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An Outbreak of Salmonella Typhimurium DT49 in Ireland

An Outbreak of Salmonella Typhimurium DT49 in Ireland. C. O’ Hare H. Pelly P. McKeown M. Di Renzi G. Corbett-Feeney M. Cormican. County Dublin . County Longford. County Roscommon. 1 dot = 1 case of Salmonellosis (random placing). Map & Key. Case Definitions.

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An Outbreak of Salmonella Typhimurium DT49 in Ireland

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  1. An Outbreak of Salmonella Typhimurium DT49 in Ireland C. O’ Hare H. Pelly P. McKeown M. Di Renzi G. Corbett-Feeney M. Cormican

  2. County Dublin County Longford County Roscommon 1 dot = 1 case of Salmonellosis (random placing) Map & Key

  3. Case Definitions Probable case: Diarrhoea plus or minus one or more of : fever, headache, abdominal pain, nausea, vomiting, confusion, bloody stools AND ate at restaurant X between the 4th and the 19th April 2004 Confirmed case: criteria of a probable case and had laboratory confirmation of Salmonella Typhimurium

  4. Case Ascertainment • All patients with Salmonella Typhimurium infection in Ireland • with date of onset of symptoms between the 4th April and • the 21st April, were asked if they had eaten in restaurant X. • Contacts of cases who had also eaten at the restaurant were • interviewed and stool samples were obtained. • Characteristics of Cases • 9 confirmed cases, 1 probable case • 8/10 female : (1 food handler) • Mean age 36.5 years (range 8-77 years) • Hospital admission required in 3/10 cases • One isolate was invasive and was cultured from blood • No fatalities

  5. Epidemic curve, by date of onset of symptoms

  6. Epidemic curve, by date of eating in restaurant X Foodstuffs analysed by Food laboratory from Restaurant X Chicken Stuffing Pepper sauce Red pepper sauce Meringue Manufactured ice-cream Tiramisu Egg white Whipped cream Raw shelled eggs Coleslaw

  7. Case control Studies • 10 Cases (9 confirmed) • 26 controls (including) • 13 controls (asymptomatic contacts who dined in • restaurant X during the period 4th to 19th April) • 13 staff members (asymptomatic contacts who • confirmed that they consistently ate on the premises)

  8. Relationship between Food exposure and salmonellosis (Univariate) Foodstuff Cases Controls OR P value Tiramisu 5/10 4/26 5.5 0.04 (5th and 11th) Tiramisu 3/7 0/9 /// 0.06 (11th) Foods containing 9/10 16/26 5.6 0.1 Liquid egg (5th and 11th) Foods containing 7/7 4/9 /// 0.03 Liquid egg (11th)

  9. Salmonella Reference laboratory • Serology (Kauffmann-White scheme) • Phage type (Anderson scheme) • Antimicrobial susceptibility (Disk Diffusion: NCCLS) • PFGE (Pulse Net, CDC, USA) • Plasmid profile (Kado and Liu) • 9/10 patient isolates were received by NSRL Microbiology

  10. Antimicrobial Susceptibility Isolates tested against a panel of 14 antimicrobials Results: 8 isolates were susceptible to all antimicrobials tested 1 sample contained 2 isolates with different antibiograms A : ampicillin, streptomycin and kanamycin resistant B: fully susceptible

  11. S. Typhimurium DT49 in Europe Ireland: From 2001-2004: 5 isolates all human. Not travel associated Enter-net data: Austria: From 2003-2004: 2 probable DT49. Travel to Turkey? Finland: 2003: One isolate DT49. Travel to Mexico Denmark: From 2000-2004 no human cases. 1998-1999 4 DT49 in pigs England and Wales: From 1984-1988 DT49 was most common phage type of S. Typhimurium Large hospital outbreak, House of Lords outbreak

  12. Molecular Analysis – PFGE XbaI restriction. S. Braenderup control S. Typhimurium DT49 outbreak Isolates indistinguishable from each other and also from isolates from previous years

  13. Molecular Analysis - Plasmids Serotype specific plasmid * Extra Plasmid band 90kb marker 60kb marker l marker 2-16kb

  14. Discussion First outbreak of DT49 >2 people reported in Ireland Prompt Intervention of Public Health Epidemiological investigation showed that foods containing liquid egg were strongly associated with symptoms Cross contamination ? Role of Salmonella Reference Laboratory Enter-net collaboration

  15. Acknowledgements Enter-net National Disease Surveillance Center (NDSC) Food Safety Authority of Ireland (FSAI) Area Medical officers Environmental Health officers Infection control nurses Surveillance scientists NSRL Website address: http://www.nuigalway.ie/salmonella_lab/ From Midland Health Board Western Health Board Eastern Regional Health board

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