Transcript Title of presentation

Salmonella: Recurrent Trends
Lab reports (1000's)
60
Cryptosporidium
Rotavirus
Campylobacters
Salmonellas
Shigellas
50
40
30
20
10
0
77
79
81
83
85
Prof Eric Bolton
Health Protection Agency
Manchester
November 2009
87
89
91
Year
93
95
97
99
01
03
Topics - Salmonella
•Gastro-intestinal infections and Food-borne
illness
•Major Serotypes and Phage types of
Salmonella associated with sporadic
infections
•Outbreaks Associated with Salmonella
Selected GI Pathogens, E & W
60
Campylobacters
Salmonellas
Cryptosporidium
Rotavirus
Shigellas
Lab reports (1000's)
50
40
30
20
10
0
77
79
81
83
85
87
89
91
93
Year
95
97
99
01
03
05
07
Results of a Public Health Investigation
into the Use of Raw Eggs in the UK
Catering Industry 2002
Salmonella from Raw Shell Eggs Used in Catering
Country of origin
Number of
pooled samples
Number of
pooled samples
positive
Salmonella
serotypes and S.
Enteritidis phage
types
UK(Lion
Quality)
349
0
None found
UK (not Lion
Quality)
274
2
S. Enteritidis
PT4, PT6
USA
60
0
None found
France
45
0
None found
Spain
468
24
S. Enteritidis
PT1, PT5c, PT6,
PT6a, PT6d,
PT12, PT13a,
PT14b, PT58
Not known (not
Lion Quality)
200
17
S. Enteritidis
PT4, PT6a S.
Altona, S.Cerro,
S. Infantis, S
Livingstone, S.
Ohio
Salmonella Infections
England and Wales, 2000-2008
Year
Total
2000
14463
2001
16041
2002
14442
2003
14954
2004
13135
2005
11447
2006
12521
2007
11998
2008
10066
Top Ten Salmonella Serotypes,
England & Wales 2008
Serotype
Number
Percentage
Salmonella Enteritidis
4357
43.3
Salmonella Typhimurium
1916
19.0
Salmonella Virchow
289
2.9
Salmonella Agona
228
2.3
Salmonella Newport
197
2.0
Salmonella Stanley
147
1.5
Salmonella Kentucky
124
1.2
Salmonella Infantis
114
1.1
Salmonella Java
113
1.1
Salmonella Anatum
108
1.1
Total of Top Ten serotypes
7593
75.5
Total of all serotypes
10066
Salmonella Enteritidis phage types,
England and Wales
Source: HPA Salmonella Dataset (Labbase2) 1981 onwards
Emergence of Salmonella Enteritidis
Phage Type 8 - Guess What !!!
Mode of Transmission in Outbreaks
of Gastrointestinal Infection - England
& Wales 1992 - 2000.
868
208
113
82
1878
Sals
Cl. perf
VTEC
Campy
Noro
100%
90%
80%
Person to person
70%
60%
Other & unknown
50%
40%
Foodborne
30%
Foodborne & person 20%
to person
10%
0%
Waterborne
Food-borne General Outbreaks
by Year 2000 – 2008 (E&W)
Year
Number of outbreaks
2000
98
2001
91
2002
71
2003
71
2004
55
2005
81
2006
58
2007
41
2008
65*
* Provisional data
Department of Gastrointestinal and Emerging Zoonotic Infections
Health Protection Agency Centre for Infections
Food-borne Outbreaks Associated
with Salmonella Enteritidis 2000 –
2008 (E&W)
Year
All
Salmonellas
S Ent PT4
S Ent non PT4
2000
35
24
17
2001
35
26
10
2002
32
25
10
2003
44
39
8
2004
31
27
8
2005
33
26
10
2006
24
4
17
2007
21
2
15
2008
31
6
8
Salmonella Food-borne
Outbreaks 2004 to 2008
2004
2005
2006
2007 2008
Total Number of outbreaks
28
38
24
21
31
Salmonella Enteritidis
25
27
21
17
14
Salmonella Typhimurium
1
5
1
2
7
Other Salmonella serotypes
2
6
2
2
10
*Provisional data, HPA - Centre for Infections
Food-borne Sources of Salmonella
Outbreaks - 2008
Salmonella serotype
Food source
S. Typhimurium U313
Eggs, rice, duck
S. Enteritidis PT4
Kiwi Parfait
S. Enteritidis PT4
Tiramisu
S. Typhimurium DT104
Beef Biltong
S. Typhimurium PT193
Egg mayo sandwiches (non Lion
branded eggs)
Salmonella (Awaiting serotype)
Eating raw eggs
S. Enteritidis PT4
Chicken Donner
Places Associated with Salmonella
Outbreaks in England & Wales 2004 – 2006
and 2008
Location
2004 2006
2008
Restaurants
52
12*
Shops/retail
10
4
Residential
7
3
Hotels
4
1
catering
University,
College, School
4
1
Others
12
3**
*8 were associated with Chinese
restaurants
** National outbreaks
Conclusions for 2008
•There was a 16% decrease in the number of cases of Salmonella
infection in 2008 compared to the previous year
•Salmonella Enteritidis (SE) is still the predominant cause of disease
(43.3%)
•The predominant cause of outbreaks are Salmonella Enteritidis of
Phage types other than PT4.
•Restaurants are the major location associated with outbreaks
Cum. total
Salmonella Montevideo:
Cumulative Weekly Totals
for England & Wales
100
90
80
70
60
50
40
30
20
10
0
2005
2006
1
4
7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
Week
Epidemic curve of Human Salmonella
Montevideo cases in England and Wales
Salmonella Senftenberg 2007:
Human Cases
• At the beginning of 2007 there were 49 isolates from
human cases sent to the HPA Laboratory of Enteric
pathogens
•Most of these were seen after week 15 (8th of April)
•Cases had been reported from laboratories in in all
regions and Wales
•Cases were followed up and molecular testing done on
isolates
Salmonella Senftenberg 2007: Food
Microbiology
•At the time of the increase
in human cases there was a
LACORS/HPA
microbiological study of
fresh herbs in progress
•Initially 7 samples of prepacked Basil were positive
for Salmonella Senftenberg
•Isolates were sent to LEP
for Molecular typing
Molecular typing of Salmonella
Senftenberg
Pulsed Field Gel Electrophoresis
Plasmid profiling
Salmonella Senftenberg 2007
•Isolates from humans and the Basil had indistinguishable
PFGE and Plasmid profiles
•The Basil originated from Israel
•The strain was isolated from cases in England, Wales and
Scotland, from individuals who have reported travel to
Tenerife and Morocco and a case was reported from
Denmark
Cumulative incidence (weekly) of nontravel related NxCpl resistant Salmonella
Enteritidis PT 14b to week 45, 2009
NxCpl resistant Salmonella
Enteritidis PT 14b, 2009: Cases
•A total of 138 cases have been associated with the
12 outbreaks, which have ranged in size from 2 to 68
cases.
•Eighty five cases have been confirmed as having S.
Enteritidis PT 14b, and five have been hospitalized.
• Deaths have been reported in two elderly cases
infected with S. Enteritidis PT 14b,
NxCpl resistant Salmonella
Enteritidis PT 14b, 2009: Outbreaks
•All of the outbreaks have been investigated
by the HPA or Wales NPHS (in one
instance):
•Six have been linked to oriental (Chinese or
Thai) restaurants, five were linked to other
restaurant establishments, and one took
place in a care home.
•Preliminary investigations have suggested
putative links to chicken and/or eggs in some
outbreaks,
NxCpl resistant Salmonella
Enteritidis PT 14b, 2009
•
S. Enteritidis PT 14b NxCpl
has been detected in two of
80 pooled samples of 6 eggs
•
Eggs collected from catering
premises (3 oriental
restaurants, 2 cafes) in five of
the outbreaks had the same
origin (country Spain) and
farm as indicated by the egg
stamp mark on egg shells).