifying the most important risk factors for salmonellosis, we performed a systematic review of case-control studies and a meta-analysis of obtained results. Thirty-five Salmonella case-control studies were identified. In the meta-analysis, heterogeneity between studies and possible sources of bias were investigated, and pooled odds ratios estimated. Results suggested that travel, predisposing factors, eating raw eggs, and eating in restaurants were the most important risk factors for salmonellosis. Sub-analyses by serotype were performed when enough studies were available.

Isolation of Salmonella enterica in laying-hen flocks and assessment of eggshell contamination in France

The present investigation was conducted in conjunction with the European Union baseline study for the estimation of Salmonella prevalence in laying-hen flocks. It aimed at evaluating eggshell contamination in farms positive for Salmonella, characterizing the genetic patterns of Salmonella strains and identifying the factors associated with Salmonella contamination of eggshells. For this purpose, a total of 4,200 eggs were collected from 28 positive flocks and analyzed according to draft Annex D of International Organization for Standardization Method 6579. Molecular characterization of the Salmonella strains was obtained by the pulsed-field gel electrophoresis method with two restriction enzymes, XbaI and BlnI. The relationship between the presence of Salmonella on eggshells and rearing practices was studied by using multiple correspondence analysis. Results showed that 39.3% of the positive flocks had at least one positive eggshell, with a total of 1.05% of eggshells testing positive for Salmonella. We detected the same serovars on samples taken from the farm and from eggshells within a given flock, with isolates sharing the same genetic pattern in 7 of 11 flocks. Eggshells tested positive for Salmonella in flocks (i) located where delivery trucks pass near air entrances of the poultry house, (ii) with high holding capacity (>30,000 laying hens), and (iii) with more than five positive samples coming from the farm environment, as well as in cases of flocks with a maximum egg-laying rate of >96% and in cases where farmers worked in other animal production. This study provided valuable information that could be used for risk management and risk assessment studies.

Foodborne Salmonella ecology in the avian gastrointestinal tract

Foodborne Salmonella continues to be a major cause of salmonellosis with Salmonella Enteritidis and S. Typhimurium considered to be responsible for most of the infections. Investigation of outbreaks and sporadic cases has indicated that food vehicles such as poultry and poultry by-products including raw and uncooked eggs are among the most common sources of Salmonella infections. The dissemination and infection of the avian intestinal tract remain somewhat unclear. In vitro incubation of Salmonella with mammalian tissue culture cells has shown that invasion into epithelial cells is complex and involves several genetic loci and host factors. Several genes are required for the intestinal phase of Salmonella invasion and are located on Salmonella pathogenicity island 1 (SPI 1). Salmonella pathogenesis in the gastrointestinal (GI) tract and the effects of environmental stimuli on gene expression influence bacterial colonization and invasion. Furthermore, significant parameters of Salmonella including growth physiology, nutrient availability, pH, and energy status are considered contributing factors in the GI tract ecology. Approaches for limiting Salmonella colonization have been primarily based on the microbial ecology of the intestinal tract. In vitro studies have shown that the toxic effects of short chain fatty acids (SCFA) to some Enterobacteriaceae, including Salmonella, have resulted in a reduction in population. In addition, it has been established that native intestinal microorganisms such as Lactobacilli provide protective mechanisms against Salmonella in the ceca. A clear understanding of the key factors involved in Salmonella colonization in the avian GI tract has the potential to lead to better approach for more effective control of this foodborne pathogen.

How effective is good domestic kitchen hygiene at reducing diarrhoeal disease in developed countries? A systematic review and reanalysis of the UK IID study

Background

To assess whether domestic kitchen hygiene is an important contributor to the development of diarrhoea in the developed world.

Methods

Electronic searches were carried out in October 2006 in EMBASE, MEDLINE, Web of Knowledge, Cochrane central register of clinical trials and CINAHL. All publications, irrespective of study design, assessing food hygiene practices with an outcome measure of diarrhoea were included in the review. All included studies underwent data extraction and the data was subsequently analysed. The analysis was conducted by qualitative synthesis of the results. Given the substantial heterogeneity in study design and outcome measures meta-analysis was not done. In addition the existing dataset of the UK IID study was reanalysed to investigate possible associations between self-reported diarrhoea and variables indicative of poor domestic kitchen hygiene

Results

Some 14 studies were finally included in subsequent analyses. Of the 14 studies included in this systematic review, 11 were case-control studies, 2 cross-sectional surveys, and 1 RCT. Very few studies identified any significant association with good environmental kitchen hygiene. Although some of the variables in the reanalysis of the UK IID study were statistically significant no obvious trend was seen.

Conclusion

The balance of the available evidence does not support the hypothesis that poor domestic kitchen hygiene practices are important risk factors for diarrhoeal disease in developed countries.

Recovery and transfer of Salmonella typhimurium from four different domestic food contact surfaces

Domestic food contact surfaces can play an important role in the transmission of foodborne disease, yet debate continues as to which surface materials pose the greatest risk to consumer health in terms of cross-contamination during food preparation. Salmonella Typhimurium was inoculated onto stainless steel, Formica, polypropylene, or wooden surfaces (25 cm2) in the presence or absence of protein (tryptic soy broth supplemented with 5% horse serum) and held at room temperature. The pathogen was recovered from the test surfaces immediately after inoculation (T=0) and every hour for up to 6 h, by a conventional microbiological sampling technique and by direct transfer onto a model ready-to-eat food (cucumber slices). On all surfaces, pathogen numbers declined during the 6-h holding period, with the most rapid reductions occurring within the first hour. The presence of protein significantly increased (P < 0.05) the number of bacteria recovered from all surface types. However, regardless of application medium or holding time, the number of bacteria recovered from Formica (in all cases) and stainless steel (in most cases) was significantly higher than were the numbers on polypropylene or wood. Similarly, regardless of application medium or holding time, significantly higher bacterial numbers were transferred to the model food from Formica or stainless steel than from polypropylene or wooden surfaces. These differences were greater when the bacteria were applied in a protein-rich medium and the test surfaces held for 1 h or more. The results of this study emphasize that differences, both in recoverability and in the number of bacteria transferred to the model food rather than simply reflecting differences in pathogen survival, may also reflect differences in the ability of the test bacteria to remobilize from the different surface types. However, the results also demonstrate a fundamental problem when choosing food contact surfaces, i.e., that those characteristics that make a surface "easy to clean" may also render it more likely to release contaminating pathogens during common food preparation practices.

Prevalence of Salmonella in grade A whole shell eggs in the island of Ireland

Following the emergence of Salmonella Enteritidis as a widespread contaminant of eggs and the role of eggs in the transmission of human salmonellosis, control measures were introduced to curb the spread of infection. Two approaches to Salmonella control are currently used by egg producers in Ireland, because Northern Ireland producers, like those in the rest of the United Kingdom, widely adopted a vaccination regime, whereas the Republic of Ireland does not permit vaccination but introduced controls based on routine monitoring for specific Salmonella serovars and subsequent culling of infected flocks. To compare the efficacy of these two approaches and determine the prevalence of salmonellae in eggs produced for retail sale in the island of Ireland, a major survey of approximately 30,000 grade A eggs was undertaken. Egg shells and contents were analyzed separately for salmonellae by procedures based on International Organization for Standardization methodology. The survey yielded only two positive samples, with Salmonella Infantis and Salmonella Montevideo isolated from shells; no egg contents yielded salmonellae. There was no statistically significant difference in the prevalence of salmonellae between eggs produced in Northern Ireland and those from the Republic of Ireland; hence, both regimes appeared to be equally effective in controlling salmonellae. The prevalence was also significantly lower than that found in a recent major United Kingdom survey. Hence, shell eggs produced in the island of Ireland are unlikely to be a source of human salmonellosis.

Consumer-phase Salmonella enterica serovar enteritidis risk assessment for egg-containing food products

We describe a one-dimensional probabilistic model of the role of domestic food handling behaviors on salmonellosis risk associated with the consumption of eggs and egg-containing foods. Six categories of egg-containing foods were defined based on the amount of egg contained in the food, whether eggs are pooled, and the degree of cooking practiced by consumers. We used bootstrap simulation to quantify uncertainty in risk estimates due to sampling error, and sensitivity analysis to identify key sources of variability and uncertainty in the model. Because of typical model characteristics such as nonlinearity, interaction between inputs, thresholds, and saturation points, Sobol's method, a novel sensitivity analysis approach, was used to identify key sources of variability. Based on the mean probability of illness, examples of foods from the food categories ranked from most to least risk of illness were: (1) home-made salad dressings/ice cream; (2) fried eggs/boiled eggs; (3) omelettes; and (4) baked foods/breads. For food categories that may include uncooked eggs (e.g., home-made salad dressings/ice cream), consumer handling conditions such as storage time and temperature after food preparation were the key sources of variability. In contrast, for food categories associated with undercooked eggs (e.g., fried/soft-boiled eggs), the initial level of Salmonella contamination and the log10 reduction due to cooking were the key sources of variability. Important sources of uncertainty varied with both the risk percentile and the food category under consideration. This work adds to previous risk assessments focused on egg production and storage practices, and provides a science-based approach to inform consumer risk communications regarding safe egg handling practices.

Salmonella prevalence in free-range and certified organic chickens

Many consumers assume that broiler chickens grownunder traditional commercial conditions will have more Salmonella than free-range or organic chickens, which usually are less crowded, have access to outside spaces during grow out, and are fed special diets. Despite these perceptions, there is a lack of published information about the microbiological status of free-range and organic chickens. A total of 135 processed free-range chickens from four different commercial free-range chicken producers were sampled in 14 different lots for the presence of Salmonella. Overall, 9 (64%) of 14 lots and 42 (31%) of 135 of the carcasses were positive for Salmonella. No Salmonella were detected in 5 of the 14 lots, and in one lot 100% of the chickens were positive for Salmonella. An additional 53 all-natural (no meat or poultry meal or antibiotics in the feed) processed chickens from eight lots were tested; 25% ofthe individual chickens from 37% of these lots tested positive for Salmonella. Three lots of chickens from a single organicfree-range producer were tested, and all three of the lots and 60% of the individual chickens were positive for Salmonella.The U.S. Department of Agriculture Food Safety and Inspection Service reported that commercial chickens processed from 2000 to 2003 had a Salmonella prevalence rate of 9.1 to 12.8%. Consumers should not assume that free-range or organicconditions will have anything to do with the Salmonella status of the chicken.

Salmonella and raw shell eggs: results of a cross-sectional study of contamination rates and egg safety practices in the United Kingdom catering sector in 2003

This study was prompted by epidemiological investigations of the unusual number of Salmonella Enteritidis outbreaks associated with the use of eggs in catering premises in England and Wales during 2002. The aims of the study, performed between April and May 2003, were to establish the rate of Salmonella contamination in raw shell eggs from catering premises, investigate any correlation between the origin and type of eggs and the presence of particular serotypes or phage types (PTs) of Salmonella, and examine the use of raw shell eggs in catering premises in the United Kingdom. A total of 34,116 eggs (5,686 pooled samples of six eggs) were collected from 2,104 catering premises, most of which were eggs produced in the United Kingdom (88%). Salmonella was isolated from 17 pools (0.3%) of eggs. Of these, 15 were Salmonella Enteritidis, which were further characterized to PTs as follows: PT6 (0.1%), PT4 (0.07%), PT12 (0.04%), PT1 (0.04%), and PT14b (0.02%). Salmonella Livingstone and Salmonella Typhimurium definitive type 7 resistant to ampicillin, streptomycin, sulfonamides, and tetracycline were also isolated. The Salmonella contamination rate of eggs produced in the United Kingdom appears to have decreased significantly since 1995 and 1996. This trend is reflected in the decrease of Salmonella Enteritidis and, in particular, Salmonella Enteritidis PT4. The impact of the United Kingdom Food Standards Agency's advice on the use of eggs, issued in January 2003, is discussed.

Egg consumption patterns and Salmonella risk in Finland

To estimate the consumer risk of contracting Salmonella infection via shell eggs and to evaluate the effect of possible preventative measures, quantitative microbiological risk assessment is being developed in Finland. As a part of the risk assessment, a survey of 918 respondents was conducted to study how households purchase, store, handle, and use eggs. In addition, suitability of the Internet as a survey method was compared with a postal survey. Shell eggs were usually purchased once every 2 weeks (41% of all the respondents). Ninety-one percent of the respondents bought eggs in groceries and 93% stored eggs at chilled temperatures. The majority of the respondents (80%) only had eggs in their home for which the best-before date had not expired. Only 34% of the respondents said that they always washed their hands after breaking eggs. Consumption of well-cooked eggs accounted for 84%, consumption of soft-boiled eggs for 12%, and consumption of raw eggs for 4% of the total amount of eggs consumed. The elderly used eggs more frequently than the whole population, but the consumption of raw egg dishes decreased with age. The Internet survey was a rapid method for transmitting information, but its response rate was low (9%), and it did not appear to be a suitable tool for data collection in a general population. The results indicate that although the majority of the respondents had safe egg-handling practices, a substantial minority of the consumers had risk-prone behavior.

Food safety in family homes in Melbourne, Australia

Poor food handling practices in the home are a likely cause of gastroenteritis. This study examined how often reported practices in Australian homes met public health food safety recommendations. During 1998 in Melbourne, Australia, food handling and food storage questionnaires were completed by an adult member in 524 and 515 families, respectively. Each family consisted of at least two adults and two children. Respondents were surveyed regarding washing of hands, cutting boards, and fresh produce; use of kitchen cloths; egg storage; where cooked foods were cooled; the duration before refrigeration of cooked foods; where food types were positioned in the refrigerator; and the method of thawing chicken. Nearly every household reported handling food in a way that could cause food to become contaminated. Overall, 99.0% of respondents reported some form of mishandling, which encompassed 70.3% who handled food preparation surfaces poorly, 46.6% who did not wash their hands appropriately or in a timely manner, 41.7% who mishandled raw foods, and 70.1% who mishandled cooked foods. Food was inappropriately located in the refrigerator by 81.2%, and chicken was thawed using unsafe means by 76.3% of respondents. People preparing food in the home need to be reminded of the increased risk of disease that can arise from poor food handling practices.

Differences in perception of risk between people who have and have not experienced Salmonella food poisoning

It is believed that food hygiene precautions in domestic kitchens are an important strategy in efforts to reduce the incidence of sporadic food poisoning, but recent research has shown that people who have suffered food poisoning handle the same types of foods and adopt similar food hygiene precautions in their kitchens to the rest of the population. This suggests the need to examine other factors. A case-control study of sporadic Salmonella food poisoning was conducted to investigate several domestic kitchen risk factors. Measures of perception of risk, knowledge, and control associated with food poisoning in case and control respondents are reported here. It was found that perceived personal risk from food poisoning in the home was less than perceived risk to other people. In contrast, ratings of personal knowledge about food poisoning and personal control over food poisoning in the home were seen to be greater than other people's knowledge and control. There were no differences between the cases and the controls in their ratings of knowledge about food poisoning or their control over food poisoning. However, cases perceived their personal risk from food poisoning to be higher than controls. Both case and control samples exhibited optimistic bias but this was reduced in the case sample, suggesting that experience with food poisoning may reduce optimistic bias.